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Acute Hospital Services

Volume 457: debated on Wednesday 21 February 2007

I beg to move,

That this House recognises the need to develop and improve acute hospital services; is concerned that current reconfiguration proposals are being dictated by financial and staffing pressures; believes that the Government cannot call for change whilst failing to put in place the commissioning and tariff structures necessary to support, for example, maternity services, acute stroke care, cardiac care and vascular surgery; regrets the Government’s lack of support for models of service configuration which would secure high standards whilst maintaining access; calls on Ministers to bring forward proposals to mitigate the effects of the European Working Time Directive on hospital services; insists that reconfigurations should be based on safety, quality of care, accessibility and choice; is deeply concerned that NHS staff, public and patient voices are not given appropriate weight in the decision making process; and calls for a stronger local democratic voice that will contribute to public confidence in the planning of acute NHS services.

It is just over a year since the Government’s White Paper. Far from being the best year ever for the national health service, it has been a year of deficits and financial and staffing pressures. We learned yesterday that the gross deficits across the NHS will be continued from last year into this financial year, that the number of redundancies continues to rise and that—as a consequence of the White Paper—hospitals across the country are threatened with cuts and closures. There are widespread concerns and anxieties, to put it mildly, about the implications.

The Secretary of State mandated that state of affairs by saying in the White Paper that resources would be moved into the community. In practice, the implementation of those words means that hospital budgets are being constrained, so cuts and closures are happening in the hospitals, but the infrastructure has not been created, or resources supplied, for patients to be looked after closer to home. I was interested to see that that point came across in the results of a recent consultation in Warwickshire. People said, “Don’t cut back our hospital services, because we cannot yet see the resources being put into the community.”

The process that the Secretary of State set in train a year ago has led to demonstrations in west Cornwall, Banbury, Chichester, Haywards Heath, Salford—[Interruption.] Yes, even in Salford. The Labour party chairman was there with her megaphone and placard. I must not leave out Worthing. Those demonstrations were against the consequences of the Government’s policy and are unprecedented in my experience in their scale and extent, especially over such a short period of time.

My hon. Friend has missed out the demonstrations in Surrey. Surrey does not demonstrate about much, but people are demonstrating about the health service, marching in stony, angry silence. They await the review of hospitals in the anticipation that Surrey and south-east London hospitals will suffer several closures. Among the factors that are presumably considered are usage and demand, and there are strong rumours of engineering, with the directing of patients to certain hospitals or, more importantly, from others. A constituent was recently referred by his GP to the Royal Surrey county hospital at Guildford for general surgery. The patient was told to use the choose and book system online, but he found that the Royal Surrey was not listed. He rang the booking number and he was told that the Royal Surrey was not taking bookings for general surgery—

Order. I hope that the hon. Gentleman will make his point as quickly as possible. Interventions should be brief.

I am grateful to my hon. Friend and I should not have left out Surrey. In fact, I should not have left out lots of places, but I did—[Interruption.] Yes, I should not have left out Hertfordshire or Shropshire. I am grateful to my hon. Friends. I could have mentioned Worcestershire, home to the Labour Chief Whip, or Lanarkshire, home to the Home Secretary.

My hon. Friend the Member for Mole Valley (Sir Paul Beresford) makes an important point. I do not know whether he knows it, but one of the consequences of the way in which the reconfigurations are being pushed by NHS bureaucracies is that referrals are being manipulated through the choose and book system. I was talking to GPs in Yorkshire a few weeks ago, and one told me, “I sit there with my patient and we look at the waiting times for the hospitals that are available to us. The patient chose a hospital in Leeds, where she could be seen quickly. We went through the choose and book system, but the primary care trust, which has an enormous deficit, took hold of the referral.” The PCT, in effect, said to the patient, “Yes, you might like to go to Leeds, and Leeds could treat you in two or three weeks’ time, but you will not be seen until April because that is when the new financial year starts.” So, what is the point of choose and book?

The hon. Gentleman talks about Leeds, but can he understand why his words ring somewhat hollow with people on this side of the House? Under the Conservatives, six hospitals in Leeds were closed: Killingbeck, St. George’s, Marguerite Hepton, Roundhay maternity, Woodland orthopaedic and The Grove. Deficits were just as large in percentage terms and they were dealt with not only by closing hospitals and wards, but by keeping patients waiting longer and longer. Does he acknowledge that?

I am grateful to the hon. Gentleman, because the hon. Member for Leeds, North-West (Greg Mulholland), who is not here, would, under these circumstances, no doubt get up and say, “Has the hon. Gentleman any idea what is going on in Wharfedale hospital?” It is all very well to build a hospital and open it, but it is another thing not to start shutting down the wards in it. We have constituencies where such facilities are being built. The hon. Member for Pudsey (Mr. Truswell) should know that major new hospital building projects have been conducted at a rate of five a year since 1997. The rate was also five a year between 1979 and 1997, so he cannot tell us that there has been a massive increase. He says that there have been a lot of hospital building projects, but they have been undertaken through a private finance initiative system that, frankly, has not transferred enough risk, and the their cost will be borne by the NHS for the next 30 years.

On the point about new hospital projects, my hon. Friend will be aware of the new super-hospital that was going to be built in Hatfield. It was pledged before the last election and would have involved a £500 million investment in Hatfield. Strangely enough, the project just disappeared after the election. Not only that, it took years for all sides to agree on the investing in health process, and not only have we lost the new hospital, we are losing the current hospital. Does he think that that is part of a national picture?

I am glad that my hon. Friend made that point. In our motion, we say that we want to reassert the need for the voices of local people—not just the public, but professional local voices—to be heard in questions about reconfiguration. He is right—it might not have been something that everybody in Hertfordshire was entirely happy about, but they signed up, by means of a long investing in health process, to the idea that it was necessary for them to have specialised services provided in a new hospital. That happened before the general election, and the hospital was going to be in Hatfield. My hon. Friend, happily, secured his seat at the last general election. However, because of the increase in deficits that has occurred since 2005—if the Government say that the issue is not about deficits, this gives the lie to that proposition—that large new hospital has gone completely out of the window. Every time Ministers say, “The evidence tells us that you’ve got to have more specialised services that are in a larger, new hospital,” just think of Hertfordshire, where it is obvious that deficits are destroying even the Government’s own proposition.

May I just return my hon. Friend to what he was saying about the choose and book system? Is he aware of what is happening in my constituency? When GPs who are required to use choose and book try to refer someone to a consultant at the Royal Surrey county hospital, that persons gets an appointment not with a consultant, but with another GP. That is part of the demand management process that has been imposed by the primary care trust. So, in fact, instead of making it easier to get to hospitals quickly, there is now an additional layer of bureaucracy, which totally negates the whole point of choose and book.

Yes, it is astonishing that at the same moment as the Government are talking about the desirability of transferring greater responsibility into the hands of GPs, one of the core responsibilities of general practitioners—determining to whom referrals should be made and how patients should be treated—is being taken out of their hands by the local primary care trusts. That is not to say that there is not a role for GPs with special interests, but we have been talking about this matter for years and nobody should be under any illusions.

It is quite difficult and probably quite expensive to develop GPs with special interests. [Interruption.] Yes, I will give way in a minute. The silent one on the Government Benches seems to think that the doctor from Dartford needs to be heard. Well, we have heard from the doctor from Dartford too many times before to think that we could learn anything from him. [Interruption.] I do not think that we could. The point is that if GPs with special interests are valuable, their colleagues will know that and they can make referrals to them. [Interruption.] I will give way to the hon. Member for Dartford (Dr. Stoate), and then we will find out what he has to say.

I grateful to the hon. Gentleman for giving way, particularly after his warms words about me. I think that I am right in saying that I am the only person present who uses the choose and book system. I use it regularly and the only thing that I find wrong with it is that there are not yet enough specialties for which we can use choose and book. The faster it expands and becomes universal for all referrals, the better. I can now sit down with one of my patients, go through every available hospital in my district and tell them precisely how long each waiting list is for each consultant. It cannot get much better. It needs to improve, but the basic system is very effective.

I am sorry, but the hon. Gentleman is completely missing the point. A GP in Yorkshire who used choose and book said that he made a decision on the basis of the available waiting times at different hospitals. The primary care trust then took that decision away and negated it by saying that people had to wait 17 weeks anyway. I do not see what point the hon. Gentleman is making. We are not against direct booking or online booking. He ought to take the matter up with his colleagues on the Front Bench, whose job it was to deliver choose and book on time and who have not done so. Norman Warner pushed off. He was supposed to deliver choose and book, but he has gone already. He has got other fish to fry, and perhaps we will talk about them later.

Sorry. With regard to reconfiguration, does my hon. Friend agree that areas such as Shropshire—rural counties—are far more affected because of the huge distances that constituents have to travel? Will he press that point strongly to the Secretary of State?

I am grateful to my hon. Friend, because he takes me to where I wanted to go next.

There should be no argument about the desirability of moving acute hospital services forward and of adapting and improving. In my experience, all the campaigns that we have been talking about across the country are not saying that nothing must change—

Well, except perhaps where the Labour party chairman was concerned. In my experience—[Interruption.] The hon. Gentleman says “Hinchingbrooke”. I seem to remember that in the last debate we had on this subject he was at pains to quote me as saying that I believed that there needed to be change at Hinchingbrooke so that, for example, blue-light ambulances took people with certain specialised conditions past that front door to Addenbrooke’s hospital in my constituency—so I will not have any of that nonsense.

No, I am answering another point.

