First of all, Miss Begg, may I ask you to convey my thanks to Mr. Speaker for permitting me the opportunity to raise this issue in the Chamber this morning? On countless occasions, I have occupied the Chair that you occupy now, Miss Begg, as Deputy Speaker here, but this is only the second time that I have availed myself of the opportunity to raise an issue from the Floor. In doing so, I am rather pleased and relieved that my hon. Friends the Members for Stockton, South (Ms Taylor) and for Hartlepool (Mr. Wright) are in attendance. Hartlepool is my home town. I managed to escape the rope—I do not know whether he will, but I wish him well. However, I thought that one or two other Members might have attended because although the issues I am raising relate directly to that area in the north-east, I shall make some comments on the general reorganisation of the health service.
Perhaps the easiest way to achieve my aims this morning is to approach the matter historically—rather than hysterically, which I am afraid is how far too many comments have been made in the past, without true regard for the facts. I suppose that I have been concerned about the hospitals involved ever since Frank Harsent was rejected as director, which goes back some years. We had some very troublesome exchanges when trying to mollify the acrimony between my home town of Hartlepool and my adopted town of Stockton. My hon. Friend the Member for Stockton, South will remember some of those episodes with tinges of regret, as do I.
The aspect of the saga that concerns us now, however, really started with a phone call that I received when in the USA in the early months of 2004 from Sue Coward who told me that during the by-election, in which my hon. Friend the Member for Hartlepool was thankfully elected, voters were being terrified by claims from the hyenas of the political savannah—the Liberal Democrats—that Hartlepool general hospital was under threat of closure. That was a downright lie, and they knew it, but as ever that did not stop them propagating inaccuracies.
I was so concerned that I phoned the chairman of the primary care trust, the leader of Stockton borough council and my contacts in Hartlepool and alerted them to it. That resulted in the Home Secretary, who was then a Health Minister, and the Prime Minister, issuing statements saying that Hartlepool general hospital was not under threat, which of course was true. Nevertheless, that campaign went ahead, but my hon. Friend won the day and the Liberal Democrats were discredited by their false accusations.
The outcome was that the Tees review conducted by Ken Jerrold under the chairmanship of Tony Waites was put on the shelf and almost allowed to gather dust. Professor Ara Darzi—a noble man, and I will not hear a word said against him—was given the task of making sense of it all. His remit was that first he should read Ken Jerrold’s review and then recommend measures to preserve Hartlepool general hospital. That was an astonishing instruction bearing in mind the fact that the hospital was not under threat of closure.
Professor Darzi set about his work with a will, and quickly produced a report that could have been submitted, but it was then thought by elders and betters that it might be a bit embarrassing if it was announced before the general election. At that time, my hon. Friend the Member for Hartlepool was already sitting with us on the green Benches and contributing effectively to our debates. There was a worry, though, because a general election was in the offing, so it was thought that it would be better if the report was published afterwards, but the later publication had to be justified, so the idea was proposed by a gentleman whom I shall not name to extend the terms of reference to include the James Cook university hospital and the Friarage hospital in Northallerton.
That was done, and finally we got the Darzi report, which was a magnificent piece of almost critical path analysis—it had arrows going left and right, and Departments going here, there, up, down and all around. It was beautiful, and to the uninitiated it looked convincing, but to the medical profession I am afraid that it was an outright disaster. Many have said that and many have acted on it: we lost an outstanding orthopaedic surgeon called Mr. Miller, who moved to Liverpool because he was unhappy with what was happening—although he still comes back to Teesside to get his hair cut. We lost an eminent paediatrician and gynaecologist who went south. I happen to know also that an anaesthetist with 30 years’ service at the hospital is looking to finish his professional career elsewhere. They are all excellent senior men disturbed by the Darzi proposals.
Staff at the James Cook university hospital south of the river were not disturbed at all. In professional, collective unanimity they said, “It’s not going to happen and we’re not going to participate.” The Darzi report as it was first presented was doomed to failure from the outset, because the medical profession would not have it. Now we are left with a residual concern manifesting itself in the pages of Hartlepool’s local press. It seems that there is still a fear that the hospital is under threat of closure. I state quite boldly that it is not under threat of closure and never has been, and—as people will hear from the words that I shall utter this morning, if I am allowed—it never will be until such time as it collapses into a pile of dust.
Agencies in Hartlepool are seeking to acquire the maternity and paediatric services at the University hospital of North Tees, which has an excellent maternity and paediatrics unit. It is a centre of excellence—so much so, in fact, that it was opened six and a half years ago by none other than my right hon. Friend the Prime Minister, accompanied by his good lady, Mrs. Blair. North Tees’s record is superb—indeed, it is second to none—because right next door, in the same building, are the emergency surgical services that are necessary to take care of cases that might go awry, when mother nature gets awkward. Hartlepool wants to take that unit, yet it does not have the emergency surgical services. There seems to be a hiccup—is that the word?—or at least a glitch in the logic being applied. To take a unit on which millions of pounds have been spent and convey it 12 or 13 miles to the north-east, where it will not have immediately to hand the necessary back-up services that it has at North Tees, is frankly madness.
If we consider the proposal in terms of demography, it is even screwier. Hartlepool is my home town, and my family still live down there. According to the figures for 2005, the population of Hartlepool is 90,000. That is a lot of people—or at least a lot of Hartlepudlians. They are formidable one by one, so 90,000 of them can be a real problem, although I am sure that my hon. Friend the Member for Hartlepool realises that. However, the same figures, from the Office for National Statistics, show that the population of Stockton is 186,700. In other words, it is more than twice the size. Yet we seek to remove the maternity unit from the larger area and take it to the smaller one. That is another glitch in logic.
My hon. Friend the Member for Stockton, South and I have also recognised already that because of the distances involved many of her constituents will not naturally and instinctively make a beeline for Hartlepool. There is nothing wrong with Hartlepool, by the way—I want to survive the rope as well. For some of those constituents, Hartlepool is a distance of between 19 and 21 miles. They will make a beeline for the James Cook university hospital of South Tees, south of the river. I have known the Minister for many years and hold her in high regard. She is an intelligent lady and will not need me to tell her that the James Cook university hospital is already in serious trouble, with saturation of medical cases, and has overspent to a mega degree. It is a wonderful hospital, by the way. It has saved my life a couple of times—much to the consternation of some of my Labour party colleagues—and I hope that it will continue to do so, but it has hugely overspent. However, the people from Stockton, South will make a beeline there simply because it is 15 miles closer than the hospital in Hartlepool
The whole idea of even considering moving the maternity and paediatrics unit from Stockton to Hartlepool beggars belief. I just cannot understand it. Hartlepool has never been under threat and it never will be. Why will it not be under threat? Let me try to put the matter in military terms. When our young men and women are in a firefight and get wounded in a foxhole, their first port of call is the person next to them—the person sharing the foxhole—or they shout for a stretcher bearer. That person comes along with their casualty pack, and might give the victim a shot of morphine, put on a tourniquet and bandage the wound up. That is primary health care.
