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Robert Neill: From listening to the hon. Gentleman, I got the impression that unitaries would have become compulsory under a Labour Government. We accept diversity. We believe that if a unitary would cover a small urban area, its impact on the surrounding counties must be taken into account. That aspect is left out of Labour Members' analysis, although several of my hon. Friends raised it, particularly my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Broadland (Mr Simpson), who effectively shredded the arguments of the right hon. Member for Don Valley.
Chris Williamson: I know we have. I wanted to give the Minister another chance to answer the question. Were the Conservative Government wrong to create so many unitary councils in the 1990s, particularly when many were formed in the teeth of opposition from the county councils- [Interruption.] I can hear the Secretary of State saying, "Don't bother, don't answer," but I would be grateful for a response. The Minister appears to believe that it was wrong for us to try to create unitary authorities in Exeter and Norwich, so were the Conservative Government wrong to create so many in the 1990s? It is a simple question-yes or no?
Robert Neill: I do not think that they were wrong, but although I am always interested in history, I am not a prisoner of it. Since the 1990s local government has developed mature and sophisticated means, which were much less well recognised then, of working jointly across boundaries. It is also worth remembering that several issues, which must be tackled-interestingly, they arise in the case that we are considering-require cross-boundary working. For example, the ambitions for economic growth and development in both Exeter and Norwich involve developing important sites outside the city boundaries. I have been to both cities; I have not simply telephoned. Many of the development sites, which in Exeter stretch towards the airport, involve collaboration with the district councils, which will be the planning authorities, and with the county councils, which will be the highways authorities, in those areas.
Ernest Newman described extracts from Wagner operas as bleeding chunks, removed from "Tannhäuser" or "Parsifal" to be used at a concert. Taking a city out is extracting a bleeding chunk, disconnecting it from its hinterland. The proposals that Labour Members advocate would be the worst thing for the welfare of the citizens of both cities and counties.
Because they had not realised the extent to which an incoming Conservative Government would encourage and facilitate joint working through creating local enterprise partnerships rather than remote economic
development associations, and grant the power and general competence to enable local authorities to set up special purpose vehicles. We can answer the arguments very well, without incurring the costs of reorganisation, which is a distraction at a difficult time.
I shall skim briefly through the other contributions out of courtesy. My hon. Friend the Member for Great Yarmouth (Brandon Lewis), like several other of my hon. Friends, forcefully made the point about the need to recognise links. To remove considerable elements of the tax base from the two counties and leave sparsely populated areas with a lower tax base but with, as is generally accepted, the higher costs of delivering the full range of services across rural populations, would significantly undermine their ability to deliver quality services in their areas. That is why the views of residents of the surrounding county areas must be taken into account just as much as those of the residents of the cities. The Opposition have been conveniently silent on that subject.
Mr Keith Simpson: On a very important point, I failed to catch the eye of the hon. Member for Derby North (Chris Williamson), but he gave the impression that there was a sharp distinction between the poverty-stricken urban deprivation of Norwich and the wealthy rest of Norfolk. I do not think that he has ever been there. That, of course, is the problem. Labour has no MPs in the area: the nearest one is in Luton. The people of King's Lynn, Great Yarmouth and Thetford would be amazed at such a caricature.
Robert Neill: My hon. Friend, who has lived in and around the county pretty much all his life, makes a very well-founded point. I know from when I used to practise as a lawyer in parts of East Anglia that there is real deprivation and difficulty in some of those villages-a fact that seems to be ignored.
That brings me neatly to thanking the hon. Member for Luton South (Gavin Shuker) for his contribution. It was much appreciated, particularly by Government Members. He confirmed that as a Luton MP, he was the nearest Labour MP to Norwich-a mere two and half hours away-which was a wonderful and graphic illustration of the abyss into which the Labour party has fallen. Next time, so that he can strengthen his arguments about Norwich rather than rely on a telephone canvass, we will all club together and get him a day-return fare. He can go there in person, which I hope will help.
Robert Neill: There is sometimes an argument for quitting while in front, but the truth is that the hon. Gentleman demonstrates the complete lack of touch that the Opposition have with people in that part of England, which is why they did not understand the point about rural deprivation that my hon. Friend the Member for Broadland (Mr Simpson) just made.
We would rather not have brought the Bill to the House, but it is necessary to undo a mess that was created by our predecessors for reasons of the grossest party venality. That must be put right. They pursued that process for no reason other than to pay off some party debts and settle some party scores. It lacked objectivity and intellectual coherence, so now perhaps the kindest thing to do is to lay it gently to rest.
That the following provisions shall apply to the Local Government Bill [ Lords]:
1. The Bill shall be committed to a Public Bill Committee.
Proceedings in Public Bill Committee
2. Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 4 November 2010.
3. The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
Consideration and Third Reading
4. Proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on consideration and Third Reading.
7. Any other proceedings on the Bill (including any proceedings on consideration of any message from the Lords) may be programmed.- (Robert Neill.)
Mike Gapes (Ilford South) (Lab/Co-op): It is a great pleasure to begin the Adjournment debate so early in the day. I rushed back to get here in time, and I am delighted that my constituency neighbour, the hon. Member for Ilford North (Mr Scott) is here, because the future of the NHS in outer north-east London is vital to both of us as constituency MPs, and to residents not only of the London borough of Redbridge, but residents of Barking and Dagenham, who all use the facilities at King George hospital, Ilford, which is in my constituency.
