to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt

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with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.

Dame Joan Ruddock rose

Gavin Barwell: I am afraid I cannot take any more interventions.

The hon. Member for Lewisham West and Penge was wrong to state that that has only started to happen under this Government. In my part of London in the past things have gone wrong in neighbouring boroughs and Croydon PCT has had to help them out. In the past two years Croydon PCT has got into trouble and neighbouring boroughs have helped us out. That does not mean that what is happening is right. I am not making a judgment on it. I am just saying that it is not fair to suggest that the present situation is a wholly new departure.

Hon. Members have made powerful arguments for their local hospitals, but there is a balance to be struck between convenience of locality and ensuring sufficient acute cover. I completely understand the point made by the hon. Member for Mitcham and Morden (Siobhain McDonagh) in relation to St Helier, but as a Croydon MP I have to say that there must a solution that gets us to the recommended minimum level of consultant cover in our hospital, and I will continue to fight for that.

4.10 pm

Mr David Lammy (Tottenham) (Lab): Twelve years ago I sat where the Minister is sitting, when I was the Under-Secretary of State for Health. I had responsibility for accident and emergency services in particular, and I want to impress on her that she has power to respond to what is being said in the House today.

All Members will understand that the NHS does not stand still. Reconfigurations are necessary. Changes are necessary. I was born in a constituency that had a wonderful hospital called the Prince of Wales; it no longer exists. In the Roehampton part of London, there was a hospital; it no longer exists. Things change. In London we have seen changes to stroke services. It is possible that someone in an ambulance, having been unfortunate enough to have a stroke, will drive past a hospital to get to another hospital, a centre of excellence. That was a configuration that was carried out with great consensus across London. I pay tribute to Richard Sumray, who was chair of the primary care trust in Haringey and led the consultation on changing stroke services in London.

The Minister has heard deep concerns expressed about the changes proposed in every area of our capital city—deep concerns about King George hospital in the

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east and about the much loved hospital in Lewisham in the south. No one can understand why Lewisham should pay for problems in an adjoining area, as currently proposed. We raised concerns about the problems in the north. I will refer briefly to the Whittington, although my hon. Friend the Member for Islington North (Jeremy Corbyn) is in his seat and will major on that. We have heard about Chase Farm and about pressures deep in the south, in St Helier and the Croydon area, which were described by my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). We have also heard about concerns in the west of London around Ealing. That is unprecedented.

Jeremy Corbyn (Islington North) (Lab): Does my right hon. Friend accept that one problem is that London’s population is rising, health inequalities are rising, and health demands are rising among poorer people? Although I understand all the arguments about putting services in the community, if hospitals are closed, many desperately poor and ill people will not be properly served.

Mr Lammy: My hon. Friend makes the point beautifully. Let us look at the demographics of London. The Mayor’s London plan estimated London’s population to be 7.8 million. The census later showed us that it was 8.17 million at least. The London plan assumed that the population would break 8.5 million in 2027. We now believe that it will exceed that figure in 2016. By 2031 there will be 9.5 million people living in our capital city. The areas marked for growth are the upper Lea valley—Chase Farm; the Metropolitan line corridor, with nine A and E units now turning into five; and the south-east of London, where Lewisham is based. There will be 9.5 million people using services that the Health Secretary is seeing shut down. There are huge concerns.

I sat in the Minister’s seat. That was after the terrible winter flu epidemics in the late 1990s. At that point the Whittington hospital in north London was at the epicentre of a public storm because of the bed waits and other long waits. My job, set by the former Member for Darlington who was then Secretary of State for Health, was to ensure that that four-hour wait was a reality across our country. I would sit with chief execs and we would go through the so-called sitreps to ensure that those hospitals were meeting the four-hour waiting target. That was the key element of my job.

I decided to look at the sitrep for the past four weeks across London. There is a target, and if hospitals are doing badly they are flagged as red, while if they are doing well and meeting the target, they are marked as green. I was startled. Ealing, Hillingdon, Imperial, North West London Hospitals, West Middlesex, Barnet and Chase, Whittington, Barking, Guy’s and St Thomas’, King’s College, Lewisham, South London, Epsom and St Helier, Kingston, Croydon and St George all currently fail. Yet it is proposed that we can lose many of our A and E departments—eight across London—at this time. It does not make sense.

This is a health service in London that we look to when a helicopter falls out of the sky or when bombs go off in Canary Wharf or on the underground. This is an A and E service that we look to following riots. I remember the A and E serving our police officers on the

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first night of riots in my constituency. Londoners will be very concerned indeed that this debate is being framed and structured in this way at this time, with the lack of consultation described so well by my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock).

I was staggered when I found out about the proposed changes to Whittington hospital in Camden New Journal. In November, I had a meeting with the chair and the chief executive, with other Members of Parliament, and we found out that a third of the hospital was to be sold off, that it was apparently to be totally reliant on community services, that it was to lose 500 jobs, and that the people of north London would again have to fight to retain the hospital that they loved—a hospital in my constituency in which my two sons and I were born, and which has been served particularly by nurses from the Caribbean.

Londoners are concerned and Londoners will fight. The Minister has the power to act to put an end to the disarray that we are now seeing across London, and I ask her to do so.

4.17 pm

Kate Green (Stretford and Urmston) (Lab): I want to speak about changes to the A and E department at Trafford General hospital in my constituency.

Over the years, Trafford General has experienced financial and management problems, and last year it was absorbed into Central Manchester University Hospitals NHS Foundation Trust. We all expected that there would be a reconfiguration of services following that acquisition, and that is what happened. Last month, following public consultation on the so-called new health deal for Trafford, NHS Greater Manchester announced its intention to proceed with a downgrade of the A and E at Trafford General, first to an urgent care centre open from 8 am until midnight, and in due course to a nurse-led minor injuries unit, alongside other changes to services. I expect those changes now to be referred to the Secretary of State for decision.

Nobody in Trafford is opposed to change that can improve clinical care. Already, major trauma cases are diverted away from Trafford General, while serious stroke and cardiac cases go not to Trafford but to centres of excellence at Salford Royal, University Hospital of South Manchester and Manchester Royal Infirmary. That approach is widely understood and accepted by the public. Equally, plans to develop a model of integrated care locally are popular, and it is recognised that they could help to keep people out of hospital for longer.