The next step is to get the casualty removed from there to secondary care, which is usually a mobile army surgical hospital. As a matter of fact, I am going to visit one of those units tonight, here in London. It is a unit that has been used more than any other unit throughout the Iraq and Afghanistan campaigns. Those units perform wonderfully well and I pay all tribute to them. The casualty is moved from primary care to secondary, to the MASH. Having received attention there—successfully, I hope—they undergo CASEVAC, or casualty evacuation, to a tertiary hospital, probably in Frankfurt or in this country.
The health service is having to adjust its structure to a similar pattern—not identical, but similar. We are developing primary provision, through our paramedics in ambulances, our nurse practitioners in GPs’ surgeries, and GPs themselves. That must be the pattern throughout the country. The GPs, the nurse practitioners and the paramedics in the ambulances in the north-east perform so well already and will perform even better as we develop the service to its full potential. I suggest that they will provide the primary care and that Hartlepool university hospital will provide secondary care, as will the North Tees university hospital in Stockton.
However, our constituents who need more specialised attention currently have to go south of the river to the James Cook university hospital, increasing the congestion there, up to the Royal Victoria infirmary in Newcastle or down to Jimmy’s in Leeds. Those two hospitals will provide secondary care, so what are we going to do for tertiary care? Are we going to depend on the James Cook, the RVI or Jimmy’s too? That does not make sense at all. I suggest, as I have suggested many times before, that in seven, eight or nine years’ time, regardless of what happens tomorrow, we are going to need a tertiary hospital north of the River Tees to take care of the larger communities of Stockton and Hartlepool. There is no doubt in my mind about that. Mark my words: it will happen because it has to happen.
I have been talking for about the right amount of time, but I will take a couple of minutes more if I may. I would ask the Minister to take the advice that I offer to her Secretary of State. Tell her to ignore the dust storm that has raged for so long as a result of the Darzi report and to let that dust settle. If it settles in a manner that buries the report—without burying Professor Darzi, of course—I will be a happier man and the world will be a safer place. However, if the dust does not bury the report, I urge the Minister to advise the Secretary of State to put the issue of maternity and paediatrics on the highest shelf, out of anybody’s reach, and forget it. She should then take down the Tees review, so ably completed by Ken Jerrold, and praised so highly by every medical authority that read it that it took my breath away. She should look into that report to see what we can put in place to resolve the problem, if it still exists. I do not think that there is a problem; we should leave the issue of maternity and paediatrics as it is. Hartlepool has a pretty good maternity and paediatric service anyway; why would we want to add to it when we have only half the number of people?
Hartlepool’s advocates will say, “Hartlepool is not just Hartlepool—it includes Blackhall, Easington and Horden,” but Stockton has similar surrounding areas. Not only that, but the town has developed enormously to the south since the 2005 figures were published. It is now developing along the A66 towards Darlington. Its population is far larger than 186,700.
The Secretary of State should look carefully at the Tees review, which is much more sensible. Ken Jerrold was in place for years. Professor Darzi is a very bright man, but he had little time and a bowdlerised remit that had been changed for him. That was not his fault; other people changed it—I do not want to get too heavily into that, but it was not very wise.
The Tees review is valuable because its first priority is patient care and community need, which is where we should have started in the first place. Sadly, however, the Lib Dems changed the argument right from the start, saying that there was a threat that Hartlepool hospital would close. It has not and will not, regardless of what the hyenas say.
All Members involved have received a letter from Peter Carr of the strategic health authority, which states:
“You are aware that the Secretary of State for Health, in August 2006, asked the Independent Reconfiguration Panel to undertake a review of maternity and paediatric services in Teesside following representations made by local authority overview and scrutiny committees…..there is a possibility that the results of the Panel’s work and its advice to the Secretary of State could be published at the end of this week.”
I wonder whether we will hear something to that effect later in this debate. The letter continues:
“Whatever the Panel advice…it would be helpful for David Flory and I to meet with you to discuss the outcome.”
I have arranged for representatives of the strategic health authority to come to my office first thing on Friday morning, at 9 o’clock or half-past 9, to discuss the issues. My hon. Friend the Member for Stockton, South has agreed to be there, and I invite my hon. Friend the Member for Hartlepool to join us, although the authority would meet him separately anyway.
If the issue is not resolved in the sensible way, the electoral consequences in Stockton will make those in Hartlepool seem like nothing. Frankly, Stockton’s reaction will be indescribable. There are other things to be said, but I leave that to my hon. Friends. I thank hon. Members for listening.
I congratulate my hon. Friend the Member for Stockton, North (Frank Cook) on securing this debate. A couple of weeks before Christmas, I secured an Adjournment debate in the House on maternity and paediatric services in Hartlepool. During that, my hon. Friends the Members for Stockton, North and for Stockton, South (Ms Taylor) and I had a number of clashes, and I look forward to something similar today.
I do not want to talk about Professor Darzi and the independent reconfiguration panel’s look at maternity and paediatric services. They carried out a series of consultations. I was interviewed twice, and I understand that they provided their report to the Secretary of State for Health on 18 December. As my hon. Friend the Member for Stockton, North mentioned, it is anticipated that the report will be published some time this week.
In Hartlepool on Thursday, there was a meeting attended by members of the public and the chairman and chief executive of the North Tees and Hartlepool NHS trust, during which the first phase of Darzi’s recommendations was discussed. Patients and clinicians universally recognise that the first phase has been an immense success since it was introduced on 14 December, and there is no reason to suggest that all Darzi’s recommendations would not have similar success. I shall come to that.
I want to talk about the provision of health services in general. In all parts of the country, health services should be based on clinical safety, best practice and specific local considerations and wishes. The residents of Teesside deserve no different from those in other parts of the country; indeed, there is a strong argument that because of our legacy, the people in our area deserve better than average.