The Royal College of Surgeons, which is quoted quite a lot across the country, produced a consultation document in March 2006. It said something quite important, which is often referred to:

“The preferred catchment population size, as recommended in previous reports, for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency medical and surgical care would be 450,000-500,000.”

However, it went on to say:

“The majority of acute hospitals currently have, and are likely to continue to have, a catchment population of approximately 300,000.”

So, it is looking for 300,000 in the first instance. It continues:

“Where more centrally located units will have the option of closing down services on one site to be provided on another, the rural units do not have such inherent flexibility. Furthermore, in many cases, the Trust must provide, for example, A&E services on each site and have no hope, therefore, of lowering their reference cost.”

It adds:

“The College would strongly urge the government to consider the plight of rural hospitals and act accordingly to protect them.”

I have not heard Ministers quoting that bit of the Royal College of Surgeons document.

To continue my point about a decade of this issue, the recommended catchment population size in the Royal College of Surgeons report was not invented in 2006; it was in documents that it published in 1998. Ministers—not just current Ministers, but previous Ministers—have been sitting around debating this matter for years, and then they pop up in 2006 and say, “We’ve got to do it and we’ve got to do it now.” What they meant is not that we have to do the reconfigurations and specialisation in 2006, but that we have to cut the hospital budgets and do that now.

I have not yet given way to a Liberal Democrat, and as I am talking about rural areas I give way to the hon. Gentleman.

On rural areas, I assume that the hon. Gentleman would agree that if the acute system is to work, we must have cottage hospitals to manage non-acute patients. If those hospitals are closed—Llanidloes hospital in my area is threatened with closure—pressure is increased on the acute services and they end up doing the jobs that they are not best placed to do. Does the hon. Gentleman agree that if we see the persistent shutting down of rural services, the pressure on acute services will increase so that no one will get the service that they need at an affordable price?

Yes, I agree with the hon. Gentleman. He might recall our debate on maternity services at the beginning of January, when that point was illustrated well. When I visited Brecon Memorial hospital—it is not in his constituency, but it is close by—I could see that it provided an excellent service. The hospital makes an enormous difference to the mothers who give birth there and also relieves what would otherwise be serious pressures on other hospitals.

It is important to say that we accept the drivers of change. Let me quote the Secretary of State:

“Modern medicine means also that we can treat more patients with fewer beds. Many more services can be provided outside hospital”.—[Official Report, 16 February 1993; Vol. 219, c. 133.]

The Secretary of State is agreeing not with herself, but with what the then Conservative Secretary of State said on 16 February 1993. The argument has not changed; the point is, what have the Government been doing about it? They have not been doing anything.

Let us have a look at what the Government have been saying. Their amendment to the motion focuses on some of the things about which they have started to talk. Suddenly, in December 2006, the clinical directors at the Department were invited to pop up and say why there was a case for the reconfiguration of clinical services. We had a maternity services debate on 10 January and, lo and behold, by 6 February the clinical director for children’s and maternity services popped up with a report—we will come to that in a minute.

As was illustrated by the clinical directors’ reports on accident and emergency and cardiovascular services, the question of A and E is often at the heart of this. A central point that has been argued for a long time is that full access in A and E to every specialised form of treatment cannot be maintained. Conservative Members—and certainly Conservative Front Benchers—do not argue that every A and E department in the country should be able to treat every patient. We have never believed that. For example, when Richard Hammond had his accident, he went to not the local hospital, but to Leeds general infirmary—quite rightly so, because it was able to provide excellent neurological care. The same will be true in every part of the country, but the question is how far that specialisation should go.

The Government’s documents focus on such issues as heart attacks and stroke. With regard to heart attacks, they talk especially about primary angioplasty—the Government cite that in their amendment—which is a mechanism whereby rather than giving thrombolysis in all cases, even if this takes a little more time, a balloon is put in a patient’s artery to re-engage the blood flow, after which a stent is put in to maintain the flow.

The procedure is not new. We did not suddenly discover it at the end of 2006. When Roger Boyle, the clinical director, produced his document, I asked him on what clinical evidence he based it. I was referred to an article of January 2003, which itself said:

“In 1995 and in 1997, systematic reviews of this topic were published, with the later analysis of 2,606 patients, showing improved short-term clinical outcomes … with primary PTCA”—

the primary angioplasty intervention—

“compared with thrombolytic therapy”.

So, from 1995, 1997 and 2003, there has been consistent information about the procedure.

I am not saying that the Government’s study discovered that in 2006. Towards the end of 2004, they began pilot studies. The hon. Member for Pudsey talked about Leeds. I visited Leeds general infirmary in March 2005, when it was involved in the pilot studies on primary angioplasty. However, I remember a conversation with the clinical director—if he puts himself in the frame of being the Government’s mouthpiece, he must take this—when I hosted a reception here on “saving minutes, saving lives” to celebrate success on call-to-needle times for thrombolytic therapy. I asked him what plans he was putting in place to move beyond that procedure to primary angioplasty, and he said, “Well, for the moment, we’re going to concentrate on the target and we’ll worry about that later.”

I will not take lessons from Government Ministers about us standing in the way of progress when the situation regarding the procedure has been clear for a long time. A million cardiological interventions involving primary angioplasty already take place in America—it is increasingly routine. I remember a cardiologist telling me in early 2004 that although the procedure was routine in the Czech Republic, it was virtually not happening at all in this country. The one place in this country where it is increasingly routine is London. There are 32 accident and emergency departments in London, nine of which offer primary angioplasty. Patients with myocardial infarction are going to those nine departments. Why are they going there? It is not because the Government have published anything—they are still spending their money and time on pilot studies and it will take a while before they publish the evaluation—but because the London ambulance service has taken the initiative. Frankly, if the Government got out of the way and people in the national health service were given greater freedom to deliver the services that they know are right, we would make more progress, more quickly.

I am somewhat disappointed by the hon. Gentleman. I usually have high regard for what he says, but today he appears to be trying to turn fiction into fact. Of course the procedure is routine in America and the Czech Republic. It is routine on Teesside. In 2003, I had angioplasty and several stents inserted in my left anterior descending artery. Routine? How routine does he want to get?

The hon. Gentleman might say that, but the procedure is not routine in this country. There are 11 pilot sites, and a limited number of places throughout the country in which it is offered.

Is he? Oh well—[Interruption.] If the hon. Member for Stockton, North (Frank Cook) had angioplasty, that is one thing, but if he had primary angioplasty, it is another. If he had an acute MI—[Interruption.] It helps to have a doctor, although I prefer my doctor to the one from Dartford.

I shall not give way.

The hon. Member for Stockton, North might be right. Angioplasty is absolutely routine. However, primary angioplasty, which takes place when someone in a blue-light ambulance who has had a heart attack goes straight to having a balloon and a stent put in, instead of having thrombolysis, is not routine in this country. It happens in some places, but not in others.

Does my hon. Friend agree that the reports suggesting that change is for the better would be more convincing if they were not being used as a smokescreen? In March 2005, Surrey Members were told that a hospital and its A and E department had to be closed to save £120 million. Nine months later, a report was commissioned and it is now being waved about as an alternative justification for something that we were told was being done to save that money. No wonder we do not believe reports if they are used as smokescreens.

My hon. Friend is absolutely right. St. Peter’s and Ashford hospitals, along with others in Surrey, are wondering where on earth the evidence is for the reconfiguration that will be forced upon them. They know that it will be forced upon them because the Secretary of State went to a meeting with the chairman and chief executives of the then strategic health authority, at which she told them that a hospital needed to shut and that she would be prepared to push that through. She can always intervene to deny that if it is not true.

No, because I need to cover this point about accident and emergency.

The clinical directors produced documents with the intention of somehow pretending that there was an established case for reconfiguration and that we were standing in the way of that. That is not true at all.

Let us consider stroke—I declare an interest as the chair of the all-party group on stroke. In October 2004, I went to see Gary Ford, the consultant stroke physician at Newcastle Freeman hospital. He gave a presentation about stroke care, the acute care of stroke and the use of thrombolysis for stroke. One of the slides that he used contained a quote from a Scandinavian consultant:

“What is most striking for a non-UK stroke physician is the organisation and medical management in the acute phase—it appears that stroke is not seen as a medical emergency in most UK hospitals.”

Back then, in late 2004, the all-party group on stroke and I pressed the Government to treat stoke as a medical emergency and to introduce the routine use of thrombolysis for stroke patients where appropriate, so I will not listen to any lectures from the Government on that. Roger Boyle and George Alberti’s document says that the changes have to be made somehow, and the all-party group, the Stroke Association and the ambulance service have all been asking and arguing for that to happen. We want it to happen, but it is not happening for two reasons. First, the Government have not amended the tariff, so there is a financial disincentive for hospitals to provide acute care for strokes. That is the Government’s responsibility, and they have not made the necessary changes. Secondly, they have not produced the national stroke strategy.

The Public Accounts Committee produced a damning report on the Government’s failure to recognise that they could actually save money and lives by implementing changes to acute care for strokes, in a way that is now routine in other countries—in America, on the continent of Europe, and in Australia, where up to 15 per cent. of stroke patients receive thrombolysis. In this country, the figure is 0.2 per cent.

The Minister says that, and she is responsible for the issue, but as she will know, because she came to see the all-party group, we want action and we want it now. We are not standing in the way of it, so I will not take any lectures from her, or from the national clinical director. They produce documents that say that it is important that we adopt those measures, but it is they who have been standing in the way of those changes.