Those who follow Hansard closely may have a feeling that this is a case of déjà vu yet again. I introduced a debate in Westminster Hall in December 2006 on the future of King George hospital and a debate in the Chamber in November 2009 on the same subject, and I am here again today. Why is that? We had a consultation process-the misnamed Fit for the Future proposals-launched in 2006, with supposed options that would have led to the scrapping of the accident and emergency department and all elective work at King George hospital. Then we had an independent review by Professor George Alberti that said that the proposals would be clinically unsound. The people behind the proposals, including Heather O'Meara, the then chief executive of the Redbridge primary care trust, were forced to go back to the drawing board, and we thought that we had seen those proposals off. But in 2008-09, they came back. In autumn 2009, we discovered that the new proposals would lead to the loss not-this time-of all the elective work, but of the accident and emergency department, all children's surgery and all births at King George hospital.
The consultation on the original proposals was launched at a board meeting of the outer London primary care trusts held at Upton Park football ground-as a West Ham United season ticket holder, I feel very uncomfortable about this-in November 2009. Many glossy documents were published, and the whole exercise cost £800,000. One of those documents was called "Health for North-East London: Delivering high quality hospital health service for the people of north-east London". It said that it was a consultation document launched in November 2009 until-or so we were originally told-15 March 2010. That was subsequently extended to 22 March.
The document gave people all kinds of boxes to tick and options for the future. However, in the summary, on page 39 it had a list of improvements or reductions in services, with only two red crosses, which meant a reduction in services. One was
"A & E, acute inpatient care for adults and children, complex planned surgery."
There will be a reduction in services because it is proposed to get rid of the services at King George hospital in the London borough of Redbridge. The other was maternity and birthing services. It was proposed that women could have their antenatal care in Ilford and their postnatal care in Ilford, but they could not actually give birth there.
I had some doubts about the whole consultation exercise, including the questions being asked and the
selection of the subjects, and I refer hon. Members to the debate that I introduced in November 2009 for the details.
We went through the consultation exercise-I still believe, as I said at the time, that it was as free and fair as a rigged Afghan election-and people sent back their responses. I worked closely with my right hon. Friend the Member for Barking (Margaret Hodge) and my friend, the hon. Member for Ilford North, on a cross-party basis, and we went to see the then Health Minister, Mike O'Brien. He was an excellent Minister and is a sad loss to this House. He agreed to come and visit King George hospital with us at the end of the consultation. He said that he understood the deep concern and recognised that tens of thousands of people had signed petitions against these proposals because they had serious concerns about the implications for the future. He agreed to refer the matter to the independent reconfiguration panel of the NHS. Over the next few weeks, the panel looked into the matter, but decided that it was not appropriate for it to intervene. The panel said that the consultation conclusions should be reported and that the process should continue.
Fair enough, but in July the results of the consultation were revealed to us at a meeting, again at the West Ham United football ground. There were a number of different documents, one of which was a great big analysis by Ipsos MORI of all the boxes that had been ticked, all the replies that had been received and all the different statements that had been sent in by clinicians, individuals, local authorities, LINks-local involvement networks-and various other organisations. In summary, despite the rigged nature of the consultation and the fact that those responsible did not take into account the petitions that I and others had organised-they simply said that petitions had been received, but did not add the figures into the equation-the proposals for maternity and accident and emergency were rejected by the public, by a two-to-one majority among all the respondents in all the boroughs concerned. Indeed, if we add the petitions, the figure is 90% against the proposals.
I went along to the meeting, I sat there, and I had my say, eventually. We were told that no decisions would be taken at that meeting, that people would go away over the summer and work up proposals, and that there would be further consultation with "stakeholders"-obviously we are not talking about vegetarians, but I do not quite know about the term "stakeholders".
There was a report back to "stakeholders" in September. I shall come to that in a moment, but let me first give a flavour of the responses that were received as a result of the whole exercise. For instance, the responses from the local authorities have been listed. The London borough of Redbridge sent in a clear response, which was a resolution adopted unanimously by the council that said:
"having taken account of the need to provide a wide range of health services in Redbridge which are able to meet the needs of our growing and diverse population, we express our strong opposition
to the Health for North East London ONEL proposals to downgrade services at King George Hospital which would include (a) closure of the Accident and Emergency department (b) the ending of critical care support and acute surgical and medical treatment; (c) the ending of Children's surgery and (d) the ending of maternity delivery in the Borough".
Barking and Dagenham council took a similar position, writing in its covering letter that it was "concerned about the proposals". In particular, it was concerned that Queen's hospital in Romford, which is the larger of the two hospitals in the Barking, Havering and Redbridge trust, would not be able to cope with the increased pressures, including the increased pressures on A and E, and maternity services. Interestingly, Waltham Forest council, which, in a previous incarnation in 2006, had come out in favour of the Fit for the Future proposals, said in 2010 that it would not comment on the A and E position. However, the council was critical that concerns about mental health had been neglected, saying that alternative services were needed. Waltham Forest council also said that Health for North East London needed to
"spell out what will be involved in reducing the number of A & Es from six to five especially in terms of impact on the remaining A & E departments",
"We also note the significant changes to service provision at King George's hospital. It will be necessary to closely monitor any resulting impact on our local Newham Hospital... Our expectation is that any increase in activity will be matched by appropriate resource levels."
That was a conditional position. Tower Hamlets did not want to comment on the proposal either. Among the borough councils-these are representative bodies, the people who represent the community-there was either a clear opposition or at least indifference or ambivalence.
"experience with the Gateway Surgical centre supports the model of locating elective care in a separate building but on the same site as acute provision, allowing easier access for staff."
The whole thrust of the proposals is to separate the two out, whereby the elective and the acute are in different places, yet this has been questioned even by one of the hospitals that could benefit by receiving the transferred patients.
The position adopted by other organisations is also significant. The Ipsos MORI documents make it clear that very strong views were expressed. The essence of my debate is captured by an important sentence, which states:
"The views opposing the reduction... from six to five hospitals providing accident and emergency, critical care and maternity services...came from organisations representing the public (elected local authorities and patient representative groups such as LINks)".
