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Westminster Hall

Volume 454: debated on Thursday 14 December 2006

Westminster Hall

Thursday 14 December 2006

[Mr. Eric Illsley in the Chair]

Medical and Clinical Practice

Motion made, and Question proposed, That the sitting be now adjourned.—[Huw Irranca-Davies.]

Given the number of Opposition Members present, I feel a little outnumbered. However, I have plenty to keep us busy.

This is an important debate in which politicians must show a little more leadership. Many changes that we now see in medicine and in the health service are about human progress and health progress, and the focus of every single Member of Parliament should be on saving lives not buildings. That should be our guiding principle in consideration of health service change, and it is the right way to approach the subject. The issue is difficult, and we know that change in the health service is not easy. However, it is a question of demonstrating political leadership at times in localities, so that the public understand the changes that are proposed.

I shall put the matter in context. I am pleased that so many members of the Conservative party are present, because it is important that we remind ourselves of the health service situation in 1997, when the infrastructure in which we could deliver safe and high-quality care simply did not exist. There were too many old and inappropriate buildings, and the infrastructure was largely Victorian. According to the King’s Fund, in 1997, the average age of national health service buildings was older than the national health service itself. Capital spending in the latter years of the previous Administration was slashed, and between 1992 and 1997, there was little new development in the fabric of the NHS.

The problems were not only with buildings, but with people. There were staff shortages: 37 per cent. fewer doctors than there are today; 27 per cent. fewer nurses; 36 per cent. fewer allied health professionals; 17 per cent. fewer GPs; and health care scientists could not even be counted separately. The legacy of NHS underfunding created a cumulative underspend of£220 billion between 1972 and 1998 when compared with the European Union average.

I hope that the Minister understands that our constituents will be perplexed by his launching into a description of what the health service may or may not have been like a decade ago. They want to know what the Government are going to do about the catastrophic crisis in health care at the moment.

I am coming to precisely that topic, but I hope that the hon. Gentleman understands that it is important to set the context. There has been considerable change in the NHS since 1997. If he were to deny that, he would not be speaking plainly to his constituents. There has been considerable change because of investment, and there must be further change. However, I shall come to his question if he will allow me.

Ten years ago there was no threat to the accident and emergency unit at Worthing and Southlands hospital, nor was there a threat to the accident and emergency unit at St. Richard’s hospital. Both units are now under threat, and that is affecting my constituents. Is not it true that the West Sussex primary care trust’s £33 million deficit is due to a formula that was introduced in the past 10 years? There were changes to the formula in 1998 and in 2001. The Minister would be better off addressing that issue rather than engaging in historical analysis, and he would be better off addressing the funding formula rather than trying to downgrade the accident and emergency units at two well loved, highly efficient and clinically excellent hospitals.

Quite honestly, the hon. Gentleman has a nerve to say that the issue is about the funding formula. Over the past couple of years, every primary care trust in the country has received a considerable increase in funding. I do not have the exact figure, but the minimum increase was about 9 per cent.—in his constituency, too. Members shake their heads. Why then did the Opposition vote against the national insurance increase? [Interruption.] Let me just put my point.

No, I shall not.

If that vote had been carried, and the national insurance increase had been turned down, does the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) think that the primary care trust in his constituency would have more or less money today? Will he answer that question—simply? If he had had his wish in the House when he voted against that extra money for the NHS, would the PCT in his constituency be better or worse off?

I am grateful to the Minister for deciding to give way, because he has now been speaking for six minutes and I am still none the wiser as to what the debate is about. The title is “Medical and Clinical Practice”, but his office was unable to tell hon. Members what he intended to speak about this afternoon. Will he also explain the difference between “medical” and “clinical”? They seem to be the same thing. Can we return to the debate—the reason why we are all present—and to what he wants to tell us?

Does the hon. Gentleman want answers to questions that his colleagues have raised? He may not like the answers, but it is courteous of me to answer them.

I began by saying that the debate was about change in the NHS. It is about medical change: medicine is changing, and therefore the NHS may need to change, so that we provide the very best service to our constituents. I gather that many of the hon. Gentleman’s colleagues are present because they want to discuss those changes in the health service. However, I hope that he will permit me to set out the context for those changes. I shall make some progress on those points.

Back in 1997, the adoption of medical technologies was late and slow, with those people needing medical care being the least likely to receive it. There is a history of widespread hospital closure in the 1980s. The closures, which were opposed by NHS staff, the unions and the public, included one in my constituency where an accident and emergency department was shut down. Since then, there have been far-reaching improvements. After years of low growth, UK funding matches European levels and we have increased capacity. There are now more than 300,000 extra staff, and there are more staff in every main category.

I have been alerted to an issue by someone who works in the health service in south Northamptonshire. Apparently, six midwives are supposed to cover that area, their number being down on previous staff levels. There are actually only four midwives because of the cuts, however, and they believe that the service is at breaking point. How does that relate to all the extra staff the Minister is talking about?

I shall examine the hon. Gentleman’s point. It is up to each local health economy to ensure that it has the right number of staff to provide safe and effective services, but if that is not happening in his constituency, I am happy to consider that particular issue.

We have also invested more in training places to secure future staffing levels. Some 10,600 more medical students have entered training since 1997; there has been a major expansion of dental training; and more than 10,000 extra nurses and midwives are being trained than in 1996-97. Facilities have been modernised: there are 54 major new hospitals, 2,850 refurbished or replaced GP surgeries, 520 new one-stop centres and 61 walk-in centres.

I am grateful to the Minister for listing those buildings—having told us at the beginning of his speech that the buildings did not matter. Will he take for granted that we have read Lord Warner’s speech, and move on to the subject of this debate, rather than repeat what was said in the House of Lords on 7 December at column 1289 of the Official Report?

I know that Conservative Members feel uncomfortable about the story of progress in the national health service, but I shall lay out the facts. The fact is that the infrastructure in which care is delivered has been substantially modernised and improved. That sets the context for this debate. In many places, we have the most modern facilities possible, and I am proud of that. I visited University College hospital earlier this week. It is a superb facility providing possibly the highest-standard health care that the NHS can offer today. It is extremely important that we do not gloss over such facts as though they were irrelevant or meaningless spin. They are not. They are the facts. Our facilities on the ground enable the highest standards of health care to be delivered.

I freely acknowledge that Hemel Hempstead hospital has had substantial investment in the past 10 years in new cardiac unit, stroke and birthing units and extensive modernisation of the accident and emergency department, all of which will now be closed because of the funding crisis in the NHS.

As the hon. Gentleman knows, consultation will begin soon in Hertfordshire and will be developed in the new year. He might accept this point: there are four acute hospitals serving the county that he represents, a county of roughly 800,000 people. The problems that he is describing are long standing, and he should accept—

I will give way to the shadow Secretary of State in a moment, but first I shall develop my point. My local authority has a population of about 320,000 and one acute hospital. The hon. Member for Hemel Hempstead (Mike Penning) should acknowledge the long-standing debate in his county about ensuring appropriate secondary provision without siphoning off funds and preventing money from being available for other areas. I have answered his question, and I give way.

I am grateful. I hope that my hon. Friend the Member for Hemel Hempstead will forgive me if I pre-empt the point that he was going to make. I visited Hertfordshire the Monday before last. The people there have been debating for four years how they should respond to changes in clinical practice. The message that the strategic health authority is sending them even now is, “We need greater specialisation and greater concentration of services in major units in order to deliver.” That is what Members of Parliament in Hertfordshire signed up to in the investing in health strategy—they signed up to a new hospital at Hatfield. Just weeks ago, the East and North Hertfordshire NHS Trust said that, for reasons of affordability, it could not go ahead. What the Minister will tell the House should be happening is precisely the opposite of what is happening. The concentration of services in a new central unit will not happen in Hertfordshire. How does he explain that?

I explain it very clearly. The Government do not say that services should be provided in any particular way. If the hon. Gentleman thinks that we do, I am afraid that he does not listen to our points. We say clearly that it is for each local health economy to decide the right shape of services for itself. We do not say—I ask him to show me where we say it—that one model of care should be imposed on every community, nor do we take decisions at ministerial level about whether a scheme should go ahead or be scrapped. Those decisions are taken in the locality, and I believe that if the debate is conducted in the right way and Members listen to the arguments rather than simply pulling out their placards and going out in the street, they will do their constituents a service.

The issue is not just about buildings. Recently, there have been enormous improvements in mortality rates. Deaths from cancer in under-75s fell by nearly 16 per cent. between 1997 and 2004—that is 50,000 lives saved. We are on track to reduce deaths from heart disease by 40 per cent., saving 150,000 lives, by 2010. I am immensely proud of those achievements.

I would like to make some progress, as the hon. Gentleman’s colleagues are accusing me of not making any, but I give way.

I am grateful to the Minister. He and other Ministers often make the point that, under this Government, deaths from coronary heart disease have decreased by 150,000 since 1997. However, one of his colleagues answered a question on similar terms. Health Ministers were asked how many lives had been saved from coronary heart disease between 1979 to 1997, so will he confirm that the answer was that 535,000 lives had been saved from coronary heart disease and premature mortality in the preceding 18 years, compared with the 150,000 that he mentioned?

I will be honest with the hon. Gentleman. I do not have those figures to hand. Obviously, it is his job to make the case for his party’s Government, but I am making a proud case for mine with the health improvements that my constituents and those of my hon. Friend the Member for Ogmore (Huw Irranca-Davies) have seen in recent years. I give way one more time.

The Minister is gracious in giving way. On the same point, will he also confirm that during the 18 years that the Conservative Government, whom he has been doing his best to denigrate, were last in charge of the national health service, the decline in mortality rates was comparable to that of the past 10 years under the present Labour Government, despite their proclaimed achievements?

As I said, it is not my job to make the case for the Conservative party. The national service framework introduced by this Government for coronary heart disease made an immediate and important change to the care of coronary heart disease patients when it was introduced in 2000. That change came with the change in Government. As a result, a large number of people in the hon. Lady’s constituency and mine were prescribed statins, and a much greater emphasis was placed on preventive health care. Hon. Members might be claiming that the national service framework had no impact on the health of coronary heart disease patients, but I am not sure what intellectual credibility that argument would have with specialists in the field. I notice that the hon. Member for South Cambridgeshire (Mr. Lansley) has gone quiet on that point.

I am proud of what has been achieved in the national health service with the investment that we have made. It has been achieved with change—sometimes painful and difficult change—but more is needed if we are to make the long-lasting improvements in health and social care that everybody wants to see.

Consultation for the White Paper “Our Health, Our Care, Our Say” told us that patients want services that are more convenient and closer to their homes. Many of the commitments in the White Paper were developed with that in mind. For example, we are supporting a procurement exercise to secure more primary care services where the number of GPs is insufficient and people have to travel some distance to visit a doctor. We will also be testing advanced assistive technologies, such as telecare, that would enable frail and elderly people with long-term conditions to be more independent and reduce the need for frequent visits to hospitals and doctors. We are carrying out a major project with a number of royal colleges and other professional bodies to consider care pathways and models to make care more accessible for patients in six speciality areas.

We have asked the National Primary Care Research and Development Centre at Manchester university to review care services and generate an evidence base for replicating existing good practice. It will be researching the cost, work force, safety and equipment implications of shifting care, as well as what patients think of the shifted services.

Did the Minister say that research would be undertaken to generate the evidence base for the changes that will be made? If so, does he not think that it would be a good idea to acquire that before embarking on the changes?

In the abstract, that is a good point. Acquiring the evidence base is often an important precursor to change, but we are talking about the years to come. Some of the changes about which the hon. Gentleman and his colleagues are getting excited have yet to happen.

We have a model of health care in this country that is still dominated by the acute hospital. That situation will change over the next 50 years, whatever Government are in power. There will be a trend towards more self-care and more care in the patient’s home. The advent of some of the more personalised pharmaceutical technologies will lead to far more different treatments. I am not sure that we can imagine today quite how medicine will change in the next 20 to 25 years. So yes, it is right to generate that evidence base as we go along.

I was in a brand new local improvement finance trust centre—or LIFT centre—in Leeds on Friday, talking about the dermatology service, which has been brought from the acute trust into the local community, where the consultant is working extremely closely with a GP with a special interest. They are treating far more patients at that level who would previously have had to go to hospital for an out-patient appointment. Much more is being done in the community, which also means that consultants’ time is used to much greater effect, because they do not see patients whom they perhaps do not need to. The new arrangement also ensures that NHS resource is used more appropriately, through a more streamlined pathway. That is the evidence that is being gathered now on the change to services.

I met a group of patients who are benefiting from that service, all of whom said that the care provided by the LIFT centre was much more convenient and that it made sense for them. The old system, under which they had to have an out-patient appointment at the hospital, led to days off work and disruption, whereas they now have a much better service all round, working with specialists.

The Minister highlighted the change in how services may be provided, and in particular the emphasis on primary care and the LIFT initiatives. Does he accept, however, that the proposed reconfigurations are due to take place in the near term, even though the primary care facilities might not be in place to meet the demand? Indeed, we have a number of LIFT buildings in my area that, sadly, lie empty, because no GPs have moved in to deliver the services and take up the demand.

The hon. Gentleman makes a reasonable and fair point, and I agree with him. Before such steps are considered, it is important that proper capacity should be developed on the ground. In areas where there have been substantial LIFT schemes, I would argue that there is that capacity. What is required is a change in culture and thinking, possibly with hospital-based consultants bringing services out to the patient and perhaps providing them to an even higher standard, because the patient will be treated closer to home, which is a good thing in itself. In many parts of the country, there is the potential to start to bring services out.

To pick up on something encouraging in what the hon. Gentleman said, the Conservative party has to move out of its position of knee-jerk opposition to change in the health service, which is not a sustainable intellectual position, given the change that is happening in medicine. In their heart of hearts, Opposition Members know that some of that stuff is being run for purely political reasons.