On accident and emergency services, I accept that there are cases in which a blue-light ambulance is called, and it does not go to the nearest hospital, and of course we have to accept the argument for that. However, as a consequence, across the country, primary care trusts and strategic health authorities are saying, “We’ve got to downgrade units.” I went to Chase Farm hospital accident and emergency unit, and people there were saying, “We want to become a minor injuries unit.” Frankly, the choice is not between having a full-service accident and emergency department and having a minor injuries unit. As George Alberti makes clear in his document, it is perfectly valid for us to retain accident and emergency departments.

If we add up all the myocardial infarctions, strokes, major head injuries, aneurisms and demands for vascular surgery, they still account for only about 300,000 out of 13 million attendances at type 1 accident and emergency departments. We cannot have a situation in which the NHS, because of financial deficits and the impact of the working time directive, shuts accident and emergency departments across the country, so that 97 per cent. of the people visiting those departments lose access to them, on the excuse that 3 per cent. of patients need to be blue-lighted to a more specialised centre.

I am grateful to my hon. Friend for referring to Chase Farm, and I share his concern about its move towards having a minor injuries unit; that is simply one option among many concerning accident and emergency. Does he welcome the fact that Sir George Alberti is now to report on Chase Farm specifically, and the options open to it? Will he make the point that Chase Farm has a wide catchment area, and we should not move quickly to downgrade, simply in the interests of saving money?

I entirely agree, and I hope that George Alberti, for whom I have a lot of respect, will come to the right conclusions in his report. I will not go on about maternity services in detail, because our debate on 10 January covered that subject, or most of it, but since 10 January, the Government have produced a document from the national clinical director for children, young people and maternity services. Fascinatingly, what is does not tell us is far more significant than what it does. It does not tell us anything about whether there are enough midwives to provide maternity services, and it does not tell us what might be regarded as safe transfer times between a midwife-led unit and a consultant-led unit. It does not tell us how swiftly, and under what circumstances, mothers should be able to have an emergency caesarean section.

In fact, at one point the report commends the fact that, in Huddersfield, a unit shut down because it could not maintain eight consultants and at least 2,500 births a year, but two pages later, it says:

“There is no optimum number of births to make a unit sustainable.”

There is no evidence in that report, published by the Department, that informs thinking on the delivery or configuration of maternity services across the country. It does not help at all. Indeed, I am afraid that across the country, campaigners are having to put together the arguments themselves, because the arguments are not presented in the work done by the Government.

Who is standing in the way of change? Let us have a look. The Labour party chairman, in Salford, does not agree with the Government’s policy. The Labour Chief Whip, who stood outside the Alexandra hospital in Redditch, does not agree with the Government’s policy. The Home Secretary does not agree with the Government’s policy, because of the closure of his local accident and emergency department up in Lanarkshire. I could go on; the list even extends to the Prime Minister. Back in September 2004, there were proposals for the reconfiguration of acute hospital services in north Teesside, and the Prime Minister, with the then Secretary of State for Health, now the Home Secretary, came to Hartlepool. As it happens, it was in the middle of a by-election, but of course I would not suggest for a minute that, in the heat of a by-election, the Prime Minister would say something that he did not believe, and that he was not prepared to deliver on subsequently. He arrived and said:

“There is no question of the hospital closing or being run down.”

Subsequently, it was proposed that precisely that should happen.

The decision taken in that case may be right, or it may be wrong; it is not really for me to say, but the independent reconfiguration panel has become involved. Curiously, there have been 20 referrals from overview and scrutiny committees to the Secretary of State, and five of those, including three from local authorities in north Teesside, have been sent to the IRP. There is one single characteristic shared by those five referrals: they all related to places where Labour Members of Parliament were arguing with each other. They concerned north Teesside, Calderdale and Huddersfield, and, more recently, Greater Manchester. If Labour MPs are arguing with each other, and the Secretary of State does not want to have to decide between them, the case goes to the independent reconfiguration panel. In places where Liberal Democrat or Conservative Members of Parliament are involved, she will rubber-stamp the decision. Bang! There we go; the decision is made, and the debate is shut down immediately. She does not care.

At one point, the Secretary of State received proposals that the NHS hospital rebuild should be in Sutton, but she not only did not accept what the local NHS was telling her, but said that the rebuild had to be at St. Helier hospital, which—lo and behold—was in a Labour constituency, but she subsequently had to completely abandon her proposal. [Interruption.] Well, it serves a Labour constituency. We know perfectly well what that was all about. She subsequently had to abandon her intentions in the face of judicial review. Credit must go to my hon. Friend the Member for Reigate (Mr. Blunt) and other hon. Friends for seeing off the Secretary of State’s desire to gerrymander NHS services for political gain.

I want to read the hon. Gentleman a quote from the Minister without Portfolio, my right hon. Friend the Member for Salford (Hazel Blears). He referred to her three times, saying that she disagreed with Government policy. Some time ago, following the picket that has been referred to, she said:

“I’ve made it clear to readers of the MEN”—

That is, the Manchester Evening News

“that I support Labour’s policy of investment in the NHS and reform to improve services.”

The hon. Gentleman keeps making the point that there is a link to investment decisions or cuts, but that is not the case. Hope hospital is not in financial deficit, and more money is being invested. [Interruption.] I am just disagreeing. The hon. Gentleman has made a number of points that are simply not true.

The hon. Lady should have read the debate on 10 January. I was not making the case that the changes in Greater Manchester were being made entirely for financial reasons. That is why we talk about financial and staffing pressures.

No, I will not give way. If the hon. Lady reads “Making it Better, Making it Real”, the Manchester document, she will see that the matter is driven by the European working time directive. This Government signed up to the social chapter; they are implementing it, and they said, in 2004, that they would amend the working time directive, but they have failed to do so.

It is a long time since I studied politics at Swansea university. Indeed, one of my lecturers was the hon. Member for Huddersfield (Mr. Sheerman). In those days, however, I learned about the concept of collective responsibility. We have all seen the photographs of Government Ministers and read quotes in which they directly oppose the decisions that they made in cabinet. Will my hon. Friend tell the House where he believes collective responsibility now lies?

Since my hon. Friend and I were politics students the world has moved on. We now have sofa government, so collective responsibility probably extends to the sofa and the armchair, but no further. We know precisely what members of the Government are doing. As my right hon. Friend the Leader of the Opposition said at lunchtime, they are all manoeuvring to try to save their skins when the time comes. We should have humility, because it happened to us in 1997: when a Government fail and the electorate decide that they ought to go, the tide goes out a very long way, and it will do so for Labour Members of Parliament.

I must conclude, because many Labour Members wish to make their own contribution.

The point of the motion is straightforward. I do not accept the proposition that we stand in the way of change. We believe in change to improve the national health service, whether it is primary angioplasty services, stroke services or reconfiguration to make sure that we deliver maternity services more effectively. We have made that clear, both today and in our previous debate. We will not allow the Labour Government to pretend that clinical considerations drive changes in the NHS that are not in patients’ interests. The proposed changes are not substantiated by clinical evidence, and there is no basis for them. The Government have not introduced a national stroke strategy or made an evaluation of primary angioplasty pilots. They have not conducted a review of walk-in centres. The Secretary of State said that it would be published in the new year, but we have not seen it. It has all gone out of the window. The Government argue for change, but they do not provide the evidence for it.

We know what it is going on, as the Government published the figures yesterday. Deficits of some £1.3 billion are littered across the national health service, and one third of trusts are potentially in deficit. The Government, however, are determined to drive down activity in the hospital sector to try to rescue the Secretary of State from the consequences of financial deficit. Astonishingly, the right hon. Lady now argues that fewer beds are a sign of success. It is “Yes Minister” politics, and in the next episode it will be suggested that if none of the patients turns up at hospital the NHS will work brilliantly. Fantastic! The Secretary of State has said that we are just over halfway through the NHS plan, but how many of her colleagues have re-read that document, which was published in 2000? I suggest that they look at it, because it is very interesting. It does not say anything about payment by results, practice-based commissioning or foundation trusts. It says, however, that the Government will implement a national beds inquiry and increase the number of beds by 7,000. Bed occupancy rates are so high that the number of cases of Clostridium difficile has risen from 17,000 six years ago to 45,000 in the past year, so we will not accept their lectures on the subject. Fewer beds will be acceptable when occupancy rates in hospital are such that patients can be treated properly and nurses have time to clean a bed before it is taken by the next patient.

I will give way for the final time, as I have great respect for my hon. Friend’s campaign on community hospitals in his constituency.

Thanks to the advance of modern medicine and improvements in public health, the number of beds has generally declined over the years, but that will not continue for ever. Our bed use is similar to that of the United States, where it is among the most efficient in the world. In the East Riding of Yorkshire alone, every year there is a net increase of 500 in the number of people who are over 85. When elderly people are ill, they need a hospital bed. They need time to recuperate, and they need community hospitals as well as decent acute hospitals. The Government believe that that downward curve can go on for ever, but it cannot.

Absolutely. I agree with my hon. Friend. We have made that point, and I know that his constituents subscribe to the campaign that he is fighting on community hospitals. Indeed, I recently read a letter from Professors Flint and English from Beverley in east Yorkshire making exactly the same point about the necessity of maintaining access to services closer to home. That is what the Secretary of State told us that she wanted. It is what my hon. Friend wants, and it is what we are arguing for but, as a consequence of Government policy, we could lose it.