"It should also be noted that some opposition was also expressed from representative groups associated with NHS staff, notably some Local Medical Committees."
Who, then, is in favour of these proposals? Not a lot of people, it seems. Within the local community in Redbridge, it is very hard to find anybody in favour of
the proposals. Perhaps some people in other boroughs might be found, but it is certainly true that in Redbridge it is very hard to find anybody of any authority or any representative political role who is prepared to speak out.
Mr Lee Scott (Ilford North) (Con): Does my constituency neighbour agree that of the people who seem to be in favour of this proposal, none have actually lived in the area? Indeed, if I am not mistaken, some of the doctors involved in it were from Newham.
Mike Gapes: The clinical director behind these proposals is Dr Mike Gill, who is based at the Newham General hospital, and the general practitioners involved come from Waltham Forest. I think we can safely draw the conclusion that they have other interests in these matters.
On the proposals to end maternity services, I remind the House that we have had a maternity hospital in Ilford since 1926 and there are presently about 3,000 births a year at King George hospital. The Ipsos MORI summary of the conclusions states:
"On maternity services specifically, there were detailed submissions that made specific comments",
"changed its view of maternity service provision"
"The trend towards a rising birth rate in this area over the next decade cannot be ignored, which will have a direct bearing on the capacity of a large unit at Queen's Hospital."
"Both units (King George V Hospital and Queen's Hospital Romford) should be developed and sustained as fully-fledged maternity units."
"the ability to deliver the configuration of services in such a way as to not result in a high volume of births at Queen's Hospital."
"challenges in relation to...capital investment and workforce planning...in achieving the recommendations."
"Geographically, there will be no obstetric unit in Redbridge to serve the women of this area. Residents of Barking will need to travel further for obstetric led care... Although women will have greater choice for low risk birth there will only be one option for hospital birth in three boroughs."
I could produce more quotations. There are so many in the document. But what has been the outcome? A meeting was organised on 30 September, of which neither the hon. Member for Ilford North nor I was given notice. I only received the information about it because one of my local councillors managed to get hold of the slide presentation. It was advertised as a "stakeholder discussion event", and was held not at West Ham
football ground but at the Holiday Inn, Newbury Park, in the constituency of my constituency neighbour, the hon. Member for Ilford North.
The "stakeholder discussion event" document is very interesting. Anyone reading it might assume that the recommendation was done and dusted. It contain presentations by Heather O'Meara, who is now the chief executive of all the outer north-east London primary care trusts; by Helen Brown, who works for NHS London; and by leading figures in the process. They spoke of "proposals".
There has been a consultation, which has revealed serious concern among professional organisations in the area, and strong opposition from the local authorities. It might be assumed by anyone believing that consultation and public involvement really matter that something would have changed. On Friday morning, my neighbour and I had a meeting with Heather O'Meara, who described the outcome of the consultation as "some caveats". She also said that the stakeholder discussion event had been based on clinical working groups where the ideas had been tested, and that there had been consultation with GPs and a huge number of public events. I had not noticed those huge events. Perhaps they happened in big places.
Mr Scott: Is it not fascinating that neither of the two local Members of Parliament most closely affected by the proposals was informed about the events and consultation that were allegedly happening, or was invited to take part? Is that not slightly strange? It might give us a complex: we might imagine that they did not want us there.
On Friday morning, we discovered that the stakeholder discussion document and other proposals would be put before a meeting on 15 December of the joint committee of primary care trusts for outer north-east London. We asked questions. We asked what the process is before then. We asked whether there will be a role for the health overview and scrutiny committees of the local councils-we were told that there would not be. We asked what would happen to the role of the London region NHS and we were told that the meeting on 15 December will make the decision. So we asked who is to be consulted about these proposals before that meeting. That is when the statements that have been made and the positions of the Minister were quoted to us; what we were told is in line with the guidance from the Government since the election.
"In May, the Secretary of State for Health announced a review of all service change proposals. He has outlined new, strengthened criteria that he expects decisions on NHS service changes to meet...proposals must have support from GP commissioners; arrangements for public and patient engagement, including local authorities, must be further strengthened; there must be greater clarity about the clinical evidence base underpinning proposals; and proposals must take into account the need to develop and support patient choice."
Let us leave aside the last two of those. We have been given a clear view from our local authorities about the original proposals and we have been given a clear view
of the public attitude to those proposals. What we have now been given is a slight tweaking of the consultation document. Three or four minor modifications have been made to the proposals and, as a result, those involved now intend to go ahead with the essence of the original proposals.
To confirm what I am saying, I wish to quote from a document produced by Helen Brown as part of the stakeholder consultation. On page 48 of the stakeholder presentation, under the title "Activity and capacity", is a table describing the
"Proposed shift of activity to hospital sites".
The figure for the row headed "Non-elective", which relates to people admitted to the accident and emergency department for King George hospital, is minus 25,937 or minus 100%. That hospital's figure for "A&E" is minus 59,565, or 100%, and its figure for births is minus 2,910, or minus 100%. Its elective activity is increasing, with some 18,000 being transferred from the Queen's hospital, so that is a partial shift. Originally this was to be limited, but now some facilities are being moved in. However, the essence of the proposals-to get rid of the A and E department, the children's surgery and births at the King George hospital site-remains.
So what does this mean? It means that the consultation that has been engaged in at great cost-the public stakeholder engagement-is a sham, a charade and a waste of money. The people behind the proposals, who tried and failed in 2006, and who tried in 2009 only to have this dragged out for longer, are now absolutely determined. This is a juggernaut being driven by unelected people in the NHS bureaucracy. They are disregarding the views of the local community and disregarding the Members of Parliament and the local councillors, and they are not going to be stopped because as far as they are concerned they are right.
