The result of the Scottish referendum will change our Union for the better. The Opposition are completely clear that we will keep our vow, made to the Scottish people on the eve of referendum. It is also clear that we
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now have a great opportunity to change the governance arrangements in the rest of the UK for the better, and it is that to which I now turn. It is right that we do not just consider further powers to Scotland in isolation from a wider crisis of trust that we are seeing in our politics across all four nations, and it was widely alluded to in many of today’s speeches. There are a number of reasons for this breakdown. The age of deference is long gone, thank goodness, but it is not welcome that it has been replaced by the age of contempt. All institutions have been affected by this breakdown in trust: Parliament, the Church, the police, the press—I could go on. We need to address that.
Globalisation has increased the feeling of powerlessness, and the view that supranational forces are more influential than national Governments makes it hard to persuade potential voters of the possibility of change at national level. The commercialised retail model of politics as a brand choice, rather than a contest of values, encourages passive consumer behaviour, rather than empowering potential voters to become actively involved. The way politics is carried on in Westminster is becoming increasingly incomprehensible to an electorate who are alienated, rather than charmed, by our arcane and quaint procedures.
It is clear that we need a radical plan for reform and change. That is why Labour has built on our proud tradition of constitutional reform, and has announced a comprehensive programme for change. We will deliver a new English deal, which will devolve over £30 billion to city and county regions. We will ensure that the Welsh model of devolution is on an equal footing with the Scottish, and will hold an unprecedented and wide-reaching constitutional convention, in order to have a conversation with all parts of our country about the change that we need if we are to modernise the way that we are governed. We will introduce regional investment banks; devolve powers to encourage economic development in cities, counties and regions; and ensure that skills, transport and the Work programme can be planned and delivered locally.
Sir Gerald Howarth: Can the hon. Lady tell us how long she expects this modest endeavour to take?
Ms Eagle: Does the hon. Gentleman mean the constitutional convention?
Ms Eagle: We are already doing some pre-work, before the election. We want this to happen very quickly after the election, and want to be ready to come forward with some views after proper conversations with people from across the entire country. We are looking at models such as the Scottish constitutional convention and the Irish constitutional convention, which happened after the crash. There are good models out there that we can use to bring about a process that would give a new settlement the legitimacy it deserves. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. The shadow Deputy Leader of the House needs to stop enticing colleagues to speak. I want to hear the shadow Leader of the House.
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Ms Eagle: Thank you, Mr Deputy Speaker. My hon. Friend the Member for Dunfermline and West Fife (Thomas Docherty) is naughty like that.
Mr Deputy Speaker: I will let you deal with him.
Ms Eagle: I will get on with that later, Mr Deputy Speaker.
Our amendment, had it been selected, would have brought about proposals that would meet the scale of the challenge and unite the country through conversation and consensus; that is exactly what we would seek to do.
When the Prime Minister appeared on his front step just hours after the result of the Scottish referendum was announced, his intention was not to bring our country together, but to try to find a new way to divide us with his partisan suggestion of English votes for English laws, which he appears to want to apply to Finance Bills. Instead of behaving like a Prime Minister, he behaved like a man concerned only with his own narrow party interest who was running scared of the UK Independence party.
The need for a distinct voice and identity for the English is something that I understand, but the issue is much wider than who votes on what, and in which way, in this House; today’s debate has demonstrated that. Look at what this Government have done to make worse the problem of unfair access to resources. They have instigated huge cuts to local authorities in England, and they have hit the poorest areas hardest.
The effect of the Barnett formula distribution pales into insignificance compared with what has been happening in local government allocations. My local authority will have suffered a 57% cut to its 2009-10 budget by the end of this Parliament, which is a loss of over £700 per household. While the social safety net is torn away in the Wirral, Surrey Heath has received an increase of £25 per household. With their modest announcements on some cities, the Government have come very late to any thought of meaningful devolution of power to the English regions. Indeed, they have centralised power quite significantly, beginning with the complete dismantling of the regional development agencies.
Meanwhile, Labour Members have been proposing the biggest devolution of power ever to the English regions. After the McKay commission reported on the West Lothian question, the Government’s own press release said:
“The Government is giving serious consideration to this report. Given the significance of the recommendations for both England and the UK as a whole, it is right to take the time required for a thorough and rigorous assessment.”
