Skip to main content

Health Services (North-East London)

Volume 456: debated on Wednesday 31 January 2007

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Heppell.]

I thank Mr. Speaker for granting me this debate on the fit for the future programme in north-east London, and how it impacts on Whipps Cross and King George hospitals. Whipps Cross is in my constituency, but the area that it serves is much wider, as my hon. Friend the Member for Walthamstow (Mr. Gerrard), the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) and the hon. Member for Ilford, North (Mr. Scott) will testify. The King George is an important hospital for a different population. The populations served by those hospitals have high degrees of deprivation and serious health needs. Indeed, the full functioning of those hospitals is highly relevant to the Government’s policy of tackling health inequalities. If they do not function fully, health inequality will be exacerbated.

The fit for the future programme that covers those hospitals, and the newly built Queen’s hospital in Romford, began last summer. Its alleged purpose is to make the best use of NHS assets, but it came very swiftly in the wake of uncovered serious financial deficits in several local health trusts. I believe that those trusts are the driving the programme, and that the real purpose behind it is to run down either Whipps or the King George.

On 15 February 2001, the then Health Secretary, my right hon. Friend the Member for Darlington (Mr. Milburn), announced on the Floor of the House that there would be a major new investment in a number of hospitals, including Whipps Cross. Some £328 million was promised. That figure fluctuated in subsequent years as the plans were drawn up, but the Government commitment was maintained.

As recently as 22 March last year, my hon. Friend the Member for Walthamstow and I met the then Health Minister, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), who assured us that

“the commitment to build the new hospital is still there”.

She told us that the hospital modernisation would begin in late 2008 and be fully completed by 2016, with the most important elements of the hospital renewal completed earlier.

The modernisation is necessary, but not because the hospital is bad or the performance of its staff is poor. On the contrary, last October, the Healthcare Commission gave it a “good” score for the quality of its services in the local community. Let me make it clear that only 4 per cent. of NHS hospital trusts scored “excellent”, and only 30 per cent. scored the next category of “good”. So, for the delivery of services, Whipps Cross is among the top 34 per cent. of hospitals in the country.

In the sub-ratings, Whipps Cross got an “excellent” for meeting new Government national targets such as: reducing mortality rates from heart disease, stroke and related disease; achieving year-on-year reductions in MRSA levels; and ensuring that nobody waits more than 18 weeks for hospital treatment from when they were referred by their general practitioner. It also scored an “excellent” for its medicines management, and a “good” for meeting core standards and existing national targets.

I emphasise those scores because I believe that some health officials, in the Department and locally, are prepared to run a campaign of denigration against Whipps and to claim that it is amongst the worst hospitals in the country. That is a lie and the Minister needs to be aware of that. Indeed, he should be. In 2004, the Department of Health described Whipps as

“the most improved NHS trust in the UK with regard to its provision of emergency care”.

The hospital was given a “weak” score on its “use of resources”, but then so were many others—37 per cent. of trusts in the country—including Waltham Forest primary care trust. The hospital trust is addressing that problem, albeit with considerable pain.

Whipps needs to be modernised because it has long Victorian corridors and wards. It could be more efficient and run at a lower cost. That reform is needed, but, instead, we have been presented with a fit for the future process that was born out of panic because of the financial deficit. The firm promise of major investment is being reneged on, and the option of running down Whipps is being mooted. That has led, quite properly, to enormous public protest.

The Waltham Forest Guardian and the Wanstead and Woodford Guardian, collected 18,515 signatures in just six weeks on a petition that my hon. Friend the Member for Walthamstow and I fully backed. My hon. Friend and I have presented further petitions bearing about 2,000 signatures. The London borough of Waltham Forest Labour party has launched an “I Love Whipps Cross” campaign to support the development and maintenance of a modern general hospital at the Whipps Cross site.

The leader of the council, Clyde Loakes, told the Secretary of State in a letter this month that

“the response has been overwhelming”.

The right hon. Member for Chingford and Woodford Green recently presented his own petition, which is reported to contain 21,000 names. The letter handed in by the editors of the local Guardian newspapers stated:

“Our concerns lie in the fact that the Fit for the Future programme for the north east London sector includes the possibility that Whipps Cross could be stripped of many essential services”.

It went on to put succinctly the case against that happening:

“Fears can be summarised as follows: This densely populated area of London, with many social needs and the health problems which are the consequence of poverty, will suffer if services are moved away. Sickness and death rates speak for themselves. The journey to Romford, Goodmayes or elsewhere will put lives at risk, make treatment difficult for people who are made less mobile by age, disability or illness, and deter relatives and friends from visiting patients. Our staff have travelled these routes by both car and public transport and shown that the trips are time-consuming and expensive. While we understand that some treatments for which it was previously necessary to attend hospital can now be delivered in the community, we seriously doubt the capacity of our Primary Care Trusts to cope, given that they too are suffering financially and many staff cuts have been made. We certainly do not believe they are capable of expanding care, either for patients requiring tests and treatment or for people who will leave hospital sooner than they did in the past.”

The letter goes on:

“Whipps Cross University Hospital has received a “good” rating this year for its clinical care, has had many new facilities built in the past few years, is at the centre of a needy community and can be reached easily by the people who live in the areas we have mentioned. In our view it would be criminal to dismantle services which work, either to move them to other hospitals or into new community facilities which would cost a great deal of money to build and equip, probably in duplication, when those facilities already exist at the hospital.”

I support the Government’s policy of increasing the number of medical treatments given in the community, GP’s surgeries and people’s homes, rather than hospital, but the consequent improvements in the locality are decidedly modest, although welcome. Councillor Loakes pointed out in his letter that the number of people attending accident and emergency has increased by 39 per cent. in 10 years, so the extra non-hospital provision has had a negligible impact on that.

GPs have had more money but are limited in the improvements that they can provide. For example, some GPs’ premises cannot fit in the latest equipment. In my deprived area, the workload of GPs remains high, and they do not have the extra time to perform numerous new medical treatments. The Secretary of State rightly says that community nurses can do much, but as the “Save Whipps Cross Hospital” campaign pointed out in its December newsletter,

“the reality is that in Waltham Forest, community nurses have been cut by 8 per cent. through not filling posts and staff are struggling to provide the care patients need now.”

My own survey of local GPs revealed that they are not employing any extra community nurses, and rely instead on the PCT, which is cutting back. The situation certainly does not warrant hospital rundown. The Government’s policy of using more community treatments can be achieved without any local hospital rundown, because of the population growth in north-east London. The indications in relation to Thames Gateway are that the population will be more than 20 per cent. higher in 2016 than in 2001. The planned Stratford city proposal will also add to population growth. As no extra hospitals are planned, it makes sense to maintain the existing ones.