In the motion, we are seeking to reassert the right and need for the NHS locally to make decisions in the light of views expressed by professionals, patients and the public. Decisions should be based on clinical evidence, rather than being driven by deficits and financial pressures. We want an NHS in which we do not stand in the way of change. That change, however, must be managed well. [Interruption.] The Secretary of State scoffs, and says that change must be managed by the Department of Health, but before she goes down that track, she must accept that 96 per cent. of senior civil servants in the Department did not believe that departmental change was managed well. Some 81 per cent. disagreed or strongly disagreed with the proposition that change was managed well. There is no belief in the Department itself that it manages change well and there is no confidence in the Department’s leadership. I do not blame the civil servants, as it is Ministers who decide and lead. This Minister has failed to lead her Department or the national health service. Doctors do not have any confidence in her, and we know from Monday’s edition of The Times that they have far more confidence in my right hon. Friend the Member for Witney (Mr. Cameron) than in the present Government or prospective Government under the leadership of the Chancellor of the Exchequer. They believe in what we are saying about the national health service, and they know that we are fighting for it, so I commend the motion to the House.

I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

“recognises that the NHS must respond to developments in medical technologies and changes in patients’ needs if it is to continue delivering high quality care; acknowledges that the Government established a clear process for consulting patients, the public and their representatives on changes to the NHS; notes advice received from clinicians that some services need to be concentrated in centres of excellence so that professionals with the right expertise, experience and equipment can treat patients safely and effectively; further notes that, in the case of primary angioplasty services, this could save 500 lives a year and prevent around 1,000 further heart attacks and around 250 strokes; recognises that advances in medical technology mean that other services which were previously delivered in hospitals can now be delivered safely and effectively in the community and people’s homes, such as minor operations and outpatient appointments in GP clinics; understands that with an ageing population and more people living with long term conditions there needs to be a shift in services into the community, as patients and the public said in response to consultation and as set out in the White Paper ‘Our Health, Our Care, Our Say’; welcomes the Government’s commitment to supporting this shift including £750 million being invested in new community hospitals and services; and agrees that the focus of Government policy and NHS services should be on improving health and saving lives, not on preserving buildings and beds.”

I welcome every debate on the health service, but I am afraid that they are developing a familiar pattern. Every time, I look forward to hearing from the Opposition an acknowledgement of the dramatic improvements that NHS staff are making and an apology for the condition in which they left the NHS 10 years ago. Every time, I hope that we will hear constructive criticism and practical proposals to build on the success that has already been achieved to meet the enormous challenges that we still face. Every time, we are disappointed. Today, we have had to listen again to the usual mishmash of evasions and contradictions, the whingeing and nit-picking that passes for a speech from the hon. Member for South Cambridgeshire (Mr. Lansley). He complained about reconfigurations and changes—

No, I should like to make some progress first.

The hon. Member for South Cambridgeshire complained about reconfigurations and changes to the health service across the country, before complaining that they have not taken place fast enough. Of course health services are changing fast—and they will continue to do so—because medicine and, people’s needs are changing. The NHS has to keep up with those changes, as it has always done. The hon. Gentleman referred to the White Paper entitled “Our health, our care, our say” that we published last year after the biggest ever public engagement on health policy that any Government have undertaken. The White Paper was warmly welcomed by professionals, staff and trade unions, as well as by voluntary organisations across the country.

What the White Paper said on the subject of care closer to home came as great news to Members on both sides of the House. It suggested that facilities should not close because of short-term budgetary pressures, yet more than 160 community hospitals across the country face cuts and closure, or have already closed. How does the Secretary of State justify that, as patient need is not being met?

The hon. Gentleman is talking absolute nonsense. It is a pity that he did not refer to the additional funding that there has been and the additional staff, and the benefits that those have delivered to his constituents.

In the White Paper, as the hon. Gentleman will recall, we examined the biggest challenge that is facing the health service in every developed country—that is, the need to support the growing numbers of elderly people, in particular, with long-term conditions—and we set out a strategy for taking advantage of modern medicine and bringing health care that was previously available only in an acute hospital closer to people’s homes, improving their care and transforming their quality of life as a result. Those changes are already taking place, and it is high time the Opposition celebrated, rather than criticised.

No. I will make a little more progress before I give way again.

Already 109 new health centres have been built and there are more to come—on average, one new community health centre is opened every week, bringing together GP services, district nurses, physiotherapists, minor surgery and diagnostic tests, all under one roof, convenient for people and in their own neighbourhood. That is reconfiguration.

Community nurses and other professionals are looking after elderly people in their own homes. In Dudley, for instance, one case manager alone prevented 88 admissions to hospital in just eight months last year. One case manager transformed the lives of elderly people—I have met some of them—who no longer needed to go into hospital as emergency admissions time after time. Dudley also has a superb new acute hospital, one of more than 150 already built, refurbished or under way. That new acute hospital, as my hon. Friend the Member for Dudley, North (Mr. Austin), whom I see in his seat, well knows, has almost 300 fewer beds than there were in the old hospital, meaning better care for the people of Dudley and better value as well. That is reconfiguration.

All that my right hon. Friend has outlined is indeed welcome, but will she please outline her vision and the Department’s vision for the future of district general hospitals? The Homerton hospital in my constituency is losing at the accident and emergency end because it is providing better services through GP acute services, but it is also losing out because the easier cases are being treated in the community. That is good for patients, but what role is envisaged for the district general hospital in the future NHS?

The role of Homerton hospital and others like it—Homerton hospital is a superb hospital taking full advantage of its relatively new foundation trust status—is to do the things that can be done only in an acute hospital, working with GPs, health centres and other parts of the local NHS to ensure that wherever possible, care is delivered to people closer to their own homes because that is more convenient for patients, better for them, and better value for the local NHS. Then we can focus in the acute hospitals on the particularly complex cases, the specialist care and the in-patient surgery that can be done only in a hospital like Homerton. That is the future policy of such hospitals, and I know very well from my own visits to Homerton that staff there not only understand that, but welcome it and embrace it because it will improve care in one of the most disadvantaged parts of London, as my hon. Friend well knows.

I am enjoying the Secretary of State’s Pollyanna-like vision of health care in this country, and it is striking that she takes the example of investment in Dudley, where there are two Labour marginal seats. In Surrey, how are patients better served when an accident and emergency unit is likely to close at Frimley Park hospital, the Royal Surrey or St. Peter’s? How will care be closer to patients if cuts are made there simply in order to meet the right hon. Lady’s budgetary criteria and in flagrant defiance of patients’ needs?

I notice once again that an Opposition Member whose party voted against the increased investment that we have made in the NHS is demanding a blank cheque for the NHS in his own area, and refuses to face up to the fact that one of the things that any health service must do is ensure that services are organised in a way that gives patients the best possible care within the available budgets, which are bigger in Surrey and every other part of the country under this Government than they ever were or ever would be under the Conservatives.

Is not that reply from the Secretary of State a clear admission that what is taking place in, for example, West Sussex, where at least one accident and emergency department is to close, is that such departments are closing not on the basis of clinical need, but purely because of the budgetary constraint that she has just mentioned?

No proposals have yet been made either in West Sussex or in Surrey. Opposition Members should stop telling people that hospitals are to close when there is no intention that that should happen, and no proposal has even been made.

No. Let me say to right hon. and hon. Members on the Opposition Benches that we have written a very big cheque for the NHS, bigger than they ever did or ever would, but it is not a blank cheque. Part of the changes that are taking place are designed to give patients care that is at least as good and, in many cases, far better than they are getting at present, but to do so in the most effective way within the available budgets, delivering better care and better value at the same time—a point to which I shall return.

Does my right hon. Friend agree that many of the closures that one hears about are not closures at all? Wandsworth council is running a scare campaign against what it calls a closure, when in fact the proposal is to move out-patient services half a mile into larger premises in a brand new NHS building that has not yet been opened. At the same time, Conservative Wandsworth council really is closing two libraries, a museum and an art gallery.

My hon. Friend is right. It is typical of the Conservative party to tell people that services are to close, when in fact they are being reorganised and improved. If I may say so, we heard exactly that from the hon. Member for South Cambridgeshire, who told people last year that Hinchingbrooke hospital was to close. He took part in a human chain, no less, around the hospital to protect it from the wicked plans to close it, and he now has the nerve to claim that he has saved a hospital that nobody was planning to close. That is a disgrace.

I am astonished at the comments of the Secretary of State. There was an option to close Hinchingbrooke and there is still an option to close it. I am against that. If we win, that is good. I am in favour of that.

The hon. Gentleman is talking nonsense. He scare-mongered, he campaigned to save a hospital that nobody was planning to close, and he now claims a triumph. As was always going to happen, the local NHS—the strategic health authority—has been looking at hospitals across the region and has presented sensible proposals, on which there will be full local consultation.

No. I shall make progress.

The hon. Gentleman referred to hospital beds. One of the changes that mean that we need fewer acute beds now than we did in the past is the increase in day-case surgery. A little less than 70 per cent. of all operations across the NHS are now done on a day-case basis. The figure was only 60 per cent. just 10 years ago, but in the best hospitals it is now 85 per cent. What does that mean? It means better care and faster recovery for patients, a service that is preferred by staff, but yes, fewer acute beds are needed as a result, as in the Dudley hospital, for example, so that money that is saved on those beds can be invested in better services, better quality treatment and new drugs. That is reconfiguration.

Why, then, not so long ago was the Secretary of State parading as a great benefit the fact that there were extra beds in the NHS? The right hon. Lady cannot have it both ways. She could not be right then and be right now.