That welcome and sensible approach was thrown over on the morning after the referendum. I hope that we can see it reasserted in the months ahead.
Labour has a proud record of constitutional reform achieved by trying to find cross-party consensus. We devolved power to cities as well as nations. We passed the Freedom of Information Act and the Human Rights Act. We began the process of Lords reforms, and I hope that we will be able to finish it by establishing a senate of the nations and regions. We understand that there is more to the debate than just English votes for English MPs; it is about how our democracy works and how we can rebuild trust in it.
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I urge Members to vote against the motion because of its reference to a review of the Barnett formula, which would go against the promises that were given to the Scottish people before the referendum. There is an exciting possibility of progressive change ahead and the prospect of a radical improvement in the way the UK is governed, which would take power and accountability closer to the people and renew our democracy. I believe that we should seize it.
4.45 pm
The First Secretary of State and Leader of the House of Commons (Mr William Hague): It has indeed been an interesting, lively and, in the main, good-tempered debate, with one or two reminders from the hon. Member for Birmingham, Edgbaston (Ms Stuart) to other Members to be good tempered and well informed, which seemed to be successful. Many hon. Members, including the shadow Leader of the House, referred to the sense of alienation and powerlessness that many voters and observers of politics feel, and I think that is true. It is very important that we grasp that and respond to it. It will be important in the months ahead to have further detailed and substantial debates in the House about these matters.
I will try in the short time available to respond to as many of the points that have been made as I can, leaving a few moments for my hon. Friend the Member for Esher and Walton (Mr Raab) to respond to the debate, which I congratulate him on launching, with the support of the right hon. Member for Birkenhead (Mr Field).
I disagreed with much of what the hon. Member for Birmingham, Hall Green (Mr Godsiff) said, but he did call for a smaller House of Commons. I hope that the next time that comes up for debate, all parties will vote in favour of the proposals, as some of them failed to do so in the course of this Parliament. My hon. Friend the Member for St Albans (Mrs Main) said that a logical conclusion of what is happening in Scotland and Wales is that a democratic deficit in England has to be addressed. I think that is absolutely true, and I will move on to what should be done about it in a moment.
The right hon. Member for Knowsley (Mr Howarth) spoke convincingly and constructively about how cities and counties have sometimes underperformed and how they can take on greater responsibilities. Just before this debate I met many of the leaders of the core cities, including representatives from Liverpool, to discuss, building on what has now been agreed with the Manchester authorities, how we can imaginatively pursue greater decentralisation, with greater accountability among the cities, city regions and regions that include rural areas, because this is not just about metropolitan Britain.
I believe that there is an opportunity for an exciting cross-party agenda on that. We might differ from one party to another on the pace or detail, but the time has come for a general recognition in this country, and in all parts of the United Kingdom, including Scotland, Wales and Northern Ireland, that decentralisation towards local government is the way forward. That has not been pursued by the Scottish Government, and I hope that they will do so, just as we are doing in England.
My hon. Friend the Member for Argyll and Bute (Mr Reid) stressed the importance of honouring the timetable of commitments to Scotland. It is important to stress that the timetable is being honoured. The
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Government published the Command Paper on further devolution to Scotland ahead of schedule, setting out the proposals from each party. Lord Smith of Kelvin is overseeing a cross-party process to produce an agreed set of proposals by the end of this month—in the next 10 days. Based on those proposals, the Government will publish draft clauses by 25 January so that the legislation is ready to be implemented after the next general election.
The hon. Member for Moray (Angus Robertson), who spoke for the SNP, remarked on the election of the First Minister; indeed, I congratulate her and wish her well. He said that change in Scotland should not be dependent on dealing with the West Lothian question. It is not dependent on that; it is an unconditional commitment by all three of the United Kingdom parties. I know that the SNP is almost longing for it not to be an unconditional commitment, but it is.
Mr Hague: I will give way briefly but I must make progress.
Pete Wishart: Can the right hon. Gentleman clear this up once and for all? The hon. Member for Aldershot (Sir Gerald Howarth) said that the vow is not worth the paper it was written on because it was not agreed by Parliament. What is the right hon. Gentleman’s message to his Back Benchers? Is it that the vow is something that is promised and guaranteed or that, as the hon. Member for Aldershot says, it is not worth the paper it is written on?