Does the Minister agree that the reason there is so much anger in my constituency and in so many others throughout the country is that people see the Government using the argument of clinical change and advance, which many accept, purely as a fig leaf to disguise savage cuts that have come out of the blue?

Not at all. That is a ridiculous point. The change is evidence-based and led by patient safety—[Interruption.] I have heard the shadow Secretary of State for Health, the hon. Member for South Cambridgeshire, and his colleagues talk about A and E. To take the example of Hinchingbrooke hospital, according to last Saturday’s Cambridge Evening News, it seems that it is sometimes quite acceptable to talk about health change in a local setting. For a large part of the year, the thing to do is spread rumours, provoke fear, raise the spectre of health change and scaremonger about the nature of change, but last Saturday he told his local paper:

“I would like to see A & E”

at Hinchingbrooke

“remain but slightly changed. Perhaps it should concentrate on self-referrals while more serious incidents are dealt with at Addenbrooke’s, for example.”

Does the hon. Gentleman stand by that point? I am not saying that that is the right or wrong thing to do, but that was the day after he had issued a document raising the spectre—indeed, that was scaremongering—of the closure of 29 A and E departments. The very next day, he went to his local paper and advocated what one might call the downgrading of Hinchingbrooke A and E department, for the benefit of his local hospital. This is quite astounding stuff.

The Minister is completely wrong about that. The point in the document that we produced, which came out before the Department said that it would be quite a good idea for specialist care to be provided in specialist units, was straightforward. It was that although perhaps 3 per cent. of accident and emergency attendances which are caused by severe head injuries, strokes, ruptured aneurysms and myocardial infarction go to specialist centres, that does not mean that the other 97 per cent. of patients who attend accident and emergency should have those services removed. That is precisely what I said about Hinchingbrooke, but the finances and the deficits are driving the options for Hinchingbrooke, and that could close the whole unit down.

The hon. Gentleman’s first point was extremely reasonable and I agree with him. In fact, that is exactly what Professor Sir George Alberti said only last week in the advice that he gave the Department about A and E change, and I welcome the fact that the hon. Gentleman has repeated it. However, on the day before he made that point, he issued a document—[Interruption.] I think that I am right about this. I also think that he knows that I am right and that I am near the knuckle. He says one thing in his local paper about downgrading the local A and E department, but he was on the “Today” programme the day before, raising fears about 29 A and E departments being threatened with closure. I do not know whether my hon. Friend the Member for Ogmore agrees, but that is not an intellectually honest position.

The Minister can settle the issue on the record once and for all by allaying the fears of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and my other hon. Friends. Which of the 29 hospitals on the list that we flagged up are not in any danger of losing their A and E departments or of being downgraded? Let us go through the list now, so that we can all go home happy.

Hon. Members cheer, but I am not sure that they will be cheering in a minute, but let us see, shall we? The Royal Cornwall Hospitals NHS Trust is on the list that the Conservative party produced of A and E services under threat, but let me read what the trust said. It has accused the Conservative party of “scaremongering”, following the claim that it was to lose its A and E department. The trust insisted that the claim was wrong and demanded that the statement be retracted. Opposition Members do not like this—it has all gone quiet over there, as they say—but a trust spokesman said:

“There is no threat to either the A and E or casualty services provided by the Royal Cornwall Hospitals Trust. Neither the Trust nor the Primary Care Trust were contacted by the Conservative Party press office to check the accuracy of their research. We have made it quite clear to them today…that their statement should not have included reference to the Royal Cornwall Hospitals Trust and have asked for it to be retracted. Misrepresentative statements such as these are upsetting not only to our staff but also because of their potential to lead to unnecessary scaremongering and concern among our local community.”

Read the quote again in Hansard. If any Conservative Member feels comfortable with that comment from the trust spokesperson, that is up to them; I would certainly feel deeply unhappy about it.

The Royal Cornwall Hospitals NHS Trust interpreted our document as referring to the accident and emergency services in Truro. In fact, we were referring to Penzance. There were 10 documented press reports, including on the BBC, and material on its own website that pointed to the option for withdrawing emergency medicine in Penzance. It misunderstood what we were saying. That is all.

I used to be a health researcher for Labour’s health team in opposition. If I were the hon. Gentleman, I would think about the quality of his research. If we had put out stuff like that—[Interruption.] It is shameful—[Interruption.]

Order. The quality of the debate might improve if there were fewer sedentary interruptions and if we moved away from narrow arguments about individual hospital closures and went back to the wider debate.

I shall do so, Mr. Illsley. However, the hon. Gentleman asked for evidence of scaremongering. I move to another example. In a maternity document—[Interruption.]

The Calderdale and Huddersfield NHS Foundation Trust was mentioned in the document on maternity services. It states that Calderdale and Huddersfield rejected the claim—actually, this is about A and E. Forgive me, Mr. Illsley.

A and E. Let me go on to see whether Opposition Members like the comment. Helen Thomson, deputy chief executive of the Calderdale and Huddersfield NHS Foundation Trust said:

“These claims are absolutely untrue … We have recently undergone a lengthy reconfiguration of services and central to this was the retention of both A&E units at Huddersfield Royal Infirmary and Calderdale Royal Hospital…This was always the case and has not changed.”

The hon. Member for East Worthing and Shoreham (Tim Loughton) was shouting “28” at me a moment ago. I have given two examples. I do not think that Mr. Illsley will bear with me if I read out further statements from NHS chief executives. Let us be clear: what is being done is designed to scaremonger, unsettle and get headlines. It is not reputable political campaigning.

This point is very important. The hon. Gentleman has given a wrong answer in a claim that he made about Cornwall. He has mentioned Calderdale and Huddersfield. That leaves 27 A and E departments for which we need answers. I am sure that all Opposition Members would allow the Minister more leeway if he went through the list and assured us that all the hospitals that concern us are safe. Are they?

They do not like it up ’em, as they say, Mr. Illsley. If the hon. Gentleman had been listening, he would have heard your request to move the debate on. He asked for another example, and I gave him one. Clearly, his figure does not bear much scrutiny. The figure of 29, which he put out in the press last week, has clearly gone. He can stand by his figure of 27 if he wants to.

On a point of order, Mr. Illsley. The Minister indicated that the Chair has barred him from replying to the question of whether the service in Penzance was under threat. Will you confirm that he is free to confirm that it is or is not? If he wanted to, he could say that he did not know.

The Chair did not bar the Minister from confirming that, but encouraged him to widen the debate beyond issues relating to narrow documents. Such things would be discussed better in correspondence or another medium.

Incidentally, this time is not the Minister’s, but that of the debate and the House. Obviously, a large number of Conservative Members wish to join the debate. Hopefully, hon. Members will take cognisance of that.

If the hon. Gentleman does not mind, I shall answer the questions in my own way. I was taking the Chair’s advice in seeking to move on, which I shall now do.

We are considering a range of different services in different settings, which include nurse-led services, direct access services provided in hospital settings, services provided jointly by consultants and primary care clinicians, and services provided in community hospitals. One of the demonstration sites of our better health care closer to home initiative is a mastectomy service in Hartlepool. Women are admitted to hospital, have their operation and are discharged with 23 hours. They receive intensive support from community nurses while recovering from surgery at home.

In Ipswich, we are evaluating a virtual audiology service. Patients see an audiologist in a town centre clinic. The results of their test are passed to the ear, nose and throat consultant at the local hospital, who reviews the results and carries out a virtual consultation on the patient. The results are passed on to the audiologist, who informs the patient. All that happens in a few days, and patients need not go to the hospital.

If we are to shift care, there will need to be high-quality services in locations convenient to users. The White Paper made it clear that we would support PCTs by investing in a new generation of community hospitals and services grounded in local communities and fostered by local partnerships.

I am glad that the Minister mentioned Ipswich. The A and E consultant from Ipswich has written to us to ask what on earth

“will happen to the 97 per cent. of patients without Ischaemic Stroke, ST elevation MI who would not benefit from these specialist centres”

mentioned by the Minister. He also asked what would happen to children with broken arms and legs, because they use A and E. He asked about those with heart failure, cardiac tamponade, cardiac arrhythmia, cardiac arrest, anaphylaxis, meningococcal sepsis, children who have inhaled foreign bodies and so on.

People with all those conditions come to the A and E in Ipswich. The consultant running that department is seriously worried that the downgrading of his A and E department would mean that the 97 per cent. of people not covered by the super-hospital improvements that the Minister put to us would seriously miss out. What does he say to that expert on the front line at the hospital that he has just named?

Have I made any proposals about Ipswich? Basically, that is a response to the Alberti report, and I think that that debate should be led clinically, not politically. If the issue is about changing services, it is right that there should be a debate among clinicians about the right way to provide emergency services in this day and age.

The question about where we would locate some of the more specialist centres and where we would have more localised A and E services is secondary. It is jumping the gun somewhat to say that any such statement has immediate implications for any particular A and E department. The debate should be clinically led.

A clinician of great standing and authority made proposals last week and helped further public understanding of the changes that we may need to make if we are to save lives. I do not know about the hon. Gentleman, but if any member of my family needed emergency care, I would want them to be in the best possible environment, not necessarily the closest. That is an important consideration as we discuss the issues.

In June 2006, we announced that up to £750 million of capital would be available over the next five years to develop a range of different models for new community hospitals and services. Bids for the first wave of tenders have been submitted by strategic health authorities, and announcements will be made shortly. As has been mentioned, we have already refurbished and replaced nearly 3,000 GP premises and we will have built 750 new health centres by 2008. Even more NHS one-stop centres will open in the next couple of years.

Change is not new for the NHS. Lifestyles, society and medicine have radically changed in the past60 years. That has meant that the NHS has had to change and reform, and it will continue to have to do so to provide the very best of modern medicine to all citizens.

People are now eating more and exercising less, and the mortality rate from chronic liver disease is rising as a result. Treatment for lifestyle diseases has increased significantly. In the 1950s, most health care problems that led to hospital admission, such as heart failure and pneumonia, occurred in people in their 40s, 50s and 60s. Now, those conditions are most common in people in their 70s, 80s and 90s. Some 80 per cent. of NHS patients currently have a long-term condition.

Community matrons or specialist staff are providing many services, which would previously have required hospital care, better and more conveniently in people’s own homes. Up to half the 45 million out-patient appointments each year could be dealt with in the community, along with some minor surgery and treatments. By introducing community nurses, Dudley PCT, for example, has dramatically improved the care of patients with long-term conditions.

I am pleased that the hon. Gentleman pays attention to our speeches.

New drugs developed in the past 10 years have allowed us to treat new conditions. For example, thrombolytic agents have reduced mortality, complication rates and lengths of stay for acute heart conditions.

The Minister has just said that we would all want the best rather than the nearest care for our families in an emergency. My constituents in Bognor Regis and Littlehampton have carefully considered that issue. Indeed, they are all thinking about it right now because of the consultation process that is going on in West Sussex. They have taken the view, almost to a man and woman—indeed, I have not really met anyone who takes a differing view—that they want the services for people in Littlehampton to continue at Worthing and those for people in Bognor Regis to continue at Chichester. They would prefer to have that care in those two hospitals, because they are happy with the quality. They do not want slightly improved care that would require them to travel an additional 20 miles. Given that we live in a democracy and that my constituents, together with those of my colleagues, fund those hospitals, should this matter not ultimately be for the people to decide, rather than left in the hands of clinicians?

The hon. Gentleman makes an interesting point, and he knows his constituents’ views better than I do—I do not seek to claim otherwise. However, the important point about what Professor Sir George Alberti said last week is that it was an attempt to expose people to a different argument so that they can understand why change may need to be made. I think that they have understood that argument— indeed, the hon. Gentleman nodded when I mentioned it a moment ago. What that argument makes clear is that we cannot, by definition, always provide the very best locally in every community for the most serious and life-threatening emergencies in which people may find themselves. It makes sense to base some of those services in regional centres or to group them in a more concentrated way. Sir George Alberti put that important argument before the public to improve the debate on the issue.

If the hon. Gentleman looks at the work of the royal colleges on similar and related topics, he will find that a growing body of clinical opinion says that some of this change is necessary and that it is important to explain it to the public and take it forward. The hon. Gentleman and every Opposition Member should ask—indeed, I would do the same in my constituency, too—whether any changes that are put before the public enhance and improve provision and help us save lives. That has to be the first question, does it not? If we hear local commissioners saying that those services will do that, we must, in all honesty, listen to their voice.

Conservative Members sometimes like to say that such issues arise only in their areas, but that is not true. Greater Manchester, where my constituency is based, has been through a difficult, long and controversial set of changes in respect of maternity and child care, which culminated in the PCT decision last Friday. It was very much a question of quality versus localised services. It was a difficult debate for many colleagues in the House—

I will just finish the Greater Manchester point before giving way to the shadow Secretary of State and then the hon. Gentleman.

The issue in Greater Manchester was a difficult one. It was difficult for people to be taken through the arguments, but a leading clinician in the region said clearly and publicly that the changes would lead to30 babies’ lives being saved in Greater Manchester every year. It is not always easy to get the local press on board on these issues, but the Manchester Evening News, to its great credit, ran an editorial the day after entitled, “Do mums want the nearest or the best?”. It concluded:

“It is right that decisions about our hospitals are closely examined and questioned. But we must also be willing to embrace whatever change is necessary to ensure our children get the best care possible.”

It was a difficult exercise, but I think that people could understand in the end why changes were being made. Such debates are taking place everywhere, not just in the south-east.

What has been going on in Greater Manchester is one of the reasons why we published a document at the beginning of this week asking about the evidence base for some of the changes that are occurring in maternity services. In Manchester, the changes will see us move from an average of 2,920 live births in each of 13 units to an average of about 4,700 births in each of eight units. The Minister talks about clinicians. I have been to Macclesfield district general hospital and to Fairfield general hospital in Bury, and the clinicians there believe that they are providing a safe service. Macclesfield has obstetric cover, anaesthetic cover, neonatology cover, paediatric back-up and a dedicated obstetric operating theatre. Even though they have fewer than 2,000 live births, the clinicians there believe that their safety record justifies the maintenance of their service. What is the Minister’s evidence for the proposition that much larger units necessarily provide for greater safety in births?