I certainly can. Given the state of the NHS that we inherited from the Conservatives 10 years ago, we desperately needed more capacity—both beds and staff—which we delivered, thanks to the record investment that we made and the Conservatives opposed. We are now seeing a reduction in the number of acute beds as a direct result of modern medicine and more day-case surgery in particular, and a continuing increase in the number of critical-care and intermediate-care beds where those are needed.

The Conservatives constantly accuse us of closing hospitals. That, too, is absolute rubbish. More than 150 acute hospitals have been refurbished or rebuilt, or are on the way. Hospitals are working differently, as was pointed out by my hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier). They are doing what only hospitals can do. Health services are provided as close to home as possible, but are provided in hospital where necessary.

Waiting lists are at their lowest ever in the NHS. Almost no patient waits for more than six months for operations such as hip replacements for which people used to wait over a year, sometimes up to two years, under the Conservatives. But now the NHS is doing even more. Earlier this week my right hon. Friend the Prime Minister announced that 13 hospital trusts expected to be able to guarantee most of their patients a maximum wait of just 18 weeks from GP referral to hospital operation—far less, in the majority of cases—and to achieve that by the end of the year, a year earlier than the goal that we set. That is an enormous achievement, and I congratulate all the staff involved. However, as the medical director at King’s College hospital told my right hon. Friend and me on Monday, the NHS cannot get rid of waiting lists by doing things in the same old way; it can do that only by transforming the way in which hospitals, local GPs and other services work.

Bolton, for instance, has provided a clinical assessment and treatment centre where patients who would formerly have waited to see the orthopaedic consultant at a hospital are now referred to a community team. An orthopaedic consultant in the community, one of the first consultant physiotherapists in the country and other staff are all working together, treating patients who do not need surgery. Those patients—about 70 per cent. of the total—are given physiotherapy, or other treatments that they may need, much faster; meanwhile, hospital consultants can concentrate on the patients with the most serious problems, and spend more time on surgery. As a result, waiting times both for patients who need physiotherapy or other community treatment and for those who need in-patient care have been cut from months to weeks. That too is an enormous achievement. It means that the right care is being given to patients by the right professionals in the right place. That is the kind of reconfiguration that we need throughout the country.

To work towards reducing waiting times, hospitals have to function. How would the Secretary of State respond to an e-mail sent by Morecambe Bay Hospitals NHS Trust on Monday, putting people on red alert that all routine elective surgery was to be cancelled and that any patients referred to the hospitals would have to be referred outside the trust area?

I am not aware of the specific circumstances of the Morecambe Bay trust, but obviously we keep a close eye on what is happening in individual trusts, particularly during the winter months when pressures on beds are building up. The hon. Gentleman will recall that 10 years ago—in fact, only five years ago—pressure on beds in the middle of winter was typical in every hospital in every part of the country. Now it is very rare indeed.

I am listening carefully to the Secretary of State’s arguments, which have been put to people in West Sussex over the past six months. If the consultation process in West Sussex reveals almost unanimous opposition to any of the options proposed by West Sussex primary care trust for downgrading the accident and emergency unit at St Richard’s hospital in Chichester or the A and E unit in Worthing, will those plans be scrapped or is the consultation process just a sham, with Government imperatives overriding local public opinion?

The consultation process is absolutely real. We strengthened it and put it on a statutory basis. We require any significant change in NHS services to go through a very full—some would say too full—process of local consultation with staff, patients and the public, including, of course, their elected representatives. That will apply to any proposals for reconfiguration of emergency services. I will not anticipate the results, but the hon. Gentleman will be aware that as a result of consultations in many other parts of the country, changes have been made to ensure that patients always receive the best possible services with the best possible value for money.

What assessment has the Secretary of State made of the impact of local improvement finance trust projects in reducing the need for acute hospital beds?

Although we have not made a formal assessment, it is clear that one of the great benefits of the LIFT centres—the new health centres that I have described—is a reduced risk that, for instance, an elderly person with chronic heart disease will end up in hospital as an emergency patient seven, eight or nine times a year, which is what has been happening. As the number of centres increases—and, as I said earlier, we are opening an average of one a week—along with the number of community nurses caring for people in the centres and, indeed, in their own homes, emergency admissions will fall rather than rise. As a result, acute hospitals will need fewer beds and more staff will be employed in the community.

Has my right hon. Friend received a report from the Minister of State on his visit to my constituency, where he launched a brand new £12.8 million LIFT centre? It has been widely welcomed by my constituents, because it will reduce the pressure that was building up on the general hospital.

My right hon. Friend is absolutely right—and I do wish him a happy birthday. I know about the new LIFT centre, and it is very good news for all his constituents, including those who are not celebrating their birthdays today.

I thank the Secretary of State for being generous and giving way again. May I return her to the subject of public consultation on the closure proposals in the West Hertfordshire Hospitals NHS Trust area? Just under 90 per cent. of consultees opposed the closures, but that opposition was ignored and the board proceeded with them. Will the Secretary of State now step in and stop them, on the basis that the public are against them?

In my view, such decisions are best made locally. Account must be taken of local consultations, and I can step in only if the local overview and scrutiny committee, consisting of elected councillors representing the area concerned, chooses to refer the matter to me.

When the Hornsey and Wood Green overview and scrutiny committee in Haringey approached you, it received a letter from the equivalent of a public relations department saying “Thank you for your letter”. There was no sense that, as you have suggested from the Dispatch Box, you had actually—

Order. May I remind the hon. Lady not to include me in the argument, but to refer to either the office or the constituency of the Secretary of State?

I do not recall any referral to me from the overview and scrutiny committee. I think the hon. Lady is referring to a new hospital that is being built in the area. But as I have been accused of refusing to accept referrals from overview and scrutiny committees that do not happen to be in Labour constituencies, let me say something, first, about maternity services and the recent review in Greater Manchester. I have already accepted referrals from the overview and scrutiny committees of Bury, Rochdale and Salford, and have referred them to the independent reconfiguration panel. As for the “Healthy Futures” review in North-East Manchester, I have had one referral from the overview and scrutiny committee in Rochdale, and I announced today that that too was being referred to the panel.

I am grateful to the Secretary of State. I have been trying to intervene for some time, while the person to whom she gave way just now had just walked in.

The right hon. Lady said that decisions were best taken locally. If that is so, will she tell the House why the chairman of the Surrey PCT is telling people that we are wasting our time organising petitions because the Government have ordered him to make cuts?

As I am sure the hon. Gentleman is aware, it is the statutory responsibility of the chair and board of every primary care trust in the country to ensure that their trust lives within its budget. Thanks to the investment that we have made, which he and his party voted against, that budget is bigger than ever before. He and the Opposition need to decide whether they believe that the NHS, like every other organisation, needs to live within its means; whether they are willing to support the sometimes difficult decisions needed to improve value for money for the public, whose money is being invested in the NHS; or whether they simply want to try to pretend to the staff and the public that there is a blank cheque for the NHS and that nobody need worry about value for money.

With respect to the Conservatives making their mind up, does my right hon. Friend agree that there is something strange about Conservatives in my area signing up to the Bristol health services plan for reconfiguration, along with the other political parties, and then realising that they can exploit a part of the plan for political reasons and going ahead, with the support of the hon. Member for South Cambridgeshire (Mr. Lansley), in campaigning against their publicly stated position? Do they not need to be consistent?

Thank you, Madam Deputy Speaker. I have long since learned not to be surprised by any degree of inconsistency on the part of Conservative Members.

The Secretary of State said that consultations are real, but the Barking, Havering and Redbridge Hospitals NHS Trust is about to embark on a public consultation exercise with five options, and before it has started, we have already been told that option 1—the choice of most members of the public, as it does not involve any closures—is not viable, that there is no point in choosing it and that the NHS has already identified its preferred option—option 4, which involves a further closure of one of my local hospitals. What confidence can people have in the genuineness of the consultation?

I have no doubt at all that the local NHS in Barking, Havering and Redbridge will undertake a very full consultation on the future changes that need to be made in that part of London in order to give much better care, particularly to people living in some of the most disadvantaged communities in the country. The consultations must take place on the basis of an honest and grown-up conversation between the NHS and the local public about what is affordable and what the options are for getting the best possible care for all patients, including those who need hospital treatment and those who can be better cared for outside hospital, in order to ensure that the NHS delivers the best possible value for the additional investment that the hon. Lady’s constituents are making in it.

It is very kind of the Secretary of State to give way, even from behind her papers. I agree entirely with the point that she makes about the requirement for a serious, grown-up conversation about the services. The point that my hon. Friend the Member for Upminster (Angela Watkinson) made, however, applies in constituencies throughout the land, where serious grown-up conversations are taking place and people acknowledge that changes need to be made, but where local people know that lines in the sand are needed to protect services that are vital for local people, such as proper A and E and maternity services. When vast numbers of those people, after serious conversations, object to what is proposed, what then should happen?

Thanks to the changes that we have made in the whole statutory framework for consultation, there is now a very clear process of initial involvement with the public and staff to generate the options and formal consultation on those options, with the involvement throughout the entire process of the local overview and scrutiny committees. In many cases—it is probably the majority of cases in which reconfigurations take place—the issues are settled through the process with the support of the local councillors on the overview and scrutiny committee. It is only if the committee is not happy with the outcome, the consultation process or both that the matter even comes to me as Secretary of State. Depending on the strength of the clinical case and the nature of the objections that are being made, what I am able to do—I have done it in a number of cases—is bring in an independent panel of clinicians to take a further look from outside the area at the decisions that are proposed locally. I think that that is the right way to deal with decisions that are often difficult, but need to be made in a way that ensures the best care possible for everybody in every part of the country.