Stratford is also the site of the 2012 Olympics, to which Whipps Cross is the second-nearest hospital. For a successful Olympics, we need a fully functioning Whipps Cross as part of the back-up infrastructure. The recent policy of the Department, which I believe to be simplistic and ill-considered, is that one hospital can be emergency only and the neighbouring one elective only. It is claimed that such a separation reduces waiting lists because emergencies can lead to the cancellation of elective work. Local figures show very few cancellations for that reason.

The policy of separation ignores the reality of where people will present for treatment, and several neighbouring hospitals have said that they could not cope or that they would be adversely affected by it. Worse still, it breaks up the team of medical practitioners—it currently works well, but people would move on. There needs to be collaboration in emergency and elective work. It works well in a district general hospital such as Whipps but may very well not do so under the fragmented system that could be created under this separation policy.

Public anxiety is high and staff morale low as part of this fit for the future process. There is no cause for it to be rushed, ahead of the full-scale review of Londoners’ health needs over the next five to 10 years, which is to be conducted by Professor Sir Ara Darzi of Imperial college and was announced last month. In this context, “Fit for the Future” just amounts to a pre-emptive strike.

There is also no confidence locally in how the health chiefs are conducting the process. They are all in the fit for the future team, but behind that is a turf war with no one taking responsibility for the local NHS overall. That really should be the primary care trusts’ role, but they are intent on the cheapest provision for patients, even if it is a false economy and if the local hospital goes under.

The Government’s choice agenda of four treatment choices for patients risks not including the local hospital, which most local residents want to use. There is also the suspicion that these health chiefs waver with the wind. Whipps has come out top in their initial assessment on non-financial criteria and again on the financial criteria. Public and MP reaction might have had an effect, but now there is similar reaction in the King George hospital area. I remain suspicious that some further criteria may be found or that a decision may be taken against their own assessments in the future. In any case, I resent this being set up as a competition between worthy hospitals and their needy, distinct, populations. I believe that the health chiefs genuinely hope to release cash via hospital rundown for community medical use, but I do not believe that such cash would go, to any significant extent, to such community treatment.

The Government have new pet projects, such as intermediate treatment centres, and the private finance initiative bills for new hospitals, such as Queen’s, to fund. The bills for doctors, drugs and new treatments remain high. Furthermore, the growth period for the NHS is coming to an end. The Government should have ensured that they could fund its core services, such as local hospitals, and change them in a planned way when replacement provision is fully in place. This speed of change, without replacement provision, is leading to crisis. That is a reason why this fit for the future process is not acceptable.

It is unbelievably negligent to think that the people who rely on Whipps could do without its emergency and elective provision. It is understandable that local people are anxious; I, too, think that if Whipps were rundown on this basis, it would lead to unnecessary local deaths, so I urge the abandonment of the process.

I congratulate the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this debate. He knows that all of us bid for it at the same time. We have co-operated fully, regardless of party, on the key issues. I think that we are all united in our rejection of what has been happening. He laid out in detail all the relevant issues, giving specific emphasis to the situation at Whipps Cross hospital. I know that our colleagues representing Ilford constituencies will set out more detail concerning King George hospital.

I should say at the outset that I do not believe in the divide-and-rule policy that health chiefs are undertaking in our local area. I am for retaining Whipps Cross hospital and King George hospital. If either one fails to remain as a district general hospital, it will be for the worse. My comments will focus mainly on Whipps Cross, but I want to make it clear that I am wholly with my Ilford colleagues—and, I believe, with all hon. Members present—in wishing to retain King George hospital.

I want to pick up three points. Why is this process taking place? I agree with the hon. Member for Leyton and Wanstead on this. He outlined why this is happening: a short-term, sudden, snap panic over the idea that the acute trusts have been running particularly strong financial deficits for the past two to three years. When one examines what the deficits are about, one begins to understand that the whole accounting process in the NHS has made this a ludicrous process.

Let us consider the reality of how most of this is run. We are shifting one set of problems from the PCT to the acute hospitals. In the past two to three years, they have told people endlessly about their problems in getting the PCTs to pay for the treatment that they have undertaken in good faith, so they say. I accept that there have been inefficiencies and that there has been poor accounting in some of those acute trusts—particularly, in this case, at Whipps Cross.

The PCT is running a deficit of £1.8 million and trying to claw that back from the acute hospitals by saying that it will not pay for all the treatment that they undertook. In its refusal to pay, the balance of deficit shifts on to the acutes. It is absurd to suggest that we can simply split the two bodies and say, “This lot have bad accounting practice and are not doing very well whereas this lot, who control and run what the acutes do, can decide who will bear the cost.” What has been hidden is a problem for both the PCTs and the acutes. The PCTs, which are running the process, can shift a huge amount of the blame on to the acute trusts.

The second aspect that I want to highlight, which has been raised, is the nonsense about how this process is taking place. The London area is doing its own survey and summary of what needs to be done. I believe that at the same time, running ahead of that, four areas are examining the need for treatments in our areas, driven by the PCTs—how ludicrous. Given that they are running ahead of what London is doing—we are now told that this will dovetail back into London’s review—it beggars belief as to how this can be done. They will arrive at conclusions that might not directly relate to London’s conclusions, unless a nudge and a wink is going on here. We rather suspect that that is the case and that they are clearing the way for London to be able to publish a review that has already assumed certain changes in our area. Either way, this is the wrong way to do things.

Any strategic consideration of what health systems and health care should be in London must examine a London standpoint first and foremost to decide what the needs are. One of the things that would emerge in such a consideration is the peculiar problems of transport—getting from A to B—in parts of London. I shall give hon. Members an example of how little is thought about that.

A meeting with the PCT took place on 9 November as part of the fit for the future programme. MPs were not allowed to attend, but there was a discussion about what would happen if Whipps did not continue as a district general hospital. The answer given by one of the PCT’s members was that plenty of health treatment was on offer in the several acute hospitals that surround our area.

That point has been made to us on many occasions. First, it was said that North Middlesex hospital would be able to take people, but people at the meeting had rung North Middlesex to ask whether it could absorb the demand if Whipps Cross ceased to be a district general hospital in the sense that it is today. The answer given was that it certainly could not do so because for at least the next five years, during which time it will be going through changes—there will not be any spare capacity. The people at North Middlesex were not sure even about what would happen after that.

When that information was presented to the individual whom I mentioned, he turned around and glibly said, “Well, of course there is University College hospital.” That was interesting and it made me wonder about things. UCH is difficult to get to, but of course one would know that only if one had bothered to try to get there by public transport from our borough, particularly from the northern part of it.

I then asked the fit for the future team whether it had corresponded or had discussions with, or drawn in, any of the other acute hospitals in the fit for the future programme going on in our area. By the end of December, it said that it had corresponded with the hospitals. I then decided to write to a number of the hospitals that might be affected. Most interestingly, I asked UCH what correspondence or involvement it had had with the review team. I quote a recent letter:

“As yet we have not been directly involved in discussions concerning these proposals so we have not made any assessment of the likely impact on UCLH. I have asked Whipps Cross Hospital for a copy of the document.”