Mr Hague: I will defend my hon. Friend, to save time. To be fair to him, he said that the SNP had called the vow a gimmick and now treat it as being of huge importance, which it is. [Interruption.] That was absolutely his argument.
The hon. Member for Moray said that he was speaking on behalf of 1.6 million people who voted yes. Actually, our duty in this House is to speak on behalf of, and consider the interests of, all 62 million people in the United Kingdom. When asked by Labour Members, he left some doubt as to whether the SNP will accept the outcome of the Smith commission. The rest of us made compromises on the basis that we will support the outcome of Smith.
My hon. Friend the Member for Cardiff North (Jonathan Evans), who has had to leave, made the powerful point that in 1997, when he and I opposed devolution in Wales and it was carried by a very small majority, we accepted the result of the referendum and did everything possible to make the Welsh Assembly work in the interests of the people of Wales and to support the success of devolution in Wales. Nationalists seem to have an asymmetrical view of democracy, whereby if there is a referendum that confirms their view, it is for ever, and if there is a referendum that differs with their view, it is only a temporary thing before going on to the next one. It is time for a symmetrical view of democracy as well as more symmetrical democracy within the United Kingdom.
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That brings me to the point made by my hon. Friend the Member for Salisbury (John Glen), who said that he was against an English parliament. I agree with that, and I agree with those who have said—
Mr Hague: I will not give way again because I have only a few minutes before I must let my hon. Friend the Member for Esher and Walton speak.
I agree with those who have opposed a federal system for the United Kingdom, because the United Kingdom does not lend itself to a federal structure. Therefore, we have to find our own answer to what we have always called the West Lothian question. This debate goes wider than votes in this House, as the shadow Leader of the House said, but it does include votes in this House. That is something that we have to address, and in the coming months, we must make specific proposals to do so.
Various commissions have worked on the issue over recent years. There was the Norton commission that I established within the Conservative party. There was the democracy taskforce of my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke). There was the McKay commission, which set out the important principle, to which the Prime Minister referred at the Liaison Committee this morning, that
“decisions at the United Kingdom level with a separate and distinct effect for England (or for England-and-Wales) should normally be taken only with the consent of a majority of MPs for constituencies in England (or England-and-Wales).”
Although there are many different ways of implementing that principle, it will be important to do so. Refusing to face up to that would be the true “insider fix”, because the great majority of the people of the United Kingdom expect some such principle to be implemented and adopted.
The hon. Member for Nottingham North (Mr Allen) said that it was time for England to come to the devolution party. I agree, although I think he was unkind to the Prime Minister in saying that there was a lack of urgency. There is a great sense of urgency in the Government in taking forward decentralisation to cities and other localities, and in addressing the West Lothian question as well.
My hon. Friend the Member for Aldershot proposed the idea of reducing the number of MPs from Scotland and Wales. I do not agree with that opinion. It is important to address the issue in other ways, and I do not think that they should be reduced below their proportionate representation in the House.
I will not have time to go through all the hon. Members who have spoken. The hon. Member for Dudley North (Ian Austin), who is not in his place, made the case for a Minister for the west midlands, largely on the basis that he would be the Minister for the west midlands. I think we have now moved past that idea to address the issue in new ways. The hon. Member for Newport West (Paul Flynn) made the case for the importance of languages. He can be assured that the Welsh language lives very strongly in the family I have married into, and I am extremely conscious of that.
If I may finish on the question of Wales, it is important for Wales to play its full part in the greater decentralisation and devolution. The Secretary of State for Wales has
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made it clear that he wants to hear views from across the political spectrum in Wales on the best way forward. He has begun discussions with the leaders of the Welsh parties with a view to building consensus.
These issues now have to be addressed and resolved in a way that is fair to the whole of the United Kingdom. We are absolutely committed to the timetable for Scotland and we are committed to further powers for Wales and on the special needs of Northern Ireland, but we cannot ignore the needs and the rights of England. Being fair to all is now our mission.
4.56 pm
Mr Raab: It is a pleasure to follow the Leader of the House’s rousing summation. I certainly agreed with all the gusto and spirit of his peroration. As we move forward, it is very important that the views expressed in this debate are adequately reflected in the proposals that all the parties make.