My neighbour, the hon. Member for Ilford North, will doubtless wish to comment on the fact that on Friday morning we got into the essence of the issue, when we heard the argument that clinicians know best. In which case, what is the point of pretending that a public consultation is being carried out? What happens if the consultation comes up with a conclusion that these people do not like? I recall the old quote of Bertolt Brecht, "The electorate has made the wrong decision, so change the electorate." Joseph Stalin's 1936 constitution was adopted and the result was announced the day before the referendum was held in the Soviet Union. Are we moving that way with certain people in the professions believing that they know best, disregarding the wishes of the community?
King George hospital is not perfect. We have a lot of problems, but we also have a lot of problems with the other hospital in the trust, Queen's hospital. The two together have a big ongoing deficit that they have had for five years and, despite promises to get rid of it, they have not done so. There is a real difficulty and I believe that an element of this is financially driven. As I pointed out in 2009, getting rid of the A and E at Newham general hospital would save £28 million a year, whereas getting rid of the A and E at King George hospital-according to the figures provided by those behind the proposals, not mine-would save only £19 million. Nevertheless, the decision has been made to go ahead with getting rid of the A and E at King George.
We are facing a very important time. We need a decision that is in the interests of the people, not in the interests of the people who run the bureaucracy of the national health service. There are strong arguments, but I want to finish with a quotation of the Prime Minister. In answer to a question yesterday from my hon. Friend the Member for Ealing, Southall (Mr Sharma), the Prime Minister said:
"The whole point of the reform of the NHS is to put power in the hands of patients and doctors, so decisions about hospitals will be made on the basis of what local people want".-[ Official Report, 20 October 2010; Vol. 516, c. 947.]
Interestingly, last Friday morning we asked, "How will the doctors be consulted?" We were told, "We will take soundings," so we asked, "How do you take soundings? Is there a ballot? Do the GPs vote on whether they agree to the proposals?" We were told, "No, we will take soundings of health practices." So we asked, "What is a health practice?" My GP is part of a health centre and there are eight or nine GPs. We were told that each practice would have one vote. So a single-handed GP could be equivalent to eight or 10 GPs in a group practice or health centre. That is a very strange way to find something out. It is perhaps like the Hong Kong Legislative Council or the estates in pre-revolutionary France, but if we are talking-as the Prime Minister said-about decisions made on the basis of what local people want, we need to be clearer about who is making those decisions.
I fear that at the meeting on 15 December these proposals will be pushed through regardless, and the running down of the accident and emergency-which is already beginning, with salami-slicing-and of the maternity services will start, so that in future no one will be born in Ilford except in the back of a car or taxi rushing them to the Queen's hospital in Romford. People who need to go to the local hospital will not have that hospital facility, because they will have to go several miles away.
These matters are so important to my community and my constituents that I hope that I will not have to come back to this House for a fourth time with a debate on the future of my hospital-but if necessary I will do so. I hope that when the Minister responds he will reassure me that this process will not be allowed to be driven in the interests of people who are disregarding the wishes of the local community and their elected representatives.
Mr Lee Scott (Ilford North) (Con): I congratulate my constituency neighbour, the hon. Member for Ilford South (Mike Gapes), on securing the debate. We must both be feeling déjà vu, because we have found ourselves on many previous occasions debating and saying exactly the same things about this issue. However, the situation now is totally different.
I will try not to repeat anything that the hon. Gentleman has said, although the events of last Friday were a little surreal, to say the least. We sat down and were told about all the consultation that had been taking place, which was surprising news to us. I had received an invitation that was posted the day after the meeting had taken place-so my hosts were obviously desperate for me to be there! I realise that they might have been unhappy with me because of my views about Redbridge
NHS, but not inviting me to the meeting until after it has happened was, perhaps, a step too far. The hon. Gentleman has compared that to a rigged Afghani election, but I think that is being unkind to rigged Afghani elections; it was far worse than that.
This House has been presented with a petition of about 9,000 signatures from my constituents in Ilford North and another from the hon. Gentleman that brings the total of signatures to about 27,000. Our local paper, the Ilford Recorder, has also presented petitions to Downing street, of a further 16,000 signatures. In my past five and half years as Member of Parliament for Ilford North, not once has anyone e-mailed, phoned, come to my surgery or written to me to say, "We think it would be a wonderful idea to carry out these proposals," and all these thousands of people are opposed to it.
I shall now turn to the process. Two weeks ago I received a phone call from the Ilford Recorder asking what I thought of these proposals, which, as the hon. Gentleman said, are virtually identical to proposals we have previously seen on various occasions over the past number of years. I said that these proposals could not be proposals because they had not undergone any independent review, which we had clearly said would take place if we became the party of government and which was clearly stated during the last days of the previous Government. Miraculously, by the time the press phoned Redbridge NHS back, they were no longer proposals; they were now just a possibility or an option-although, funnily enough, I did not see too many other options in the document. Like the hon. Gentleman, I found that my copy of the document turned up three weeks after the meeting-which I admit was not held at West Ham United football ground. It turned up in my office late-after the meeting-so I could not possibly have commented on any of its contents as I had not known about them at the time of the meeting.
It seems to me that the previous leader of Redbridge NHS, who is now in a much more exalted position, had decided that, come rain or shine, she wanted to push through the proposals. In the past, both the hon. Gentleman and I as the local Members of Parliament were called in for a meeting or a briefing separately, not together. I should say here that even though we clearly disagree on a number of political matters, it is not possible to put a cigarette paper between us on this matter; we are in total agreement on it. Those at Redbridge NHS have, without any question, tried to change that by briefing us separately. The people briefing us have come from Newham and a practice that is serviced by Waltham Forest, so would obviously not be affected by any changes at King George hospital. They would say what a wonderful idea it was, yet in all the conversations and meetings I have had, not one GP has said that; they have all said that they are concerned about its impact .