That was on 18 January, when we were heading towards the conclusion of the report. One of the hospitals, which it was said people from Chingford would magically head off to, knowing that North Middlesex could not take them, was UCH, which did not know anything about it and was not even involved. What a brilliant way to go about it. That proves our point that unless the review is done on a London-wide basis we cannot possibly consider the difficulties in hospitals such as North Middlesex and UCH.

The situation is absurd and indicates what is happening: the review is being done in a last-minute panic, well ahead of the main review, simply because it has been ordered by officials who say that we have to make reductions in the area. There is no consideration of what is going on in our area or the transport difficulties.

That brings out another point that I wish to make. All along, we have all felt that we have not been told the full story by officials. When we ask questions they hide away some elements. That is shown by my correspondence: we were told that the review team was in correspondence with UCH and we now discover that most of that happened directly after the meetings at which the problems were pointed out—not before them, as we thought.

A letter that I received from Sally Gorham at the PCT said that it would be in direct consultation with the hospitals, particularly in early January. The letter that I received from UCH was written in mid-January and UCH had not heard even a word from the PCT. There is always such presentation of things that simply do not take place.

I wish to mention another matter raised by my colleague the hon. Member for Leyton and Wanstead—the Olympic bid. Reading the bid documents, it is fascinating to note that either we lied when we presented our case to host the Olympics here or we had no right to present the fit for the future programme in the way that we did. Whipps Cross hospital is referred to specifically in those documents, as is the investment programme for it. Yes, Whipps is coupled together with two or three other hospitals, but it is in there.

The document states:

“Within the health area that covers the Olympic Park and Olympic Village, there are a number of planned developments for hospitals and primary care premises. These include… the Whipps Cross… University Hospital”

in a total investment of £2.4 billion. It continues:

“The Secretary of State for the Department of Health has provided the guarantee on behalf of the UK Government …Between now and 2012, there is planned capital development on each of these hospital sites”.

The Secretary of State signed that document off. I wonder whether the Olympic committee, if it were to understand what is going on in the fit for the future programme, might have a case to sue Her Majesty’s Government for failing to live up to part of their promise.

We know that a serious terrorist problem is causing the costs of the Olympics to rise, including for access to accident and emergency care in London, part of which is Whipps Cross hospital. King George hospital is part of that as well, although it is not named in the document. The review has completely run across international undertakings. Whipps Cross should never have had its services reduced under fit for the future; that was wrong from the outset.

I turn to what is happening in north-east London. We know that a huge change is about to take place—the Thames Gateway project. The figures in the final Thames Gateway health service assessment make that clear:

“North East London SHA (part of NHS London) will experience a 311,000 population increase”

by 2016. Where do we think those people will go for health care treatment? The situation is absurd. There cannot be a review with that as its cornerstone without having a London-wide review that says where the health care will be for the increased population.

We are engaged in the ludicrous game of people saying that they do not like Whipps Cross hospital or King George because, somehow uniquely, they are bad hospitals. As the hon. Member for Leyton and Wanstead pointed out, both those hospitals scored highly on the quality of their health care. Ironically, the hospital that is held up all the time as the future in our area—Queen’s, which used to be known as Oldchurch—scored low on that measure and has real problems. It will not be able to take any increase in numbers if people have to transfer from either King George or Whipps Cross in the foreseeable future. That does not make any sense either.

This has been a most ill thought through, precipitate review and it should never have taken place. It is wrong in its terms and in the spirit of what we are about. The matter is not party political; it is about what is going on locally. Politicians have got to get a grip on the officials who are running wild in our area and trying to do what they think is the bidding of the strategic health authority and, in turn, the headquarters of the NHS.

The hospitals matter because we in London are unique in having serious transport problems and real difficulty. In our area, we have deprivation figures that leave us with a particularly bad health care problem at both PCT and trust level. Services cannot be removed out to PCTs without prior investment—there is no provision for that. We have set PCT against acute trust because officials are saying, “If we close these or reduce services, we will get more money.” I say that that is unlikely ever to happen. This should stop, and stop right now.

I say at the outset that I support what has been said by my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) and the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith). I shall try not to repeat too much of it, but there will inevitably be some repetition because the key points are the same for us all.

The first issue to mention is the wider context. Professor Ara Darzi is just starting the London-wide review. I spoke to him recently and he said that he would be examining the clinical context of what is happening across London and that he wanted to speak, among others, to Members of Parliament who might be affected. He obviously regards his work as just starting. How there can be major changes going on in one sector of London in advance of the London-wide review is beyond me.

We are being told by NHS London that it will not let the review go ahead unless it is confident that it fits in with the general pattern of where it wants to go. That suggests one of two things: either it has already made its mind up about the general pattern or, more likely, it has already made its mind up about what it wants to do in north-east London and it does not really matter what comes out of the general review.

The area covered by the review is quite artificial. When one considers patterns of travel and where hospitals are in north and east London, the lines that have been drawn are an artificial boundary. For people in my constituency, Queen’s is a long way away, or they would regard it as such. It might not look very far on the map, but it is when people are trying to get there. Compared with going to Newham, North Middlesex or Homerton, Queen’s is not on the radar for where people would want to go if there were changes at Whipps Cross.

We have asked questions about what will happen to the other hospitals such as North Middlesex, Newham and Homerton, and whether they will have extra capacity. We have been sent copies of the letters from the fit for the future review team to the hospitals. We have also been sent the replies, although I do not see how the hospitals can reply in any sensible way when they do not know what will happen to them in the London-wide review. For instance, a decision that affected Chase Farm hospital in Enfield—we know that there have been discussions about what might happen there—would have an enormous impact on North Middlesex hospital. That, in turn, would affect what North Middlesex could do for areas such as Waltham Forest.

The review is starting with certain givens. One is that Queen’s hospital will remain as a major acute hospital, irrespective of anything else. Of course, that is because it is a new private finance initiative project. The second given is that the independent-sector treatment centre on the King George hospital site is guaranteed a certain number of routine operations every year. We are then told that there is over-capacity in the hospital system, but I do not remember ever being asked whether I wanted an independent treatment centre at King George, and nor does anybody else locally. We therefore face the possibility that established hospitals will be run down, while we are lumbered with an independent treatment centre for which nobody asked and which nobody wants. However, that centre will cream off work from Whipps Cross and King George.

My hon. Friend should be aware that the contract for that independent-sector treatment centre on the King George hospital site is for only five years. Therefore, if elective work is removed from King George, as proposed under fit for the future option 4, there is no guarantee that any operations will be carried out overnight at that site in five years.

That is absolutely right. As has been said, a lot of what is going on is the result of very short-term thinking. We do not know whether the independent treatment centre will be there in 10 years, but we do know that there will be significant population growth in the area over 10 years as a result of work on the Thames Gateway and the Olympics. A significant amount of accommodation will be built as part of the Olympics, and the Olympic village will stay there after the games, but the people who live there permanently will need health care.