I again thank the Backbench Business Committee and all its members for allowing this debate to take place. It is very important that all voices and all parts of the United Kingdom are adequately reflected in such debates. Rightly or wrongly, there is a sense that parts of the Union may have been shut out of the debate, because we did not want to prejudice or interfere in the referendum campaign or to allow points made during it to be twisted or manipulated. Following the referendum, it is therefore important to broaden the debate and open it up to all parts of the United Kingdom—to England, as the Leader of the House said very powerfully, but also to Scotland, Wales, Northern Ireland and to all the constituent parts of the nations. I want briefly to refer to the many great speeches that hon. Members have made.
Mr David Hamilton (Midlothian) (Lab): I congratulate the hon. Gentleman on bringing forward this debate. The issue at stake is getting fairness right throughout the regions. It is not just about Scotland, Wales, Northern Ireland or, indeed, London, which, as everybody seems to forget, already has an assembly; at the end of the day, we are looking to get to a position where everything is seen to be transparent and fair for all parts of the country.
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Mr Raab: I thank the hon. Gentleman for his intervention, and I agree with all his points. Indeed, they were reflected by the hon. Member for Birmingham, Hall Green (Mr Godsiff), who warned of the risk that other parts of the UK may feel discriminated against unless we proceed on the fundamental principle of democratic equality.
Sir Oliver Heald (North East Hertfordshire) (Con): Will my hon. Friend give way?
Mr Raab: I will make some progress.
My hon. Friend the Member for St Albans (Mrs Main) made a powerful speech on the logic of devolution and the fact that devolution cannot be just a one-way street. The right hon. Member for Knowsley (Mr Howarth) made a strong case for the application of local democracy to the Liverpool area. We heard from the hon. Member for Argyll and Bute (Mr Reid), who made it clear that the Liberal Democrat manifesto to move from the Barnett formula to a needs-based formula has been superseded —that is the nicest way of putting it—by the post-referendum negotiations.
The hon. Member for Moray (Angus Robertson), the SNP leader at Westminster, made a very interesting speech. When we look at the principles, I am not sure that we see a huge difference between what we have each said. I join him in congratulating the new leader of the SNP on her appointment. I pay tribute to Alex Salmond for his leadership. In fact, I will go so far as to quote Alex Salmond who, on the eve of the referendum rally said:
“To our friends in the rest of the United Kingdom, I say this. We don’t seek division, but rather equality”
That is certainly the point of the sponsors of this motion.
My hon. Friend the Member for Salisbury (John Glen) made a typically cogent speech and talked about the importance of addressing the West Lothian question and financial fairness for his constituents, and also about the balance that we need to seek and retain across the UK—
5 pm
Motion lapsed (Standing Order No.9(3)).
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Health Services (Halifax)
Motion made, and Question proposed, That this House do now adjourn.—(Gavin Barwell).
5 pm
Mrs Linda Riordan (Halifax) (Lab/Co-op): I am delighted to have secured this debate on health services in Halifax, and I will focus particularly on the proposal to close the accident and emergency department, which is the most important issue that has faced Halifax since the banking crisis of 2008. The axe hanging over Calderdale Royal hospital has been handled in the most underhand way. People have been left in the dark over the future of the services they need and value the most. That is simply not acceptable.
I hope that today’s debate will shed some light on what is taking place. I also place on record the excellent health care staff that we have in Halifax, and the nurses, doctors, consultants, clinicians and everyone in the NHS wider health family who do a superb job in difficult circumstances. That is why, as Healthwatch Calderdale has found, although it is sometimes difficult for patients to get an appointment with their GP, the clinical treatment administered by GPs in the district is good and makes a positive contribution to residents’ health in the area. It is, however, the future of A and E that has caused most worry and concern in the town, and the Government, the clinical commissioning group, and the trust’s approach to the whole debate has been lacking in openness and transparency.
I will focus on three key areas in my speech: the funding of health services in Halifax; the so-called consultation and engagement process; and the future of A and E. Those factors tie the whole debate together and I hope that today, the Government can at least provide me and my constituents with some answers in those important areas.
Let me set out briefly the background to the case. Calderdale Royal hospital opened in 2000 thanks to investment from the then Labour Government. It was a new, modern hospital to serve communities across Halifax and Calderdale. There were concerns at the time that the new hospital might not have enough capacity—it did, although that is rather ironic when we consider the arguments and debates that are used to justify the closure of A and E in Halifax. Any problems back then have been overcome, and the hospital has proved a real success story.