However, there are consequences to the reconfigurations that have already taken place and to what is now proposed. More than half of Trafford residents now attend an A and E other than Trafford General, partly because more specialist and complex cases are rightly diverted to other centres, partly because local people are choosing to attend other nearby hospitals that offer them greater convenience or the kind of care they want, partly because it is widely believed that ambulances will not take people to Trafford General unless they specifically instruct them to do so, and partly because the whole downward spiral in activity is reinforcing public behaviour so that they are increasingly even less likely to decide to go to Trafford General. In other words, reducing activity levels are, to a degree, a self-fulfilling prophecy.

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There are concerns about the capacity at neighbouring hospitals. My right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) has been raising concerns about capacity at the University hospital of South Manchester in Wythenshawe since we first knew about the proposals last summer. Its A and E is already coping with tens of thousands more admissions than the 70,000 for which it was designed. It simply cannot absorb more patients from Trafford without additional investment.

Commissioners assure me that there is progress in the development of integrated care, but that is pretty well invisible to local people. Recovering patients report long waits and great difficulty in getting rehabilitative care and support at home. In the meantime, many of the admissions to our A and E are elderly and frail patients, which is undoubtedly in part the result of the gulf between the ambition for integrated preventive services in the community and the reality.

There are concerns about the capacity of the North West ambulance service. If there is a reduction in hours and capacity at Trafford general, there will clearly be more patient journeys to other hospitals. There are also worries about what will happen if mental health patients present at Trafford general’s urgent care centre and it does not have the capacity to care for them.

All of that is taking place against the backdrop of a wider planned reconfiguration across Greater Manchester. Last year, in the middle of the consultation on the changes at Trafford, we learned about Healthier Together, a major redrawing of health care provision across Greater Manchester, including A and E provision. If, as is likely, that leads to further closures and reductions in A and E services across Manchester, there will be further capacity questions that will have a significant effect on Trafford. We are in an invidious position. It has been said that the new health deal for Trafford offers the best hope of a secure future for Trafford general, but we are planning in a vacuum. We know for sure that change is coming, but we have no idea what it will look like.

Late last year, my right hon. Friend the Member for Leigh (Andy Burnham) wrote to the Secretary of State asking him to halt the reconfiguration at Trafford and to consider it within the wider Healthier Together review. The Secretary of State refused to do that, but he has offered no guarantees or reassurances regarding the impact of Healthier Together on Trafford general.

There is now a broader context still with Sir Bruce Keogh’s review of emergency services. I hope that the Minister will reassure me that decisions about the future of services at Trafford will not pre-empt Sir Bruce’s review. Sir Bruce has made it clear that it is vital that new services are in place before existing services are closed. In The Guardian on 24 January, he was quoted as saying:

“I don’t think we can change the system until we know we have a solution that is OK.”

He specifically highlighted concerns about

“the idea of some poor mum having to travel to A&E on two buses because we closed an A&E down and she doesn’t have confidence that what is left is good enough”.

That is precisely our fear in Trafford.

I have no doubt about the good intentions and efforts of local NHS managers and commissioners, but they are being constrained by financial pressures and limited, as has become clear this afternoon, by a lack of overall

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vision and strategy from the Government. Local people cannot be expected to sign up to changes that they do not know have been future-proofed against changes that we know are imminent.

Last month, my right hon. Friend the Member for Leigh set out a vision for the future of district general hospitals such as Trafford general, which offered a different kind of future and a secure one. I agree with the hon. Member for Croydon Central (Gavin Barwell) that it is important to strike the right balance between quality and convenience, but process and trust are also important. Today, I have to inform the Minister that people do not feel that trust in relation to the plans for Trafford.

4.23 pm

Mr Iain Wright (Hartlepool) (Lab): The A and E department at the University hospital of Hartlepool closed in August 2011. I want to raise five points relating to the experience of the 18 months since.

First, clinical safety is paramount in all health reconfigurations. There was clear consensus among senior medical staff that there were significant safety issues with the A and E at Hartlepool. The number of medical staff was insufficient to cover two rotas at Stockton and Hartlepool, and the supervision of junior medical staff was inadequate and did not meet modern guidance criteria. When senior clinical staff say that lives will be saved if changes are made, it is irresponsible for anybody, whether elected representatives or others, not to listen to those expert voices.

Despite the paramount importance of clinical safety, however, it is clear that the people of Hartlepool did not and do not want the closure of their A and E department—no community does. More provision can be made outside the hospital setting and in the local community to make services closer and more convenient to where people live. A One Life centre—a minor injury unit—has been built in the heart of the town centre and should be more easily accessible to a greater number of the town’s population. That is a welcome step. During a debate on A and E in September 2010, I said:

“Moving more serious cases to North Tees is very unwelcome as it is detrimental to my constituents”.—[Official Report, 14 September 2010; Vol. 515, c. 202WH.]

I stand by that.

My area has seen bitter disputes about the reconfiguration of acute services for the best part of 20 years. There is real tension between the views of professionals, who are best placed to consider the safest and most clinically effective means of providing a service, including in specialist concentrated centres, and the general public who will be the recipients and beneficiaries of that service, and who will pay for it through general taxation, even though they may often disagree with the means and location of that service. Successive Governments over two or three decades have failed to reconcile that basic tension. The concept of “No decision about me, without me” and the four tests of reconfiguration that are often bandied about are a fallacy. It is an understatement to say that Hartlepool would have preferred to maintain a full A and E service. People do not feel as if they have had a proper say in the matter.

Safety, changing medical practices and, increasingly, financial considerations, will play the decisive role in where A and E and other health services are located,

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and invariably it will be against the general wishes of the local population. I would be interested in the Minister’s views about how that tension between clinicians and the public can best be resolved.

That was my second point. My third point concerns communication about where a patient should go. If a child bangs his or head in Hartlepool tonight, where should their parent take them? Previously, it was a relatively simple choice—they went to A and E. Now, a parent is confronted with going perhaps to the A and E at North Tees hospital, perhaps the One Life minor injuries unit and urgent care centre, or even the university hospital of Hartlepool. The new arrangement seems more complex and fragmented, and surely if the system contains greater complexity and fragmentation, there is greater risk.

Some 18 months after the A and E closure, the system is bedding down; it was not perfect from day one, although that is another matter. However, I am not convinced that the risk is being adequately managed. There is inadequate communication and subsequent misdiagnosis, leading to obvious and understandable alarm among my constituents. What will the Minister do about that?