If, God forbid, someone were to be involved in an accident or have a heart attack in my constituency, they could die before they got to Queen's hospital accident and emergency unit. I am not over-dramatising; that would sometimes happen, and that is why there has been such an outcry against this plan from the whole of Redbridge-not from one part of it or from one political party, but from the whole of Redbridge.
I go back to one freezing cold day last year when I, the hon. Member for Ilford South and hundreds of others marched through sleet to protest against proposed
closures to the accident and emergency, maternity and other services at King George hospital. We did the same again-admittedly in much more clement weather-this year. The message was loud and clear: the results of this lack of consultation that are going forward to the meetings on 15 December are absolutely null and void and do not meet any of the criteria, because there was no proper consultation.
I and the hon. Member for Ilford South have held meetings in our respective constituencies and invited members from Redbridge NHS. I want to state clearly that in no shape or form were they political meetings, because they were open to the general public and I have no idea of the allegiances of those who attended them. None the less, the message was loud and clear: we need to maintain our accident and emergency and maternity services at King George hospital. They cannot be closed by stealth. They cannot be salami-sliced and closed. They must remain.
I would like to thank my hon. Friends the Members for Hornchurch and Upminster (Angela Watkinson) and for Romford (Andrew Rosindell) for their help and support. Their areas are serviced by Queen's hospital. People might not think, because that hospital is not under threat, that the proposals would affect my hon. Friends' areas, but of course it would, because the pressure of 250,000 extra people using Queen's hospital will have a knock-on effect for their constituents.
I do not intend to detain the House further. However, like the hon. Member for Ilford South, I tell the Minister that this consultation is wrong. If those concerned try to railroad through the suggested closures on December 15, we will resist.
The Minister of State, Department of Health (Mr Simon Burns): I congratulate the hon. Member for Ilford South (Mike Gapes) on securing this debate. I know from previous debates he has secured on this subject how strongly he feels about it-and rightly so-as a constituency Member of Parliament. I also congratulate my hon. Friend the Member for Ilford North (Mr Scott) on his contribution. He has worked for a long time with the hon. Member for Ilford South in representing the interests of their constituents. I know that the quality of service provided by the local NHS is very important to both hon. Members and their constituents, and I assure them that I share their commitment to achieving the best possible health care for the people of north-east London. I also praise the hard work and dedication shown by NHS staff in north-east London. Their jobs are not always easy, but they always strive to provide the best possible care for patients.
Today, the NHS has some of the best people and facilities in the world, but when it comes to what is really important-outcomes for patients-we lag behind many other countries. The Government's ambition is clear: for health outcomes in this country to be among the best in the world. Just over three months ago, we published the White Paper "Liberating the NHS", showing how we will achieve the real gains. We will liberate clinicians from top-down targets and endless micro-management by politicians and civil servants. It is an
ambitious plan for reform focused on three key aims: the first is to put patients first. Patients should feel that no decision is made about them without them. Secondly, we want to focus on outcomes, not inputs or processes, and to build a culture of evidence and evaluation, to ensure that health care uses innovation and evidence to provide quality care and is accountable for improving outcomes. Thirdly, to deliver the best care, we must empower NHS staff, whose responsibility it is to give that care. Decision making must take place close to patients, so that clinical decision making can be better combined with the use of resources. GPs already influence the commissioning of decisions by the way in which they manage and refer patients, and by deciding which medicines to prescribe and which treatments. They decide what is best for their patients based on the options available and on their clinical judgment of what would be best for them.
We are asking GPs to take the next natural step by giving the responsibility for designing, commissioning and paying for local services to groups of GP practices. This will ensure that decisions are clinically led, involving all other health care professionals, hospital consultants, nurses and social care workers in order to design services that put patients first and are focused on improving clinical outcomes.
GP commissioning also opens up the potential for working closely with local authorities to commission services jointly-even for the pooling of budgets to tackle local priorities jointly. For example, by working closely with local authority and social care providers, far more can be done to help older people or those with a disability to live independently, reducing their reliance on the NHS by avoiding things such as hospital admissions.
My right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith) recently opened the Macmillan information and support centre at Whipps Cross hospital in north-east London. The centre is available free to anyone affected by cancer and offers confidential advice and support. Such partnerships between the NHS and the third sector take exactly the kind of innovative and exciting approach to health care that we are actively encouraging.
Before addressing the specific concerns of the hon. Gentleman and my hon. Friend, I should set out the wider context of local health care reform. Thanks to the NHS, most of us will enjoy better health and longer lives than our parents and our grandparents. That is a tremendous achievement, as I am sure both hon. Members recognise, but, as the NHS effects great change on the health of this country, so the changing nature of the population must transform the NHS.
An ageing population is just one of the many challenges to which the NHS must adapt over time. Every day, new medicines and treatments are developed to meet our changing lifestyles and expectations. We know that change can sometimes be unsettling, but we also understand that the NHS needs to evolve-to move with the times. All we ask is for the NHS to make collective, informed and local decisions that improve outcomes for patients.
On 15 December a joint committee of primary care trusts will make some important decisions about the future of King George hospital and about health services in north-east London more generally. I am confident
that those decisions will be made by those best qualified to make them, based on a solid foundation of clinical evidence and local engagement.
Mike Gapes: How are the views of elected local authorities, of elected Members of Parliament and of the community, as expressed even in that dubious consultation exercise, to be taken fully into consideration against an NHS management bureaucracy who seem determined to carry on regardless? Is 15 December the date of the final decision? Is there no other way in which we the public can have our say?