As I said, the evidence that was put before people in Greater Manchester was that that would lead to babies’ lives being saved every year. It stands to reason that units will deal with more cases and that clinicians will not work in more isolated facilities. Precisely the same issue arose with the Calderdale and Huddersfield reconfiguration and, again, it came down to the volume of cases that clinicians have to see.

I did not give that example to suggest that every dot and comma was right or wrong, but simply because the hon. Member for Bognor Regis and Littlehampton raised a reasonable point. I made a general point about taking the public through difficult change in the health service and showing that the prism through which changes are judged should not always be financial pressures; it can and should be patient safety.

The Minister claims to be a researcher, so he will have investigated this issue. He comes from the north-west, and I have read the document that led to the maternity reconfiguration in Manchester that was announced last Friday. It contained the assertion that children and babies do better in larger units, and there was a reference to a research paper that has been published. It looked at the number of neonatal deaths in southern California in 1991 in places where children were of low birth weight and there was no regional neonatal intensive care unit. I accept the proposition that babies of low birth weight should not be born in places where there is no good neonatal intensive care, but that does not stretch to the proposition that the larger the maternity unit is, the better it is. What is the Minister’s evidence? Given that the largest maternity unit in Germany, for example, has 4,000 births, and 3,000 births is about as large as it gets in France, why do we in Britain have to go to 5,000, 6,000 or 7,000 live births and deny mothers the access and choice that they need?

I was not actually arguing that large is necessarily best, and part of my argument here and when we were talking about the Alberti report was that—

Manchester was not just about maternity; it was also about children’s services. My argument was that there is clear evidence that higher quality care can be delivered to critically ill children by services that see a greater volume of such cases. There is a body of clinical evidence that says that that is the thing to do. Maternity is a different point, and there is a balance to be struck between safety, access and local services. The debate over the balance between safety and access is being had in other places all the time. We support the principle of choice as far as possible when it comes to child birth and where women deliver, and I guess that the hon. Member for South Cambridgeshire does, too. That will continue to be the case. I shall give way now to the hon. Member for Chichester (Mr. Tyrie) if he wishes.

The hon. Gentleman is okay; all right.

New drugs have been developed over the past10 years, which have allowed us to treat new conditions. People are becoming more educated about their care and demand to have more say in it, and the latest drugs and treatments. Their expectation of public service is also changing. They want access to services quickly, at a time that is convenient to them. In recent years the NHS has improved the services that it offers, and waiting lists are at a record low, but we are building on that. By the end of 2008, patients should wait no more than 18 weeks from GP referral to hospital treatment, and the NHS is funded to meet that commitment in its 60th anniversary year. It will be the end of waiting lists as we have known them in the national health service.

The Minister has returned to the highly controversial issue of funding, and many Opposition Members think that the deprivation weighting has been skewed to enable one part of the country—mainly the midlands and the north—to receive a disproportionate share at the cost of the south and rural areas. Has the Minister become concerned about that, and does he think that the fact that the Opposition Benches are packed, whereas there is not a Labour Back-Bench Member here to help him, may have something to do with the fact that Labour Members are reasonably satisfied with the huge cash handouts that they have had for the NHS, at the expense of the south?

The hon. Member for Ogmore (Huw Irranca-Davies) is leaving; they are all going now. [Laughter.]

And then there was one.

I do not have the figures to hand for the region of the hon. Member for Chichester, but I attended the meeting with the strategic health authority that he attended, where the issue was discussed at some length. It may have been in a parliamentary answer to him that we issued the capitation figures for PCTs in his region. If memory serves me correctly—and I do not think that I am wrong—the figures for PCTs in his part of the world vary from somewhere below the England average to somewhere above it. There was actually a fair mix of funding above and below the average, and overall the region was, yes, below the England average, but not far below it.

While we are on the crucial subject of funding, may I also point out that in our area we have the highest proportion of over-85-year-olds in the country? I have one constituent, Mr. Henry Allingham, who is 110, although he is in quite good order. The formula does not sufficiently reflect that high proportion. To put it another way, 26 per cent. of the population of East Sussex is over 65.

I think that we should debate that point—although I accept, Mr. Illsley, that I have spoken for a long time—because clarity about the funding formula is needed. Age is a factor in how funding is allocated, but it is balanced by other factors, including deprivation and the market forces test—the cost of delivering health care in one part of the country compared with another. A range of factors has an influence on how health care funds are allocated. It is right to say that the funding formula that was in operation for many years—certainly under the Conservative Government—was largely age-driven. The age component of that funding formula—and I acknowledge that it was not just age-related—was given more weight than now. However, I hope that the hon. Gentleman understands that in constituencies where life expectancy is lowest—Manchester is the example with the lowest male life expectancy in the country; even today there is a 10-year gap between male life expectancy in Kensington and Chelsea and in Manchester—people get sicker younger and there are higher levels of chronic disease, caused by a range of factors but crucially linked to deprivation. Those are the communities in which—and I think this is a no-brainer—health funds should go to health need.

I know that the Conservative party has said that funding should be allocated by burden of disease. The hon. Member for South Cambridgeshire has written to me at some length and I shall reply to him soon.

I am sorry; it was to the Secretary of State. In the letter, the hon. Gentleman makes a neat side-step into the question of age, and argues that burden of disease equals age, effectively.

He does. That is not his party’s policy. Burden of disease is something very different. We debated that in the House the other day. Burden of disease, to me—and perhaps we misunderstand each other—is rates of cancer per 100,000 of population and rates of coronary heart disease per 100,000 of population. Does he agree that that is the indicator of burden of disease?

The point that is made in what is admittedly a long letter to the Secretary of State is that the resource allocation formula should be set both independently and on the basis of the burden of disease. The burden of disease of course represents things such as the amount of cancer in the population. However, the Government interpreted it as premature mortality. It is a bit like saying that there are people under the age of 75 in Greater Manchester who die of cancer. Indeed there are, and a disproportionate number. But with a population like that of Eastbourne—because the older the population is, the greater the occurrence of cancer—there is a great deal of cancer. The only point that we are making—which my hon. Friend the Member for Eastbourne (Mr. Waterson) made—is that the formula does not sufficiently recognise that age is the principal determinant of morbidity.

I may be wrong, but I tend to think that if people live longer they are healthier, generally. An area may have longer life expectancy—Kensington and Chelsea has the highest life expectancy in the country. Is burden of disease there greater or lower than in Manchester? I have a direct question for the hon. Member for South Cambridgeshire to answer: is the burden of disease higher in his constituency, in the constituency of the hon. Member for Eastbourne or in my constituency? It is his policy I am talking about, not mine. Where is the burden of disease higher?

I do not have the statistics for all three constituencies, but my guess would be that the burden of disease is lower in South Cambridgeshire than in either of the other two constituencies. Leigh probably has a lower burden of disease than Eastbourne simply because, although it may have greater areas of deprivation, the average age is considerably lower. The Minister can see in the evidence on deficits to the Select Committee that the burden of disease rises significantly and the principle determinant of morbidity is age. Will he now accept what the Health Committee accepted on the evidence that it received—that the resource allocation formula requires review, and consideration should be given to actual need rather than proxies of need? That is precisely our point. Let us find out, in the formula, what is actually required to deal with disease in an area, rather than simply use deprivation indices.

Obviously, Mr. Illsley, you cannot join the debate, but I think that what I am saying is relevant to your constituency, too. In such areas as ours—former mining areas—there are high levels of chronic disease. Many people have chronic obstructive pulmonary disease, for example. The hon. Gentleman—his hon. Friends are not listening, but perhaps they will listen to this—said that, yes, the burden of disease is probably higher in Leigh than in South Cambridgeshire. Therefore, Leigh, under his funding formula, should get more money than South Cambridgeshire. That is the logic of his funding formula. How would the burden of disease formula reallocate funds around the country? There is not a chance that the burden of disease is higher in the constituency of the hon. Member for Eastbourne than it is in mine.

I suggest that the Minister read the report by the Select Committee on Health. I had the honour of being a member of that Labour-dominated Committee. It criticised almost everything that the Minister has said and called for an inquiry into the funding formula. It cannot be right that constituencies in some parts of the country get twice as much money through their PCT as constituencies in other areas— the Secretary of State acknowledged that to the Committee—and it cannot be right that a Secretary of State comes before a Select Committee and says that the reason that her constituents get £400 per head more than, for example, my constituents is that my constituents are healthier. That is absolute madness. It does not matter whether someone who is knocked down by a car is healthy, because they still need an accident and emergency department at the end of the street.

The Government will respond to the Committee in due course, but I refer the hon. Gentleman to what the hon. Member for South Cambridgeshire said a moment ago. He acknowledged that the burden of disease is higher in constituencies such as mine and that therefore more money should go to them. I fail to understand how the policy that the hon. Member for Hemel Hempstead and his colleagues are advocating is substantially different from the current funding formula.

The advisory committee to the Department of Health is made up of academics and others who advise on funding. The consideration of how to track health need is very complicated and precise. [Interruption.] The hon. Member for Hemel Hempstead and his hon. Friends repeatedly suggest that it is a political fix to benefit certain parts of the country. There is no debate about that. We have established that more money should go where the burden of disease is higher. That is what our funding formula does, and it is what the hon. Member for South Cambridgeshire acknowledged his formula would do.

Let us move on. [Interruption.] How can age apply?

If age was the basis of the Conservative position in the past, why does their policy document not say that the funding formula should be principally determined by the age profile? That is the position that they held before, and it is one that they are advocating today.

I shall not repeat myself, but I do not think that the Minister quite understands. The present formula allocates almost the same weight to measures of deprivation under the additional needs index as it does to age. It is not just us who make the point that weighting for deprivation indices is inappropriate. Academics made that point to the Health Committee. One can look in the formula for things such as morbidity indicators, but what is measured is the number of people on income support or the number of people receiving attendance allowance. The formula does not measure, directly in relation to deprivation, the extent to which age gives rise to disease. We are saying what the Committee rightly said: let us try to determine actual need rather than what the formula determines, which is deprivation indices that use proxies of need.

I understand the hon. Gentleman’s point. He is saying that we should allocate funds according to actual levels of disease in constituencies, whether cancer, coronary heart disease or stroke. However, the levels of disease are higher in my constituency than they are in his.

Perhaps higher than in mine but not higher than in the constituency of my hon. Friend the Member for Eastbourne.

The levels are higher, and I shall write to the hon. Gentleman on that. They are higher than the levels in every constituency represented on the Opposition Benches. Manchester has the lowest life expectancy in the country. [Interruption.] I do not misunderstand the issue at all; in fact, I know it extremely well. The burden of disease is higher in areas with the lowest life expectancy than it is in areas with the longest life expectancy. Our formula creates a balance. It does not take just one thing and say that that will be the key determinant by which resources are allocated. It balances deprivation and need against factors such as age.

It is a balanced formula that tries to allocate resources fairly across the country, and that is what it does.

Is not the proof of the pudding in the eating? If, as the Minister says, it is a balanced formula, why are the Opposition Benches swollen with Members from the south of England whose local health authorities are in financial crisis, yet not a single Labour Member with a constituency in the midlands, the north or anywhere else is here to stand up and complain? Is there not a fundamental financial imbalance between north and south and, de facto, a formula that does not work fairly?

The short answer is no. I gave two examples of reconfigurations—in Greater Manchester and in Calderdale and Huddersfield—that are in Labour areas.

I shall give the hon. Gentleman an honest answer to his question about why there are differences between one health economy and another: it is because the NHS is not the same everywhere. The money funds different infrastructure in different parts of the country. For whatever reason—the reasons are complicated—there are more GPs per 100,000 population in the constituencies of almost every Opposition Member in the Chamber. Pre-NHS, those communities probably could have afforded to build health infrastructure that areas like mine could not afford, so there is greater provision of community hospitals and smaller hospitals there. In some parts of the country, there are acute services and, as I was saying to the hon. Member for Hemel Hempstead, a district general hospital for a smaller population.

The NHS establishment is different in different parts of the country. Constituencies such as mine have fewer GPs, no community hospitals and a large acute trust. The infrastructure is different. Some argue that it is more efficient. I will not be the judge of that, but it is different. That is why some of the issues to do with change in health services are extremely important. I hope that I have answered the question of the hon. Member for Bexhill and Battle.

What the Minister is saying is right, of course. Health services are different in different parts of the country because health needs are different. However, on the subject of GPs, if he were to go to Worthing, Eastbourne or Bognor Regis and speak to any of the GPs there, they would tell him that an 85-year-old requires, on average, twice as much attention from a GP as a 75-year-old. We are talking about extra old weighting. If the Minister is now saying that we will lose GPs, we will have serious problems because of the requirements of our elderly population.

I am not saying that. That demonstrates the dishonesty of the hon. Gentleman’s position. I do not accept the argument—this is the nub of the debate—that an 85-year-old needs more attention from a GP because she is 85. We know that cancer patients, stroke patients and coronary heart disease patients will need help from a GP and access to their time. The fact that somebody is old does not necessarily mean that they will be a high consumer of health services. I remind him that his party allocated resources based on the burden of disease, not on age. Which one is it?

The hon. Gentleman clearly does not like the explanation, but it happens to be true. My point is that there are more GPs in his constituency than in mine, and there is an intermediate tier of facilities and secondary services. That is why some of these debates are occurring. If he wants to intervene and contradict that, he is welcome to do so. [Interruption.] I have been generous with interventions and have taken every one that has been asked for, so hon. Members cannot complain that there is not enough time for their contributions.