My fourth point concerns the pressing and persistent need to link reconfiguration of health services with transport policy. Such a link is just not there at the moment. How on earth will my constituents be able to travel to North Tees hospital 13 miles away? The hospital is a long way from many of them and difficult to get to. Hartlepool has low rates of car ownership and poor public transport links, and bus services are virtually non-existent, certainly at weekends and evenings. I would not have thought that the Government or local NHS trust wanted the public to rely solely on ambulance services. The point I wish to stress, and which I hope the Minister will address, is that any reconfiguration of services requires transport and accessibility at its heart. At the moment, transport policy is merely being paid lip service. What will the Minister do about that?

My final point is about the wider reconfiguration of health services north of the Tees. Although, as I said earlier, much of the decision to close Hartlepool A and E was based on immediate clinical safety grounds, it is fair to see that decision in the context of the Momentum programme, which is designed to move health services out of the hospital setting and into the community. The Momentum programme culminates in the building and opening of a new hospital in Wynyard, which is designed to incorporate the most advanced equipment and medical and surgical practices and serve the acute health needs of the populations of Hartlepool, Stockton, Sedgefield and Easington. The original plan was for construction to start last year and for the first patients to be admitted by 2014-15. Soon after taking office, however, the Government withdrew public funding for that hospital, and despite warm words and a series of announcements from the Foundation Trust Network, no alternative source of private funding has been approved. We do not appear to be any further forward.

Two procedures are running dangerously out of parallel. We have the Momentum programme, with the reconfiguration of services, and the funding programme for the new hospital. That is now three years out of date and there is no concrete indication that private funding

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is on the table. Services have been moved without any clarification about the endgame. My big fear is that my constituents will have the worst of all possible worlds with services moving to North Tees and no new hospital. Something must be done.

4.29 pm

Jeremy Corbyn (Islington North) (Lab): I will try to be as brief as possible so that the debate can be properly concluded.

This debate goes to the heart of what the NHS is about. Many Members of Parliament are deeply frustrated about health plans being hatched in their constituencies, but they have very little power to influence events. The health service is being atomised by a large number of private interests through private finance initiatives, and by a large number of trusts with competing interests. We need a properly planned health service rather than the internal market and competition, which are at the heart of so many of our problems.

If the hon. Member for Enfield North (Nick de Bois) were still in his place, I could tell him something that would make him even more depressed about the future of Chase Farm hospital. As a former member of the late Enfield and Haringey area health authority in the 1970s, I recall debates on whether Chase Farm should be closed. There are agendas—colleagues will recognise such agendas all over the country—that live on beyond past directors, trusts and reconfigurations: somebody always has an aspiration to close something and centralise something else. If hon. Members think politics in the House of Commons is robust, they should try NHS politics, which is far more robust and nastier than anything we experience here.

I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on opening and securing this debate, and on the campaign he is running on behalf of the people of his constituency. Many Members are involved in that campaign in west London and the one in south London. What is going on in London is outrageous. I ask the House to consider what my right hon. Friend the Member for Tottenham (Mr Lammy) said. London has a fast growing population, great health inequalities and poverty, and a fast growing number of people in the daytime: the population of central London goes up phenomenally during the day because of people commuting to work, going to cultural or sporting events, or simply passing through the capital city. If we start closing A and E departments and saying that everything should go out into the community, and thus that hospitals can be reduced and closed, we are making the future very dangerous for our communities.

As the House is well aware, I represent Islington North. The Whittington hospital is in my constituency. Anything I say about the hospital is not a criticism of it or its wonderful staff—I absolutely support them and their work. Some three years ago, we discovered that the A and E department was due to be closed. As ever, there were denials all over the place. I tell the hon. Member for Morecambe and Lunesdale (David Morris) to be ever so sceptical when told that an A and E department is not closing, because closure is probably in a plan somewhere.

We exposed the plan to close the Whittington A and E and eventually had the most bizarre general election rally ever in 2010, when the right hon. Member for South Cambridgeshire (Mr Lansley), the hon. Members

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for North Norfolk (Norman Lamb) and for Hornsey and Wood Green (Lynne Featherstone), my right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Tottenham, and my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) and I were on a platform pledging to save the A and E department, which was duly saved. However, time moves on. The hospital wants to become a trust and has begun putting together a financial package, to which my right hon. Friend the Member for Tottenham referred. The package involves the sale of a quarter of the site—apparently, £17 million is to be made from that—the loss of 500 jobs and a reduction in the number of beds in the hospital to 177, which is about half what it was five years ago.

We asked whether an A and E department with a hospital of only 177 beds behind it was viable. Is that not a plan to remove the Whittington as an overall local district general hospital with an A and E department in future? The Camden New Journal and Islington Tribune reported on this with great alacrity last week. I congratulate Tom Foot and all those who put the story together, because I suspect the issue would not otherwise have reached the light of day. At a public meeting next Tuesday, friends, neighbouring MPs and many others from the local community will be questioning the chief executive and others from the hospital, and taking part in a big campaign to protect our hospital.

We all face issues of health care. I think there is a consensus that we all respect and value the principles of the national health service, but if we allow buildings to be sold off and A and E departments to close, we will end up with the health service becoming a service of last resort and with the promotion of private medicine at the expense of the NHS. We will end up with much poorer societies and much greater health inequalities, and that is in nobody’s interest. Let us get control of this in a democratic way, so that we can control what goes on in the health service in our name.


4.35 pm

Mr Andy Slaughter (Hammersmith) (Lab): May I first thank my hon. Friend the Member for Ealing, Southall (Mr Sharma) for picking up the baton and sponsoring the debate? It was first proposed to the Backbench Business Committee before Christmas by me and colleagues from other parties as a London debate, and it has had the feel of a London debate. However, colleagues from elsewhere in the country should not feel excluded, because a lot of what is being tried out in London will soon be spreading to the rest of the country if they are not careful.

I had to attend the Justice and Security Public Bill Committee, which meant that I was not here at the beginning of the debate, but I am grateful for the opportunity to speak. Balancing whether to oppose the Government’s attacks on civil liberties or the Government’s attack on the health service is difficult, so it is nice to be able to deal with both in one day.

I will not get involved in a hierarchy of misery. Many Members have spoken passionately about their own experiences, but I will say that both the A and E departments at the world-class hospitals—Hammersmith and Charing Cross—in my constituency are marked for closure. Charing Cross hospital, which in many ways has the best site and some of the best facilities in north-west

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London, is marked for almost complete closure. All 500 beds will go, the A and E will go and the specialist services will go, leaving an urgent care centre and other services high and dry, such as the Maggie’s cancer centre and the mental health services. To its shame, Imperial College Healthcare NHS Trust is supporting those closures because it will provide a very valuable piece of real estate for it to sell and thus improve other campuses.