My hon. Friend the Member for Leyton and Wanstead mentioned the promises of capital investment at Whipps Cross, and there has been significant capital investment over the past few years. We have a state-of-the-art eye surgery unit, a brand-new high-class endoscopy unit and walk-in centres, and A and E has been refurbished. There is no question but that that investment has led to significant improvements in the quality of care at the hospital. That is reflected in the Healthcare Commission’s comments and in the fact that significantly fewer people get in touch with me to complain about the quality of the care that they have received at the hospital than was the case a few years ago.

What is happening now as regards capital investment? It appears that the fit for the future review started from the assumption that there will be no capital investment at Whipps Cross. If so, it will produce very different answers from those that it would have produced had it assumed that there would be capital investment. Whenever I have met members of the review team and asked them about the assumptions that they have or have not made about capital investment, I simply have not got a straight answer. My suspicion is that the starting assumption was that there would be no major capital investment at Whipps Cross in the next few years. That, in turn, will drive the direction in which the various options go.

The five options that have been looked at have been scored under a system of assessment. The methodology behind the scores is presented as if it were almost a scientific process and allowed us to look at the factors involved. There are several criteria, such as

“improving the quality of health services…ease of access… providing a…flexible physical capacity…supporting a developing and motivated workforce”.

Weighted scores have been attached to those criteria, and we are presented with a table of scores, as if we were dealing with a scientific, rather than a pseudo-scientific, assessment. That, however, is what is going to the seven trust boards in the next month, and I wonder what will happen if they disagree. What will a board do when faced with a paper that says that serious cuts will be made at the trust for which it is responsible? If the board disagrees, who will decide which option is taken? Who will decide what is or is not viable?

We are clearly told that the status quo is not viable and that that option is virtually ruled out. Some of us believe, however, that it is viable, and that is certainly true when it comes to keeping the current pattern of hospitals. When I say that the status quo is viable, I am certainly not suggesting—I do not think that any of us is suggesting—that there should never be any change. I have no problem with seeking greater efficiencies and, for example, improving the length of stay at Whipps Cross after routine operations, because the hospital’s performance on that has not been terribly good and does not compare tremendously well with the national average. We can, therefore, achieve greater efficiencies, and no one has any problem with that.

Nor do I have any problem with the concept that a lot more can be done. GPs can perform operations that have traditionally been performed in hospitals, and community nurses and practice nurses can do more.

The assumption in all the analysis is that primary care is confident that it can take the strain. However, the London borough of Barking and Dagenham has had three top-slices to its primary care budget allocations over the past 12 months. Does that give confidence to those who assume that the primary care sphere will take the strain as the area’s general capacity is run down?

Absolutely not, and I am about to come on to what is happening in primary care. I know that in 20 years hospitals will look different from how they look now, in the same way that hospitals now do not look exactly like they did 30 or 40 years ago. The buildings may look the same, but what is happening in them is quite different. However, whether the community and GP facilities are there is another matter.

Let me quote what some local GPs have told me in recent weeks, because they address the point that my hon. Friend has just made. One GP said that the number of community nurses

“is not only inadequate, but is actually falling…this is an unsustainable situation in the long-run… If this situation is not urgently addressed…we will reach a crisis situation especially if services are suddenly shifted from secondary to primary care”.

Another GP said:

“The number of Community Nurses currently employed by the PCT is insufficient for current needs rather than capable of taking on extra workload in the community.”

In another letter, I was told:

“Community Nurses are already over burdened and my colleagues at our surgery feel that if more and more services are moved into the community without adequate resources…this would not be to the benefit of our patients.”

That is the stated view that we hear again and again when we talk to the people who do the work on the ground.

We cannot expect a hospital to function when all the elective work has been taken away, as is proposed under one option. The consultants tell us that if that happens, they will leave, because the better consultants will not want to work there if they do not have the full range of work. That will affect all the training and teaching that is done at the hospital. In the longer term, it will lead to the hospital gradually declining and running down.

Throughout the process, there has been real resentment about the involvement of local Members of Parliament among some of those who have conducted the review and who will be involved in making some of the recommendations. They do not like our being involved. They do not want to talk to us. When we question what will happen to services that affect every one of our constituents, they seem to resent it.

Can I provoke the hon. Gentleman into relating the story from 15 December, when he asked about consultation, and what was said to him about the reason for embarking on consultation and how little was needed? Will he relate it, so that Mr. Cook can understand?

I will be provoked. When I asked about the consultation process and where it was going—there was the feeling of resentment about us asking the questions, as I have described—a comment was made to me: “We need not have involved you in the first place. We didn’t have to talk to you at all.” That is what came out, and I felt that the view that it is possible not to involve constituency representatives in the process is totally unacceptable. Well, we are involved, and we will stay involved.

We know, and everyone in the area knows, how local people have reacted. Thousands of people in Redbridge and Waltham Forest are deeply unhappy about what is proposed. I share the attitude of other hon. Members who have spoken and who still wish to speak, in that, although I have spoken mainly about Whipps Cross, because it is the hospital in Waltham Forest, I do not mean to say, “Forget about the King George; I don’t care if it is run down instead.”

What happens in the whole area matters, because if either hospital is run down that will inevitably rebound badly on the other, and affect everyone. We are all supporting our constituents in the aim of having local services of good quality that will not disintegrate, but that is where fit for the future is in danger of leading us.

I find my constituency is in a quite unique position. The whole process that we are debating exists, in my view, to set resident against resident and Member of Parliament against Member of Parliament; but my constituency is split so that 50 per cent. of it is served by Whipps Cross and 50 per cent. is served by the King George, so it is an attempt to set me against myself.

It is right to say that thousands of local residents have become involved in the matter. I have received representations from the London borough of Redbridge and its leader, Councillor Alan Weinberg; there has been a resolution of the whole council—across all political parties—to stop this lunacy. Epping Forest district council has not been mentioned yet but its residents are served by Whipps Cross and, at the other extreme, at Buckhurst Hill, by King George’s.

I shall not repeat what has already been said, because I wish to associate myself with the remarks that have been made by other hon. Members. For today, I hope, Mr. Cook, that you will forgive me as a new boy for perhaps not following parliamentary protocol: I think that on this issue we are all friends, not just Members. We are all in total agreement that what is proposed is lunacy.

I shall start by discussing Whipps Cross. At a meeting attended by other friends and colleagues, I asked whether any plans had been made to sell off land at Whipps Cross for housing. As colleagues will remember, I was categorically told no. I can only assume, then, that the former chairman of Barratt Homes, who is now on the Whipps Cross board, is there for his medical expertise, and not his housing expertise.

Yes, that must be it.

I have held two large public meetings and would like to answer some of the questions that have been raised by colleagues. My right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) raised the question: what about all the new people coming in from the Thames Gateway? I asked that question of the health services at a public meeting a few weeks ago and was told that the homes being built are obviously for young people, and young people will not be ill or need hospitals. I shall be recommending that anyone who wants to guarantee that they will never be ill should move to our area. It is guaranteed: the health authorities say that they will not be ill if they live in Redbridge. That is lunacy, and unless I am much mistaken, young people get older.