We are working towards an 18-week target by the end of 2008. That will lead to further change of NHS services. It will mean more vertical integration of services with more services where GPs and consultants work more closely together. That will benefit the patient because it will offer quicker care. It will put services in the right setting and the right location. Conveniently for them, it will allow consultants time to spend with the cases that they really need to see.

This is an ambitious programme of change for the national health service as it approaches its 60th year. We are making changes because medicine is changing. As I said, the priority should be saving lives and improving the quality of care to our constituents. It is in that challenge that politicians need to show leadership. They need to speak up for change where the clinical community says that it is in the best interests of the local population. That challenge falls to every hon. Member, and if we can grasp that challenge I am confident that we will build a national health service that is better able to meet the needs of the British public well past its 60th year, into many further decades.

Order. It goes without saying, but time is now somewhat limited. Can I appeal to hon. Members for a reasonably crisp and brief contribution so that I can try to accommodate everybody?

Earlier this afternoon, the Minister introduced a debate on medical and clinical practice. Last weekend at six o’clock on Saturday, at Worthing hospital, the mayor of Worthing together with patients and others—with Labour people, Liberal Democrats, Conservatives and people without party all taking part—started a 24-hour vigil. During those 24 hours, 10 new mothers had their babies delivered safely, three by section. It is not obvious to anybody in Worthing why mothers should either have to have their babies at home or travel for40 minutes to an hour down the road to go to another hospital. Accident and emergency saw and treated147 patients, 24 of whom were admitted. I think that the Minister would accept that if they were admitted, they needed to be in hospital. Such cases cannot be treated at home; they should not be expected to go for 40 minutes to an hour down the road to another hospital. Four people had moderate or severe injuries as the result of accidents and the hospital’s trauma team was in attendance awaiting the arrival of the ambulance.

In the week before the vigil, the Prime Minister put his name to the estimate that if people could be taken straight to the relevant hospital, 500 lives a year could be saved. That would be a worthwhile total. Such a hospital could give angioplasty straight away—Worthing hospital can do so. It would be good if the Prime Minister were not quoted by other parts of the health service as saying that his words will save lives when the consultants at Worthing say that they could provide the angioplasty themselves and that if people from A and E at Worthing had to go down the A27 to Brighton, to Chichester or to Portsmouth lives would be lost. Clearly, such issues are a matter of balance.

I am trying to illustrate what is behind the courteous disagreement between the chief executive of the strategic health authority and me. In the middle of the year, she said that I was being alarmist and sensationalist—she also included my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—about the future of our hospital. I rang up and asked whether, when the proposals came out, she was sure that they would not include proposals to close the A and E or to downgrade Worthing and Southlands hospitals. She said no. I asked whether she was sure that there would not be a proposal to close the hospital altogether. She said no.

It is not an MP’s job to keep quiet when information that six out of the nine options that are being considered include the closure of the A and E unit or the closure of the hospital is disclosed under freedom of information provisions rather than in a straightforward notification to MPs. I hope that there will be an instruction throughout the health service that, if options are being considered that include the closure of A and E in a busy hospital, MPs should be informed without having to apply under freedom of information provisions. I do not see why any director of a strategic health authority or primary care trust should have information of that nature without the MP being informed.

I return to what happened during the 24-hour vigil. The intensive therapy unit was running at full capacity, treating critically ill patients. The high dependency unit was full to capacity. There were 500 beds available throughout the Worthing and Southlands hospital trust, and fewer than 13 were unoccupied. That does not strike me as being a reason to downgrade a hospital or to close it.

My hon. Friend adds the useful information that it was a quiet night. In total,35 patients were admitted. That is estimated to be more than are admitted to many of the big London teaching hospitals, and I do not think that anyone is going around suggesting that one of those should be closed.

Two heart attack patients were treated in the coronary care unit. There were three cardiac arrests. The hospital team assessed, resuscitated and stabilised one critically ill patient and provided medical management for the ambulance transfer to the regional specialist unit. Co-operation across the region for Worthing and other hospitals happens as it does in other parts of the country. That has not changed in terms of medical and clinical practice, and it is not likely to change.

In the 24-hour period, four patients had their broken hips replaced or repaired. That could not happen at home and need not happen 40 minutes to an hour down the road at Brighton, Chichester or Portsmouth. Radiographers took 144 X-rays. We might at some stage have portable X-ray equipment, but at the moment it is probably better that X-rays take place in hospitals, so that will not be transferred to the community, although I recognise that GPs are capable of doing more.

The Minister rightly referred to developments in audiology. I want to add that he could have said that audiology is excluded from the “Let’s have no more than 18-week waiting times in two years’ time” target. In Worthing, and I suspect in many other places, the waiting time for a 20-minute hearing test is more than two years. Someone aged 89 whose hearing might have deteriorated and who plays their radio or television—often their only companion—at a level that disturbs their neighbours who live above, below or either side of them if they live in a semi-detached property, has to wait more than two years for a 20 minute procedure and then face an emergency block on capital spending ordered by the strategic health authority so the £71 for the hearing aid is not allowed. My hon. Friend the Member for East Worthing and Shoreham and I managed to get that decision reviewed and overturned.

Many people live on the south coast. When we first became MPs for our constituencies, 44 per cent. of the population was over 65 and the figure for those over 85 was pretty equivalent to those for the constituency of my hon. Friend the Member for Eastbourne.

The A and E department at Worthing is particularly crucial and my hon. Friend will know that over recent weeks the Royal Sussex county hospital in Brighton, to which it is possibly proposed to transfer the A and E admissions from Worthing—some 63,000 last year—was on divert for its ambulances to go to Worthing A and E department. The hospital in Brighton could not cope with the level of work that it already had, let alone take on what it might have to in the future, which would be a large proportion of that 63,000 if these crazy proposals go ahead.

May I put on record a point of detail in the expectation that the primary care trust, the strategic health authority, the national headquarters of the NHS and the Department of Health will pay attention to the debate? If we have 3,500 staff in our hospital trust and if more than 1,000 patients a day are treated and many of those patients have family or friends who bring them in or come to visit and use the car park, diverting those patients to a hospital with no easy access either by public or private transport would make life worse rather than better.

I return to what happened in the 24 hours from 6 pm on Saturday to 6 pm on Sunday. There were 144 X-rays, and four patients had CT scans in the new scanner. There were hundreds of blood tests: 115 patients had haematology tests and 119 had biochemistry tests. The blood groups of 60 patients were determined, 30 units of blood were cross-matched for administration and two patients required haemodialysis and ITU to treat acute renal failure. During the day, before the vigil started, 20 patients had regular dialysis for chronic renal failure.

On that day 22,000 litres of oxygen were given; 3,000 litres of nitrous oxide were given; 345 litres of intravenous fluids were given and administered through 500 metres of intravenous tubing; and more than 1,000 syringes were used. I doubt whether all that treatment could easily be transferred into the community; and I do not see why it should have to be transferred, along with the staff, 3,500 patients and their families and friends, who would have to go by minibus from Worthing to a hospital in Brighton or Portsmouth along the A27, especially as the road is often blocked. It seems to me that if the staff, the patients, and the family and friends are in one town—the biggest town in West Sussex—the patients probably ought to be treated in the hospital where they are treated at the moment. Ministers have rightly taken credit for continuing investment in that hospital; it started before 1997, but I assume that we can be non-party political about it and share the credit.

I move on. That 24-hour period saw the administration of £20,000 worth of drugs, with pharmacy staff dispensing more than 200 prescriptions. That weekend, a total of 28 patients had surgery. The operations lasted from30 minutes to 10 hours. Such operations could not have taken place in a GP’s surgery or a one-stop clinic. On Saturday afternoon, while others may have been watching football, four operating theatres were running simultaneously. It was a quiet weekend; 1,000 patients are normally seen and treated every weekday.

None of that is a criticism of the Minister; it is a description of what we take for granted from the support staff, the nurses, the doctors and the managers in our health service, and I do not exclude the family doctor service and clinics, as many patients were referred by their GPs. There is much co-operation.

I hope that those figures help to illustrate the debate, but it is wrong to say that we could do without one or even two acute hospitals in West Sussex. We do not want two towns to get into a fight; we believe that we have an established service that can be adapted and that can evolve, but we do not want people trying, in effect, to wreck one of our centres of excellence.

I hope that we can spend some time talking about funding. I illustrate the point to the Minister, but I do not wish to get into an argument; we should resist that temptation. In my constituency, people live at the same address for an average of 14 years. That is twice the national average. Many people come to the area in their maturity. Someone who retires to the constituency at the age of 65, perhaps from an inner-city area, may live there for 14 years, but it is during the last eight years—often the last four years and frequently the last 18 months—that they make most demands on the health service. Those demands would be roughly the same if they had been less fortunate and been ill at the age of 55. However, if people do not spend their healthy years in our constituencies, but spend only their mature years there—the times when they are ill—the funding formula clearly cannot continue as it is. I shall not elaborate on that. The Minister is clever enough to understand the point.

We are also suffering dramatically from the penalty formulas for hospitals in deficit, and that has had an impact on our medical and clinical practices. The Government now understand not only that the penalty system introduced in 2000-01 is inappropriate but that it must end. If our hospital has apparently overspent by £10 million, it will have to save that money the following year. That is a £20 million hit, and it is wrong. I hope that the Minister accepts that that needs to change. Hospitals are being told first that they will lose 3 per cent. for one reason or another, secondly that they will lose their penalty money and thirdly that they will have to repay it. In addition, they are under instruction from the strategic health authority that no consultant with a space in their clinic is allowed to see a patient referred in the past eight weeks by a GP. Such interference from the centre is totally unjustifiable—unless the Minister wants to justify it.

Finally, funding problems affect doctors in training—people who are cheerfully called junior doctors even though they may be 37 years old and just about to take a consultant’s role. The SHA, I think on instruction centrally from the NHS, has been told that junior doctors in training will have none of their training costs reimbursed for the rest of the year. That is an in-year imposition. If that is untrue, I hope that the Minister will say so. If he does not contradict me, we must assume that I am correct. However, although the information may be correct, it is the wrong thing to have done.

Health Ministers have a difficult job, especially as during this last year the chief executive of the health service has changed twice, every strategic health authority in England seems to have changed and primary care trusts and personnel have changed. Many hospital trusts also have new chief executives or chairmen. It is a miracle that we still have as much medical service as we have.

I am pleased to have the opportunity of speaking in this debate. The Minister began and ended his speech by lecturing us on political leadership. I have two or three points to make on that subject.

First, the Labour party does not seem to be showing a great deal of leadership or even interest in the subject, as the Minister is now the sole Member on that side of the Chamber. Even his Whip seems to have deserted him. Secondly, I and all my hon. Friends have been drawn into giving political leadership on the NHS in our constituencies because people are worried and concerned, and it is not only patients and potential patients but local NHS staff.

Thirdly, I seem to spend a large part of my life coming to debates like this, attending meetings with the SHA—much good they do me—with my constituents, with the primary care trusts and the various other bodies that have arisen from the Balkanisation of the NHS in recent years, but I have the impression that far from showing political leadership, Ministers are hiding behind what they call local decision making.

I recently had a meeting with my campaign group and the chairman and non-executive directors of our local PCT. Although they are clearly concerned about issues, such as accessibility and others that have been touched on during the debate, they are restricted by what the NHS tweely calls the financial envelope within which they have to operate. I had a meeting with the SHA a few weeks ago, at which the Minister was present. The hon. Member for Hastings and Rye (Michael Jabez Foster)—Hastings and Eastbourne are part of the same hospital trust—asked whether, if the PCTs were happy to commission roughly speaking the services that we already have, what would happen. No real answer came from the SHA, but I suspect that if it is not part of the overall plan they would not be allowed to get away with it.

I stress that we are not being luddites in our various campaigns in the south of the country. We appreciate that day surgery is a massive change in practice. Indeed, my hospital in Eastbourne has one of the highest rates for day surgery and it intends to improve even on that. We appreciate that new drugs and treatments are making a substantial difference. Of course it has always been true and always will be that really serious cases will be referred—serious children’s conditions to Great Ormond Street hospital, or serious head injuries to Hurstwood park hospital, and so on. We are not trying to stand in the way of progress or change. However, it is important for all who take an interest in the matter, including the Minister, that there is a proper debate about changes in medical and clinical practices. I have yet to hear from the Minister what is the distinction between them. Perhaps it is a distinction without a difference.

The problem for me and my constituents, however, is that sensible debate has been irretrievably contaminated by financial issues. Those with an afternoon to spare could look through the agenda documents for the strategic health authority. Its last agenda states:

“the NHS across Surrey and Sussex will be overspending by£237 million … in 2008/9, exclusive of historic debt if no action was taken.”

It is the action that is to be taken that is the real subject for debate.

The hon. Gentleman makes some fair points and is developing an interesting argument. Does he accept that there has always been overspending in the NHS, but that under the old financial system it was masked because of brokerage and other changes in how funds were passed around the system? Does he not believe it is right and responsible for somebody in my position to take action where those financial pressures are exposed by a new financial system?

Clearly there must be some financial discipline in the system—I am not for a moment saying that there should not be. As we have been in Government before and have every expectation of being in Government again—[Interruption.] Soon, as my hon. Friend says—how could we say it differently?

It is no earthly good starting discussions with those of us from the south-east by saying, “You are overspending by £237 million, or you will be by 2008/2009 and everything flows from that.” We have already had some debate about the formula and I intervened on the Minister on that point. There should be an on going debate and the formula should not be set in concrete, as it is clearly not working in our area.

My hon. Friend and neighbour is making an excellent speech. Does he not think it would be helpful if the Minister’s clarity in drawing attention to the deficit in the health service brought about by the new financial systems was adopted throughout the argument? People might respect the Government a bit more if they were honest and said that changes are being brought about by a deficit thrown up by a new financial system. Instead, they are pretending that such urgent and rapid changes are being moved exclusively by clinical developments.