As my hon. Friend the Member for Harrow West (Mr Thomas) said, it is not the case that community services have been improved before these closures will take place. Indeed, the White City collaborative care centre, which should have been the first polyclinic in the country is, thanks to a Conservative council, six years late and with a fraction of the services it should have. It is still not open and will not adequately replace any of those services.

What is happening in north-west London flies in the face of the facts. Most hospitals in the area do not meet the four-hour target, owing to the demand on their services. Ambulances are less safe and effective than A and E care. For patients, it is clearly better to be in A and E than in an ambulance. Longer journeys and journey times need to be avoided. There is no evidence that when a good A and E closes most cases get dealt with better via centralisation. There are good data suggesting the opposite is true, as local A and Es have the capability to select patients who require more specialised care, easing the pressure on large units, and to stabilise those patients in the critical intermediate period.

In a nutshell, my constituents are being offered a second-class service. There is no clear demarcation. The health service itself cannot tell us which conditions should go to an urgent care centre and which should go to an A and E. The majority of my constituents will have a worse health service, and that particularly applies to poorer constituents who do not have access to private transport.

Let us look briefly at the process we have gone through, which has been utterly scandalous. As soon as the coalition Government came in they started preparing these closures. They gave millions of pounds to McKinsey to draw up the plans, yet when I asked it about those plans I was lied to about the fact that hospital closures were being prepared and was even told that I had been consulted when I had not. We have heard already about the phoney consultation, the 80,000 signatures that were ignored and the 3,000 or 4,000—

Mr Speaker: Order. I am sure the hon. Gentleman was not suggesting for one moment that he was lied to in the House of Commons.

Mr Slaughter: Absolutely not. As part of the consultation process that was undertaken, it is on the record in the documentation that I was consulted. I was not consulted on those matters.

Stephen Lloyd: Will the hon. Gentleman give way?

Mr Slaughter: I am sorry; although I would love to give way, I have been asked not to.

That consultation was ignored. The body taking the decision has no stake in these matters whatever. The joint PCT council, NHS North West London, will not exist. The bodies that do have a stake, namely the

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clinical commissioning groups that are taking over—the puppet masters, as it were—have too much influence in my view and too much to gain personally. I wish I had time to go through the declarations of interest that members of the CCGs have made. They show that most hold shares in Harmoni, Care UK or other private interests that might benefit from the commissioning powers that the CCGs are about to get. I have not received proper answers from the health service about what those interests are or what they remain.

To conclude, the decision for north-west London will be taken on 19 February, so this debate is very apposite. I have no doubt that the decision will be taken to go ahead with most or all of the proposed closures, but the protests that have taken place—the demonstrations, marches and petitioning—will continue, because this now becomes a political decision for the Secretary of State. In the early-day motion that I tabled last June, I referred to the fact that the health service locally was saying it would run out of money if it did not make these cuts. Services are already being run down by sleight of hand. The buck stops with the Secretary of State and the Government. The ball is in their court. I hope the decision will be taken, first, by the independent panel and, secondly, by the Secretary of State. The Government cannot dodge this issue. This is about cuts, as it was in the 1990s, and the denigration of our local health service. The buck cannot be passed beyond this point. I call on the Minister in her reply to say how she intends to preserve the local health service in north-west London.


4.41 pm

Mr Jamie Reed (Copeland) (Lab): First, let me commend my hon. Friend the Member for Ealing, Southall (Mr Sharma) and the hon. Members for Newark (Patrick Mercer) and for Eastbourne (Stephen Lloyd) for initiating this debate and the Backbench Business Committee for agreeing to it. As we have heard, given the geographical spread of concerns, this will clearly be the first of many such debates.

The recent events in south-east London have demonstrated just how timely this debate is. Members from all parts of the House have made compelling cases and shown the depth of feeling on this issue, which cannot be approached easily or without extremely strong emotion. I have always fought for the services provided by West Cumberland hospital in my constituency and I always will. I know just how Members feel about the issues facing their hospitals and I am sure the Minister does too. Indeed, I am sure we have all faced them.

The needs and best interests of patients were at the centre of the inspiration to create the national health service, almost 65 years ago, from the ashes of the second world war. The needs and best interests of the patient must remain at the centre of any discussion about health services today. This is the crux of the issue. With that in mind, the recent decision that the Secretary of State for Health took on the A and E department at Lewisham has set the NHS on a dangerous path whereby the core principle underpinning and shaping the design and delivery of hospital services—that which is in the best interests of patients—now looks set to be redefined. This Government have introduced a new basis on which to take decisions—namely, that financial considerations

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should take precedence over clinical considerations. Any A and E department in the country is vulnerable to change on that basis.

Those two fundamental points—financial considerations taking precedence over clinical considerations and the Government allowing the reorganisation of well functioning hospitals on that basis—create a toxic mix that could have consequences for patient care and well-being. As we have seen—today’s debate is testament to this—the new emerging principle has consequences for the legitimacy of the decision-making process for reconfiguration and the accountability of those behind such processes. We must return to the first principles of health care provision. The patient comes first. Their health care and well-being are paramount. The needs of the patient must always take priority over the needs of any other interest in the system. Services should reflect that, as should their design and delivery.

If a clinical case and clinical evidence suggest that services and, most importantly, patient care can be improved by reconfiguration, we have a duty to support those arguments in the interests of the patient. Where a reconfiguration is shown to improve patient care and ultimately save lives, we cannot and must not stand in the way. Where services can be better provided to those who use them, changes cannot and should not be opposed simply for the sake of opposition.

My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, has made clear the massive challenges facing our health-care system. It is a 20th-century system struggling to answer the questions asked of it by a 21st-century society. There is a huge sustainability challenge characterised by an era of economic austerity, for which there is no line on the horizon, and rapidly rising demand. However, any community that is experiencing reconfiguration without clinical evidence should know that the Opposition will be by its side fighting with it every step of the way. The NHS is our greatest achievement and we guard it jealously.

There are important progressive principles at stake. First, every penny of taxpayers’ money should be spent to its maximum effect, even more so in austere times. As arguably the nation’s most valued public service, the first duty of the NHS is to the patients and public of our country, not to public servants.