No, I am sorry. Having accidents is not allowed.

Hundreds of people have attended the public meetings that I have been holding, and there are thousands of signatures on a petition that I shall present early in the coming month. At a meeting chaired by the editor of the Ilford Recorder I asked the head of the primary care trust the reason for the proposals and she said that if she did not do it they would sack her and get someone who would. Those were her words, not mine.

I do not want option 1, option 2, option 3 or option 4. I do not want any of the options. The people of Waltham Forest, Barking and Dagenham, Redbridge, Havering and Epping Forest deserve better, and there should be no cuts to any of the services. I agree with the hon. Member for Walthamstow (Mr. Gerrard) that no one is saying that there should not be change or improvement. Of course there should; things should evolve. What we are talking about is not change. The new Queen’s hospital, as a matter of interest, has fewer beds than the old Oldchurch and Harold Wood hospitals that it has replaced, so I am not sure how it will cope with input from Redbridge or Waltham Forest.

I live midway in my constituency and I travelled—not in the rush hour—by car to Queen’s hospital, to see how long it would take. It took me 35 minutes, outside traffic, from my home. Some people are without the use of a car, and need to use three or four buses to get there. People will die. That is not over-dramatic or over-emphatic. People will lose their lives if they have to go to the new Queen’s hospital. The Minister may want to hear—he will not hear it often—that I congratulate the Government on Queen’s hospital, which is wonderful for the people of Romford. However, it will not help my constituents one iota. Taking away our services will not help us.

I want to describe some issues that have arisen during the period of this proposal. No one really wants our input. I have been invited to various meetings and because both hospitals affect my area I have been to meetings with both trusts. Some of them have not involved colleagues; I have been invited on my own to meetings where I have not learned anything different from what other hon. Members have been told, but there has been an attempt to get my support for something that I cannot support in any way. I have made it clear that I will campaign with my colleagues to stop the cuts.

A few weeks ago a reporter took more than 1 hour and 10 minutes to get by bus from the constituency of the hon. Member for Ilford, South (Mike Gapes) to Queen’s hospital. It would have taken even longer by bus from my constituency, because I am a bit further away. We are at a stage in the procedure at which consultation has been pushed further and further back. To echo what we heard earlier, at my last public meeting various heads of different bodies involved with health care provision were asked whether they had been consulted. Every one said no—nothing, not a word. An apology was given for that; it is said that they will be consulted after the final option has gone forward. I think perhaps if we are truly going to consult we should do it in all communities, at the start.

We are sending out a message loud and clear today. Because of time and because of other hon. Members wishing to speak, I shall not go over points that have already been covered, but I want to send a final message, which is, I hope, from us all: we are not going to stand for it. It is not on. All our constituents deserve better. I plead with the Minister to think long and hard before any proposals are put into practice and to consider all the wider issues.

We have heard about the Olympics and pressure on neighbouring hospitals that cannot cope. Before Christmas certain treatment provisions were transferred from the King George to Queen’s hospital. The Minister may be interested to know that they have been transferred back, because Queen’s hospital could not cope. How will it cope with the present proposals?

It is a real pleasure to follow my friends who have made speeches or interventions. We are all on the same side in this debate. I am the Member of Parliament for the constituency with the hospital that will be decimated under the preferred option of those under consideration—option 4. King George hospital is not an old hospital; it is a new hospital in health service terms. It was built in 1993. I was at the official opening of the hospital by the then mayor of the London borough of Redbridge, my friend, former constituency neighbour and predecessor to my friend the hon. Member for Ilford, North (Mr. Scott), Linda Perham. The hospital serves a community and it is incredibly busy. There was a period when it had on average 97 to 98 per cent. bed occupancy. More than half its admissions were to its accident and emergency department, and the hospital has had to put on two so-called temporary wards for some years, because it has not been big enough to cope with the pressure.

About 10 years ago, the acute trusts in north-east London were reorganised, and Barking, Havering and Redbridge were put together. At that time, the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Frank Dobson) assured me that there was no threat to the hospital or to its accident and emergency department as a result of the reorganisation. I believed that promise: I persuaded local trade unionists at a meeting that there was no hidden agenda, and I also attended a public meeting with the then chief executive of the new trust.

On the basis of that assurance, the bureaucrats working on the north-east London proposals are, by subterfuge, undermining the promise made to me by a former Secretary of State for Health, and they are already transferring from King George hospital to Queen’s hospital. Queen’s hospital is a fantastic new building. Some of my constituents think that it looks more like an hotel or an airport than a hospital; nevertheless, they regard it as a fantastic building. However, other constituents have written to me about problems with it. One constituent said:

“I have had the unfortunate experience of having to attend the new Queen’s hospital for an outpatients appointment. When you walk through the doors you are confronted with an enormous almost empty open space with a few shops etc either side and, believe it or not, a grand piano!! Wow that immediately made me feel well again!

I was directed to the outpatients waiting room, a room no larger than my lounge, where all outpatients wait. When a hospital porter tries to get through with a wheelchair or trolley everyone waiting in the queue to book in with one of the two or three receptionists, has to try to disperse to make space. If it wasn’t so pathetic it would be laughable… They have concentrated on design without giving any thought to suitability.”

I received that e-mail from a constituent only yesterday.

I have a fax of a letter that was sent three weeks ago:

“I am Polio Disabled and use a wheelchair. I regularly go to King George’s for check-ups for Breast Cancer and I have had occasion to use Gynaecology and Orthopaedic departments as well as the A and E department. Whereas I can be wheeled to King George for appointments or treatment, I would have to use the car to go to Queen’s and car parking space is at a premium. To go to Whipps Cross does not bear thinking about.”

And I also received the following correspondence:

“Alice is very old and fading fast in KGH, where her care has been excellent. If she was in Whipps X or Queens, she would have had no visitors.”

I said during the Christmas Adjournment debate on 19 December that the problem is the bureaucrats. They have a mindset driven by accountancy and by models of health care that take no account of the poorest people in the poorest communities. Forty per cent. of my constituents in the Loxford, Valentines and Clementswood wards do not have access to a car. My constituency has a large and growing ethnic minority population. It includes refugees and people from the Indian subcontinent, many of whom have young children and do not drive cars. If the accident and emergency department closes at King George hospital, they will expect to go, as the Ilford Recorder reporter did, by two or three buses to get to Romford.

The original proposals in “Fit for the Future” said that it was “addressing health inequalities”. As I told the House on 19 December, it does address them: it makes them worse. The proposals are designed to penalise the poorest and the weakest in the interests of a financially driven model that takes no account of local needs or wishes.