The hospital serves communities across Calderdale, and right across to the Lancashire border to the west. It is estimated to have a catchment area of nearly 200,000 people—some as many as 30 miles away. We are talking not about a small, rural hospital, but a major health centre in the heart of an urban area. Why does that matter? It matters simply because it underlines the importance of the hospital services, including A and E, to thousands and thousands of my constituents. The hospital is at the heart of local health services and needs. That is a reason to invest in health services in Halifax, not to cut them; to keep wards open, not close them; to protect A and E, not put it on a life support machine, its future clouded in doubt, with Ministers and the clinical commissioning group playing for time to deal with the issue post the general election in 2015. Questions are dodged, not discussed. Information is wrapped in secrecy and the
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people of Halifax and Calderdale are, it would appear, treated with contempt on this issue. This is their hospital. These are their health services. They deserve some answers.
That is the brief history. Where are things at today? Well, frankly, it is all a bit of a mess. At its heart are the inherent contradictions in the Government’s approach to health policy across the country generally, and in Halifax specifically. Let us take a look at some of them. The Government say the funding of hospitals is not a problem. Why then is there a funding shortfall in Halifax of potentially £50 million? I noticed this week that Monitor is to investigate the trust to understand why its finances have deteriorated so much. This is an extraordinary amount of money by which to be in deficit.
We all know that the Government’s desire to cut A and Es like the one in Halifax is to save money. It has nothing to do with improving patient care.
Craig Whittaker (Calder Valley) (Con): At a recent debate in the Calder Valley with my Labour opponent, I asked him eight times whether he had been out to see the doctors, nurses and decision makers about the strategic review. His answer was no, he had not been out to see them and he had not read the strategic review. He said, instead, that he was following the hon. Lady’s lead and the lead of the candidates in Halifax. Will the hon. Lady tell me how many times she has been out to see the decision makers and whether she has read the review?
Mrs Riordan: I thank the hon. Gentleman for that intervention. Talking about confusion—that is what the whole debate is about today—let me remind him of his article in the Halifax Courier last week, in which he said:
“There are no proposals to close our A and E”.
Then we have the Conservative candidate’s website for Halifax:
“On the frontline defending the A&E cut in Halifax”.
I use the health service regularly: I am a patient and I visit my GP regularly. The Government say that funding for hospitals is not a problem but we all know they want to cut the A and E. I know the Minister will get up in a moment and tell me that Halifax has not suffered health cutbacks in the past four years. Well I can tell him that I use Halifax hospital regularly. Recently, there have been staffing cuts, ward closures and fewer and fewer beds available on the wards. Sadly, I fear that Halifax is suffering cuts, cuts and more cuts. If there is not a funding problem, why are these reductions taking place? Is it a lack of demand for services?
If there is a funding problem, why do the Government claim to have protected health spending? Both cannot be correct. I say today that what Health Ministers are being told in Whitehall offices and what is happening on the ground in places like Halifax are miles apart. Ministers urgently need a reality check if they think that closing Halifax’s A and E will not put lives at risk.
Craig Whittaker: On that point, will the hon. Lady give way?
Mrs Riordan: No. I am sorry, but I must make progress now.
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I would be grateful if the Minister explained to me the reality of the funding situation in Halifax. What has the clinical commissioning group been required to do? What front-line services will be a cut as a result of this financial black hole? My constituents want some answers today—they do not want fobbing off until next May. This issue is too important to be kicked into the post-general election long grass.
The issue has never gone away in the town, despite the best efforts of the powers that be. Now, more than ever, is the time to set out why the A and E is important and needed in Halifax and Calderdale. I am not here today to discuss Huddersfield hospital or play the two off against each other. For the record, I want both to stay open, serving their communities as they have done for many years. Both cater for diverse and distant communities. To outlying communities, the local A and E is, quite literally, their lifeline, their reassuring presence should tragedy strike. In that sense, I have to say that the issue of engagement, consultation and information over Halifax A and E has been handled pretty woefully.
Craig Whittaker: Will the hon. Lady give way?
There has been buck passing, misinformation and a lack of honesty and clarity. Neither the CCG, the trust nor the Government have stood up and accepted responsibility for what has taken place. Just because things have gone a bit quiet does not mean that this is not the biggest issue in town.