People who design health services for my area need to be aware of, and take into account, the specific geographical, historic and demographic factors that demonstrate that in Teesside one size of health service provision does not fit all. On the Order Paper, the title of this debate is “Provision of health services on Teesside”. However, in many geographical, administrative and—most crucially—psychological respects, Teesside does not exist. Although the towns of Hartlepool, Stockton, Middlesbrough, Darlington and Redcar and Cleveland occupy a relatively small geographical area, they are very distinct and have proud and separate identities of their own.
It is significant that in many areas there was very little public support for Cleveland county council. Since its abolition and the establishment of unitary authorities in 1996, coupled with the election of a Labour Government the following year, all areas in the sub-region have improved. Co-operation takes place between the local authorities, but autonomy remains important because of local considerations. Centralisation has been avoided—perhaps health bureaucrats could take heed of that.
Hartlepool has a particularly distinct identity, although I would say that. It is compact and separated geographically from other parts of what is known as Teesside. In addition, in the past few decades population growth and migrant flows into the town have tended to come from south Durham—the former pit villages of Blackhall, Horden and Easington and the new town of Peterlee—rather than from the Teesside area.
There are many family ties between Hartlepool and south Durham, and as my hon. Friend the Member for Stockton, North said, the university hospital of Hartlepool not only serves Hartlepool’s population of 90,000 but is the major hospital centre for the 50,000 or so people from Easington and south Durham. My hon. Friend the Member for Easington (John Cummings) could not be here today—he is performing a duty similar to yours, Miss Begg, in another part of the House—but he suggested that I mention those issues on behalf of his constituents. When we have taken those issues into account, we need to consider taking health provision northwards, not only into my town but into Easington. That applies particularly in the new era of “choose and book”, in which family ties, which help patients who have had hospital treatment to recover, will be a major consideration.
It is unfortunate for health bureaucrats that population areas do not come in neat bundles subject to clear administrative boundaries. Professor Darzi rejected an option that I shall mention in a moment, but now that it appears that all of Darzi’s recommendations are up for grabs, I will say that there is a strong case for reconfiguring NHS trusts in the area to reflect local health considerations, with greater ties between Hartlepool and Easington, to tackle the acute health inequalities. I suspect that more people in my constituency would feel at ease with and have greater loyalty to a Hartlepool and South Durham NHS trust than to the current arrangements.
That distinctiveness and sense of geographical separation is heightened by the transport infrastructure in the area. As my hon. Friend the Member for Stockton, North said, Hartlepool and Stockton are about nine or 10 miles apart. That does not seem far, but it is actually much further than it appears. Public transport between the two towns and between the two hospitals is poor. In many ways, the A689 and A19 cut off Hartlepool from the rest of the Tees area, and the A19 is frequently crowded. If plans for economic expansion in the sub-region come to fruition, particularly the growth of Wynyard, the road—in particular the stretch between Wolviston and Norton—will become even more congested. That will not help achieve the objective of local and accessible health services.
In addition, car ownership in my constituency is about half the national average, which causes problems for people travelling to hospitals or visiting relatives and friends. I fully acknowledge that there are similar rates of car ownership in neighbouring constituencies. My hon. Friend the Member for Stockton, South told me last week that 40 per cent. of households in her constituency do not have access to a car. That makes my point that it is difficult for people throughout the Tees area to access hospital services in other towns. A distance of some nine or 10 miles does not seem far, but somebody who has to attend an appointment in a hospital outside their town, whether it be Hartlepool or Stockton, will find the journey time-consuming and stressful. It may require two or three bus changes. Some people sneer at that, but for some of my constituents an appointment at North Tees hospital might as well be on the moon.
I am not taking issue with what my hon. Friend is saying, but I want him to carry on to a much more pertinent aspect. I agree that there are travel problems, but why does he want more maternity, gynaecology, obstetrics and paediatrics services at his hospital, which already has them? Why does he want to take from Stockton to put in Hartlepool?
I said that I would not discuss specific Darzi recommendations but deal with health provision in demographic, geographic and industrial terms. The point that I tried to make in my Adjournment debate on 11 December—the point that I put to my hon. Friend then—was that Darzi had come up with a set of proposals that sustained all hospitals in the area, not only the University hospital of Hartlepool but the University hospital of North Tees and also James Cook. He did that by proposing a model of regional centres of excellence that takes into account the need in the modern age to recruit and retain staff to allow technical specialist teams to build up expertise, and to ensure that patients are served as well as can be expected.
It appears that my hon. Friend is suggesting that a centre of excellence should be taken from Stockton and given to Hartlepool. That seems nonsensical, because millions of pounds have been spent on Stockton, it has more people, and in any case it is already doing a good job for everybody. He wants more of those services in his own town, but that seems illogical.
A fundamental point is that members of the same political party oppose each other on this issue. Frankly, I believe that there is an inconsistency at the heart of Government policy on hospital and health reconfiguration. Ministers and strategic health authorities say that the provision of local health services is a matter for local consideration—Ministers do not want to get involved in a devolved NHS—and I accept that, but it is inconsistent with the push towards centralisation of technical services.
The result is a situation such as that in Teesside, where centralisation means that services that previously were provided on both the North Tees and the Hartlepool sites should now be provided on one site, for technical and clinical safety. Given that the local NHS takes into account the needs and wishes of the population and decides what the provision of services should be locally, how does one square the circle? I do not quite understand the inconsistency. We are all doing our job of standing up for our constituents, but in an era of increasing specialism and centralisation, how does the policy marry up with the idea that local people should be able to choose the nature of health provision? I do not believe that that has been fully resolved.
Teesside was one of the first areas in the world to experience the effects of heavy manufacturing industry. Until relatively recently, it was the home of many steel and iron works, engineering firms and shipbuilding yards. It still retains a position as a centre for chemical engineering. Indeed, Teesside, particularly the area of Seal Sands, which spans my constituency and that of my hon. Friend, remains the area with the highest concentration of heavy and chemical industry in western Europe. My constituency is also the site of a nuclear power station.
There are two distinct but separate reasons why that industrial consideration, both past and present, should have a powerful bearing on the provision of health services. First, the legacy of industrial illnesses remains acute and distressing. People in my constituency and surrounding areas still bear the scars, often literally, of industrial accidents and disease. There is a higher incidence of diseases such as asbestosis, vibration white finger and respiratory diseases, and many people’s quality of life is adversely affected as a result of working with hazardous materials and perhaps having been injured while at work.