My hon. Friend makes an excellent point. There is, of course, a considerable overlap between his constituency and mine in terms of medical demand and age profile. Issues surrounding historic deficits could themselves lead to a debate. Why should historic deficits be hung around the neck of some trusts and primary care trusts when others have them written off, as has recently happened?

On the issue of over-performance, it puzzles me when I am told that our local hospital is over-performing. Perfectly fit people from my constituency do not volunteer to be treated at the hospital for no reason. I suggest that over-performing means they are actually having their medical needs met.

There are issues about the location and the setting for treatment, but that is for another important debate rather than for this afternoon. On getting from here to there, in my constituency there is a recent history of shutting one rehabilitation hospital without, at the time, having the community facilities in place to take up the slack.

We understand that there are possible threats in my area to paediatrics and A and E, but most importantly we keep coming back to maternity. Despite large numbers of 85-year-olds, we also have a healthily rising birth rate—different groups of the population use the NHS. As recently as August 2004, a detailed clinical review carried out by the trust concluded that maternity facilities should remain on both sites—Eastbourne and Hastings. What has changed since then, in barely two years? The road communications are just as bad: 21 miles of poor roads between Eastbourne and Hastings. The population continues to rise with a lot of new house building—much of it imposed by Labour Ministers—and the requirements of the population in terms of maternity and other needs have increased.

So what has changed? All that seems to have changed is the financial envelope. If one of those maternity units were to close, would it really be safe for mothers and babies? A senior consultant gynaecologist and obstetrician who has recently left East Sussex NHS Hospitals trust has said in public that he thinks lives would be at risk as a result. I understand that the Royal College of Obstetricians and Gynaecologists has a gold standard of half an hour between deciding to perform a Caesarean operation and actually performing it. There is no way, short of using a helicopter, to get from one of those sites to the other, admit a patient and carry out an operation in half an hour.

As touched on earlier, Ministers tend to argue these points by assertion. In a debate I held on 31 October the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint)—the hon. Gentleman’s fellow Minister—talked about deliveries in Eastbourne and the Conquest hospital in Hastings. She said:

“The problem is that such units tend to have poorer outcomes.” —[Official Report, Westminster Hall, 31 October 2006; Vol. 451, c. 73WH.]

Where is the evidence for that? Dr. Vincent Argent, the consultant I have just referred to, pointed out in the recent Worthing report that Eastbourne and Conquest hospitals have

“perinatal statistics…in line with regional and national norms. There was no evidence that the units were or are unsafe (or would be, if the two sites are maintained).”

The British Journal of Obstetrics and Gynaecologists published evidence showing that smaller units can indeed be safe especially when there is proper national and regional networking of maternity units.

Some of the problems that have recently been highlighted about the safety of units in places such as Northwick Park, Wolverhampton, and St. Peter’s Ashford came from large or merged units. So can we have less assertion and more evidence?

On the process, the mantra that we have had from the SHA and from Ministers has always been that there will be full public consultation in due course on the options and that that will be listened to. That is, of course, reassuring and designed to be reassuring. However, the other day, the medical director of our hospital trust, Dr. David Scott, let the cat out of the bag when he made it clear in public that they were already planning for a one site solution for maternity from 1 August. The trust had not been consulted about postponing the public consultation, and when I spoke to Dr. Scott, he confirmed that they were planning for the eventuality of there being one site. He was quite clear that that had always been the solution and plans had to be made based on that. I understand that recruitment and so on is proceeding on that basis.

What earthly point is there in telling people that there will be public consultation when one of the most important options has apparently been closed off? There are also some so-called temporary closures in the offing—particularly for paediatrics. One thing we know about the NHS is that temporary closures have a habit of becoming permanent and part of the status quo. I have some real concerns, which I hope that the Minister will take seriously, about the way that this process is operating. He has talked about political issues, but it would be fundamentally anti-democratic and bad for the whole system if my constituents felt that they were being invited to take part in a public consultation that may not now start until the end of January when some of the options have already been removed from the table.

The trust, the PCT and the SHA have all subsequently been trying hard to stuff the cat back into the bag. Indeed, they have issued a statement saying that Dr Scott regrets any misunderstanding that might have arisen from his interview with the BBC. However, he could not have been clearer and he could not have been clearer in his direct conversation with me.

The working time directive and pressures on the hospital to plan to close one of its maternity sites all relate to financial pressures. Ultimately these issues are all about money. That is the impression I have formed and it is certainly the impression that my constituents have formed. I cannot stress too heavily to the Minister that that impression will undermine any public consultation and any decisions that have to be taken. People in my constituency simply do not believe that the options are still available and that this is driven by anything other than a desire to save money.

The winding up speeches will start at 5 o’clock and I intend to allow10 minutes each for the Front-Bench spokesmen and for the Minister. If anyone has a problem with that, they can approach the desk.

I notice that the Minister recently won The Spectator award for the Minister to watch. We have had little choice about that this afternoon as he has been the only Minister that it has been possible to watch. I am sure that he will be acutely conscious that previous winners have included Estelle Morris and Christopher Leslie. We did not have to watch them for long.

The Minister knows, because I mentioned this to him when he kindly agreed to see me about this issue—we have not yet had that meeting, but I am sure that he will honour the generous promise that he gave me—that I am especially concerned, as all Opposition Members here are, about the reconfiguration of acute health care facilities in relation to my constituency, because it is comprehensively affected by what our local health authorities are proposing. The following are acute hospitals in West Sussex: the Princess Royal hospital at Haywards Heath, St. Richard’s hospital at Chichester, and Worthing and Southlands hospitals in Worthing and Shoreham. None of them is in my constituency, but all of them serve my constituents and all are in the firing line when it comes to the potential downgrading of A and E and maternity facilities. They already face difficulties. Between the four trusts that serve my constituency, 1,000 jobs have been cut, or there has been an announcement that they will be cut, and 100 beds have been lost.

The principal concern that I want to articulate on behalf of my constituents, who are watching the progress of the proposals with enormous anxiety, is the travel distances and times that will be involved if they have to go to units that are much further away from them than the units are currently. Right in the middle of my constituency, in the downs, is a little village called Washington. There is even a place called the White house in Washington, to which I have been—that is almost certainly the first and last time that I will ever have tea in the White house in Washington. At the moment, the nearest hospital—Worthing hospital—is just 8 miles from Washington. Should Worthing be downgraded, the travel times involved in going to an A and E department could increase by 2.5 to 5 times, if patients have to travel as far as Portsmouth. I could make that argument across my constituency. People, particularly the elderly population, are extremely worried about the increase in travel times that they may have to face, not just for A and E services, but for other treatments that they need.

Someone came to my constituency surgery the week before last who was having cancer treatment in Brighton. She lives in the middle of my constituency and was already having to make a round trip of some 40 miles three or four times a week for treatment. That was taking hours out of her day and she was extremely worried about it. That is the prospect faced not just by a minority of people in my constituency but, potentially, by the majority if the acute facilities that I am talking about are moved away from them. Furthermore, people face a potential increase in travel times along roads that the Government have continually failed to upgrade. The A27 in particular does not resemble anything like a coastal highway; it is a coastal car park. People are worried about the travel times for ambulances should there be additional travel times to A and E facilities.

We are constantly told that the reconfiguration is about bringing new facilities closer to people’s homes and delivering great centres of excellence in what the Minister called “regions”—in this case, in Brighton and Portsmouth. The point is that we have seen no credible or costed proposals for the services that are meant to be brought closer to communities. We have seen none. In a rearguard action, the Prime Minister started a few weeks ago to make the case for the changes and the documents by Sir George Alberti and Professor Boyle were published. Those documents amount to just seven and 12 pages respectively. They include many attractive photographs, anecdotal argument and diagrams, but no costings whatever. It is impossible to make a judgment on whether the proposed reconfiguration of health care will be financially sustainable or will save money, which is presumably what it is intended to do, when no costings have been provided either locally or nationally. There may well be a strong case for saying that bringing care closer to people’s homes will be more expensive.

A great mistake that the Government have made, to which my hon. Friend the Member for Eastbourne (Mr. Waterson) alluded, is that the reform proposals that they are now purporting to set out are in fact being elided with cost-cutting proposals. That is what this is really about. We all know that. It is about addressing local deficits. The trusts have been instructed to cut costs on a very short time scale, and that is the real purpose of the proposed downgrading.

The hon. Gentleman is digging his own grave with that point, because it is he and his colleagues who are seeking to put those two things together. They are seeking to put the deficits and the pressures that there are this year in some parts of the country together with the longer-term structural changes that are needed in some parts of the country to ensure that those health communities are fit for the future. That is precisely the point. For their own purposes, the hon. Gentleman and his colleagues are trying to weld those two things together to create an impression that this is all finance driven, rather than safety driven. If the hon. Gentleman feels able to throw away the Alberti report, claiming that it is glossy nonsense or whatever he was trying to say, that is a dangerous thing to do and will not serve his constituents.

The point that I made was that the Alberti document and the Boyle document are completely uncosted. We have seen no credible proposals from the Government, either on clinical grounds or on cost grounds, that demonstrate whether the proposals will deliver affordable health care locally, yet we are told that a reason for the changes is that there is a need to save money. The local trusts and the health authorities are clear that the reason why the proposals are being considered in relation to acute hospitals is to save money. The closure of major hospitals—at one point, it was even being considered that we would have no acute facilities in West Sussex at all; now, apparently, we have a reprieve and will possibly have one where there are currently three—is designed to save money, and the Minister should not pretend otherwise.

The Minister dismissively talked about people pulling out placards. Yes, 25,000 people have marched in West Sussex. Yes, 250,000 people have already signed petitions across West Sussex. That is a staggering number and it will increase. People are going out on cold evenings to hold 24-hour vigils because they are immensely concerned about what is going on. They are, quite rightly, subscribing to the notion of something that the Government constantly espouse—patient choice. The question that I put to the Minister is: if people are not to be allowed to choose to keep their local hospital, which is what they clearly want, what does patient choice mean?

Just let me finish. If people are not to be allowed to choose their local hospital, which is what the NHS website proposes that they should be able to do, what does patient choice mean? Perhaps the Minister, instead of intervening on me, will answer that question when he winds up the debate.

The truth is that the consultation that we have been offered in West Sussex has been largely a sham. In April, members of the strategic health authority came up and spoke to West Sussex Members, but they made no mention of the proposed downgrading of acute hospitals. We now know from minutes of the board meeting that were leaked that, in fact, they had been proposing that downgrading since the beginning of the year. Not surprisingly, people are extremely suspicious about whether the objections that they are registering in their hundreds of thousands in West Sussex will make any difference to the Government’s thinking, because they fear that the die is cast.

What are the Government doing to make the consultation a real process? We know that they have delayed the process, but we also know that they are planning to recruit a director of communications each for the South East Coast and for the East of England strategic health authorities. For a salary of £90,000 a year, that person will have to

“Understand public perception and patient experience of health care services”.

That is all right, but the next job purpose is to

“Deliver appropriate and timely information to the Ministerial Briefing Unit.”

Is, then, the purpose of the director of communications to ensure that Ministers are armed more effectively with the facts? Another task is to

“Translate and communicate effectively the vision that health reform policy can transform local health systems for the benefit of the patient”—

in other words, to propagandise on behalf of the trust.

The Minister talked about hearing the voice of local clinicians. Let me tell him that we cannot hear the voice of staff in the NHS, because locally they have been forbidden to speak out. When ambulance drivers and paramedics were asked by the local trust whether they would do an interview with Sky TV to speak for the changes proposed by the trust, they refused to a man and woman because they do not believe that the proposed changes are safe or viable. From that moment on, they were banned from talking to the press at all. Indeed, some of those whom I met recently feared that they could not even talk to their local Member of Parliament because of that stricture. I would be grateful to the Minister if he would confirm in his winding-up speech that it is perfectly proper for local NHS staff members to talk to their MPs about their fears.

We all fear that there will be a salami slicing process with acute hospitals and that once they lose their A and E departments, the process of downgrading will continue. I have good reason to fear that because of what happened with a hospital that serves my constituency—the Princess Royal hospital in Haywards Heath. I am sorry that my hon. Friend the Member for Mid-Sussex (Mr. Soames) could not be here today because I know that he would strongly share these views. Just a year ago, a consultation process called “Best Care, Best Place” resulted in the loss of trauma cases from Haywards Heath to Brighton. The hospital is barely able to cope with the transfer of patients now and will be still less able to cope with the transfer of tens of thousands given that A and E admissions and attendances are on the rise across the county.

In March 2005, the then Minister of State for Health, the Secretary of State for Work and Pensions, told my hon. Friend the Member for Mid-Sussex, in relation to this proposed health care change:

“There is no question of A and E services being downgraded or becoming a minor injuries unit. That is not going to happen.”—[Official Report, 16 March 2005; Vol. 432, c. 383.]

Just one year later, local health authorities are considering precisely that further downgrading of the A and E unit in the Princess Royal.

Of all the hospitals in West Sussex that are likely to be downgraded to become minor treatment centres, or whatever is to happen—and we simply do not know—the Princess Royal is most in the firing line because it is on the east of the county. That promise has been breached just one year later. How can we accept the assurances of Ministers and health officials about how we are to enter this brave new world of care closer to the home when we cannot even take assurances that were given on the Floor of the House just one year ago? Can the Minister understand just how angry people are given that they have received such assurances from Ministers and health officials and that those assurances were so flagrantly and cynically breached?

The Minister cannot allow the blame for the deficits to be landed at the door of local health authorities. There has been substantial Government mismanagement of the NHS that I could go on to discuss for some time, but will not. I shall, however, point out that the cost of endless reorganisation has to be laid at the Government’s door. We have seen the abolition of GP fundholding, the creation of 330 primary care trusts and now the halving of that number. We have seen the abolition of health authorities to create 28 strategic health authorities and now the halving of that number. There has been enormous disruption in West Sussex. The latest reorganisations across the country have cost more than £320 million. I wonder what the local cost has been compared with the deficits that have grown up in the local trust.