Last week, we published a report on the state and condition of A and E services throughout the country. The scale of demand and the pressures on the system are frightening. In the financial year to date about 100,000 more patients are being left to wait for more than four hours in A and E waiting rooms before being seen. That does not show the full scale of the pressure, as an extra 23,000 patients were left waiting on trolleys for more than four hours after being seen and before being admitted to A and E. The pressure then backs up through the ambulance services and, because of the lack of capacity in A and E, patients are being left waiting in the back of ambulances for, in some cases, many hours. This is an issue of capacity or, to be more accurate, lack of capacity. It shows that the system is creaking under the pressure, so reconfigurations based purely on financial considerations are simply unacceptable.

The distinction between the different forms of reconfiguration is important. If a change in services is supported and motivated by clinical evidence, it can offer real improvements to patient satisfaction and to

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overall levels of care; but if a closure is motivated purely by financial reasons—and if it is taken in the absence of clinical evidence or consultation—that is simply a cut to services hidden beneath the label of reconfiguration, and that is not acceptable.

There are always genuinely hard choices to be made in the national health service, but I would never accept a reconfiguration of hospital services in my constituency based on non-clinical considerations. I am sure that the Minister would not either, and I am convinced that no Member of this House would accept reconfiguration on that basis.

Lewisham A and E was not downgraded because it performed badly or because the level of care for local residents could be improved by focusing services elsewhere; it was downgraded because of financial problems in neighbouring trusts, and that is wrong.

The figures that I have quoted show a system that is on the brink. Further increasing pressures by reducing capacity without clinical reasons has the potential for truly dangerous consequences. Closing without clinical evidence an A and E department that is relied upon can be damaging to local patients and a community, but it also has wider implications for the health care system as a whole. Performance in A and E departments is a barometer of how the wider NHS is performing. Patients on trolleys indicate lack of capacity on wards, and the increased number of delayed discharges shows that patients are being kept in hospitals when they could be receiving care in their communities, but there are clear gaps in primary care provision. A and E departments are under immense strain. Department of Health figures show as much and there is simply no justification for the financially driven closure of services or the downgrading of facilities.

At the heart of the health care service is patient need, and ensuring the right provision of health care services can only be done by speaking with patients and clinicians. That is why it is crucial that consultation is undertaken at every level in any process relating to reconfiguration. A and E services should first of all be about people and not pound signs. Those of us who care about the national health service must guarantee that people are engaged at every possible juncture in the decision-making process. That will ensure that they have a stake in the future design of services, that, crucially, they have the services they need and that they are not subject to back-door, cherry-picked reconfigurations, such as that in Lewisham.

Pressures in A and E departments are felt across the whole health economy of a local health service. Removing an A and E department without clinical support or evidence is hugely disruptive and will have a profound effect on the provision, level, quality and type of every associated service in any and every local health economy. A reconfiguration of emergency services without sound clinical guidance is not a reconfiguration— it is a cut. It is a cut in services and in provision that will be detrimental to the people who rely on those services. In real terms, national health service spending has been cut, and £3.5 billion has been wasted on a reconfiguration that was not voted for by anyone at the last general election. It is not wanted by anyone in this country, including medical professionals, and it has caused chaos in the NHS and in the delivery of its key services.

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Opposition Members will never accept purely financially driven reconfigurations. I call on the Minister to commit unequivocally to that principle, and to intervene without delay on reconfigurations that are being driven not by clinical need but by financial pressures. I can only echo the powerful invitation made to the Minister by my right hon. Friend the Member for Tottenham (Mr Lammy), and remind her that she has the power to intervene and stop this happening. I look forward to her doing so.

4.50 pm

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I congratulate the hon. Member for Ealing, Southall (Mr Sharma), my right hon. Friend the Member for Newark (Patrick Mercer)—if he is not right hon., I am sure he will not complain at my saying that he is—and my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. It has been a good debate, if rather heated at times. There has been a great deal of passion, and rightly so. Fighting to defend our NHS and our hospitals in whatever way we need to is something that all Members should do. It is one of the reasons that we come here—to be champions of our local causes and to advance the cause of our constituents.

I apologise to the hon. Member for Lewisham West and Penge (Jim Dowd) if my intervention exacerbated his rising blood pressure. As the Minister for public health, I get concerned about his blood pressure, but he made it clear that he spoke with passion.

Jim Dowd: Will the Minister give way?

Anna Soubry: I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members

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want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

Mr Virendra Sharma rose

Anna Soubry: I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.

As part of the review’s work, it needs to consider public understanding of the best place to go for care.

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Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.

I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.

My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.

I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.

I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.

4.59 pm

Mr Virendra Sharma: How disappointed I am that the Minister failed—utterly failed—to address the issue—

Mr Deputy Speaker (Mr Nigel Evans): Order. Sadly, time has defeated us.

5 pm

The debate stood adjourned.

Motion lapsed (Standing Order No. 9(3)).

Business without Debate

Sittings of the House

Motion made,

That this House shall sit on Friday 22 March.—(Greg Hands.)

Hon. Members: Object.

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A47 (Upgrading and Dualling)

Motion made, and Question proposed, That this House do now adjourn.—(Greg Hands.)

5 pm

George Freeman (Mid Norfolk) (Con): The A47 is a strategic route of national and regional importance to the East Anglian and the Norfolk economies. I am delighted to have an opportunity to raise the subject in the House, and to encourage and thank the Minister for his support for the work of all the Norfolk Members and others in the region; highlight the importance of the proposed works to our local economy and the national economy; and seek further reassurance from the Minister on some of the points on which he reassured me when we met before Christmas.

Let me first thank the Minister and his colleagues in the Department for Transport for their encouragement. Last summer we went to see the Minister’s predecessor as roads Minister, my hon. Friend the Member for Hemel Hempstead (Mike Penning), who told us that historically the road had not been supported by the regional development agency and that we had our work cut out to make the case. The Government’s approach now is to invite local parties to set out a clear business plan for roads, and to make the case that Government investment will be more than matched by significant co-investment along the route.

I am delighted to say that the county council, New Anglia—the local enterprise partnership—and all the local Members of Parliament and business organisations came together to produce a report that set out exactly what the Government had asked for: a business plan for the route entitled “A47—Gateway to Growth”. I am delighted that that document was so well received by the Government, and grateful to the Minister and his officials for their support for it.

Mr Henry Bellingham (North West Norfolk) (Con): I congratulate my hon. Friend on securing the debate, and I am delighted that he has supported the Minister, who has taken a great interest in the issue. We in west Norfolk were delighted by the Minister’s recent announcement that we would indeed be given the Middleton crossing for which we had been pushing for a long time. Does my hon. Friend agree that the A47 really does need more dualling to ensure that Norfolk fulfils its full potential? He may be aware that the White Paper “Roads for Prosperity”—published in 1988, before he was born—recommended that the entire road should be dualled. After all those years, we really must make more progress.