Secondly, the concentration of industry results in a higher risk factor for my area than for many others. Only this month, a toxic leak at a chemical factory on Teesside—in my hon. Friend’s constituency, I believe—injured 37 people and produced burns, skin irritation and breathing difficulties for those who were affected. The majority of people injured at the scene were decontaminated on site by the North East ambulance service, but 17 people had to be taken to the nearby hospital to be treated. That incident shows the risks to Teesside in still being involved in heavy and complex industry, and demonstrates that my constituency and others nearby require a high level of hospital cover, perhaps higher than comparable areas, to help manage the risks properly.
However, the biggest factor in determining health service provision is undoubtedly deprivation and the links to ill health. Twenty-eight per cent. of all super-output areas in the Tees region are in the bottom 10 per cent. of deprivation in the country. In my constituency the figure is higher, at 40 per cent., and it is 55 per cent. in Middlesbrough. Easington, whose population accesses hospital services in my constituency and in Teesside, has an even higher level of deprivation: all but one of the super-output areas in the district of Easington are in the bottom 20 per cent. nationally.
Hartlepool and the wider area of Teesside face acute challenges when it comes to tackling the effects of decades of ill health. I mentioned in my Adjournment debate last month that life expectancy in my constituency is markedly lower than the English average. Hartlepool males live 2.8 years less than the national average, and females live 2.4 years less, but such statistics mask even wider differences. For example, the life expectancy of a man living in Stranton ward in Hartlepool is just 66 years. That is a difference of 13 years from the most affluent ward, which is also the one where life expectancy is best. Life expectancy is similarly bad for Middlehaven ward in Middlesbrough.
People in Hartlepool do not have a healthy diet, as hon. Members can probably tell. It has been estimated by Hartlepool primary care trust that, across the Teesside area, it has the lowest consumption of fruit, with only 34.4 per cent. of males and 45 per cent. of females eating any item of fruit, let alone five, most days.
The death rate from smoking-related diseases is higher in Hartlepool than the average. That is a direct result of the fact that 40 per cent. of Hartlepool adults are believed to smoke.
Death rates from heart disease, stroke and cancer are significantly higher than the national average. Indeed, in researching for this debate, I stumbled on an Adjournment debate initiated by my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) in 2003 about cancer rates in Teesside. Although the figures are slightly out of date, they remain pertinent and dramatic. If 100 is the national average cancer rate, the standardised mortality ratio for all cancers is 128 for Hartlepool PCT, 123 for North Tees PCT and 129 for Middlesbrough PCT.
For lung cancer among women, with 100 as the national average, the rate is 205 for North Tees, 162 for Middlesbrough and 169 for Hartlepool. More frightening is the fact that the rate for lung cancer for women under the age of 50—remember that this is only recorded deaths, not lung cancer contracted—is three and a half times the national average. That means that women in Teesside are three and a half times more likely to die from lung cancer.
Future demographic changes should also play a major role in shaping health provision. It makes sense that the shape of health services over the next 15 years should reflect what the population of an area looks like. I have in mind what my hon. Friend the Member for Stockton, North said about the growth of Stockton. However, the population of the Tees area is projected to fall, according to the Tees Valley joint strategy unit, by about 2.5 per cent. by 2021. According to the JSU’s forecast, that is largely because people of working age, particularly the younger end of the group, will take advantage of a prosperous economy in London, the south-east and other city regions and will migrate away from the Tees valley. Without appropriate Government intervention, the economic base of the Tees valley will not be as strong as it could be, but that is a whole other debate.
It is forecast that the demographic group of those aged 75 and over—the so-called older retired group—will increase in the Tees area by one third, from 46,300 in 2003 to 63,100 in 2021. The group will also make up a significantly larger proportion of the total population, from 18.4 per cent. in 2003 to more than 25 per cent. in 2021. The increase is vital to the design of public services in the next 15 years, because members of the older group tend to be more infirm and to make larger demands on services, particularly health services. The JSU concluded that
“the total provision of services would have to increase substantially simply to retain the current level of service to this section of the community”.
Yet in my constituency, health services in the community have in the past been poor—a consequence of the lack of investment over the past 40 years. The number of GPs is not what it should be for a town of Hartlepool’s size and for its demands on the health service. Department of Health statistics have stated that Hartlepool has 47.5 GPs per 100,000 weighted population, putting my constituency in the bottom 10 per cent. of primary care trusts with the fewest doctors. I know that the Labour Government have done something about that, making Hartlepool a spearhead PCT with additional funding to tackle the problem of recruitment and retention of doctors, but I am afraid that the theme is all too common in health. The Government are making progress, but we are trying to turn around decades of under-investment.
The underdevelopment of community health facilities over 40 years has meant that we as a town rely far too much on the hospital. The take-up of local health facilities is markedly low, with the consequence that people engage with the NHS only when something goes dramatically wrong with their health and they have to go to the hospital. Admissions to accident and emergency have increased by more than 40 per cent. over the past four years in Hartlepool, largely because it is the only health institution that my constituents and their families have been able to rely on for years.
The use of community facilities, even as they come on stream—which they are doing now—will be slow during the period of weaning ourselves off the local hospital. Last year, I opened an emergency care facility in Owton Rossmere in Hartlepool. That is exactly what the NHS of the 21st century should be doing: providing local specialised care within neighbourhoods. However, within weeks of its opening the facility was closed because of clinical concerns at the PCT about safety. That does not help to embed the vital trust among my constituents that community facilities are operational and work safely and effectively. If anything, the opening and rapid closure of the unit fuels the perception in my town that we should rely even more on the hospital for our health needs. That perception would be wrong and unfair.
Much positive work is being carried out in Hartlepool to try to redress the balance in accessing health in the acute or community sector. The modernisation building programme is encouraging, with work taking place at the Headland surgery, the Owton Rossmere health centre and the planned GP complex in the centre of town. Hartlepool PCT is having real success with such initiatives as its smoking cessation services and its teenage pregnancy reduction strategy. However, even with the record investment provided by the Government, we are still probably a decade or so away from establishing a true network of neighbourhood health facilities in Hartlepool that would enable my constituents to reduce their reliance on the hospital. It is wrong, in those circumstances, and completely contrary to Government policy on choice and on moving health locally, to move access to health care away from constituents before community facilities are up and running.