People do not understand why money has to be spent on management consultants and endless reorganisations, yet they face the potential downgrading of much-loved local health care facilities. I beg the Minister to reconsider this issue and to understand just how strongly people feel. I beg him to consider that he has not properly set out the alternatives to the current structure of acute hospital provision and I should be grateful if he were to see me as he kindly promised.

I respect the Minister for coming along on his own and valiantly trying to defend something that everyone knows is indefensible and that he probably would not have done. He inherited this policy from his Secretary of State. The absence of any of his Labour colleagues tells its own story about their level of commitment to what the Government are doing.

I pay tribute to the efforts of clinicians and staff at St. Richard’s hospital and others in West Sussex. They have had to put up with extraordinary disruption and have managed to maintain a high level of care despite the disruption caused by the announcements of the past 12 months from the Department of Health and the strategic health authority.

I found particularly reprehensible the Minister’s suggestion that the Opposition are scaremongering. What are MPs supposed to do when documents such as “Fit for the Future” are published telling us that major trauma A and E departments in our constituencies are to be closed? Of course, our constituents will be extremely concerned about that. What are we supposed to do when we find that there is no evidence base for the suggestion that there might be improvements in health care as a result of such a publication? The Minister effectively admitted as much today when he told us that he and his Department have only just started to collect the evidence required to justify the proposed changes that have already been published. We know that this is policy making on the hoof and is about money, not clinical practice. Indeed, senior people in the NHS have told us as much. It is a charade to pretend otherwise, and it will not do the Minister any good if he has another go at trying to pretend that it is something to do with clinical practice.

We know what is going on: the Government are trying to save money by closing district general hospitals, replacing them with a smaller number of large critical care hospitals and perhaps creating new urgent care centres. We have no idea what urgent care centres are supposed to do or deliver. Nobody knows; the Government do not know. Neither do they know what savings those centres might generate. What we do know is that the policy will lead to a reconfiguration of health care in West Sussex, which will mean the hollowing out of virtually all trauma A and E provision in the county.

In an effort to find out what urgent care centres might do, I gave the SHA a detailed 18 or 20-page response to “Fit for the Future” in which I asked a large list of questions, none of which it has answered. Of course, it does not know the answers, and the Minister himself has admitted that he does not know them either. We do not know whether any of the proposed services can be brought in safely. We do not know whether a business case has been put together that accommodates the fact that counties such as West Sussex have large rural areas in which many elderly people live alone.

We do not know whether the new services that are to be created will generate demand and, if so, how it will be financed. We do not know whether the acute trust can reasonably remove the direct, indirect and overhead costs associated with service reduction without there being a risk to other parts of the system—whether services can safely be closed down. We do not know whether or how GPs are to be trained to develop the specialist skills required to plug the gap.

The argument for specialisation, which suggests that we should go for critical care hospitals, itself argues against allowing GPs occasionally to perform some of the tasks that are currently dealt with in district general hospitals. Surely, the argument for specialisation points to the need to continue to provide such care in district general hospitals, not to give it to someone whose main function is to do other worthy work, as is the case with GPs. The GPs in my area have made that point to me vigorously. So it is not only clinicians in hospitals who have made that point, but GPs themselves.

I repeat that I have received no answers to any of my questions. I do not ask the Minister to respond now. I shall write to him with the list of the questions and I would be grateful if he would have a go at answering them. The plain fact is that the evidence does not exist.

That leads me to one last major point: at policy level, the strategic handling of this issue has been nothing short of catastrophic. We had the publication of “Fit for the Future”, which was so mangled by the people who know most about it—the clinicians, the GPs and a good number of the health managers—that it has effectively been withdrawn. The consultation was apparently initiated by the strategic health authority, but halfway through it was taken over by the primary care trust. The PCTs have been merged, and there have been endless delays on the start of the consultation period, and we still do not know when that will begin. We also remain unsure about who will ultimately be taking this decision, the PCT or the SHA. If something as strategic as this will not be decided by a strategic health authority, we must ask what an SHA is for.

We must also consider the shocking ignorance of Ministers, including the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), about even the most basic questions involved in this reorganisation. For example, she told Mrs. Ellis, a constituent of mine who had written to her, that she should write to Steve Phoenix who, she said, was in charge of the consultation. He has been replaced by John Wilderspin. My constituent was told to write to Western Sussex PCT, but that has been abolished. My constituent was also told that the consultation would begin “in the autumn”—the letter from the Minister of State was dated 13 November. Yet she chaired a meeting at which this Minister and I heard the chief executive of the strategic health authority announce, in response to a question, a delay in the consultation until the end of the year, if not until 2007. That extraordinary ignorance about what is going on—it is as if she does not care at all about the effects of these changes—leads my constituents to be deeply sceptical and worried about the whole process.

I implore this Minister to do three things. First, he should not make changes until the evidence has been collected. The clear indication that he has given today is that such a process might only now be occurring. If so, it is deeply reprehensible.

Secondly, he should reconsider the increased weighting that was put into the additional need adjustment—the deprivation formula—as a matter of urgency. Something has gone seriously wrong in the allocation of national health service funding across the country as a whole. The deprivation weighting has given huge increases to some areas where life expectancy is lower, but few people in the NHS believe that extra health spending in those areas, when channelled through hospitals, can tackle the problem of lower life expectancy. That is largely a problem of lifestyle and not of hospital care. The consequence is that a large amount of money is probably being wasted and inefficiently used, and because there is a limited national pot, money is being taken from areas such as ours, which have increased need as a result of the ageing of the population.

Thirdly, the Government should show greater understanding of the consequences of what is happening. They should recognise that the expressions of concern in my constituency and by those of my colleagues is deep-seated and strongly held. Some 130,000 people have signed the petition onSt. Richard’s hospital, and that was collected in a few weeks. At short notice, 5,000 people turned up to a rally in Chichester on the issue. I assure the Minister that rallies are not often held in Chichester. No one could recall an occasion when 5,000 had come for a rally in the city.

The Minister suggested that Conservative Members were not showing leadership. If he were to reflect on that for a moment, he would understand that my constituents think that it is the Government, the Department of Health and the Secretary of State who are not showing leadership. We beg the Government to reconsider the decisions that have been taken and to think carefully about the funding formula in particular. If the Minister does so, he would not only do our area a service, but he might rescue some of the Government’s electoral chances.

I, too, admire the chutzpah of the Minister in defending the indefensible this afternoon. He has done a good job at standing there in the total absence of any support from his Back Benchers. I understand why there are no Labour Members present, but I am slightly surprised that no Liberal Members, bar one, are here either. Perhaps that is because they have taken to heart the instructions of their former leader, David Steel, and they have all gone back to their constituencies to prepare for Christmas.

There is a rising sense of anger in my constituency. We do not have an acute hospital in Bexhill and Battle. The majority of my constituents are served by either the Conquest hospital in Hastings or the Eastbourne district general hospital in the constituency of my hon. Friend the Member for Eastbourne (Mr. Waterson). The others, in the north of my constituency, go across the border to the Kent and Sussex hospital, which is in Kent.

The situation at the Conquest hospital and Eastbourne district general hospital, which form the East Sussex Hospitals NHS Trust, is desperate. Despite what the trust has said formally, we know that plans are being made to reduce the maternity services to a single site, either at Eastbourne or at Hastings. We also know that it is preparing to downgrade accident and emergency on one of the sites. We will lose 24-hour accident and emergency provision at Hastings or at Eastbourne, which would be very serious. We also know that the SHA is applying pressure to pass a whole tranche of services out into the community.

So there are three concerns: the loss of one of the maternity units; the downgrading of accident and emergency; and the general push out into the community of services, when there is no proven clinical or financial evidence that they would be better or more effectively administered in the community, and, more importantly, when in the short-term, there simply is not the ability to provide them in the community. Nobody in my constituency is saying that there should never be any change. But people want the case for change to be made on clinical grounds and on sound medical evidence based on proven research, and not on the basis of assertions from Ministers.

Nine months ago, I met the chief executive and the chairman of the trust at their office in the Conquest hospital in Hastings. They had just published a review discussing the overall configuration of health care in the area. The primary concern of the senior staff of the trust earlier this year was the long-term threat posed by the potential building of a new hospital at Pembury in Kent, some 30 miles to the north, which could happen some time in the next decade. They saw that as being the primary threat to services at the Conquest.

Just a few months later, however, the picture had changed completely. This had nothing to do with the publication of new research or with the bringing forth of new clinical evidence; it was entirely concerned with the financial crisis at the SHA, which cascaded down to my hospital trust and meant that, in 2005-06, the hospital will have run up a deficit of close to £5 million. At the instruction of the SHA, it will have to claw that back to a deficit of just over £3 million in 2006-07—some £2 million-worth of cuts have to be made in the current 12 months.

That is not about moving care closer to the community, providing more effective care for patients in my area or raising health standards; it is about the cold, harsh reality that money has been lost elsewhere. My constituents are having to pay the very real health price and, as other colleagues have said, they already feel discriminated against by the unfair system that benefits constituencies in the north of the country—Labour’s friends in the north—and discriminates against the older population, which is often very poor, along the south coast. The household income in east Sussex is the same as that in Hull. Pensioners, by and large, are not very prosperous and to talk of my area being affluent is absolute nonsense when so many people are over 85 and dependent on fixed incomes. The argument about affluence simply does not wash in my part of the country.

The case for not having just one maternity site in Eastbourne or Hastings has already been well made by my hon. Friend the Member for Eastbourne. If the site in Hastings, for example, were closed, people would be hard pushed to get from the east of my constituency near Rye—for example, Northiam—across to Eastbourne in less than 50 minutes. That is totally unacceptable. It is not bringing health care closer to the community, but moving it further away. It would make it not only more difficult from the health care point of view, but much more difficult for friends, relations and partners to visit at an important time in a woman’s life when she is dependent not just on medical support, but on the support of her family and partner.

I want to focus briefly on the loss of 24-hour accident and emergency care. There has been a great deal of misinformation about the clinical need to consolidate on one site when we know that that is not a clinically driven argument, certainly over the next year. I have been passed a letter from a senior consultant who is practising at the accident and emergency department in Hastings. He said:

“Most patients with multiple injuries are managed appropriately in district general hospitals throughout the UK. A large study comparing the outcome of trauma patients from a trauma centre and from general hospitals in the late 1980s and early 1990s showed no statistical difference in death or permanent injury. The only patients who need to be transferred urgently are those with serious head injuries, cardiac injury or major burns.”

In Hastings, he said:

“We receive on average 8 trauma alerts from the ambulance service each week of whom half turn out to have significant injuries. Of this latter group we would only need to transfer 1 per fortnight to a specialist centre.”

That is one per fortnight. He added:

“It is extremely difficult to accurately identify those patients who would benefit from a trauma centre at the scene of an accident and therefore bypass the local hospital.

The recent GPs contract has resulted in far fewer acutely unwell patients being seen by GPs. Two thirds of emergency admissions now come through the emergency department”

at the Conquest hospital.

“We have recently had GPs working in the emergency department to assess their impact. They are able to see patients with minor ailments but not able to assess trauma patients, review xrays or manage acutely unwell patients. The percentage of patients suitable to be seen by GPs is therefore in the order of 25 to 30 per cent. As a result of their contract GPs have been released from their ‘24 hour obligation’ and the result of this is that it now costs twice as much to employ a GP in the emergency department than an emergency medicine specialist.

You will see from the above that the clinical case for regional centres is not as clear as the SHA and DoH like to suggest. There are very few patients who would genuinely benefit from such an arrangement and many more who will suffer longer transfer, unnecessary delays, difficulty with relatives visiting and probably … length of stay particularly if social service input is required.”

I will give way in just a moment.

The consultant continued:

“This department sees approximately 1000 patients each week.”

I am mindful of the time and I have taken10 minutes. I want to return to the point about pushing more services out to the community. In the longer term, there may be a sound basis for doing that, but we have yet to see any real evidence. Part of the reason why the sham of the consultation has been delayed once, twice and, I think, will be pushed back again is that there is no evidence to show. In my part of the country, Northiam surgery, for example, has been campaigning for three years. I have even been to see Lord Warner to try to get a minute amount of capital funding to expand the surgery. That could be done very well, but the funding is simply not available. Little Common surgery is a large practice and bursting at the gills. It simply cannot provide any more services at that location.

The same applies around my constituency and throughout the area. Practices simply cannot provide those services, and certainly not the same clinical standards that are currently being offered at Conquest and Eastbourne hospitals, yet we face the prospect of more salami slicing. Nothing in the Minister’s assurance so far refutes the long-term prospect that Conquest or Eastbourne district general hospital will become little more than cottage hospitals.

We are very concerned about the health care in our area, and I hope that when the Minister winds up he will take on board the anger in my area that clinical arguments are being used to masquerade financial mismanagement in the strategic health authority and that people in my area, who can ill afford it, are having to pay the price.

As I said in an intervention, I am a proud member of the Select Committee on Health, which, earlier this week, issued a fantastic but damning report on NHS deficits. For the record, that Committee is Labour dominated with a Labour Chair.

Recommendation 29 states:

“The Department of Health has begun to tackle the deficits.”

That is the good bit, but it goes on:

“However, we are concerned that … current policies are encouraging short term measures that may further destabilise the situation and”

are not

“in the … long term interests of the NHS.”

Let us look at one example of short-term measures that are destabilising the NHS in west Hertfordshire. I am not the MP for Hertfordshire, but am proud to be the MP for Hemel Hempstead, which sits in west Hertfordshire. The acute trust that looks after my constituency is West Hertfordshire Hospitals NHS Trust.