George Freeman: My hon. Friend has made a powerful and important point, to which I am sure the Minister will want to respond.

I have initiated this debate in order to highlight the key strategic importance of this route to our economy, to raise its profile nationally and to build the momentum of the important campaign and the work that is taking place locally. The road is of key strategic importance to our region and our nation, but it is also a dangerous route for those who use and cross it. I believe, and I know that the other local Members believe, that it could act as a catalyst, enabling East Anglia to become a genuine centre for innovation and enterprise focused on

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the greater Norwich economy. I hope that the Minister will provide further reassurance this evening that the Government will make the route a priority in the next round of funding, will look kindly on my request for pinch-point funds, and will view sympathetically my concern about some of the bottlenecks that need particularly urgent attention because they have the greatest potential to unlock growth.

Mr Richard Bacon (South Norfolk) (Con): My hon. Friend raised the issue of safety. My constituents are lucky, in that the section of the A47 that is immediately to the north of them, in both the east and the west, is the bit that is immediately south of Norwich, which is dualled. As my hon. Friend knows, however, the road stops being dualled very slightly to the west of that. People whom I have employed in my office for years knew people—often they were at school with them—who were killed in accidents on that extremely dangerous stretch just to the west of the point at which the dualling ceases. Does my hon. Friend agree that of all the various considerations, safety should be one of the foremost in the Minister’s mind?

George Freeman: My hon. Friend makes an excellent point. He is absolutely right that one of the most dangerous things about this road now is its intermittent dualling. In both of our constituencies, some of the most lethal sections are those where the road goes from dualled to undualled. Every month we hear of terrible injuries and deaths on the road.

This campaign has the full support not only of the county council and the local enterprise partnership, but of all my fellow Norfolk MPs, and I thank them for their leadership and support. On this, as on other infrastructure issues, we are “Norfolk united.” A number of colleagues are unable to speak in the debate. In particular, I pay tribute to my hon. Friend the Member for Great Yarmouth (Brandon Lewis), who is now rightly on the Front Bench as Under-Secretary of State for Communities and Local Government. He has played a key role in highlighting the Acle straight and the Vauxhall roundabout, and in making our case powerfully to Ministers and helping to organise the two meetings we have had. I also thank my hon. Friend the Member for South West Norfolk (Elizabeth Truss), who also holds a Front-Bench post, as Under-Secretary of State for Education, and is unable to be here tonight. She has made clear her support for the A47 as a major route.

Across Norfolk we have for many years waited in vain for infrastructure funding. It is well recognised that this coalition Government have done more in the last two or three years for infrastructure in Norfolk than have successive Governments over previous decades. We have finally had success on the A11. Those of us who use that road, which is still a bottleneck, can now see the bulldozers laying the foundations for the dualling that will be done by 2015.

Simon Wright (Norwich South) (LD): I congratulate my hon. Friend on securing this important debate. I hope many of the important A47 junction improvements adjacent to my constituency, such as those on to the A11, the A140 and on to Longwater, will be made available through local developer contributions, freeing up land capacity to support thousands of new jobs in

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Norwich. Does he agree, however, that the city will become even more attractive to investors when harder-to-fund schemes between Great Yarmouth and Norwich out to King’s Lynn and the west become deliverable, too?

George Freeman: My hon. Friend makes an excellent point, which serves to remind me that the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Norwich North (Miss Smith), who could not be present tonight and who is also muted by virtue of being on the Front Bench, has asked me to pass on this comment:

“The A47 is an important road for Norwich businesses and households. I support the campaign for its improvement because it will bring more jobs to the city and around the county.”

Norfolk has waited for infrastructure improvements for a long time, and now, like the No. 11 bus, many have come at once: the A11 is being dualled; there is substantial investment in our rail network as a result of our putting together our Anglian rail prospectus; and the Government are funding fast broadband. All of that comes not before time, because our county is ready to rise and meet the challenge of a rebalanced economy. With the necessary infrastructure in place, we will be able to do so.

The A47 is now the most pressing and urgent infrastructure issue in our county. It is the blocked artery that runs across it from east to west, linking our economy to the midlands and allowing goods to be moved in and out. We have major ports of international significance on our east coast, and in and around Great Yarmouth there is an increasingly significant energy cluster. It is lamentable that this road was not prioritised by the RDA, and many of us may wonder why on earth not.

My personal interest is obvious. The A47 runs right through the middle of my Mid Norfolk constituency and, as my hon. Friend the Member for South Norfolk (Mr Bacon) has highlighted, its intermittent dualling presents great dangers to all its users and to those in the rural economy who seek not to use the A47, but to cross it, whether on bicycle, horse or tractor. I know from my own experiences of cycling the route before the last election just how dangerous it is. At this point I should like to pay tribute to my hon. Friend the Member for Broadland (Mr Simpson), who recently drove the route in a union flag-bedecked Mini from east to west to highlight its importance.

My other interest in this issue is as the Government’s adviser on life sciences. I have talked before in this Chamber about the potential of the Norwich research park, an increasingly globally recognised centre of science and research in three of the most exciting global markets: food, medicine and energy. Its companies pioneer some of the most exciting science in the country, such as the blight-resistant potato and the Lotus car I recently saw that is fuelled by biofuels created from agricultural waste.

Norwich is a centre of life sciences, but it sits out deep in the last county not to be connected properly to the national trunk road system, and with no non-stop links through to the rail network. It is a county that

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desperately needs infrastructure if it is to be allowed to play its part in the Government’s mission to rebalance our economy.

The truth is that this is a trans-European route of economic significance that has been neglected for far too long. The lack of connectivity and poor development are holding back the whole Norfolk economy. With investment in our infrastructure, we can spread growth around and reduce the amount that we in government have to spend on welfare and on tackling the problems of social and economic exclusion that flow from poor infrastructure.