I have spoken, as the hon. Member for South Cambridgeshire did, about the changes taking place that bring health services closer to people’s homes. At the same time, however—he made some play of this—modern medicine is becoming even more complex, and some patients will need to go further away in order to get the specialist care that they need. He referred to primary angioplasty services. A few weeks ago, at St. Bart’s hospital in London, I met a gentleman, Mr. Singh, who had suffered a major, life-threatening heart attack just two days earlier. His wife called 999, the ambulance arrived and highly skilled paramedics diagnosed him, took him straight past two or three local A and Es in that part of London and got him straight to the chest clinic. As the clinic has the round-the-clock specialist team that it needs, Mr. Singh had the operation that he needed—primary angioplasty—just 90 minutes after suffering his heart attack. Just two days later, he went home.

Those improvements are happening now, and have been doing so for the past few years in London. They are happening on Teesside, as we heard earlier, and in some other parts of the country. We want that improvement, and we are determined to secure it for every patient who needs it in every part of our country. Professor Roger Boyle, the highly expert and esteemed national clinical director for heart disease and stroke, has recently estimated that if such primary angioplasty services were available throughout the country, the NHS would be able to save about 500 more people’s lives a year and prevent 1,000 further heart attacks. Of course there will not be such specialist services in every local hospital, because thankfully there are not enough patients to support and need a specialist team in every local hospital.

This is not about closing hospitals or downgrading services, whether in A and E or elsewhere. [Hon. Members: “It is.”] Are Opposition Members really saying that they do not want someone who has suffered a heart attack to be taken by ambulance to the specialist centre that will give them the best chance of having their life saved, and that they would rather have them taken to a local A and E that does not have the services that would save that person’s life?

I am just wondering whether the Secretary of State has ever been to West Sussex. Does she not realise that, given the geography of the place, if Mr. Singh had had his heart attack in Selsey after, say, St. Richard’s hospital had been closed, he would never have got to a hospital in time? That is the problem that we have got. We need these hospitals because of the geography of the area and the distances involved. She simply has not grasped the reality of health provision on the ground.

May I advise the hon. Gentleman to read Roger Boyle’s report and indeed to talk to his hon. Friend the Member for South Cambridgeshire? The hon. Member for South Cambridgeshire rightly referred to Australia, which has much better survival rates for stroke and, I believe, heart attack, and better availability of primary angioplasty services. The distances that people have to travel in that country are a great deal larger than anything that will be encountered in most parts of our country. In north Tees and other parts of the north-east, for instance, patients who have suffered a heart attack or stroke and need the specialist services of the excellent James Cook university hospital in south Tees are in many cases brought there by air ambulance, because it would take too long for them to travel by road ambulance to get the life-saving treatment that they need. That is another reason why such decisions need to be made locally, so that local ambulance services and hospital services can be organised in the best way.

The Secretary of State has continued to assert that this is not about hospital closures. However, when she was interviewed by Jon Sopel last October and he asked her whether there will be a smaller number of hospitals with a full range of services—that is, A and E, maternity and paediatrics—she answered, “Almost certainly.”

As I have said not only in this debate but on many other occasions, this is not about closing hospitals but it is about changing how hospitals work. As the debate has vividly illustrated, we will need more local facilities in the new health centres and improved GP surgeries, in people’s own homes, and in community hospitals; we will need more services like primary angioplasty in specialist centres, because that will save more lives; and we will need our local district general hospitals to do what only they can do.

Where there is good clinical evidence that there needs to be a reconfiguration, the Government are promoting that argument. In January 2004, following a review of paediatric and congenital cardiac surgery, I asked the then Secretary of State why he had rejected its recommendation that there should be a minimum of 300 such units. He said that it was because it would require the closure of some of the most successful cardiac centres in the country, and he was not going to do that. Why did not he act on his own review’s recommendation that there needed to be a minimum throughput of operations?

I am not aware of the exchange that the hon. Gentleman mentions. It is clear that the NHS is already building up more specialist centres—for cardiac patients, burns patients and so on—that will give people the best possible care with the best possible chance of saving their lives. I think that the hon. Gentleman supports that—I certainly hope so—and I hope that he will persuade other Conservative Members to do so.

The hon. Member for South Cambridgeshire mentioned the tariff for stroke services, which is extremely important. Professor Boyle has been working on that with clinical colleagues in the tariff team, and as a result we have already announced that we are changing the tariff for 2007-08. We will continue to make improvements to it. We are sometimes accused of introducing payment by results too quickly and sometimes of introducing it too slowly; the reality is that we are doing it faster than in almost any other country, because we are determined to get the benefits from that.

Professor Sir Ara Darzi, one of our country’s leading surgeons, who is conducting a review of health care across London, has summed up the changes that are taking place very simply:

“health services as close to people’s homes as possible…in hospital where necessary”.

That is how the NHS will help more people to stay as healthy and independent as possible, how it will give patients the best and fastest care possible, and how it will deliver the best possible value for the public’s investment.

Of course change is difficult, particularly for the staff affected, and of course changes can be unpopular, particularly when they involve a much loved local hospital. However, if we knew that by changing the way in which services are organised the NHS can improve more people’s lives and save more people’s lives, we would be betraying patients and betraying the NHS if we refused to make those changes just because they involve difficult local decisions. I do not expect Conservative Members to face up to that. No doubt they will go on saying different things to different people, go on saying that they support NHS staff while attacking higher pay and decent pensions, and go on saying that they support change—indeed, that they want independence for the NHS—yet going out on to the streets to oppose every local change that is proposed. They are even organising demonstrations to save hospitals that nobody proposes to change.

They say that they believe in the NHS, but they voted against the increased investment, and their new economic policy would mean less money for public services and for the NHS in order to pay for tax cuts—

Thank you, Madam Deputy Speaker.

Real leadership is about being willing to face up to the huge challenges that confront health services, not only in Britain but in every developed country, and where necessary to take the difficult decisions that will be right for patients and for the public.

At the end of the speech by the hon. Member for South Cambridgeshire I had no more idea about what the future of acute services would be under the Conservatives than I had at the beginning of it. We have set out the case for change very clearly. We are supporting the NHS locally to make those changes, and we will continue to do so.

Yes—one is tempted to believe that the Conservatives are trying to tell us something. None the less, it is good that we are discussing a matter that is clearly of considerable importance.

There is no doubt that reconfiguration of acute services is a potent political issue. The fact that four Ministers, three of whom are in the Cabinet, are openly objecting to the main thrust of Government policy—

The Secretary of State shakes her head, but there is no doubt that they are. That demonstrates how potent the issue is and what a mess Government policy is in.

The first point to make is that political argument over reconfiguration of acute hospital services is not new. That was demonstrated by the hon. Member for Pudsey (Mr. Truswell), who mentioned six hospitals that had closed under a previous Conservative Government. It has been going on for as long as the NHS has been in existence. However, it is now more controversial than ever before, for reasons that I shall explain later.

To start with, the NHS inherited a patchwork of hospitals from the previous local authority provision, and since then there have been various landmark changes. In 1962, when Enoch Powell was a Health Minister, he published his “Hospital Plan for England and Wales”. He described the role of the district general hospital as having 600 to 800 beds serving a population of 100,000 to 150,000 people, with some specialties being dealt with in larger teaching hospitals. In 1980, we had another landmark Department of Health paper that argued the case for more accessible local hospitals. Throughout that period, under Governments of both parties, a considerable number of smaller, vulnerable hospitals have closed down despite protests from the public.

Interestingly, since this Government came to power in 1997, reconfiguration of services has not been a priority until very recently. The NHS plan in 2000 concentrated on the case for building more hospitals, not closing them. There was a promise of 100 new hospitals by 2010, many financed using the private finance initiative. That produces a straitjacket of accommodation that is particularly unsuited to adaptation to take account of changing health needs and priorities. I looked at the 2005 Labour manifesto to see what that said about reconfiguration of hospital services, but there was nothing there. Does that mean that in 2005 the Government had not thought about reconfiguration, or that they had thought about it and kept it from the public debate? Nothing was said about it in the general election campaign, yet it has become a significant part of Government policy since then.

The hon. Gentleman may have noticed that the Liberal Democrats are not in power. [Interruption.] The hon. Gentleman misses the point. The Government said nothing in the Labour manifesto in 2005, yet the policy has subsequently been implemented with a vengeance. There has been a shift. Did the Government keep it from the public in 2005 or have they invented it since then?

It is fair to record that we were happy with the Government White Paper entitled, “Keeping the NHS local”, which is often cited and completely ignored.

My hon. Friend makes a good point. In 2006, reconfiguration was mentioned for the first time in the White Paper, “Our health, our care, our say”. That title bizarrely suggests citizens’ involvement in decisions about future provision. It referred to complementing primary care and community facilities with specialist hospitals. That was the origin of the current round of reconfigurations. It was intended that complex surgery would be undertaken in those specialist hospitals and that there would be full-scale emergency departments. However, the White Paper did not refer to hospital closure.

Let me say a word about the case for reconfiguration, as the hon. Member for Kingswood (Roger Berry) asked about Liberal Democrat policy. There is a case for reconfiguration that is undertaken for the right reasons, and openly and transparently. The motion acknowledges

“the need to develop and improve acute hospital services”.

It implies, although it does not state, that reconfiguration is sometimes necessary or appropriate for improving patient care.