The Minister referred to consultation on the future of facilities in my constituency. I must inform him that the consultation is over. It finished one month ago. The result was that 86 per cent. of the consultees who responded were opposed to the removal of services from Hemel Hempstead general hospital, which was built in the 1960s for the constituents of the new town and has been extended with funding. However, an independent review of that consultation was put to the trust’s board one month ago. The review was carried out by Clear and the gentleman who attended the meeting was John Underwood. Those of us who have been in the House in different capacities recognise that name because John Underwood was a director of communications for the Labour party before the current Government came to power. I understand that the company has carried out consultation and reviews of consultation extensively around the country and, every time, it came up with the conclusion that proposed cuts, which were opposed locally, should go ahead. John Underwood has another role: he is chairman of the Labour think tank, Catalyst.

I leave it to the House’s discretion, and its thoughts, whether that review of the health service in my area was independent when it was carried out by the Labour party on behalf of the Department of Health. I asked, naturally, whether that consultation specialist contract had gone out to tender. It had not. I understand that the company was appointed on the recommendation of the strategic health authority and the Department of Health.

Let us consider what the consultation, which was rejected by my constituents and local people, proposed. Hon. Members mentioned their concern that accepting cuts in maternity and in accident and emergency acute services is the thin end of the wedge. I am sad to say that my constituency is at the forefront of that thin end of the wedge.

It is very painful, I can assure my hon. Friend. Let us say that, sadly, we lead the way in cuts.

The acute accident and emergency department, which has received substantial investment over the past 15 years—first under the previous Conservative Government and then in the past three years under this Government—will be closed and moved to Watford. Along with it will go the brand new stroke and cardiac units, the MRI scanner and all acute facilities. Their closure marks the end of acute facilities in my general hospital. At the same time, the trust is going ahead with its removal of elective surgery to St. Albans. It means that in 18 months’ time, not one in-patient bed will be left in a general hospital that caters for the largest town in Hertfordshire. That is not reconfiguration, but closure—closure that will affect the day-to-day lives and prospects of my constituents.

I speak with some experience—I hope—because for many years I was a fireman. One duty in which I trained and specialised was attending road traffic accidents. I can say to the Minister with confidence and knowledge that if one does not have an accident and emergency unit with back-up acute facilities, including intensive care—that unit is closing—and a high dependency unit, lives will be lost.

I am sure the Minister will say that the problem is going to be addressed with more paramedics and acute ambulances. I asked the outgoing chairman of the ambulance trust—good job I asked the outgoing chairman; he would not have been allowed to speak to me or tell me the truth if he were staying—how many new ambulances we will get. The answer was none. How will we keep people alive and transport them not only from my constituency, but from St. Albans, which has already lost its accident and emergency unit, past the most dangerous junction of the M1—junction 8, where there are more accidents than anywhere else in the south—to Watford?

Let me provide the Minister with a geography lesson. Watford has a football ground, Vicarage Road, which is the home of Watford football club. A few months ago, I pushed a hospital bed with several thousand of my constituents from a hospital in my constituency.

It was a very big bed; there was a coffin on it to symbolise how many lives would be lost.

We pushed that bed from the hospital in Hemel Hempstead to Watford general hospital. Fortunately, Watford were not playing at home. I wish Watford every success and I hope that they stay up, because they are struggling in the premiership. However, Saracens rugby football club was at home, and it has crowds of about 3,000 to 4,000. There was mayhem, but not because of the demonstration led by my constituents. Incidentally, the demonstration was not party political. I am sure that there were as many Labour supporters on the push as there were Conservatives, although I am not so sure that there were too many Liberals present. Perhaps that is not fair because the parliamentary candidate was there—I apologise; it is just that there are not that many Liberals in my part of the world. Anyway, there was chaos because the police have to close the roads around Vicarage Road when there is a home game.

The Minister can be derogatory towards the town of Watford. My constituents will be conscious of that remark, too.

The most important thing is lives. If one closes the roads, how does one get an ambulance into Watford? Hemel Hempstead hospital is in the heart of the town, with the best road links anywhere in Hertfordshire. The investment has been made, but the decision has been made to close the hospital completely. The Select Committee report said that the measures were short-term, and I passionately believe that. I asked the trust chief executive whether he would make such devastating cuts to services if the trust were not in deficit and if the strategic health authority and the Government were not forcing it to cut back so much to rebalance its accounts. The director of medicine, who is brand new to the area, stood up at the meeting and said, “Of course I wouldn’t. These clinical cuts would not be taking place if it were not for the deficits of my trust and PCT.”

The Minister knows that I raised the matter with the Secretary of State in Select Committee hearings. I asked her whether it was fair that people in her constituency in Leicester receive about £400 more per head than my constituents. As we heard, she said that the people in Hertfordshire are healthier than people in Leicestershire. It was the most astoundingly arrogant comment I have ever heard from a Secretary of State. However, no Opposition Member and none of our constituents is calling for parity throughout the country. We are not saying that everyone should receive exactly the same funding.

In my constituency, we would need less than £100 per head to bring us inside the deficit, and none of the cuts would need to take place. We could discuss clinical need and reconfiguration based on clinical effectiveness, but we are not doing so. We are discussing them based purely on the fact that the trust in my constituency does not receive enough money to look after the acute needs of my constituents. That situation is in the public domain, and it is wrong.

The Minister has said that with modern technology we can treat more people in the constituency, get them out of hospital quicker and look after them. I have heard other Ministers say the same in the Select Committee and in the House. That would be interesting in west Hertfordshire if it were not for a leaked letter from the PCT to GPs, saying that it is going to make district nurses redundant because it cannot keep them on and balance its budget.

The Minister cannot have his cake and eat it. We are close to Christmas, and we do not want a major conflict, but our constituents are frightened. He cannot say that the Conservative party is scaremongering, because yesterday every GP’s surgery in a consortium under the Decorum primary care trust, which administers an area that I represent in part with my hon. Friend the Member for South-West Hertfordshire (Mr. Gauke), signed a vote of no confidence in the trust. They are not convinced that their patients’ safety can be adhered to with the reconfiguration of acute services.

Unless the Minister can prove that every GP in my constituency is a Conservative—they may be, but we cannot assume it—he must accept that they are genuinely worried about the clinical care and treatment of their patients. With that in mind, I can bring the Minister up to date by letting him know that a judicial review of the way in which the consultation took place was launched today against the trust. It is not just a case of Conservatives demonstrating with banners. With my past, I have not been on the demonstrators’ side in many demonstrations. I have certainly been on the other side trying to prevent some of them, although I must stress that that was in Northern Ireland in the 1970s. However, people are not simply scaremongering, and it is demeaning for the Minister to indicate as much. People and GPs are worried.

I have a final point to which I should like the Minister to respond. Day in, day out, I receive anonymous e-mails and phone calls from members of staff in the NHS locally, telling me what is going on. They say to me, “Please, Mike, do not tell anybody that I am telling you this or giving you this document, because I will get the sack.”

It goes on every single day.

Like everybody in the House, I am an elected Member, and every member of the NHS has the right to be represented by their Member of Parliament. Will the Minister instruct every trust in the country not to threaten their staff with action if they speak to their MP? If any trust has included that threat in its contract with staff, it must be removed immediately. It is undemocratic, fundamentally wrong and an insult to the House.

Further to that, does not my hon. Friend think that it would be helpful if strategic health authority chief executives were permitted to represent their private concerns and those of their senior staff that their area is underfunded relative to the national cake? At the moment, they are debarred from participating in national debate. Would it not be helpful if the Minister could give strategic health authority chiefs an assurance about that as well?

My hon. Friend makes an important point, which I raised recently with the chief executive of my SHA at a public meeting. I said to him, “If you cannot guarantee the health care of my constituents—in other words, if you cannot do your job because you are not being funded correctly—you should get on a platform and say so.” He said, “I am not allowed to do that. That is the job of the politicians. I have to do what I’m told.”

I know that the Minister is an honourable man, and I hope and pray that the Secretary of State is of similar ilk. In evidence to the Select Committee, she said that the NHS as a whole would be in balance by March 2007 and that she would take personal responsibility if that were not the case. Can we assume that she will resign if the NHS is not in balance by 2007?

It has been an interesting, passionate and well informed debate. At one point, I thought that we should adjourn to Star Chamber Court, as that would suit the occasion better than Westminster Hall. The debate has shown the depth of the suspicion of Government intentions regarding the NHS and hon. Members’ laudable concerns about facilities in their constituencies.

There is a definite pattern in the critique arranged here against the Government, but the debate is about changes to medical and clinical practice. Medical science does indeed change and advance, and it informs medical practice. Undoubtedly, that has implications for medical service, as do people’s expectations of that service and the resources available. Those are all factors, but clinical auditing and learning and applying lessons and knowledge is, as we all agree, crucial.

Major advances have undoubtedly been made, and it would be churlish not to point to some of them. The treatment of chronic conditions has improved. I am thinking of improvements such as the expert patient programme, of which I was initially quite sceptical. I thought that people went to doctors because they were not experts and did not know what was wrong with them, but when it was explained to me that the programme was about long-term management and ownership of treatment, I accepted that it was very useful and kept patients from constantly needing to have recourse to the doctor.

Drug management is better than ever before, as are drugs. Specialist nurses are in the community and expertise is cascading out of the acute hospital and down to GP level where it is more accessible. Equally, I could point to advances in acute service and the treatment of acute conditions. There are more rapid interventions; we all know about our highly skilled ambulance service and how well kitted out they are to deal with almost any eventuality. More sophisticated interventions are available in hospitals—perhaps not in all, but in many—as well as less invasive interventions such as keyhole surgery. Procedures are done on an out-patient basis that might have led previously to a long hospital stay.

Progress has also been made in dealing with the natural hazards of life, such as maternity. Better pre-natal and post-natal care have shortened hospital stays; that certainly shows up in statistics. For conditions such as senility, supported living has reduced the need for institutional care. As always throughout history, though, many of the big effects, benefits and challenges to the therapeutic sector come from the public health sector. The modern demons of obesity, drunkenness and smoking are fast replacing the ancient demons of poor sanitation and insufficient nutrition.

I think that the outline account that I have given of the development of medical services would generally be agreed with. I do not think that anybody will dispute it. More contentious are the conclusions that should be drawn from it. One contentious conclusion is that we need fewer hospitals, that we need hospitals to do less and that we need to centralise facilities. That is the Government subtext to this debate. It is ostensibly about medical development, but it is actually about rationalising clinical provision and reconfiguring service.

Yes. It normally does. It is not a political message that is easy to sell. Quite evidently from Members’ testimony here, it leads to massive protests, loss of political support for the Government—as is manifest in the polls—and public anxiety. The Government could conclude that they need to find a better way to put the message—to refine it and deliver it slightly better, because somehow or other, people are not getting the point. Perhaps we must be told that it is not about cost, even though we know the stories about deficits and we know how deficits influence decisions, and that it is not about politics, even though we know the stories about heat maps and how Ministers agonise about the political effects of what they do.

We know the Government’s story that it is not about fewer hospitals but about more community care, and we know that research has been published saying that that policy will save more lives. The Institute for Public Policy Research said that if super-hospitals provide most service, it will save something like 1,000 lives. Quite how it manufactured that figure I do not know, but it did. When stuck, the Government will even say, “Doctors want it.” Well, some doctors do. Sir Liam Donaldson said:

“Doctors need to take charge. Many of them privately see the need to make changes, but they feel intimidated when faced by the public waving placards.”

The Government could seek to refine its message. That is a strategy that they might wish to pursue, but I regard it as entirely doomed. It will not work; it is totally impossible, and it will not benefit them in the least at the end of the day. If the Minister is wise, he will be thinking of a better or alternative strategy.

Cost cannot be kept out of the equation. It was proposed recently that accident and emergency services should move out of my constituency. It did not happen—the medical people objected to it—but the people who proposed it were not go-ahead clinicians who saw a new way to deliver effective services. They were McKinsey & Company, the consultants who had been brought in for a few weeks to investigate how to save money.

Politics cannot be kept out of it, or why would heat maps have been debated? The Government cannot specify the benefits of community care when it is relatively undeveloped and patchy at the moment. Blood testing in one of the hospitals in my constituency has been moved out of the ward and into a clinic. Fine, but the clinic is at the end of the constituency. In terms of accessibility, it is no better than the hospital was. People find it more difficult to access the blood service than they did when it was at the hospital.

Not all doctors are, like Sir Liam Donaldson, on side or on message. One has only to look at the constant stream of British Medical Association press releases to realise that. Even the argument that lives will be saved rather than lost is a little flaky. One cannot argue, as Dr. Roger Boyle does, that it makes a huge difference that 83 per cent. rather than 38 per cent. of heart patients now receive hospital treatment within30 minutes, and then argue that it makes little difference how long it takes to get to the hospital. The Government cannot have it both ways.

I suggest that, rather than refining the message’s delivery or constructing a better way to present unacceptable policy, the Government should seek to re-examine the message itself. Public instincts on matters as basic as health are rarely far off the mark. Paradoxically, the Government trust the public to choose between hospitals with choose and book, but do not trust them with any voice in how health facilities are configured. That seems to me a fundamental mistake. I believe from some experience of such issues that the public are not stupid. They can grasp what a sensible clinical audit is about. They know that hospital stays are shorter, but they also know that people are getting older all the time. If maternity and geriatric services are stripped out, it does not result in a sharp decline in the acute provision so much vaunted by organisations such as the NHS Confederation.

The public rely on consultants and hospital administrators in some circumstances but know that they are not immune to special pleading and have individual preoccupations—the former with training and professional status and the latter with making the sums add up and pleasing the Department of Health or the SHA. Furthermore, the public really understand any point one wants to make about distance. They are prepared to travel to wherever is necessary when life is at stake, but they do not want to travel miles for triage, basic treatment and competent reassurance.

The public also do not want the health service to be indifferent to the journey that they make to treatment in the first place. To cite another example from my constituency, back in 2003, children’s A and E was moved nine miles out of town. Parents were puzzled as to why when something had happened to a child, it had to be dealt with by making an unnecessary nine-mile trip past an A and E department in an all-singing, all-dancing general hospital, whether the child had fallen on a beach or at school, or whatever, with the mother traumatised by the experience. That decision was not even consistent with Sir George Alberti’s general remit and instructions, and was shored up by duff clinical advice. I can remember standing outside the building in question with a sign saying “Treat children in Southport—20,000 people can’t be wrong”, which was how many people had signed the petition. Those people were not wrong, and that was acknowledged later.