Provision of health services should be based on all criteria such as levels of ill health and deprivation, infrastructure and projected demographic changes. By any of those criteria, Hartlepool and the wider Tees area need further investment. The first consideration in the provision of health services should be what the people deserve and need. There has been uncertainty about health provision in my area for almost a decade. People are weary of the fight and cynical about whether bureaucrats take their views into consideration when shaping health services: 32,403 people signed my petition about the full implementation of Darzi’s recommendations, which I presented on the Floor of the House of Commons a month or so ago. More people signed that petition than voted for the three main parties in the 2005 general election in Hartlepool. I know that people in Stockton are similarly angry about the possible proposals.
I am concerned, as I mentioned earlier, that communities in my area and hon. Friends in Parliament are fighting each other about the matter. I ask my right hon. Friend the Minister to try to discuss the inconsistency that I consider to be at the heart of Government health policy. When health policy and the provision of health services are meant to be shaped locally, and when communities are against each other, with completely conflicting points of view over that provision, what happens? What do we do? Frankly, I think that the Government need to listen to what all hon. Members in the area say and to ensure that health services are provided that match the needs and aspirations of all our people.
It is always a pleasure to participate in a debate chaired by you, Miss Begg. I want to say a big thank you to my hon. Friend the Member for Stockton, North (Frank Cook) for securing time for us to debate the Ara Darzi report.
My contribution will specifically and solely reference the Ara Darzi report. It will reference the concern that we all share that high-quality medical services should be delivered to our constituents. There has been an overwhelming amount of comment and angry debate about splitting the function of paediatrics, obstetrics and gynaecology in North Tees university hospital so that acute services are performed by one hospital and elective services by another, and about the claim in the Ara Darzi report that an excellent department can retain its excellence, even if it is transferred to another hospital. Those views are both heartily contested, including by me.
No consultant from paediatrics, gynaecology or maternity was ever consulted about the spilt in function. I should have thought that if a split were thought appropriate, the first people who would be spoken to would be the experts who deliver the service. Equally, there seems to be no understanding in the report of the fact that it takes time to build up a medical department of the excellence of these three departments. There is a need to attract competent, complementary staff who work together and respect and trust each other. That takes a long time. It has taken North Tees university hospital a long time to attract such competence and to gain the universal respect of the northern region. That cannot simply be transferred. It most certainly cannot be transferred when no medical consultant has been involved in splitting up the department.
It is not merely about people, but about the technical equipment that the hospital has secured over time with an expenditure of more than £7 million—it is probably nearer £10 million. That has ensured that the department has up-to-date, first-rate equipment of the best standard that can deliver the best to the people who require those services—my constituents and those of my colleagues. Such activity takes place over time, not instantly. There seems to be a belief that sheer will-power and a removal van can ensure the establishment of excellent departments of paediatrics, gynaecology and maternity in Hartlepool, but it would take longer and require more persuasive activity. It would also require further expenditure—probably of £10 million—to secure it. Ara Darzi’s plan was wrong in its conception because he did not ask the people who needed to be asked whether the split in function was feasible.
I am keen to tell the House that the same professor did a report on Darlington and Bishop Auckland hospitals. His recommendation was clear. The outcome of the inquiry was that elective and acute treatment should be kept together. What is so seriously different about North Tees university hospital and Hartlepool university hospital? My hon. Friend the Member for Stockton, North put his finger on it: the professor was given the mandate to save the hospital. It was a nonsensical mandate. There never was a threat––it was a nonsense put about by the Liberal Democrats during the by-election won by my hon. Friend the Member for Hartlepool (Mr. Wright). It persisted because local people passionately want to keep what they have and do not want it closed. Professor Ara Darzi responded to that nonsensical threat, which was whipped up in the press by the Liberal Democrats—and shame on them for doing so.
My concern today is to secure the best medical services for the people that we serve. If they have to travel for half an hour or even two hours for the best, then so be it. As politicians, we should have the guts and the courage to say so. It is time that we acknowledged the fact that there is not always enough money instantly to produce the best. For me, the absolute fact is that we have the best in North Tees university hospital, and I am not prepared to let it be split in two when such a split does not make sense.
I bring to the attention of the House the fact that one clinician has resigned and that others are considering their position. People are saying that the situation is insecure and that they are not prepared to accept it. They are also not prepared to do again the phenomenal work that it took to develop the department in the first place, as they will have to retrace their steps entirely if it is to be reproduced at Hartlepool university hospital. I do not accept that the argument is about the miserably low level of health achievement universal in the north-east, about which my hon. Friend the Member for Hartlepool spoke. I am not prepared to go down that route.
We should understand exactly what Ara Darzi’s report will mean for three departments of excellence. The paediatrics, obstetrics and gynaecology consultants said that they have a very high level of emergency work. They all believe that they should not be moved to an elective site. Are we serious in not taking the experts’ advice when designing appropriate medical services? If so, our constituents will look upon us with disdain. The obstetric consultants emphasised that theirs is essentially an emergency service. They said that it makes no clinical sense for the department to be moved to an elective site, as they usually deal with emergencies.
The paediatric consultants state that, if paediatric services are separated from the acute site, it will require a significant increase in investment to provide round-the-clock cover for paediatric surgery and trauma. A doubling of the staff employed in both hospitals will have to be accepted. They also say that both sites will need a paediatric anaesthetist, and they are scarce. The consultants say that it is difficult to get staff appropriately trained to deal with trauma and emergency operations and that total understanding and competence is required of all consultants and surgeons performing such operations. They also say that running costs will be significantly greater.
The consultants gave me examples. They said that the vast majority of women giving birth need consultant care. Although the majority of women deliver babies without complications, that is not synonymous with doctors having no input. They also say that there will be a high transfer rate between the midwife-led units at North Tees hospital and consultant-led units at Hartlepool hospital. On paediatrics, they said that many decisions can be made only by specialists—for instance, a child suffering from stomach pains may have appendicitis, but paediatric emergency services with surgery competence will be needed if a misdiagnosis is made.
It does not need an Einstein to understand what is required. It is not about ensuring an easy transfer between two hospitals; the journey on the main roads between Hartlepool and North Tees hospitals from 8 am to 9.30 am and from 4.30 pm to 6 pm is seriously difficult. A misdiagnosis might not be problematic, but such a journey might have to be accommodated. A child who had received emergency surgery for appendicitis in North Tees hospital would have to be transferred to Hartlepool for post-operative care. We must understand the problem. For example, a mother with three children may have to travel by bus to see one of them in hospital. Will she be able to see her child in Hartlepool as easily as in North Tees university hospital? I do not think so. We need to consider such services in the round.