It is difficult to know where to start. First, there is the closure by stealth that seems to be taking place. I have here articles from the Halifax Courier about people being driven regularly across to Huddersfield for treatment. I could talk about the staff cuts or the stealth cuts that could easily render the A and E a glorified walk-in centre. It is just not good enough, and people across Halifax are right to be angry and dismayed, especially when they read contradictory stories such as those I have read out. If the plan is to close the A and E, why do the decision makers not say so? Let us stop this nonsense that an A and E will stay in some form or another. That is rubbish.
Craig Whittaker: Will the hon. Lady give way?
If the existing 24-hour access with full A and E services is axed, it will not be an A and E. It is as simple as that. It is time to stop the spin and give us some substance.
Craig Whittaker: On the spin, will the hon. Lady give way?
The Government and the CCG know that they cannot do this. They know that there will be a public backlash; they have read the newspapers, seen the rallies, heard the debates and studied the letters. There is not one person in my constituency saying this is a good idea, or, if there is, I have yet to come across them. This is closure by stealth, by secrecy and by drawing out the whole sorry process over months. I and thousands of other people are not going to walk on by and let this happen.
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The facts speak for themselves. This a hospital that only opened in 2000. It is an A and E unit that treats thousands of people every year and a hospital that serves people within a 30-mile-plus radius. We are already reading about a winter crisis in A and E—there was a major one last weekend—and what is the Government’s answer? To close them down. We cannot deal with one crisis by causing another. The way to deal with the A and E issue is to invest in the service, reassure people about its future and not put lives at risk.
I say not to the Minister but to the people making these decisions: do not take people for fools. If they strip away A and E services, stop 24-hour care, create an appointment system and move services to Huddersfield, we will not have an A and E service; we will have a glorified walk-in centre or an extended GP service. Will the Minister outline the case for closing Calderdale A and E? I have not heard one decent argument so far, so I would be grateful if he put the Government’s position on the record.
Craig Whittaker: Will the hon. Lady give way?
So what do I propose now? There is now a window of opportunity. The “Hands off our A and E” campaign has worked so far: we have delayed the closure, put the issue at the front of the debate and kept the issue at the top of the agenda. However, there is a lot more to do. The issue might have gone quiet, but it has not gone away. The so-called engagement process over the summer months was pathetic. A few afternoon meetings to hear people’s opinions is not good enough. I expect better, and more importantly, my constituents expect better.
Three things need to happen. First, there needs to be proper engagement. What are the plans? What is the impact likely to be? So far, we have had none of these, which has left people in the dark. Secondly, there needs to be proper consultation. Not one-way but proper two-way consultation that actually listens to people and takes notice of their views, and this needs to be done properly, not in the half-baked way we have seen so far. Thirdly, there needs to be a full reassessment of the hospital services offered in Halifax. It is beginning to get treated as a branch hospital, not one at the heart of health services. I have said that I use that hospital regularly, which I do. I have had a few appointments recently, and I have been referred to Calderdale Royal, but when I get the appointment through the post, it is always at Huddersfield hospital. That is what patients are experiencing across Halifax.
People need to be told straight what is taking place. The lack of information over the last few weeks and months has been almost as bad as the decision to axe the A and E in the first place. Let us not pretend that an A and E will exist in some form or another post-2015. There either is an A and E or there is not. The time has come for the Government to come clean on their plans; they should set them out, so we can have a proper consultation and a proper debate. This time, however, the people of Halifax need listening to.
The time has come to say “enough is enough”. The facts are clear that without an A and E in Halifax lives will be put at risk. These unnecessary cuts to front-line services will be a body blow to all ages and all sections of the local community. That is why people have been
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taking to the streets to protest at these proposals. That is why across the whole spectrum of community opinion, there has been a united voice of, “Save our A and E”.
I hope that the Minister can shed some light today on what exactly is going on. The people of my constituency, who need and deserve the best possible health services in Halifax expect nothing less. It is time to come clean and spell things out. In the run-up to the general election, people expect to know what is going to happen to their local A and E unit. I say today, loud and clear, that the fight to save the A & E goes on, and deserves to be a successful one.
5.16 pm
The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): I congratulate the hon. Member for Halifax (Mrs Riordan) on securing this debate. I know that this is an issue of concern to her and to my hon. Friend the Member for Calder Valley (Craig Whittaker), as well as to a number of other Members locally. The issues around proposed changes to health services in Calderdale and Huddersfield have been debated in this House before.