The opportunity is significant. As the business plan makes clear, with a programme of targeted improvements we can transform the 105 miles of the A47 into a truly strategic national and international link, linking our region to central and northern Europe and to the midlands and the north of England, and linking our regional clusters—Cambridge, Norwich, Yarmouth and Ipswich—of innovation and science and new business growth. As the business plan makes clear, over the 20 years for which it sets out the programme of work, we have the potential to generate 10,000 jobs, to increase the economic output of our county by £390 million a year, to attract private investment worth more than £800 million, to recruit an extra 500 investment-related jobs and to cut journey times by 30 minutes, delivering savings of £42 million to road users. These are significant numbers, and they are not, Mr Deputy Speaker, you will be pleased to know, plucked out of the air but put together by professional consultants and officials at the county council and the LEP who constructed the business case. Of course, these works will also dramatically improve safety for users and for those crossing the route.

Importantly, the document sets out a series of regional benefits across the route. In King’s Lynn, in the west, where the focus is on regeneration, the plan envisages 750 new jobs, £15 million of private investment and 400 new dwellings.

Mr Bellingham: I am very grateful to my hon. Friend for mentioning King’s Lynn. Obviously, Norwich has the most phenomenal potential and is going to move forward, and King’s Lynn wants to do the same. If King’s Lynn is connected to Norwich by an improved A47, it will really be a part of that economic regeneration. That is why this is so important not just for links to the rest of the country, but within Norfolk itself.

George Freeman: My hon. Friend is a passionate and effective advocate for King’s Lynn and that area, and he has done extraordinary work in putting it on the map, both through rail and now through road. He makes an excellent point: by connecting these centres, we not only improve the national economy but help to tackle problems of exclusion and deprivation locally.

The business plan makes clear the economic benefits in Norwich: 5,000 jobs, £240 million in additional private investment and an extra 2,500 dwellings. For Great Yarmouth—represented admirably by the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Great Yarmouth, who has to sit silent on the Front Bench and listen to me describe the benefits in his own constituency—the figures are 3,865 jobs, £227 million in private investment, and 200 dwellings.

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It is not least for that reason that the business plan has had such support from the local business community. Richard Marks, managing director of John Lewis in Norwich, said:

“Norwich is growing its reputation as a retail destination…we support the proposals which will help improve communication across the county”.

Matthew Jones, chief operating officer of Norwich research park, said:

“The NRP fully supports the plans for improving the A47 which are essential to achieving the huge potential of the park to drive economic growth and development of the greater Norwich area”.

Phil Gadd, contracts director at Norwich airport, said:

“The world can fly to Norwich. However, it cannot access the region. We need to improve the A47”

as a strategic gateway. The chairman of the Mid Norfolk branch of the Federation of Small Businesses said:

“I regularly use the A47, if I could just save 15 minutes every day and everyone else using the A47 could do the same, that equates to thousands of hours every year.”

Mr Bacon: My hon. Friend mentioned the Norwich research park, which is in my constituency and has the largest concentration, as he will know, of plant and food scientists in Europe, and possibly the world. He will also know that the Government have put money into improvements at the research park, which is extremely welcome. However, does he agree that the value of that taxpayer investment will be deflated to some extent if the connection that we want to see between Norwich and the cluster of expertise there and elsewhere, in centres such as Cambridge, cannot be improved?

George Freeman: My hon. Friend makes an excellent point. It would be madness for the Government, having recognised the potential of our region—and the NRP as the jewel in the crown of the Norfolk innovation economy—in terms of making improvements to the A11, rail and broadband, and of creating and helping to support a cluster of new businesses and growth, to then hold that back by allowing the A47, the clogged artery of Norfolk, to constrict and constrain growth. We know that if we cannot get the goods in and out and if we cannot get the talent, the goods and the people we need in to the middle of Norwich quickly—to the Norwich research park, which sits on the edge of his constituency and mine—the investment that the Government have already made will not deliver its full potential. With this artery unclogged, we will be able to make that money work properly.

The Minister gave us huge reassurance when we met before Christmas. I was delighted, as we all were, to hear him say that the Government are funding three route-based strategies in the current financial year to upgrade key routes across the country: the A1 in Newcastle, the M62 and the A12. We were told that those three strategies being undertaken by the Highways Agency will inform funding decisions to be made in the next Government spending review period from 2015 onwards. He made it extremely clear to us that he was obviously not able, at that time, to give us any clear commitment or guarantees on funding, but he did acknowledge that the case we made was very powerful and said that he would look carefully at it. He said:

“I’m convinced this could be the 4th or 5th scheme to put into this route-based strategy process.”

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I am hoping that he will now reassure us that his convictions have only been strengthened by what he has heard tonight.

I have talked to the county council and the New Anglia LEP, and they have highlighted that we have an excellent opportunity now to bring forward elements of the programme through the Government’s pinch-point programme for trunk roads. A number of the more modest schemes proposed along the route would seem to fit the criteria, and I hope that the Minister will be able to give a little reassurance that we are pushing at an open door here. In particular, I am thinking here of the A47 Acle straight ditch relocation scheme, the details of which I will spare the House, although I will happily provide them to him and his officials after the debate, if that would be helpful; the junctions of the James Paget hospital, Beacon park roundabout and Bridge road with the A12 at Great Yarmouth; the A149 Asda junction in Great Yarmouth; and the A47 and B1108 junction at Norwich.

Although support for those schemes would be hugely welcome, the criteria mean that the highest priority and most-needed measures to stimulate housing and jobs growth are not within the scope of the current funding, as they are too large. We wanted to take the opportunity to highlight a number of projects tonight, and they are as follows: a third river crossing in Great Yarmouth; improvements at the A47 Vauxhall roundabout in Great Yarmouth; the A47 Easton to North Tuddenham dualling; the Acle straight dualling to North Burlingham; the Thickthorn interchange; the A47 Longwater junction; and improvements to the A47 Hardwick junction.

As the business case shows, local partners have been active in seeking local contributions towards those schemes. However, the scale of investment is such that Government support will be essential for us to be able to secure an overall funding package. We would all welcome any advice from the Minister as to how best we might be able to access such support.

In response to the presentation of the business case before Christmas, the Minister was very clear, telling us:

“The A47 campaign had put together a very powerful and well constructed argument. They have moved substantially forward from where they were two years ago. They have the local authorities, MPs and the local enterprise partnership all working together. I certainly recognise that the A47 is a corridor of strategic importance, and I think I did give them hope there is going to be progress on this project.”

I want to close by thanking the Minister for his diligence, his commitment to this project and his encouragement for the work that we are doing. I ask him to take this opportunity tonight to reassure us that we are pushing at an open door and to give us as much hope as he can that this blocked artery will quickly be unblocked, for the benefit of the nation.