The motion also mentions the need for reconfigurations to be

“based on safety, quality of care, accessibility and choice”.

If we are honest, we should accept that those objectives, which are all worthy, sometimes conflict. Sometimes safety and quality of care are not compatible with the most accessible service. Sometimes choice is constrained. If royal colleges advise that robust mechanisms are in place to determine the numbers that need to be treated in any one year to maintain skill levels and provide sufficient quality of service, we should listen to that advice. The Secretary of State made a similar point.

The Royal College of Surgeons has argued for acute hospitals to have catchment areas ideally of 500,000, but at least of 300,000. That is because of the need to ensure that consultants in the main surgical specialties are available to provide emergency cover. It is also argued that such a catchment area provides the necessary concentration of case load for training doctors and maintaining surgical expertise. However, we must also recognise that, in remote rural areas, distance can be a safety issue, especially in respect of accident and emergency provision. We need to take that concern seriously.

The hon. Gentleman gives the impression that the reconfiguration of hospitals is a new idea. I have been in my constituency for more than 20 years and we have reconfigured our mental health services from 2,000 beds to approximately 150 and our acute beds from 1,000 to 400 in the past 15 years. In Darent valley hospital, we now have one of the most successful three-star hospitals in the country. Reconfigurations have been taking place long before the Government came to power.

The hon. Gentleman has simply not been listening. Perhaps that is because he is trying to do two jobs at the same time. If had listened, he would have noted that I made the point that reconfigurations have taken place throughout the existence of the NHS. The hon. Member for Pudsey made the point about hospitals closing under a previous Conservative Government.

The cancer plan in 2000 made the case for specialist centres. I understand that it defines the number of patients that should be seen in breast clinics to ensure a sufficiently diverse case load to maintain skill levels and quality of service. I understand that fully fledged obstetrics units cannot be run safely without accompanying fully fledged paediatric units. Liberal Democrats do not oppose reconfiguration for the sake of it. There are clearly good clinical grounds in many circumstances for reconfiguration. However, that does not mean that reconfigurations are always planned for the right reasons or carried out acceptably.

What is wrong with the Government’s approach? It has two central flaws. First, the process has become inextricably caught up in the crisis that faces significant parts of the health service, where there is overwhelming political pressure to clear massive historic deficits. The East of England region is a case in point. Clinicians to whom I have spoken raised specific concerns with the strategic health authority about whether reconfigurations in that region are being driven by the crisis in financing.

Like me, the hon. Gentleman is an east of England Member of Parliament. He knows that more than 50 per cent. of all the operational deficits in the NHS are centred in the six counties of the east of England. Many primary care trusts in that region have consequently had their budgets top-sliced to move money from one to another to try to plug the gap. How can PCTs work with acute trusts to try to plan for the future when those such as mine, in the south-east Essex area, have had £12 million taken away at short notice, with no guarantee that they will get the money back?

The hon. Gentleman makes a good point. The figures that were published yesterday show that the top-slicing has plunged many more organisations into deficit and genuine financial difficulty, potentially affecting patient care.

Not only politicians make such points about the impact of deficits on decision making. In a briefing in November, the King’s Fund wrote:

“Financial pressures within the NHS are being felt at both local and national levels, adding urgency to decisions about which services should be provided, where, how and by whom. At a local level, the presence of financial deficits in individual NHS organisations is forcing trusts to consider which services they can afford to provide and which must be cut.”

Those decisions are determined or significantly influenced by deficits. The briefing continues:

“At a national level, the anticipated end to large increases in funding for the NHS after 2008 is prompting the Department of Health to focus on how the delivery of health services across the system as a whole can be made more cost-effective.”

An impeccable independent source acknowledges that deficits and an end to the growth in funding are central in the reconfiguration debate.

Before Christmas, the Select Committee on Health made the link between deficits and reconfigurations in its report on deficits. It referred to evidence from the acute trust in Worcestershire. The trust stated that service reconfiguration was essential, but that it would not be enough. I quote:

“the Trust Board has recognised that it will not be able to make the final steps to achieve recurrent financial balance without even more radical action. This will involve a comprehensive review of services across the three sites and serious questions about their sustainability.”

That is reconfiguration driven by financial crisis.

I said earlier that I had spoken to a consultant in the East of England region, who said that his colleagues had raised concerns specifically with the strategic health authority about the dire financial situation in that region. He raised the related concern that that was driving the pressure to reconfigure. Let us be absolutely clear: reconfiguration decisions tainted by trusts suffering massive deficits cannot be justified.

The second flaw in the Government’s approach is the extent to which the whole process is being centrally driven—a point made in a number of interventions on the Secretary of State earlier. Consultations are a sham and in places there appears to be a hopeless lack of engagement with clinicians. Solutions that may well be ill thought out are imposed from above. Those who work in the service are often left with no confidence in the decision-making process.

The whole process got off to a pretty inauspicious start in September last year when the newly appointed chief executive of the NHS was reported in The Guardian as announcing that there would be up to 60 reconfigurations of NHS services, affecting every SHA in the land. That did not sound to me like an invitation for local trusts to consider their options for service delivery and to take their own decisions. It was the head of the NHS saying that there will be reconfigurations.

The Secretary of State, however, insists that the whole process of reconfiguration is locally determined. In October, she told the BBC:

“It’s got to be done locally. The local NHS, the doctors and other front line staff sitting down with each other and with the local public, to work out what is the best and the safest way of providing healthcare to the people in their area.”

Let us test how much that is the case in practice.

Decisions about reconfigurations are the responsibility of the primary care trusts working together with the strategic health authorities. I want to say a few words about the role of the SHAs and about my experience in the East of England region. I suspect that if we asked average members of the public what the SHA does they would not have the faintest idea. Yet we have seen in the East of England region and across the country how they wield enormous power in a way that totally lacks transparency. Where does accountability lie for SHAs? It lies, of course, directly with the Secretary of State.

We have seen the influence of the SHA in Norfolk, where a new PCT was established in October. A lady called Hilary Daniels was appointed as the acting chief executive. Back in August, the person who had been appointed as the new chair of the PCT announced in a letter to staff the intention that Hilary Daniels, previously the chief executive of the West Norfolk PCT,

“will hopefully become interim Chief Executive either until a substantive appointment is made or by the end of June, 2007”.

Hilary was a highly regarded chief executive and West Norfolk had been well and efficiently run. However, by 24 January, a press release from the PCT declared that Hilary

“was delighted that she is now able to bring forward”

her departure. What wonderful spin! The truth, I am told, is that she was forced out by the SHA.

I have spoken to consultants in the East of England region who have raised concerns with me about the extent to which the SHA was involving clinicians in the development of its plans for the reconfiguration of acute hospital services. The truth, I am told, is that the level of engagement appears to be minimal. One comment from a clinician was that they were

“utterly out of the loop”.

I remind hon. Members of the Secretary of State’s comment in October about local health services sitting down with clinicians and the public. Here we have a clinician in the East of England region saying that clinicians are

“utterly out of the loop”.

Perhaps to provide some reassurance of genuine engagement, the SHA announced that there would be a “major stakeholder event” in January. The only problem was that it forgot to tell the stakeholders. I heard from another senior clinician that they heard about it only four days before the event was taking place. They passed on the information to the union, which had not heard about it either. What extraordinary incompetence from the SHA. The result is that the clinicians feel that they have no confidence in a process that ignores their concerns. Of course clinicians should not dictate the process, but surely they should at least be listened to.

Going back to the Secretary of State’s comments from October, the whole approach was supposed to involve centrally doctors and other front-line staff in shaping the proposals. That is certainly not happening in the East of England region and I suspect that it is not happening elsewhere.

In my neck of the woods, most reconfiguration proposals do not result from consultation with clinicians. Their main source is management consultants, as has empirically been shown to be the case in many other parts of the country as well.

I am grateful to my hon. Friend for that intervention. He reinforces my point that the description of the process that the Secretary of State gave us in October is very far from the truth about how it in fact operates.

I want to say a few words about how the public are being involved in the process. Does that match the Secretary of State’s impressive commitment? The evidence points in precisely the opposite direction. The Health and Social Care Act 2001 imposed a legal duty on health trusts to consult the local population, which was clearly a move in the right direction. The trusts are required to consult about significant changes to service provision and to consult the local authority’s overview and scrutiny committee. The committee, in turn, may refer a case to the Secretary of State if it considers that the public involvement process has been inadequate or if it believes that the proposed changes are not in the interests of the local area.

By the end of July 2006, 16 cases had been referred to the Secretary of State, 14 of them in the last year of that period. I understand that the Secretary of State has referred only two of those cases—although I think that she said that one more had been referred in the past week—to the reconfiguration review panel. In only one case did the Secretary of State support the objections of the overview and scrutiny committee—

If the Minister would like to intervene, or to respond at the end of the debate, I would be interested to hear more about that. None the less, it appears that the number of cases in which the view of the overview and scrutiny committee is supported represents only a tiny proportion of the total. The process rarely seems to lead to a change in the proposals. So much for the local NHS sitting down with the public to decide what is best for their area. It is a sham, and the Secretary of State knows it.

Can we be reassured that local primary care trusts are centrally involved in designing proposals for reconfiguration? Sadly not. They are not locally accountable in any sense. Their boards are appointed centrally by the NHS Appointments Commission and we know just what happens if they fail to toe the line: their chief executives get sacked, as we have seen in Norfolk. That is the reality. This is not local decision making. PCTs with centrally appointed boards are kept in line by strategic health authorities whose boards are also centrally appointed, and which are accountable only to the Secretary of State and operate in the shadows without any adequate transparency. Is that really the Government’s idea of local decision making? Such a thing does not exist in reality.