Of course, the configuration of health services is an important issue for many Members and their constituents. We all agree that patients should receive the best and safest care possible. I know these issues are of keen interest locally, with Members from across the political parties taking a close interest in the changes. People always worry about any change in the NHS, because it is such a loved and respected institution. However, it is not right to play on these anxieties. Change is necessary to ensure that the NHS can offer modern, high-quality care fit for the 21st century.
It is slightly disappointing that the hon. Lady has adopted such a partisan approach. In the period running up to an election, NHS reform is not well served by party politics, and I note the hon. Lady’s refusal to accept interventions from my hon. Friend the Member for Calder Valley. I think we need to hear from people on both sides of the House. I have taken the trouble this week to talk to staff and doctors at the front line locally who are leading the work on this issue, to hear from them what they are planning and what they hope to achieve. I hope that hon. Members, including the hon. Lady, take the time to do the same; I know they would appreciate it.
Let me say a few words about our general approach to reconfiguration before touching on the specifics of the case. The Government are clear that the design of front-line health services, including A and E, must be a matter for the local NHS. It is local clinicians—not me or anyone in Whitehall—who will make decisions about health care in Halifax. That is how it should be. The NHS has a responsibility to ensure that people have access to the best and safest health care possible, and to plan for the future to ensure that safe and sustainable services are available to all patients now and in generations to come.
Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives and improve patient safety. That is why we must
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allow the local NHS continually to challenge the status quo and look for the best way of serving patients. All these service changes are being led by clinicians and are based on a clear, robust clinical case for change that delivers better outcomes for patients.
The health economy across Calderdale and Huddersfield is working to develop a shared vision for the future provision of high-quality, sustainable services. This work is necessary to respond to the challenges facing the local health economy. As in many areas, the NHS in Calderdale and Huddersfield needs to adapt to an ageing population, increased prevalence of long-term and lifestyle-related illnesses, the needs and aspirations of patients and increased pressure on our public finances. The truth is that local services are currently fragmented, with some duplication and inconsistency of outcomes. There is a need to reduce preventable hospital admissions and enable and support people to live in their own homes for as long as possible. I welcome the fact that the local NHS is looking into how community and in-hospital services can be provided to deliver the best outcomes for local patients.
Craig Whittaker: The Minister will recall that the hon. Member for Halifax (Mrs Riordan) did not say whether she had read the strategic review of our area’s health authority, but if she had, she would have seen that it contains no proposals to close the Halifax A and E. Can the Minister confirm that?
George Freeman: My hon. Friend has made an excellent point. I think it important to be guided by what the local professionals—clinicians and NHS staff—are saying. I have spoken to them this week, and I can indeed confirm that there are no plans to close the A and E at present. A clinically led consultation is taking place, quite properly, and before the local NHS leadership recommends any decisions, they will be the subject of public consultation with local people.
Mrs Riordan: I can tell the hon. Member for Calder Valley (Craig Whittaker) that I have read the strategic review. Let me also make it clear that when the consultation began, the acute trust recommended the closure of the Halifax A and E.
George Freeman: As I have said, the local NHS leadership is looking at all the issues on behalf of the patients whom they are there to serve. My point is merely that playing party politics is not helpful. We need to be guided by the local clinical experts. It is important for the NHS to engage widely on the future provision of health services, and it has done that over the last three years. Thousands of local people have given their views on what matters most to them, and that feedback is shaping thinking locally.
Local clinical commissioning groups are focusing on the phased delivery of improvements in community services ahead of any changes in hospital services. Our health system is evolving to adapt to the new landscape of modern medicine, and I think it is in the interests of our patients to encourage that, provided that it is led by clinical decision making. Local commissioners recognise the need for change in hospital services, and I suspect that, as a user, the hon. Lady would recognise that as well. The local NHS believes that the way in which
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services are currently organised in Halifax does not deliver the safest, most effective and most efficient support to meet patients’ needs. Patients rightly expect that when they see the initials “NHS”, they can expect the very best service that is available, and when they do not receive that service, it is incumbent on the system to adapt so that they do.
The trust is affected by shortages in middle-grade doctors and the high use of locums in A and E, which has an impact on the safety of patient care, and difficulties are involved in providing senior consultant cover overnight and seven days a week. Those are classic problems, which often affect smaller hospitals. We need to ensure that we are delivering the very best care to our patients.