Mr Burns: I am grateful to the hon. Gentleman for that intervention, because I fully understand how strongly he feels about the issue-what he recognises, from his constituents' point of view, as a potential problem-and how important it is to get the matter right. I shall not duck the question, but will the hon. Gentleman bear with me a little so that I can put it in context? I shall then respond to his intervention and answer his specific question about whether 15 December is the end of the road, or whether any other avenues might be open to him and to my hon. Friend the Member for Ilford North.
If the hon. Gentleman will allow me, I will describe how we reached this point. Back in February 2009, as he mentioned, the NHS in north-east London began to think about how it could better use its resources to provide safe, modern health care. The NHS in north-east London as a whole faces considerable challenges. Health outcomes and key health indicators are poor: people in the area have lower than average life expectancy and higher rates of infant death. The NHS recognised that it needed to improve services to meet those challenges head-on. For example, it found that long-term conditions could be managed better: instead of being admitted unnecessarily to hospital, patients could be treated in the community, closer to their homes.
One of the solutions suggested was to turn two of the existing hospital sites-the Royal London and Queen's-into major acute hospitals and for them to become centres of excellence. Doctors can achieve that level of quality only if they see high numbers of complex cases, and patients can receive the best care only when surrounded by expert clinicians. To reach that critical mass of doctors and patients, specialist services would be consolidated into the two major acute hospitals, not spread thinly across each hospital in the region. The Royal London and Queen's would be supported by three local hospitals, all with accident and emergency departments. The final site-King George hospital, which has been the main focus of this debate-would also play a vital role, taking a lead in providing primary, community and urgent care.
King George hospital would receive enhanced children's services. An urgent care centre at the hospital would operate around the clock, the task being to manage as many patients as possible outside A and E services. Access and continuity of care for minor injuries and illnesses would be significantly improved. I know that
there has been concern about rumours that the local NHS is planning to close King George hospital. I can categorically reassure the hon. Gentleman and my hon. Friend that that rumour is not true. Among the substantial number of services proposed to stay or to be moved to King George hospital was a recommendation that the hospital become a centre of excellence for planned surgery.
Barking, Havering and Redbridge University Hospitals NHS Trust has proposed the transfer of all breast surgery from Queen's to King George. That will mean that some women who currently have treatment at King George but then have to be transferred to Queen's for surgery will have the whole procedure carried out under one roof, which I am sure the hon. Gentleman and my hon. Friend will agree is an infinitely preferable and superior sequence of treatment to the present one. Those women will not have to go through the trauma and inconvenience of having to be moved to another hospital site for their surgery. In addition, local clinicians have identified a further 20,000 procedures a year that they believe would benefit from being provided solely at King George hospital.
Of the proposals made in north-east London, I know the hon. Member for Ilford South is most concerned about the potential loss of maternity and A and E services from King George hospital. I hope to be able to reassure him that, whatever the outcome of the meeting in December, nationally this Government remain committed to maternity and A and E services. When somebody walks through the doors of an A and E department, an urgent care centre or a walk-in centre, what sorts of service should they expect? To which facility should they go in the first place for the most appropriate care for the condition from which they are suffering? Part of the anger that we often see when the local NHS suggests replacing A and E with other, more appropriate services is due to a certain degree of confusion about what those services provide. The Government are committed to clarifying that, and work is already under way to standardise which services can be expected in various facilities. As well as improving A and E services, we want to improve urgent care radically. We are committed to providing universal access to high-quality urgent care 24 hours a day, 365 days a year. Whatever the need, place or time, patients should be able to find the care they need. That is what part of our reforms in A and E will achieve.
The Government are also determined to drive forward improvements in maternity and newborn services so that women and their partners have access to local services and so that children have the best start in life. The safety of mother and baby is paramount. It is fundamental to safe, high-quality maternity care that a full range of services must be available to all women, whatever their medical and social circumstances. Services must be as near to home as possible, depending on the complexity of needs, with facilities and expertise available to provide optimum care.
I know that the Government are committed to improving the quality of care, as the previous Government were, but I have a large number of young families in my constituency and they will be forced to go several miles for the births of their children at Queen's hospital rather than going to a hospital in the community where they live, as people in Ilford have done for 80-odd
years. Is there a national policy that births can be allowed only at sites with a coterminous accident and emergency department, or could the proposals be reconsidered? One of the arguments in the relevant documents is that maternity services have to be moved because the A and E is being moved. Is that national policy?
Mr Burns: It is not national policy that if there is an A and E department there automatically has to be a maternity facility by its side. If one strips out the whole area of safety and quality of care, which is vital, one realises that the guiding rule is that maternity services are provided where they are relevant to the local community's needs. It is about having the best siting relevant to the community's needs. Clearly, however, there cannot, for a variety of reasons, be a maternity ward in every hospital in the country. Where they are sited will be determined by need and by the wishes of local communities. Once the reforms are in place, it will also be up to commissioners to decide where to site maternity units.
Mike Gapes: The Minister has heard me quote the Royal College of Obstetricians and Gynaecologists, which takes the strong view that there should be maternity facilities and births at both the Queen's and King George hospitals. I feel very strongly about this. There is clearly a difference of opinion between the people in NHS London, who are driving the change, and the people who deal with obstetrics and gynaecology-the experts-about what is necessary. Leaving aside the democratic arguments, the views of the people in the specialist royal college have not been taken into account.
Mr Burns: As with any proposals for reconfiguration anywhere, a range of views will be fed in, including those of the relevant royal colleges, GPs, clinicians, members of the public and other interested parties, and will be considered as part of the consultation process before a decision is made. I am going to come to the whole issue of consultations, on which the hon. Gentleman rightly has strong views, because I want to clarify the situation and, as I said earlier, I want to give him some answers about the options that might be open to him after 15 December.