5.19 pm

The Parliamentary Under-Secretary of State for Transport (Stephen Hammond): I congratulate my hon. Friend the Member for Mid Norfolk (George Freeman)on securing the debate. I know that the paucity of people in the Public Gallery has nothing to do with the power of his case; I am sure that it is more the thought of the Minister replying.

My hon. Friend raised with me, the Department and the Highways Agency the subject of future improvements to the A47 along with a number of other hon. Members,

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some of whom are in the Chamber tonight. They include my hon. Friends the Members for Great Yarmouth (Brandon Lewis), for Norwich North (Miss Smith), for Norwich South (Simon Wright), for South West Norfolk (Elizabeth Truss), for North West Norfolk (Mr Bellingham) and for Broadland (Mr Simpson). Tonight we have heard from my hon. Friend the Member for North West Norfolk. I met him recently and was delighted to do what we could at Middleton, and I also heard what he had to say when he made the case for King’s Lynn. Of course, I also heard the point made by my hon. Friend the Member for South Norfolk (Mr Bacon) about the Norwich research park, and it will not be lost.

I recently met my hon. Friends to discuss future proposals to improve the A47 so they know I take a great interest in the subject. I appreciate that it is important for the constituents of my hon. Friend the Member for Mid Norfolk, those of my other hon. Friends and the economic growth of the whole region. Before I discuss the A47 specifically, it is probably worth making the point that the Government regard infrastructure as a top priority. We set out in the coalition agreement a commitment to a low-carbon transport infrastructure as an essential element of building a dynamic and entrepreneurial economy. We reiterated the importance of investment in economic growth, including in the strategic and local road networks.

The A47 is part of the strategic road network, which is worth about £100 billion and covers some 4,350 miles of motorway and all-purpose trunk roads. The fact that we recognise the importance of its maintenance and enhancement can be seen through the history of this Government’s spending. In the 2010 spending review, we announced the investment of £1.4 billion in starting 14 major road schemes. In the 2011 autumn statement we identified for accelerated delivery two Highways Agency major road schemes and introduced six more schemes, making eight in total, and we allocated £1 billion of new investment to tackle areas of congestion. In the 2012 autumn statement, the Chancellor announced additional capital investment in this Parliament that would enable four further new major Highways Agency schemes to be introduced as well as making moneys available for pinch-point schemes in the strategic and local road networks.

Within the current spending review period, we will spend £1.8 billion on local authority major schemes. They will deliver significant improvements to local road networks and public transport across the country. My hon. Friends will recognise that one of those is the Norwich northern distributor road, and I hope they acknowledge the money that will go into that project.

It is important to recognise that our investment commitment is not only in the major schemes. Importantly, the Chancellor announced in his 2012 autumn statement the provision of a further £100 million of capital expenditure to undertake pinch-point schemes on the strategic network. From my point of view and, I hope, that of my hon. Friends, the most important announcement was the £170 million for a new fund for the local authority network to allow the authorities to consider the possibilities for schemes that would unlock congestion and sponsor economic growth.

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I am sure that my hon. Friends will acknowledge our announcement last October about two pinch-point schemes on the A47—at the Honingham roundabout and at the junction between the A1 and the A47 at Peterborough. The Highways Agency is involved in delivering those beneficial schemes and they will both be delivered by the end of the spending round, by which I mean March 2015. I hope that my hon. Friends will recognise and welcome that short-term investment.

I am grateful to my hon. Friend the Member for Mid Norfolk for setting out both the context and the need for future improvements to the A47. As he and other hon. Friends will know, and as he acknowledged, I met a number of them in December to discuss the proposals put forward by the A47 Alliance in its “Gateway to Growth” prospectus. I am happy to reiterate what an excellent document that was. It showed how local and regional interests had combined, in stark contrast to what we had seen under previous Governments. Members of Parliament and representatives from county and district councils had come together and worked closely together to set out the case for future investment. They make that case more powerfully if they do so in a joined-up, coherent fashion.

I recognise what that prospectus says. It is a targeted programme of improvements to the strategic road network. It details about 15 specific individual schemes, with five related to the Highways Agency network and a range of other proposals. I could, if my hon. Friends wish, detail all 15 schemes now, but I know that they will have read that document and have it close to them all the time. I will therefore not detail all those schemes, but they are exciting and they would generate growth, unlock housing and be good for road safety. They tick all the boxes.

The partners in the A47 Alliance have secured funding for some of these propositions already, and they are confident that they can go further and secure delivery locally. I recognise the case being made. The A47 is part of the strategic road network. Sections around Peterborough, Lynn and Norwich are all dual carriageway standard. Some elements of it are not. There have been previous and significant improvements to the A47, but it is fair to make the point that the previous Government curtailed a number of improvements that would have helped Norfolk: the Acle straight, the Blofield to North Burlingham dualling, the North Tuddenham to Easton and the East Wynch-Middleton bypasses all seemed to go the way of so many regional plans throughout the country—

Mr Bacon: The A140 was the same.

Stephen Hammond: Indeed—much talked about but seldom delivered. It is worth putting it on the record that the A47 Alliance rightly puts those proposals back into the package. They would be of great benefit.

My hon. Friend the Member for Mid Norfolk rightly recognises that we are developing route-based strategies as a way of analysis. Three are already being trialled. In considering major future enhancements to the network, we are looking to local authorities, local enterprise partnerships and other interested parties, including academic institutions and councils, to work together to assess the potential of their region by addressing not only the transport problems that they face, but the economic growth that would be unleashed if those transport problems and congestion were resolved.

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It is right, as I stated in December and am happy to reaffirm this evening, that excellent work has been done by the A47 Alliance. That is ideally placed to be considered one of the earliest route-based strategies in the forthcoming programme, and I hope that it will be among the first one or two after the three that we are currently considering.

I conclude by thanking my hon. Friend for yet again making the case. I recognise absolutely the importance of the A47 and the economic improvements that it could bring. I am convinced that East Anglia is not a Cinderella region. I made that point when I was with my hon. Friend the Member for South West Norfolk at the start of works for the A11 dualling. The interest from colleagues here on a Thursday evening shows how powerfully they are making the case for their constituencies,

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sometimes purposefully from the Back Benches and sometimes a little more mutedly by my hon. Friend the Member for Great Yarmouth.

George Freeman: He is not normally that quiet.

Stephen Hammond: He is this evening, but the force of his advocacy for his constituents is recognised.

I recognise the importance of the A47 and I am glad that we have yet again been able to air its importance this evening.

Question put and agreed to.

5.29 pm

House adjourned.