There is often a need for inter-hospital transfers owing to the lack of co-location of first-class services on both sites. The co-location of emergency and acute medical and surgical expertise can result in significant improvements in survival and recovery outcomes, most notably for stroke and cardiac patients. Those who are most seriously ill, with life-threatening conditions, have a much greater chance of survival if they are treated by an experienced medical team that is available 24/7.
It is right for the local NHS to address those challenges to ensure that it can continue to deliver safe, sustainable, high-quality services. Heaven forbid that the hon. Lady should fall ill and require any of those services, but I am sure that, were that to happen, she would want to receive the very best care, and that if that were available in Huddersfield, she would want to be treated in the best possible place. To that end, Calderdale and Huddersfield NHS Foundation Trust has considered a number of options for the future delivery of services, one of which involves one hospital delivering planned care and the other delivering unplanned care. At this stage, no proposals have been ruled in or out. Preferences have been expressed in regard to how services can best be delivered, but no decisions have been made, and I can confirm that there are no formal proposals for changes in hospital services.
In August, the local CCGs decided to delay public consultation on hospital services. While they are signed up to the need for change, they have chosen first to focus on the delivery of improvements in community services in order to build confidence in the changes and demonstrate to local people the benefits they are confident they will deliver. That seems to me entirely appropriate. The CCGs are following a process of change. They understand the need to take people with them, and to build confidence in the changes that they propose. It is incumbent on all Members to encourage and support our NHS leadership locally in building that public confidence in the services.
Change can be difficult to explain to patients, particularly the most vulnerable and elderly patients whose focus is, rightly, on the immediate availability of care. Patients’ reasonable anxieties are often exacerbated by speculation in the media about potential changes and their possible local impact. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.
I know that local people care deeply about the future of their local health services and will want to be involved in decisions about the future of their local hospitals. This is, and should be, a locally led process. Local
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people should continue to make their views known to those developing proposals for the future of local services, as they have done throughout the engagement process. I also want to encourage them to listen to the reasoning behind any proposals from local NHS clinicians and management for any service changes. I encourage the hon. Lady to work with the local NHS as it further develops its proposals. I know that the CCGs have met hon. Members and are happy to continue to do so.
When talking about potential changes to hospital services, it is important to remember that it is the services, the people and the co-ordination—not the bricks and mortar—that really matter in getting people the right care at the right time. The flexibility and co-ordination of services are just as important as how they are geographically configured. In supporting our local NHS we often end up supporting the current institution—the building in its present location and configuration—but we need to allow the service to evolve and allow our local clinicians and NHS leadership to develop the best possible provision for the people it is designed to serve.
The NHS is one of the great institutions in the world; it is one of this country’s great legacies. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. Freezing a service in aspic out of love for it will not allow the NHS to develop and maintain its leadership in the provision of 21st century health care. These decisions are made only when representatives of the local NHS, working in collaboration with local people and local authorities, are convinced that what they are proposing is absolutely in the best interests of their patients.
I make no apology for the fact that it is this Government who have taken these decisions out of the hands of the politicians and the mandarins in Whitehall and put them into the hands of local clinicians and local NHS managers who have the interests of local patients at heart and who are driving those decisions in their interests. It is important that the NHS in Calderdale and Huddersfield develops solutions that will allow it to provide high quality, safe, effective and sustainable services to local people for generations to come.
Craig Whittaker: I recall when the Labour Government took the acute services from Halifax and sent them to Kirklees in 2005. I campaigned strongly against that at the time, but I was wrong because it appears that we now have a greater life-saving institution locally. Can the Minister tell me whether there is any evidence around the country that having specialists in one place, rather than having them split between several sites, does in fact save lives?
George Freeman:
My hon. Friend makes an important point. There is a huge amount of evidence—which the Department is keen to publish and disseminate in order to inform the debate—that in many areas, particularly in relation to respiratory and cardiac conditions and to diabetes, the centralisation of services in specialist centres drives up clinical outcomes, improves patient safety and prevents avoidable death. Patients have a right to expect us to put in place a framework that allows the NHS to evolve. We need to find ways of ensuring that those services that are best provided locally—community-based services—are provided in that way, and that those requiring
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increased specialisation in centres of excellence and expertise that operate 24/7 are also available. That is what the local NHS leadership is endeavouring to do, and we should support them in that because it is in the interests of the patients, whose NHS this is.
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