In pursuit of true local backing for the proposals in the hon. Gentleman's area, the local NHS has already started a debate about them. To date, it has talked through the issues with GPs, councillors, medical committees, national bodies and local patient representatives. I was going to say that perhaps he will recognise this from his own experience, as I am assured that the NHS has made every effort to keep him informed and to listen to his concerns. However, having listened to what he and my hon. Friend the Member for Ilford North said, it would seem that that is partly the case and there may have been certain slip-ups: for example, posting a letter the day after a meeting was held. I cannot confirm or deny that because I am not party to the information, but my hon. Friend has put it on the record, and if it did indeed happen that is somewhat unfortunate.
The hon. Member for Ilford South submitted a petition on behalf of his constituents, and the local NHS has confirmed that that will be taken into account. However, it asks different questions from those in the official consultation, which slightly skews the point that he made about it. I understand that one of the questions was: "Do you support the closing of King George hospital?" I suspect that in the case of the vast majority of people signing it, the answer would be no, they do not support it. The trouble is that there is not, never has been and will not be a proposal to close the hospital. I hope that he therefore understands that the question is not relevant to the consultation on the reconfiguration of services.
Mike Gapes: I do not know what advice the Minister has had from his officials. I do not want to get into a long textual discussion, but he should get the full wording of the petition that I submitted. I have to admit that there were several petitions from different organisations and individuals, but mine referred specifically to A and E, maternity and children's services. It may have been headed "Save King George hospital", "I support Mike Gapes's campaign", or whatever, but the wording specifically referred to those issues.
Mr Burns: I agree that we do not need to get into to-ing and fro-ing about what exactly was written. My point was that some of the questions-I am not saying all of them-on some of the petitions were not directly relevant to what was being consulted on. Having said that, it has been recognised that they will be considered as part of the consultation process.
Mr Scott: My own petition did not say anything like "Lee Scott's petition"; it talked purely about the proposals to close A and E and maternity services, and made no reference to anything else. I therefore trust that those 8,000 names will also be taken into account.
Before 15 December, the London strategic health authority will assess north-east London's readiness against the four tests that my right hon. Friend the Secretary of State introduced in May this year to ensure more local engagement in the proposed reconfigurations of services throughout the country. In certain previous consultations, there was a long-held view that although lip service was paid to local people and medical practitioners-clinicians and GPs-the views of the local community did not matter because, in effect, a decision had been taken at the launch and things would end up in exactly the same state at the end of the process.
To give greater credence and importance to local views, my right hon. Friend the Secretary of State announced his changes to the criteria that had to be conformed with for reconfigurations to take place, to empower people to take part in the discussions and to ensure that their views would be fully considered before decisions were taken. To achieve that, he has said that reconfigurations and consultation processes that are already in progress will have to be checked against the revised and strengthened criteria to ensure that they
have been carried out under the new format. I can assure the hon. Member for Ilford South that that will happen prior to the meeting on 15 December.
Mr Burns: It will be done by the national health service in London. People could be tempted to shout "Foul" if they do not agree with the decision, but that does not mean to say that it necessarily is a foul. In the case of a straightforward matter such as checking whether the consultation process has taken place under the new guidelines, we have to accept the professionalism of the people carrying out the job, and trust that they will do it properly. If it emerged that the guidelines had not been abided by in any way-I hasten to add that I make this point illustratively, and I am not saying that it will-the hon. Gentleman would be extremely happy. If it were found that they had been abided by, he would need to have an open mind, and not automatically say that things had not been done properly.
While the discussion in north-east London continues, the clinical working groups have already made changes to their previous recommendations. If the hon. Gentleman will allow me, I will give him some examples. From talking to parents it was obvious that many were anxious about the prospect of travelling long distances to get treatment for their children. Clinicians needed to find a way to reduce the chance of that happening, and now it is proposed that only children needing specialist or high-dependency care will be transported to specialist centres. That means that more children will be treated locally than was originally anticipated, but they will still have access to specialist care when they need it.
Women told the NHS that they wanted more midwife-led care. As a direct result, a study has been commissioned, working with local mothers and mothers-to-be, to find out what choice really means to them. Clinicians are working up plans for midwifery-led units across the region as we speak.
Some residents expressed concern about having no A and E at King George hospital. Doctors are still convinced that clinically, any small increases in travel time will be more than compensated for by having better, safer, faster care, but they have recommended changes to the original proposals for urgent care at the hospital. Now, as well as the 24/7 urgent care centre originally proposed, a 24/7 short stay assessment unit is being recommended. It would be staffed by a team of skilled clinicians with expertise in assessment and treatment as well as in emergency medicine. The service would offer facilities for longer periods of observation, assessment and treatment, including access to a range of tests not currently available in primary care and specialist advice from hospital clinicians. Staff would work closely with community health and social care services, including mental health services, so that as many patients as possible could be cared for in the community without recourse to a hospital admission.
The NHS in north-east London is also working closely with Transport for London to ensure a good bus service between Queen's hospital and King George hospital. I
am sure that the hon. Gentleman agrees that that is vital to help many of his constituents who may need to use such a service.
I believe that discussions with the local community have already made a positive impact. The local NHS is now truly listening to GPs and consequently changing its plans. That reflects the improvements that my right hon. Friend the Secretary of State introduced to engage local communities with reconfigurations.
Mr Burns: I am grateful to the hon. Gentleman for reminding me of that. My understanding is that the "health for north east London" programme team is prioritising engagement with GP practices whose patients would be most affected by the reconfiguration proposals, and GPs who are currently likely to be leaders in the commissioning consortiums that will flow from the NHS reforms.