The gynaecology service makes the same point. Someone with stomach pains could be suffering an ectopic pregnancy; that could be highly problematic. The last thing we should do is to split acute and elective surgery, as it would threaten peoples’ lives.
Of course, it is not only the consultants who would have problems. The overstretched ambulance service told me that, if it made the wrong diagnosis, the patient could be taken to the wrong hospital. Should the ambulance go to Hartlepool or North Tees? The wrong decision could have a serious outcome.
With the best grace that I can muster, I have to say that the Ara Darzi report, which splits the functions and suggests that we can transfer excellence effortlessly, is wrong. I am delighted that the independent reconfiguration panel has reconsidered it. I must tell the Minister and my hon. Friends that, if I am wrong and if I have misunderstood the information and evidence that I have been given, I will say so. I will accept the panel’s conclusions on how best to deliver the best medicine for the people whom I represent. I believe that I am honour-bound to do so.
My hon. Friends mentioned travelling. I have a large population in the south of my constituency—in Parkfield, Thornaby, Yarm, Hilton and Kirklevington. It probably takes people 20 minutes to get to Middlesbrough by bus, and it would take at least an hour and a half to get to Hartlepool. That is the operational distance. If it takes people 20 minutes to get to Middlesbrough, take it from me, they will not go to Hartlepool. If they do not travel to Hartlepool, we will have a split in elective and acute services and Hartlepool will find itself without sufficient throughput of patients. My people will not go to Hartlepool, and I am not making that up; it is a fact. The throughput will not be sufficient and that department will be vulnerable before it begins its life. I ask for someone to take that on board. It is not just because of the hour and a half journey time or because my constituents have to travel south before they travel north; people face two or three bus changes and may have buggies or young children. In addition, the cost will be three times that to go to North Tees hospital.
The conclusions regarding this issue are wrong because the report was set up with the wrong purpose: to save Hartlepool university hospital. There would never be a threat to that hospital. I would stand on the line protesting with my hon. Friend the Member for Hartlepool if I ever thought that there was a threat. The conclusions are wrong and I hope that I have made sufficient sense and that what I have said is taken on board—I said the same when giving evidence to the independent reconfiguration panel.
I end where I began by making the same statement very quickly all over again. My concern is for the delivery of competent medical services to the people whom I represent. That is what I shall fight for and that is what I believe should be delivered. I am not arguing for North Tees to have what Hartlepool does not. I am simply saying to hon. Members that the division suggested by Ara Darzi is plain wrong and that all the evidence supplied by the consultants would support that statement.
I congratulate the hon. Member for Stockton, North (Frank Cook) on triggering this debate and all hon. Members on speaking passionately in favour of their constituencies and the services within them. I will not venture too far into the details of the cases made as it would be too much like venturing on private grief and discord, which according to some hon. Members is entirely the fault of the Liberal Democrats and nothing to do with the Government, who are running the health service.
I am fond of the area and must confess that I visited Hartlepool because of recent by-elections.
I will concentrate on the generic features that an issue such as this throws up. I am a veteran of such issues. My local hospitals were reconfigured in 2002 when the Shields report, not the Darzi report, was implemented. The accident and emergency, paediatrics and maternity departments were moved, and there were marches, meetings, protests and gigantic petitions. I even had a hospital campaigner backed by Martin Bell stand against me in 2005.
Today’s events in Westminster Hall suggest that my experience in 2002 is now replicated across the land. The problems associated with this issue are a product of certain pressures and policies. The pressures are relatively well established: the working time directive, the new tougher financial regime, the drive to get hospital deficits down, changes in the hours for junior doctors, and the higher training needs specified by the royal colleges. The other factor is policies and there are some good policies based on the need to have centres for excellence, the drive to improve quality and the need to have services brought closer to the patient at a community level.
The problem is dealing with the pressures and the policies while getting the balance right. There are a variety of routes that can be followed to balance out the pressures and the policies. One mantra recited by the Government is to leave it to local decision making, which, we all understand, really means decisions by a local quango—a locally based set of appointees. Following a consultation that is often completely ignored and, in many cases, virtually an insult, quangos make their decision with all the aplomb and indifference of colonial governance. That is not genuine local decision making, but, time and time again, it is what the Government call local decision making—I have heard it said already this morning. In fact, decisions are not made by local people, but by local appointees who ultimately owe their careers to the health service, not to responding to what local people ask of them.
Answer No. 2 when dealing with the balancing out of pressures and policies is to have a report and implement it, whether it is a Jerrold report, Darzi report or, as was relevant to my constituency, a Shields report. The deficiency in that is that such reports tend disproportionately to reflect the interests of medical communities, which are more worried about litigation and the advice from the royal colleges than issues of access. The report carried out in my neck of the woods on configuring services contained a clause that suggested a configure services in a particular way that created enormous transport problems—there were not the roads or rail or bus services to support it. The report went on to say that that was not an issue for an NHS report. In other words, how people get to the services was outwith its concern. The same is true of many reports that I have seen that have attempted to reconfigure services: the transport issues are set aside for somebody else to deal with.
Reports take time and are normally a long time in the cooking before they see the light of day. During that time, the world changes and the advice changes––even advice from the royal colleges. Also, as has been alluded to today, they tend to be nipped in the bud by political tampering and do not turn out to be the honest pieces of work they ought to be. That is also unsatisfactory.
Answer No. 3, which was referred to by the hon. Member for Stockton, South (Ms Taylor), is to refer the issue to the independent reconfiguration panel, which, in principle, is a good idea. However, reference in most cases depends on the Secretary of State being compliant with it and, even when the report is done, it will not have the necessary coercive force.
The solution that we all advocate is genuine local decision making, but that needs to be based on two distinct pillars. We need to have a clear view of the entitlements and what the people of Teesside require in terms of service and access to service. The hon. Member for Stockton, North referred to the fact that people did not start by considering what people needed, but rather the more problematic question of what the services are and how they might be configured. We should also be clear and honest about what the people of Teesside and the country are prepared to pay for through taxation, because every service comes with a price tag.
We need more fairness and honesty from the Government on this issue. There are a range of concerns and three particularly affect Teesside, but they also affect most parts of the country. One issue is deficits, because they tend to affect how things turn out. There is no doubt that previous NHS methods of finance were sloppy and had broken down into a system of bailing each other out—a kind of financial pass-the-parcel. When the music stopped, and, clearly, it has now stopped, some trusts were left holding huge historic debts. Under new resource accountancy rules, that meant reduced revenue and led to a spiral of decline, added to which some trusts—I do not know what the situation is in Teesside—are saddled with substantial debts as a result of capital investment or private finance initiative schemes. Without fair funding, configuration cannot be done fairly and people will not be persuaded that clinical needs are the driving force. We have not got there yet and that is why these problems persist.