I am not confident that the upcoming consultation exercise has any significance or meaning. The hon. Gentleman referred to Barratt Homes and planning issues. He knows, because it was confirmed at the meeting in December, that North East London Mental Health Trust has had plans for some time to rebuild facilities on the Goodmayes hospital site, which is next to King George hospital. Goodmayes is a 19th-century mental health institution that has been significantly changed over the years. It now has state-of-the-art private finance initiative facilities, but the trust wanted to build new blocks next to it. Those plans, which I was told about a year and a half ago, have been put on hold because the trust now plans to switch facilities to the King George hospital site in buildings that will be vacated by getting rid of elective work and by closing down the accident and emergency department. It is an economic measure, and I want to know about the trust’s long-term plans.

I understand that the Maskells Park site, which is part of the mental health trust will be closed. The trust was going to transfer the work to the Oldchurch hospital site that was vacated as a result of building the new Queen’s hospital. Now, the suggestion in train is that the trust will use the Goodmayes site and concentrate mental health facilities there. It will be able to do so in King George hospital buildings—instead of using them for accident and emergency work to serve my constituents and those of my friend the hon. Member for Ilford, North. I ask questions now, because we were not given that information. There is stuff going on in the health economy, and we are not being given the full facts.

At the last public meeting, the trust admitted that and denied it in the same meeting, so the hon. Gentleman’s guess is as good as mine.

The basis of the exercise is rigged. Reference was made to patient flows. We have just been sent documents by Finnemore Consultants, which is like a company doctor: it closes down departments and hospitals throughout the country. It has included its CV, which shows that it has been involved in Derbyshire, in the west of England and in various other places. It is as though Finnemore is proud of its work; however, it should not be proud of what it proposes in my constituency.

Interestingly, the documents include data about patient flows out of the north-east London health economy. The reason why option 4 is favoured is that because under it, only 7,000 operations will have to be carried out outside the area; whereas under option 2, it is 11,000, under option 3, it is 22,000 and under option 5, it is 26,000. The proposals are not about patient need; they are about stopping patients leaving the local health economy, so that primary care trusts in Barking, Havering, Redbridge, Dagenham and Waltham Forest keep their patients in the local economy.

I wrote to Ruth Carnall, chief executive of NHS London, the day after my speech on 19 December. I sent her a copy of it on 20 December. I received a reply yesterday, dated 22 January, saying that she is not prepared to stop the process, pending Professor Ara Darzi’s London-wide review, because:

“My letter to MPs dated 4 December explained why, as well as commissioning a London-wide review of strategy, we thought it important to continue with some local reconfigurations where there was an urgent clinical and financial case, and where the emerging direction was consistent with national policy.

In North East London the proposals that are being developed are consistent with the policy of shifting care from acute hospitals to community and primary care settings, and concentrating specialist expertise.”

There is nothing there about the needs of patients. It is all about the needs of a model that cannot work unless the investments in primary care referred to by my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) are already in place. They are not and that bodes for total disaster.

I will not accept what is going on and I will do all I can to stop it. I will not allow my constituents to suffer as a result of these bureaucratic, account-driven, false and short-sighted plans. Given the population growth and impact in east London generally, this process cannot go ahead. Please stop it now, so that we can get proper planning of health provision throughout north-east London.

I start by congratulating the hon. Member for Leyton and Wanstead (Harry Cohen) on securing this critical debate. It is worth picking up on a couple of points he made. He set out clearly the level of deprivation in his area and its health needs, but also the progress that is being made by Whipps Cross. One issue that he and other hon. Members touched on was that of independent treatment centres and the impact of their guaranteed business, which ends up sucking business out of hospitals and threatening their viability.

We heard passionate contributions from the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) and from others. I was a bit worried that the hon. Member for Ilford, South (Mike Gapes) might need to make use of his hospital, because of the way he was going at the end of his contribution. What hon. Members have done is clearly demonstrate that this is not a party political matter, but a question of ensuring that the needs of the local community are met, and we support that notion.

The debate is not taking place in isolation from what is happening to the NHS nationally. It is worth reminding Members of a couple of points. The NHS, in spite of receiving significant, above-inflation increases, is in deficit. Many trusts are in deficit and although a few months ago the Department of Health was predicting it was going to be in surplus, it is now predicting an overall deficit. There have been in the order of 1,000 or more compulsory redundancies. The Royal College of Nursing’s estimate of the number of jobs lost is far greater: it is quoting a figure of 20,000, including voluntary redundancies, frozen posts and the cancellation of temporary contracts.

The issue of hospital reconfiguration is not only playing out in north-east London, but all over the country. The NHS chief executive announced back in September that there were going to be 60 reconfigurations, which would principally hit the accident and emergency departments, paediatric and maternity services. Hon. Members will be very familiar with the Institute for Public Policy Research report. The IPPR is a think tank that is often quoted by the Government, which has identified that there is an excess—to use its term—of 57 general hospitals in England, and eight too many in London, according to its figures. Those reconfigurations are often taking place without any regard to what is happening in the vicinity or other factors. The Olympics has been mentioned, but there is also the question of population growth, and that of the M11 corridor, in the vicinity of which 11,000 new units will be built. That will clearly have an impact on the Princess Alexandra hospital: the hospital that might have to pick up patients from Whipps Cross. Those factors do not seem to have been taken into account at all.

There is also the matter of the decline of productivity in the NHS. It is against that backdrop that decisions are being taken. The future of Whipps Cross and King George hospitals clearly commands all-party support. The right hon. Member for Chingford and Woodford Green and the hon. Member for Leyton and Wanstead have been prominent campaigners on the issue. I would also like to praise my colleagues on Waltham Forest council. The campaign there has been backed unanimously by councillors at an emergency meeting that was held in November, where a motion was proposed by John Beanse, who is the vice-chairman of the council’s health scrutiny committee. It was adopted by the council, and it called for a range of services currently available in the borough to be maintained. The council then referred the matter to the Secretary of State and I wish it good luck. I hope that it receives a positive response.

Such issues will be familiar to Members both inside and outside London. The situation described by the hon. Member for Leyton and Wanstead is almost a mirror image of the situation in south-west London. The Minister had to respond in a debate about that a week or so ago and he must now be feeling a sense of déjà vu about the issues raised. It was a lot easier for the Minister to respond in that debate by saying that it was simply a matter that Opposition Members were raising for the sake of opposition. Today, he has to address a more significant, all-party issue and will not simply be able to say that the matter has been raised only by Opposition Members.

The process of primary care trusts and acute trusts trying to address deficits is taking place without any democratic accountability, and other hon. Members have referred to that. Decisions are being taken in isolation and not only do they not want to promote democratic accountability and involvement, they want to discourage it, and they do not see a role for Members of Parliament to play in the process. It is the lack of democratic accountability that makes such decisions a lot harder. The primary care trusts and the acute trusts within the NHS in London are not seeking to engage the local community, so when they come up with proposals, they are shot down in flames because no one has been involved in the process or feels party to those decisions. When the local community has input through the overview and scrutiny committees, one sees more and more cases referred to the Secretary of State. However, I am afraid that often their views are not given any particular weight. As of a couple of months ago, only one referral made by an overview and scrutiny committee had been responded to positively by the Secretary of State.