Mike Gapes: We are considering an important point. The letter from the Minister, the May proposals and the Prime Minister's remarks yesterday place great emphasis on GPs' views and wishes. Yet what we were told on Friday has made me very worried. Which GPs are we talking about-the lead person in a commissioning consortium, single-handed practitioners joining together and outvoting a group of GPs in a health centre, or what? There is no provision for a ballot. What is the process? People can get whatever result they want if they skew the process. My fear is that the process will be discredited unless it is seen to have democratic legitimacy. I suspect that we will have a big problem, because the views of certain GPs will be taken into account and those of others will not.
Mr Burns: I will confirm what I said before the hon. Gentleman's intervention. The consultation will prioritise engagement with GP practices whose patients would be most affected by the reconfiguration. If the hon. Gentleman is saying that there should be a ballot of GPs, I do not agree. There should be engagement, discussion and GPs contributing to any reconfiguration proposals by meeting people who undertake the consultation process to make known their views and their preferences-the pros and cons that they envisage-but I do not think that a ballot is either feasible or necessary. To take his idea to its logical conclusion, why restrict a ballot to GPs? Why not have a ballot of social workers or community nurses? That sort of engagement is unnecessary when there are other perfectly satisfactory forms of engaging.
I think that he would. Let me point out gently and tactfully that my right hon. Friend the Secretary of State expressly introduced criteria for the engagement of GPs, clinicians and other interested parties because of their concern that they did not have enough ownership of consultation processes. I have to
say that until 6 May, for 13 years, we were not the Government-and that it was we who looked at the position afresh and recognised the concerns throughout the country about reconfigurations. By introducing his criteria, my right hon. Friend the Secretary of State responded to the concerns of local communities that their views were not being properly considered. This Government, in a very short time-within two and a half weeks, I think-took decisive action to give greater power and ownership to those groups to contribute to consultation processes.
On local scrutiny, which featured significantly in the hon. Gentleman's speech, I fully recognise that there are considerable public concerns about the proposals for north-east London. In the light of those, the Redbridge overview and scrutiny committee referred the case to the previous Health Secretary, the right hon. Member for Leigh (Andy Burnham), in January 2010. He asked the independent reconfiguration panel for advice. In its response, the panel concluded that a full review was unnecessary. In July 2010 my right hon. Friend the current Health Secretary accepted the panel's recommendation that due process by way of public consultation and formal engagement should be allowed to continue-a process that has not yet come to an end, as the hon. Gentleman knows.
However, as I said, we are determined that local voices will be properly heard, and we expect any concerns to be taken extremely seriously. I shall lay out again for the hon. Gentleman the critical tests that have been applied in the consultation process in the past two or three months, and that will be applied until the consultation's conclusion. First, the proposals should have the support of GP commissioners; secondly, arrangements for public-patient engagement, including local authorities, should be further strengthened; thirdly, there should be greater clarity about clinical evidence underpinning any proposals; and fourthly, any proposals should take into account the need to develop and support patient choice.
Given the complexity and scale of the challenge in London, the Secretary of State, as the hon. Gentleman knows, called a halt to existing clinical strategies and asked the NHS to look at its plans afresh. That means that north-east London now has an opportunity-it has had one for some time-to have a frank and open discussion with GPs, clinicians, councils and patients on how their health services can change for the better. I believe that if that process is managed well, any changes made will lead to better health care for people across north-east London, including the hon. Gentleman's constituents.
As was said in the debate, the question of whether those four criteria are fully met will be considered prior to the meeting on 15 December. Providing it is seen that those criteria have been met, the meeting will go ahead, and a decision will be taken. What happens if the decision is not popular with a number of people? I suspect, from what the hon. Gentleman said, that it will not be. Unless I misheard him, he said that the overview and scrutiny committee would have no opportunity to
look at the proposal, reach a decision on it and write to the Health Secretary if necessary. I am not quite sure why he said that.
Mike Gapes: My understanding of what we were told at the meeting on Friday is that the decision on 15 December will be the final decision, subject only to the Secretary of State, and that there was no intermediate process. If that is inaccurate, I would be delighted, but that was my impression from what we were told on Friday. The hon. Member for Ilford North (Mr Scott) will confirm that.
Mr Burns: I am interested to hear what the hon. Gentleman was told on Friday, and I hope that I will be able to delight him. My understanding is that after the meeting on 15 December, the OSC can look at the decision that has been made. If it is not convinced that it is the right decision, it can contact the Secretary of State. That is a step forward from what the hon. Gentleman was told at his meeting on Friday. We cannot anticipate the decision to be taken on 15 December, because that would be irresponsible, but I have confirmed that he will have some further opportunity-if warranted by the OSC's decision, because we cannot prejudge that either-to have the decision revisited.
As I have said, we must not prejudge the outcome of the meeting of the joint PCTs on 15 December, when local NHS leaders will gather to make a decision that will dictate the future of health services in north-east London. I believe-even if I do not altogether carry the hon. Gentleman with me-that that decision will, rightly, be made locally. I understand that these issues arouse strong feelings: they involve difficult decisions about how resources should be used to achieve the best care for patients, which must always be the priority for, and guiding force behind, any reconfiguration or provision of health care.
Similarly, the NHS must continue to develop its plans for the future, and it must do so by giving local people and GPs a far greater say. Obviously, we will have to wait to hear the judgment on how the consultation has been carried out in relation to the four criteria laid down by the Secretary of State, but we need to create an NHS run by empowered professionals free of the shackles of central Government. The NHS has received massive investment, but it is drowning in bureaucracy. We will cut the red tape and sweep it away, letting NHS professionals organise themselves locally. It is a measure of the importance that we afford the NHS and the future health of this nation that its budget will be protected, as was confirmed in the announcement of the comprehensive spending review by my right hon. Friend the Chancellor yesterday.
The hon. Gentleman must await the decision on 15 December. I am convinced that what will be done throughout the health service, especially in the case of difficult reconfigurations, will have as its guiding priority the desire to get the highest-quality health care for all our constituents.