The Government also need to be clear about moving care into the community. They cannot just talk about it; the funding and the service actually has to be out there. Community-based care cannot simply be an aspiration to justify closing existing facilities. There was a case in my constituency where the blood service was moved out of the hospital to a clinic. That was called “moving it into the community”. It was moved into a clinic in the far south of the constituency, so 50 per cent. of my constituents now have further to go for a simple blood test. They would much prefer to have the service in the hospital, because it would be closer to the part of the community in which they live.
It is crucial for Teesside that we have clarity on neonatal safety. We had a recent debate in the House on maternity services and I listened carefully to what the Secretary of State said. She began by praising small, midwife-led units. Later, she extolled the virtues of high-tech ones. When asked what would be the optimum size of a maternity unit and what evidence the Government had for any view that they might take, she dodged the question. I remember that she was pressed on the issue by the hon. Member for South Cambridgeshire (Mr. Lansley).
I do not think there was any desire on the part of the Secretary of State to be mendacious, duplicitous or especially evasive in this context. She was talking about units being safe for different types of birth. Clearly, midwife-led units that are well run will be safe for unproblematic births; for more problematic or low-weight births, a more sophisticated unit will be required. What is required in a maternity unit has become extraordinarily vague. It would be helpful if the Government published the evidence on what is safe and for which type of unit and birth, and the standards required. They would thereby add the clarity that the debate needs. Unless the Government contribute more clarity to the process, what we are seeing today in Teesside will be replicated in other areas and heard about in debates throughout this Parliament.
I add my congratulations to the hon. Member for Stockton, North (Frank Cook). These debates have become a familiar scene. Ministers and shadow Ministers visit this Chamber fortnightly to deal with some part of the health service that is annoying hon. Members around the country. This debate has a particular sense of déjà vu about it. It is round 2 of the debate that the hon. Member for Hartlepool (Mr. Wright) started on 11 December, with the same protagonists from Hartlepool, Stockton, South and Stockton, North, although we have had perhaps rather less heated interjections from the hon. Gentleman this time. The time was extended from half an hour to one and a half hours and, with the added reference to the hyenas of the political savannah—the Liberal Democrats—I feel something of a bystander in all this.
Hon. Members have spoken about the relative merits of James Cook university hospital in South Tees, the university hospitals of North Tees and of Hartlepool, the Darzi report and the Tees report by Ken Jerrold. I add my tributes to the very dedicated staff at all three hospitals, who must be bemused by the political to-ings and fro-ings that have gone on over too many years when they all want to do is to get on with their job of looking after their patients to the best of their ability. I have not visited any of those hospitals, but all the speeches made by the hon. Members representing the constituencies where they are based were eerily familiar.
The hon. Member for Stockton, North talked about constant reviews. In my part of the world, we have had that, too. He spoke about reviews and their timing being to do with general elections. We had that in my part of the world in Sussex as well. He and other hon. Members talked about consultants voting with their feet and leaving, which is very worrying. We have that in our part of the world, too. He also made the bold claim that Hartlepool hospital is not under threat of closure and never will be. We used to think that about some of our hospitals in Sussex, too. Just two years ago, we were given cast-iron guarantees by the present Government that there would not be any more tampering or reconfiguration. Now, they are under the spotlight of reconfiguration, closure or downgrading after all, so my advice to the hon. Gentleman is not to hold his breath.
We heard a familiar story about millions of pounds being lavished on new facilities at hospitals, only for it to be proposed that they be transferred elsewhere. The James Cook university hospital, which the hon. Gentleman referred to, is already in trouble with saturation and deficits. We, too, have hospitals like that, which will supposedly have to grow to take up the slack.
The hon. Member for Hartlepool made similar comments, although obviously tailored rather more to his own constituency hospital in Hartlepool. He talked about demographics and mentioned the greater needs of the elderly population. I think he said that 15 per cent. of his constituents were over the age of 60. He has got it easy. In Worthing, in my constituency, 45 per cent. of the population are pensioners and 4.5 per cent. of that population are over the age of 85, with all the extra health requirements that the elderly population has. I am glad that he drew attention to that issue, because it is a case that we have made and that Ministers have not paid sufficient regard to on too many occasions.
The hon. Gentleman spoke about congested roads. Again, we have it worse in Sussex, in the most densely populated part of the country. He spoke alarmingly, but rightly, about the poor public health figures. They are not down to poor hospitals or good hospitals but to the complete failure of the Government’s public health policy. He gave shocking figures for the alarmingly increased chances of death from lung cancer in women under 50 in his constituency. He talked about 32,000 people signing a petition; some 300,000 people have signed petitions against reconfiguration in my county alone.
The hon. Member for Stockton, South (Ms Taylor) concentrated on the Ara Darzi report and some of the inconsistencies between earlier reports that it threw up. That was all eerily similar to what is going on in the health service up and down the country. For North Tees and Hartlepool hospitals, I could easily substitute Worthing and Southlands hospitals and the Royal Sussex county hospital at Brighton, in my part of the world. Every Sussex hospital is under the spotlight. The difference is perhaps that in our part of the world Ministers do not join the demonstrations outside those hospitals against their downgrading. I suspect there are problems elsewhere in other areas of the region that we are discussing. Tomorrow, the hon. Member for Middlesbrough, South and East Cleveland (Dr. Kumar) will talk about education funding in the same area.
What is common to all these discussions is that we believe that any decisions about major reconfiguration should be based on three main things. First, they should be based on sound clinical practice that should improve the standard of health care for local communities, not on financial expedients. The Government need to come clean and admit that many of the decisions are being made on the latter basis. Secondly, they should take the local community with them if there is to be any credibility to Government claims about local decision making being of the utmost importance. The NHS is owned not by Ministers, NHS bureaucrats or even the staff but by the people and the patients. That is why the NHS is there. There should be genuine consultation of local people, the consultants and the clinical staff—to which the hon. Member for Stockton, South referred—not the sham, preconceived consultations that we have often seen.