We are not against changes in local services. We are against the way in which they are imposed on local people, without their having a genuine say in shaping things. Will the people of north-east London have a genuine say in what services are provided in their area? Will the consultation be meaningful? I very much doubt it. We believe in greater local democratic accountability. Consultation with local people and clinicians must directly influence local health services and do so at an early stage of the process. That will give local people real ownership of their local health service, while allowing health experts to make difficult decisions on health care delivery.

The Government promised freedom and innovation controlled by local people, but in reality, hospitals are being kept on a short leash and local people have little or no say in how their local trusts are run. It is time to introduce more accountability into the service. Local councils should play a greater role in health so that people can hold them to account for what is happening to local NHS services. We want greater freedom for NHS hospitals through local democratic involvement in the buying and planning of health services. Above all, our local hospitals should have their roots in local communities. That is what the people of north-east London want: they should not be denied that right.

Rarely have I seen such passion or, probably more importantly, consensus in Westminster Hall. The message from right hon. and hon. Members is pretty clear. I hope very much that the Minister is in listening mode and that he will not just trot our his pre-prepared speech, but comment on the many excellent points that have been made.

“Fit for the Future” sounds to me like another corny catchphrase, heralding another reorganisation driven by financial deficits and financial panic. It is not clear to me how the deficits in north-east London have arisen. I suspect that the reason, as in most parts of the UK, is an amalgam of poor financial husbandry, the rustication of the financial debt to other authorities and the funding formula.

Ministers are listening to those who suggest that the funding formula perhaps needs to be revised. They recently met a group from Plymouth, for example. I hope that Ministers will tell us how they will revise the funding formula to ensure in the long term that we are not faced with crippling deficits, which have such perverse and adverse effects on local health care economies and service provision.

The issue needs to be considered in the wider context of what is happening to district general hospitals throughout the country. We heard briefly from the hon. Member for Carshalton and Wallington (Tom Brake) about the Institute for Public Policy Research report. The significance of that report is that the IPPR is close to the Government. What it says about its perception of the need to reduce the number of district general hospitals is important, because Ministers tend to listen to the IPPR.

I think that the IPPR is wrong. The recent reports from the Department, authored by Professors Roger Boyle and Sir George Alberti, are perhaps also wide of the mark on how we should proceed with acute hospital delivery. Professors Alberti and Boyle argue that we perhaps need less A and E provision, with fewer A and E departments in the future, and that services should be concentrated in large tertiary centres. Professor Boyle in particular cites stroke and heart attack in that context. However, Professors Alberti and Boyle are not necessarily typical of doctors who work in either the primary or the secondary sector.

The British Association for Emergency Medicine takes a contrary view. Of the total number of cases that wander through the doors of A and E departments, 97 per cent. have nothing to do with stroke and heart attack, which appear to be driving the agenda forward. We have been in touch with many casualty consultants and others, who are concerned that the general direction of travel on which the Government appear to have embarked will be to the detriment of the 97 per cent. of people who need easy and relatively rapid access to acute services. I hope that the Minister will take a more inclusive view when he consults those who work in the sector before doing anything that is irredeemable.

The changes in doctors’ working hours, such as those under the European working time directive, are also driving a great deal of what is happening in the secondary care sector. As an ex-junior doctor, I can reflect on the one-in-two rotas that I used to work and on whether that was a good thing to be doing. It did not seem to be so at the time, but we have nevertheless moved away from a culture of deep, profound commitment by junior doctors—working day in and day out, through the night, all the hours that God sends—towards more of a workaday approach to duties. That brings with it costs and benefits.

I would criticise the Government in their attitude to the SIMAP and Jaeger judgments by the European courts. We had hoped that the UK would secure a derogation for the specific way in which we tend to work in this country. Unfortunately, we did not do so, and that happened on the Government’s watch. Therefore, rotas have had to be redrawn and re-jigged. Often that results in smaller district general hospitals struggling to offer the same full range of acute services as in the past. In many cases, that has led to district general hospitals facing mergers or closures. We need to understand that.

We also need to understand that, paradoxically, there has not recently been a shift of services from the acute sector into primary and intermediate care—as we understand the Government would wish—but a shift in the other direction. We heard from the hon. Member for Leyton and Wanstead (Harry Cohen) that the changes in primary care had been fairly modest, despite the Government’s intentions. In fact, attendances at casualty departments in his borough and others have increased, so there has been a shift in the other direction. We have also heard that the recruitment of community nurses has been modest, which is certainly the case in my area, as it evidently is in the hon. Gentleman’s area.

We cannot have the Government saying that they will increase provision in the community and close down acute services, without their first planning for those improvements. Those improvements must be up and running before we start contemplating closures in the acute sector. So far, we have seen very little indeed in the way of improvements, and I was interested to hear the hon. Gentleman’s reflections about his borough.

The Secretary of State for Health said last week that she wanted GPs to do more and for more to be done in the community. That is all well and good, but she also said that she felt that GPs’ salaries needed to be restrained or capped. As I know very well, GPs’ remuneration has escalated under this Government. I am sure that GPs are grateful for that. However, I am not sure that it is terribly edifying for the Health Secretary, having supervised that, to say that the Government will have to cap those salaries, particularly if she is saying that GPs must do more.

The Government cannot have it both ways. In general, I would support incentivising primary care to do more and to take more of the burden from the acute sector, because that is what patients want. However, the Government cannot do that on the one hand, but on the other say, “Ah, but we’re going to expect GPs to do more for less”. Things do not work that way and the Minister should know that very well. Ministers need to be clear about the precise direction in which they intend the change to go.

We have spoken a little about consultation, mainly in relation to elected representatives. I have been horrified by what I have heard about the attitude of local health care managers in that respect. However, we should also consider the consultation process in the round. Up and down the country, many consultations are little more than a sham or a tick-box exercise. That is deeply worrying and encourages a culture of cynicism among consultees, who feel that they are not properly listened to, which I suspect is true in the case that we are debating.

The health overview and scrutiny committee and the independent reconfiguration panel process has been mentioned briefly, as have its shortcomings. However, as the hon. Member for Carshalton and Wallington pointed out, the process is important in that there appears to be a democratic deficit. There is indeed a democratic deficit: the Secretary of State is unwilling to assume responsibility for what is happening in the health service for which she is responsible. Time and again, the message that we hear from the Ministers is, “This really has nothing to with us—it’s down to local decision making”. Under the current circumstances that is a sham. I hope very much that the Minister will grip what is happening in north-east London and assume responsibility for it.

I am tempted to say that we are all agreed, but that is not my role in this debate, which must have felt like déjà vu for you, Mr. Cook, given some of your recent experiences with your local health service.