There is no alternative for the Government, unless they go ahead kamikaze-like with their doomed strategy, to having a real dialogue with the public. That should not involve a lecture to the public or a tutorial, but it should mean genuinely allowing the public into the debate, although not in involvement forums, which are simply not good enough, as sham consultees or even as consultees at all. We should be looking soon to creating a place for the public as decision makers in their own facilities.

This has been an extraordinary debate, with an extraordinarily confused Minister. At the end of it all, I still do not really know what it was about. The Minister spoke for 71 minutes—at one stage, I thought that he would move seamlessly into the winding-up speeches, and we still have another 10 minutes to come.

What did the Minister come here to show? Why was this debate put on the agenda, with not a single Labour Member being prepared to come and support him? Not even his own Parliamentary Private Secretary came and the Whip abandoned ship halfway through, while no Liberal Democrat Back Benchers were prepared to come and speak up for their constituents on what is probably the most challenging and important issue in all our constituencies. I have never seen a debate like this in Westminster Hall before, in which not a single Member of the governing party, in the Government’s time, was prepared to come and support Minister-no-mates.

The Minister’s contribution, amazingly, was more about the Conservative party, ancient history and accusations against us of scaremongering. My 11 hon. Friends who turned up did not do so to scaremonger, but to represent the genuine fears among our constituents that have filled our postbags for many months now. The Minister then tried to challenge us on the 29 A and E departments that are under threat of closure or downgrading. He confused Truro and Penzance, and could then only come up with Calderdale. It is a long way from Calderdale to Cornwall, but he was not prepared to grant the safety of those other 27 A and E departments on the list, such as in Eastbourne, or at the Conquest hospital, St. Richard’s hospital in Chichester, Worthing and Southlands hospital or the Princess Royal hospital. They are all in constituencies represented by hon. Members who took part in this debate.

The Minister was also very good at recycling, because he gave the same speech that Lord Warner gave a week ago; but Lord Warner was wrong last week and the Minister was wrong again today. The ignorance that the Minister showed was deeply worrying. We never got the difference between clinical and medical explained. At one stage, he clearly did not know the difference between A and E and maternity departments. He also said that liver disease was caused by what people ate. That is a new one on me. If the Minister had had long enough, he might have claimed that statins were invented by him.

In the past eight years, under this Government, the health improvement outcomes in heart disease and cancer, for instance, have not been as good as they were in the previous eight years. The improvement has been gradual over many years; it has not been brought about by the Government. The Minister produced no evidence at all to back the reconfiguration proposals that his henchmen in the SHAs and PCTs are now undertaking.

The biggest insult of all was on small maternity units, where there is no evidence to suggest higher rates of perinatal mortality. It is an insult to all the dedicated staff who work in those smaller maternity units in our hospitals throughout the country to suggest that there is a higher rate, but the Minister came here without a shred of evidence to back up that claim. This is a Minister who is in denial, and he is from a Health Department in denial about the real damage that it is causing—not our scaremongering—by its refusal to hold public consultations out in the open, to engage people properly and then to listen to them properly. That is where the scaremongering is going on.

We are not against change, but we are against change that is based on a false premise, not on evidence, and that is clearly driven by financial expediency caused by the complete mess of the NHS’s finances that the Government have brought about at a time of record investment in the NHS.

When we came to this debate was it to be told about the Health Committee’s report to which my hon. Friend the Member for Hemel Hempstead (Mike Penning) referred? That report said that the problems in the NHS were down to

“the contribution of the funding formula, the effect of Government policies, poor management by the Department of Health and poor local financial management.”

Were we supposed to have explained to us the gross financial deficit in the NHS, which is forecast to be £1.2 billion this year, following the £1.3 billion last year? Well, we did not get that. Was the Minister going to tell us about changes to the financing formula? Again, no. He was completely in denial about the extra costs associated with older people, which is the very reason why we have such a problem with deficits in our part of the world.

Did the Minister come here to respond to the charges that we have made about maternity units, which are that one in six maternity units faces closure, downgrading or transfer? He did not get on to the list of 49 units at all—again, no safety was granted to any of those, and no evidence based on any research was presented.

The Minister also said nothing about public health, which has been a cause for changes over recent years and on which the Government’s record has been an absolute disaster. There was no mention of mental health or health inequalities, which have worsened under the Government and which are always a reason that he and his colleagues give for the variations in the funding formula that Militate against people in the south-east. He knows that he has failed to do anything about health inequalities.

I should like in the few minutes that I have left to return to my part of the world. It is not unusual that seven of my hon. Friends who represent Sussex constituencies have been present during this debate, because the entire health economy and NHS in West Sussex and East Sussex faces an onslaught. Again, is it not noticeable that there are no Labour MPs from constituencies in Brighton and Hove, whose Royal Sussex county hospital stands to gain patients if we lose our department? There are no hon. Members here from Hastings, who stand to gain if Eastbourne is a victim of the cuts in that trust.

My hon. Friend may not have noticed yet, but the primary care trust in question put out a press notice today with a photograph of the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), with one of the only Labour MPs in Sussex looking at some initiative, rather than dealing with what we are dealing with.

Absolutely. It is also noticeable that the Minister of State visited Crawley earlier this week and that the Secretary of State visited Brighton a few weeks ago, but neither the Secretary of State nor any of her team at the Health Department have visited any other hospital in Sussex, Hertfordshire or my hon. Friend’s constituency, despite the fact that we are the most under threat. The Secretary of State has also refused to meet my hon. Friend and me; we wanted to deliver hundreds of Christmas cards, sent with the good will of the people of Worthing and the rest of West Sussex, to send her Christmas wishes and ask her to ensure that our hospitals are safe. She will not even receive those from our constituents. Ministers are in denial and blind to the problems that the NHS faces in our part of the world.

It is for those reasons that the public have taken to the streets in unprecedented numbers, in Worthing, in Chichester and at the Princess Royal hospital—as my hon. Friend the Member for Arundel and South Downs (Nick Herbert) said, my hon. Friend the Member for Mid-Sussex (Mr. Soames) would have been here today. It is for those reasons that the local media—Splash FM radio station in Worthing, the Worthing Herald, Meridian TV and BBC South—have been at the forefront of the campaign, day in, day out. They have not been inventing scaremongering stories, but reacting to the real fears of their listeners and our constituents. Thousands have taken to the streets; the “Nurse Sunshine” campaign in Worthing and mid-Sussex has caught people’s imaginations.

Worthing is the largest town in Sussex, with a population of more than 100,000. It will have many more people in the next few years because of the house building targets imposed on us by central Government. Ten years ago, the last Conservative Government greatly expanded Worthing hospital; it is ironic that this Labour Government threaten to be the one to downsize our hospital in the largest town in Sussex, and possibly close Southlands hospital altogether.

It is pretty ironic for the Minister to call time, given that he spoke for 71 minutes. The Government are already in negotiations with a property management company to take over the site of Southlands hospital. Will he comment on that as well?

The consultants at Worthing hospital have made it absolutely clear that they believe that the proposals will cost the lives of people in our town. They have said that the closure of acute services at Worthing hospital will result in patient deaths as a result of the inter-hospital transfer of sick patients. Do the Government care? We have had little evidence of that. When the excellent Tom Wye—the mayor of Worthing, who heads the KWASH campaign—wrote to the Prime Minister, the Prime Minister’s office wrote back to say that the matter had been referred to the Department for Transport.

The Government are in denial and out of touch. If the Minister will not listen to us today, for goodness’ sake he should answer the letters, come down, see the petitions and listen to the people.

Contrary to what the hon. Member for East Worthing and Shoreham (Tim Loughton) said, I think that we have had a good debate about an important issue that is real for many of us in our constituencies. The hon. Member for Arundel and South Downs (Nick Herbert) said that I was patronising people with talk about getting out placards. I was not; I realise that the issues are real.

The hon. Member for Arundel and South Downs asked about a real issue that affects his constituents. I understand that and know that there is strength of feeling; I accept that from the hon. Member for East Worthing and Shoreham too. There is real feeling because the consultations and changes are real and will affect the hon. Gentlemen’s constituents. I understand the strength of feeling today.

However, I make a distinction between that and scaremongering, a phrase that all Opposition Members here have used. Yes, I make a distinction between real proposals—real, live, happening consultations—and other suggestions made for party political gain. The hon. Member for East Worthing and Shoreham asked about 29 A and E departments. His people may not have spoken to the NHS, but we have. He asked for more examples. I shall give them: Buckinghamshire hospitals trust, Calderdale and Huddersfield foundation trust, George Eliot hospital trust, Good Hope hospital trust, Gloucestershire hospitals trust, Oxford Radcliffe hospitals trust, Royal Cornwall hospitals trust, Royal Free Hampstead trust, South Tees hospitals trust, South Warwickshire general hospitals trust and Whittington hospitals trust. They all categorically deny what the Conservative party said in its material last week. In my book, that was scaremongering. I draw a distinction between that rubbish and the real proposals affecting Opposition Members, who have spoken fairly, passionately and rightly about real changes in their constituencies.

The Liberal Democrats are not exempt. They know—perhaps other Opposition Members do—that such rumours and scare stories can win parliamentary seats. That is why they created a rumour about the Christie hospital in Greater Manchester before the last general election. That was groundless, but done to generate political support.

I will not.

Sadly, that tactic was successful. People should not play politics in that way with such issues.

Opposition Members sought to get going another rumour, about Penzance, during this debate. There has been speculation, but the trust has reinforced the point that it is only speculation and that there are no plans or procedures in place for changes in casualty cover to occur. Will those hon. Members please stop generating groundless rumours designed to cause anxiety among the general public? It is high time that they dropped that, and sharpish.

I turn to funding figures, as lots of Opposition Members spoke about the funding formula—rightly, because it is an important issue. This financial year—[Interruption.] The hon. Member for Hemel Hempstead (Mike Penning) is waving a booklet at me. Let me tell him this: average per-head funding in the NHS this year is £1,274. That cannot be denied; it is a fact.

Let me read out some figures for some of the constituencies of Members here today. This financial year, the PCT serving Worthing is funded at £1,389 per head, above the national average. The PCT for Bexhill and Rother has £1,445 per head, significantly more than the national average and close to the highest per-head funding in the country. The hon. Member for South Cambridgeshire (Mr. Lansley) said that there were real health needs in his constituency. That is a fair point, and I accept it. His PCT gets £1,432 per head this financial year, compared with a national average of £1,274.

I am afraid that bleating about the health funding formula will simply not wash. The hon. Gentlemen should read the facts and figures before they head into large, sweeping statements.

I will not; I have other points to answer.

Denial has nothing to do with it; those are the facts and figures. The hon. Gentlemen should read them before coming to debates such as this and making large claims for which there is no basis.

The hon. Member for Worthing, West (Peter Bottomley) raised questions about the resource allocation budget formula. That is a fair point. We have said that we will look again at the case for reversing the impact of past RAB reductions. That will be done only on delivery of financial balance in the NHS in 2006-07. No funding will be allowed to do that immediately. To respond to another point, yes, the NHS will achieve financial balance this year. It will balance overall, and at that point we can consider what steps can be taken on the application of RAB.

The hon. Member for Eastbourne (Mr. Waterson) talked about the funding formula. I hope that I answered the point. He and the hon. Member for South Cambridgeshire talked about maternity and the evidence on big versus small units. That issue is not politically driven. There is clinical evidence that 24-hour cover by obstetricians and specialist anaesthetists, where that can be given, provides a safer service. I am not saying that there must be one or the other. Of course, there can be a balance and we can offer choice. However, there is evidence that that is not a political debate that we are trying to push on to the health service.

The hon. Member for Arundel and South Downs made some fair points. Again, I agree. I do not seek to dismiss the real concerns in his constituency about some of the changes. I made a point about leadership and people explaining things clearly, and that is exactly what we do. The changes are important and let us put the evidence before people. I agree that the changes should be evidence-based. I shall be happy to meet him to discuss those matters further. He asked whether there was evidence that staff had been banned from talking to the press. We have checked with the strategic health authority, which categorically denies that and says that that can be put on the record.

The hon. Member for Hemel Hempstead made a fair point. I respect his opinions on the health service, as he is a good member of the Health Committee and I listen carefully to what he says. There is a difference between an individual expressing in their professional capacity an opinion on a proposal in the public domain and the placing into the public domain of private information, which can exist within any organisation. Any organisation sometimes has information that is not for the public domain. On the former issue, I wholeheartedly support the right of any citizen of this country, regardless of where they work, to pass comment and express their opinion to their Member of Parliament or the press about a live proposal affecting services in their area. I am happy to make that abundantly clear on the record.

The hon. Member for Bexhill and Battle (Gregory Barker) made a point about the letter that he had received from a consultant at Conquest hospital. I listened to him carefully and understood his points. I must stress that the Alberti document is not predicated on the notion that more specialist regional or sub-regional centres mean the closure of local services. As I said to the hon. Member for South Cambridgeshire, it may mean that the A and E does something slightly different or has a different work load. It is not necessarily about one or the other. I hope that the hon. Member for Bexhill and Battle will take that back to the constituent whom he quoted.

I apologise to the hon. Member for Hemel Hempstead. There are two consultations in Herts, obviously. He picked me up on that point, and I would not want to confuse him. Proposals for the east and north will come forward in the new year. Clearly, they will be a matter of considerable further debate.

This debate has been good, Mr. Illsley. There has been a robust exchange of views, as there should be on such important issues. However, we are confident that we are making the right changes. We are right to give backing to health service professionals when they want to take through change that will ultimately benefit patients’ lives.

It being half-past Five o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.