Thirdly, there is more to hospital services than bricks and mortar and places of treatment. This is about the quality of life, the effect on large employers, infrastructure and transport, convenience and incentives to business. Just yesterday in my town, Worthing, the chairman of the South East England Development Agency came to a press conference to say that he believes that the proposals for reconfiguration in Sussex will have a serious detrimental impact on investment in our region—the powerhouse of the United Kingdom economy—and will downgrade the quality of life. He went on the record and said that. There is much more to this argument than just short-term financial balancing of books.
I could go into great detail about the problems with maternity services. A lot of this is about the vagueness of the proposals on which the decisions are being made. Does a maternity unit need to have 3,000 births to be sustainable and viable? In our part of the country, we are told that there must be at least 4,000 births, but Worthing hospital, for example, will have about 3,000. The largest maternity unit in Germany deals with only 3,000 births. If the reconfiguration proposals for our area go ahead and everything goes to Brighton, it will be the largest maternity unit in the whole of Europe, not just in this country. That cannot be good for patient care. Why does big always have to mean best? There is no evidence on which those decisions are being based that says that maternity departments of 3,000 or 2,500 or even 2,000 provide a lower quality of care, or pose a higher risk of mortality, to mothers and babies.
Let us have genuine horses for courses. Let us have genuine local consultation and local decision making. Let us not have the divide and rule that is going on in the health service. We have seen it graphically this morning, with neighbouring Members from the same party arguing for different things. If it ain’t bust, don’t fix it, and if it really is down to short-term financial expedients, the Government should at least have the honesty to say so, so that we can have a transparent and honest debate. The Government are busy trying to avoid that.
I will not, because the hon. Lady went over her time and I have only one minute left. I want the Minister to have her fair share of time at the end.
Too many decisions are being made by health bureaucrats behind closed doors, and that is increasing people’s suspicions and cynicism about what is really driving reconfigurations and about who is in control. We owe it to patients and our constituents to ensure that decisions are based on evidence and on what is good for their communities. This issue will run and run, and I suspect that at least some of us will be back here in a couple of weeks for a similar debate about another area of the country that faces similar problems.
I congratulate my hon. Friend the Member for Stockton, North (Frank Cook) on securing the debate. Obviously, the future of health services in Teesside is a concern for all my hon. Friends who are present, and they have closely reflected their constituents’ concerns. I was pleased to hear that my hon. Friend also has a connection with Hartlepool.
The debate has reflected the fact that the decisions that we are discussing are difficult and controversial, and strong feelings are expressed on all sides at local level. It is important to stress, however, that there are many reasons why we must look to the future provision of health services, including changing demographics and the ability to provide higher-quality services. Within that, however, there is also the need to consult local people during debates on those issues.
My hon. Friend referred to the inaccuracies in the stories that the Liberal Democrats have put about regarding the provision of health services, and I should add that there has also been a certain disdain for the actions of local people. I do not know whether the party of the hon. Member for Southport (Dr. Pugh) has any members on the joint overview and scrutiny committees, but I am sure that any such members would be pleased to hear that they are considered local appointees who take decisions with no consideration for local feeling.
The hon. Gentleman is incorrect. The reason why an independent review of local proposals is going on is that the joint overview and scrutiny committees made a referral. If that is not having an influence over the matter, I do not know what is. However, I am sure that committee members will be pleased to hear that he thinks that their contribution to the local situation is irrelevant and unimportant.
The hon. Member for East Worthing and Shoreham (Tim Loughton) must recognise that reconfigurations are often carried out to improve local services. I would be surprised if the policy of his Front-Bench colleagues was to expect the NHS never to have to change to reflect local changes in demography or medical advances. I do not think that we could expect the NHS never to change, and it would be bad news for the NHS if he said that the issues that I mentioned would never be a consideration.
It is important to pay tribute to staff in the region, and I join Opposition Members and my hon. Friends in doing so. The staff have worked extremely hard to make real changes in the provision of health services in their area by reducing waiting times and promoting higher-quality services. It is important to stress that that has been achieved in partnership by combining the achievements of staff at local level and the increased investment that the Government have been able to provide. Primary care trusts in Teesside, for example, have received more than £568 million this year, and that will rise to £626 million next year, although the Opposition have consistently opposed our extra investment.
Does the Minister accept that we are not only seeing phenomenal investments in our health services, but fighting for better services? Nobody, but nobody, should blame us for doing that. In 1992-93, we fought to ensure that the previous Conservative Administration did not close North Tees general hospital.
My hon. Friend is right. All my hon. Friends referred to the fact that their region has some of the most deprived health areas in England. My hon. Friend the Member for Stockton, North touched on the growing population served by the different trusts. My hon. Friend the Member for Hartlepool (Mr. Wright) highlighted some of the health problems that have arisen because of industrialisation and particularly because of contact with hazardous materials. It is very much part of the Government’s policy to try to reduce health inequalities through a mixture of extra investment and new opportunities for NHS staff.
Let me deal briefly with some of the issues around the current reconfiguration proposals. My hon. Friends clearly set out the background and history to some of the changes, and hon. Members have touched on the different reviews that have taken place, culminating in the Darzi review, which proposed a number of changes. Given the diversity of views and the changes in services that have been proposed, it is not necessarily surprising that the joint overview and scrutiny committees wish the issue to be referred to an independent scrutiny panel.
Let me touch on our vision for maternity services, because it is important for a number of the issues that hon. Members raised. We want there to be three main drivers for the provision of maternity services: the maternity standard of the national service framework for children, young people and maternity services; our 2005 manifesto commitment to improving choice in maternity services; and the White Paper “Our health, our care, our say”. The White Paper emphasised my hon. Friends’ point about the importance of getting services into the community, and they highlighted what happened previously, when there was a reliance on hospital services. The issue is how we ensure that we have good services in the community, and the hon. Member for Southport referred to the standard that we have set out, which, in a sense, pulls together the Government’s vision for maternity services over the next 10 years. Women should have easy access to supportive, high-quality maternity services that are designed around their individual needs and those of their babies.
All hon. Members said that it is important to consult clinicians, and I absolutely back that view, because it is important that we can do that. Following the review of maternity and paediatric services in Hartlepool and Teesside, two scrutiny bodies chose to refer the maternity and paediatric elements of the proposals to the Secretary of State. In response to the inquiry from my hon. Friend the Member for Stockton, North, let me say that the report on the issue will be published on 19 January. In view of that, it is not possible for me to comment further on the detailed points that have arisen, except to say that I agree that it is time that there was some certainty about services. The reviews have gone on for many years, and I am sure that local people and clinicians want that certainty.