I congratulate my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) on securing this debate, which has been a powerful one. Hon. Members on both sides of the House have made passionate and clear cases about why they feel so strongly about the issues that affect their local communities. In the relatively short period available, I shall try to do justice to the points made. I cannot say that I agree with everything that has been said, but I am sensitive to the fact that many of the concerns expressed have been reasonable and legitimate. I shall try to respond in that spirit.

First, I shall deal gently with the hon. Member for Westbury (Dr. Murrison). He cannot play such games. Tory policy on the national health service is in favour of total operational independence at local level, as stated by the Leader of the Opposition and the shadow Secretary of State for Health. Yet now the hon. Gentleman says that he wants Ministers sat in offices in Westminster and Whitehall to interfere in every difficult, controversial and contentious local issue and to take whatever action suits him at the time. That position is entirely incoherent and disingenuous.

No. The hon. Gentleman talks about looking at the funding formula, but what he means is moving away from a funding formula based on health inequality to redirecting resources to more affluent areas. We will not do that, because that is the policy of the Conservative party, which, furthermore, has voted against every additional investment in the national health service proposed by the Government since 1997. I shall take no lectures from the Conservative Front-Bench spokesman—I emphasise, “Front Bench”—on overall health policy.

The essential difficulty about the arguments is as follows. Hon. Members say in all debates on the health service that they acknowledge the need for change. They say that they acknowledge the comments made, the papers released and the policies developed by people such as Professors Alberti and Boyle—all of which say that more and more treatment needs to take place closer to people’s homes in the community and in primary care settings. Hon. Members acknowledge that that direction of travel is good for patients and reflects many patients’ aspirations and preferences in a modern world. Alongside that, however, hon. Members say that they want the status quo to prevail. They must accept that there is an element of contradiction in that position.

I shall give way to my hon. Friend in a minute; let me develop my argument.

For example, during this debate, hon. Members have talked about the need to invest in primary care and access to transport for their constituents. They are absolutely right to say that it would be nonsense to make changes to acute NHS care in any locality without investing properly in community services and primary health. They are also right to say that it would be nonsense not to consider the very real transport and access problems that constituents experience as services are reconfigured. However, it is unfair to suggest that, if changes were made in any locality, those issues would not be considered holistically, as part of the changes.

I take the Minister’s point, but does he not accept that there is a certain uniqueness to the geographical area that we are discussing? Not only is an increase of 311,000 anticipated in the population of north-east London, but the Government anticipate an extra 750,000 people in east London and across the Thames Gateway in the next 10 years. No one is arguing for the status quo; given those empirical realities, we are all arguing for extra capacity.

I have great respect for my hon. Friend’s work in his constituency, particularly in dealing with the far-right elements that are dividing his community. I agree entirely that any decision made in the context of the reorganisation must take proper and full account not only of the current population but of the direction of travel of population growth. Any failure to do so would be nonsense.

I want to intervene only very briefly; this is important. I know the Minister has little time, but I wish that those on our two Front Benches had not spoken. I have two points to make. First, the Thames Gateway programme talked about 1,000 extra acute beds; it did not say that there would be investment only in primary care. Secondly, we are told endlessly at the meetings that, yes, the PCTs say that there will be more investment, but only when the money is withdrawn from the acute trusts. We are looking way down the road before we even get that facility.

All I say to the right hon. Gentleman is that the future population growth in those communities matters. I would certainly be extremely concerned at any suggestion that young people do not get ill.

To reassure my hon. Friend the Member for Dagenham (Jon Cruddas), I do not think that anybody is saying that Whipps Cross hospital is bad. There is no evidence to prove that: the hospital would not have received a £2.8 million investment in emergency and urgent care, nor a £3.4 million investment in an endoscopy unit only last year if there had been a genuine belief that it was, as a matter of course, a bad hospital. There is no suggestion that that is the case.

Other hon. Members, including the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), have talked about the review of London health needs across the piece and the importance of integrating that into the review. They asked why the review was taking place separately. I have two things to say about that. First, it is not for me to instruct NHS London on what it ought to do. Secondly, when NHS London receives the proposals and has to make a decision on whether to consult on them—for that process would be about to take place—it must consider the consequences of going ahead with that consultation outside the overall review of health services in the London area. It is for NHS London to make the judgment on whether that would be an ill-advised direction of travel, but it certainly has a responsibility to take full account of that issue when it receives recommendations and before it decides whether it would be appropriate to allow a stand-alone consultation to go ahead.

I ask the Minister to get from the London region a copy of its letter to me and ask it why such a letter was sent. It is clear from that letter that it has a pre-conceived approach and will go ahead regardless.

I shall make sure that I familiarise myself with that letter.

I say to hon. Members, particularly the right hon. Member for Chingford and Woodford Green, that I do not think that it helps or is appropriate to cast aspersions on the integrity of officials in the local NHS. The right hon. Gentleman may disagree with their judgment. On occasions, he may not be satisfied with their performance, but it is entirely inappropriate to cast aspersions on the integrity of those people, many of whom are genuinely trying to do their best for local patients and the local health economy.

My hon. Friend the Member for Walthamstow (Mr. Gerrard) made some important points. He talked about the knock-on effects on neighbouring hospitals in the context of any London-wide review and the effect of doing things separately from that. He talked about the apparent resentment of MPs’ involvement. Well, I give a clear message to any NHS leader or manager anywhere in the country: engagement with MPs is a priority, although it is not the final part of the process. MPs are democratically elected and represent their local populations and communities for good or bad. They have every right to be those taken most seriously when such decisions are made. That is not the same as saying that hon. Members have the right of veto, which might sometimes lead to anarchy. However, any suggestion that MPs should not be one of the first groups to be consulted is unacceptable.

I nearly called the hon. Member for Ilford, North (Mr. Scott) my hon. Friend. I cannot do so yet, although I am sure that he will see the light one day. He talked about the gentleman from Barratt Homes and his medical expertise. It is a bit rich for the Conservative party to slag off business people sitting on public service boards for being business people, given that it completely transformed the management and accountability of public services and placed business people on boards purely because they were business people—whether they knew about anything else did not seem to matter. That policy was ideologically driven.

However, the hon. Gentleman was good enough to congratulate the Government on Queen’s hospital. I am a bit disappointed that my hon. Friends did not talk positively about the massive investment in that hospital. I say gently to my hon. Friend the Member for Ilford, South (Mike Gapes) that, yes, the hospital has teething problems, but he and we should be very proud of the Government’s £261 million investment. I am also delighted that my hon. Friend the Member for Leyton and Wanstead is a passionate advocate of PFI schemes and the Government’s choice agenda in the national health service. That is a revelation, but I promise not to tell anybody.

The hon. Member for Carshalton and Wallington (Tom Brake) talked about not opposing change for the sake of it. He has clearly not read “Focus” leaflets these days; all the literature is about opposing any politically expedient change. There will be balance in the NHS by the end of the financial year, so the hon. Gentleman is wrong about that.