The Secretary of State needs to understand that dissatisfaction with the whole process is growing out of control. It is not only her Cabinet colleagues who are objecting. There is widespread rejection of the way in which the matter is being handled, and of the motivation behind it. It is all too easy to use expressions such as, “This is Labour’s poll tax,” but that view is spreading. If we google the words “reconfiguration” and “poll tax”, we realise that that expression is being used more and more across the country. In December, The Guardian identified 50 campaigns around the country and talked about the most widespread unrest since the poll tax revolts of the 1980s.

I must express my severe doubt as to whether the Conservatives would do things any differently. Their motion talks about the need for a “stronger local democratic voice”, but the hon. Member for South Cambridgeshire (Mr. Lansley) did not tell us what that voice should be. I would be interested to hear more about what they are actually proposing in that regard. I suspect that, in reality, the process would be very much the same as the one that we have experienced under this Government.

I am about to finish, but I would be interested to hear the hon. Gentleman’s answer to my question when he winds up the debate.

We certainly need a democratic local voice to reclaim our health service from a centralised approach that ignores local opinion on major changes of this kind. This is a flawed process, and the Government need to think again. They need to do, in reality, what the Secretary of State claimed was happening in her interview with the BBC last October. She knows, and the Government know, that the reality is very different, and that the centralised approach that they are dictating simply is not working and is being rejected by members of the public across the land.

Order. I remind the House that Mr. Speaker has placed a 12-minute limit on Back-Bench speeches, which applies from now.

The NHS has had too much change, which is demoralising and disruptive for both patients and staff. Some change, however, is necessary and desirable.

“Our health, our care, our say” set clear goals for the transfer of services to community settings. That is particularly welcome in a rural setting such as Staffordshire, Moorlands, where a round trip to the acute hospital can be more than 60 miles. In my primary care trust area, community matrons help people better to manage long-term conditions such as heart disease and diabetes, improving their health and quality of life as well as reducing hospital admissions. With an increasingly elderly population, falls are a huge concern and Leek Moorlands hospital now has an innovative falls programme to prevent falls and to help patients manage better after a fall. That saves lives, builds confidence and encourages independence, keeping elderly people out of hospital and living in their own homes, where they want to be.

That is not all. My local community hospital, Leek Moorlands, has a minor injuries unit which is open every day from 8 until 8, with minimal waiting times. In addition, PhysioDirect offers telephone advice and treatment, without having to see a doctor first, for the whole range of neck, joint or muscular problems. There is also the deep vein thrombosis diagnostic service, which allows 200 patients from Staffordshire, Moorlands to be diagnosed and treated locally each year. That is a huge improvement for patients who would otherwise have to travel to Stoke-on-Trent—again, a round trip of about 25 miles.

All of that was initiated by my local primary care trust, which was going to be swallowed up by a gigantic Staffordshire-wide primary care trust—a reconfiguration too far. Although the Shropshire and Staffordshire strategic health authority steadfastly refused to take on board public opinion, the expert external panel and Ministers listened and supported my local campaign and we kept a local primary care trust, which has delivered for local people. Therefore, the public consultation did work and local health bosses were forced to accept its result.

Effective consultation with patients and public is essential, not only for the reconfigurations that I have mentioned, but to ensure that redesigned services truly benefit patients. The chairman of my overview and scrutiny committee, Councillor Mahfooz Ahmad, has worked tirelessly with the local PCT to spearhead the campaign to establish a local health centre and GP surgery in Cheddleton in my constituency—a fast-growing village with about 6,000 residents and no GP. The PCT is rightly responding by carrying out its own public consultation to ensure that there is a real demand for that service. I hope that we will soon see a GP practice in that village.

With all that happening, is it surprising that there is a huge impact on acute hospital services? The number of hospital beds nationally has decreased by a third in the past 20 years. That does not mean, however, that the amount of care has decreased; on the contrary, it has increased dramatically. We must judge the NHS by the number of people it keeps well and makes better, not by the number of beds. My local acute hospital, the University hospital of North Staffordshire, has buildings spread over three sites in an area of more than 90 acres. The age of the buildings ranges from less than 10 years to more than 150. That leads to huge problems and inefficiencies as services are split and patients have to be transported between different buildings and sites during their care.

Our fit-for-the-future project will rightly create a new state-of-the-art hospital. It will have fewer beds, but that is because out-patient appointments will take place in clinics and health centres closer to people's homes, and patients will return home or to community settings more quickly when their treatment is complete. Already, the central out-patients department is cutting its service by 20 per cent. because of fewer GP referrals.

Another change that I welcome is the decision to press ahead with the new maternity and oncology building, with the £65 million being funded from the Department of Health, rather than the private finance initiative. That will be completed in 2009. The cancer centre will be a purpose-built facility bringing together all day case in-patient and radiotherapy activity within one building. The new development will also bring together surgical and non-surgical management of cancer on one site for the first time.

At present, the oncology ward and radiotherapy services are located half a mile from where patients undergo surgical procedures for cancer treatment. All those buildings date back to the 19th century. The Secretary of State had the opportunity to see some of them. She asked when she visited the hospital, “Are these the worst buildings?” We had to tell her, “No, these are some of the best.” The maternity unit will offer a modern purpose-built facility based on the separation of a low-risk midwife-led model and a higher-risk medically led model. It will deliver the modern standards of privacy and dignity that every mother has a right to expect. The present facility just does not deliver that.

Parts of north Staffordshire are among the worst 10 per cent. of areas in England for deprivation. Almost 70 per cent. of the local population are among the 20 per cent. of the English population who have the lowest life expectancy, yet in the past north Staffordshire has been badly let down by Governments on health care. We are now at last getting the services that we deserve.

Will my hon. Friend acknowledge the lack of interventions that she has had to take during her speech?

Absolutely. I am grateful to my hon. Friend for intervening to make that point.

For decades, Governments have let down north Staffordshire. The area has always badly needed the best possible health care. Now at long last, with the new maternity and oncology building in two years’ time, a brand new state-of-the-art hospital a few years later, a huge expansion in primary care facilities, and a primary care trust that wants to ensure that it is designing services for local people in rural as well as urban settings, I am confident that we will have the services that we need, which are closer to patients’ homes and are geared up to the 21st century, not to the 20th or the 19th.

I am glad of the opportunity to contribute to the debate, not least because I, like many others here, have received a positive snowstorm of letters about the health service in past months. There is a sense of bewilderment about the changes. It is a pleasure to follow the hon. Member for Staffordshire, Moorlands (Charlotte Atkins), who started her speech by saying that there had been far too much change in the NHS, something on which all Conservative Members would agree.

People in Hampshire cannot understand why the huge increase in resources provided by the Government has not led to an improvement in services. Even worse, despite those increased resources, some services are being cut in some areas: dentistry and hearing aids are two examples in Hampshire. The series of events has contributed to the feeling that the NHS is once again in crisis. I want to examine some of the reasons why, and to relate them to the problems that my constituents are experiencing in Hampshire.

First, there is a conflict between payment by results and the desire to retain and promote community hospitals. It is clear that payment by results should not have been introduced until a formula had been devised for protecting community services. Payment by results inevitably leads to larger hospitals, where there are economies of scale, having the opportunity to increase their patient throughput and therefore their income from primary care trusts, while the smaller community hospitals find that they cannot compete on the same basis. The Government said in their White Paper, “Our health, our care, our say: a new direction for community services”, that they wish to deliver more health services in the community. If that is the case, the Government needed to find a mechanism to ensure that payment by results did not undermine community services, but they failed to do so. It is no wonder that about 100 community hospitals are now under threat.

My constituents have experienced the vulnerability of community hospitals twice in the past few years. In Alton, the community hospital faced partial closure in the summer of 2005; 24 of the 48 in-patient beds were closed because of staff shortages and a financial crisis. Eventually, those beds were partially restored, largely as a result of pressure from local GPs and the community, which caused managers to look again at their priorities. The Grange maternity unit at Petersfield was also closed in 2005, at three weeks’ notice, because of alleged staff shortages. It took another vigorous campaign—of longer than a year—to get it reopened.

The new chief executive of the NHS, Mr. David Nicholson, seems to suggest that midwife-led maternity units, such as the one that we have in Petersfield, should be closed and that only consultant-led maternity units should operate in future. That is a reversal of the move away from the highly managed, rigid and clinical approach to childbirth that was common in the 1970s. Some Labour Members seem to have forgotten that it was women themselves who rebelled against the birth factory concept and their campaigning helped to bring about the sort of local maternity services that we now have.

I agree with my right hon. Friend. I have four children, and antenatal care is important to women such as me. The fact that Hertfordshire has lost all antenatal care for new mums is particularly worrying and might well lead to more interventions at birth. People are very concerned about that. Does my right hon. Friend agree that that is not a satisfactory state of affairs?

Indeed it is not, and I am glad to have heard about a more personal experience of maternity services than I have, although I did have to take a leading part in fighting the campaign on behalf of all the mothers in Petersfield. My worry is that, our services in Alton and Petersfield having just returned, they will be undermined once again, this time because of payment by results and yet more NHS reorganisations.

The endless reorganisations of the NHS over the past decade are another major problem. I will not bore Members by listing them all, but I simply say that I do not know how anyone can expect high-quality services to be consistently delivered in an organisation whose managers seem to change responsibilities on an almost monthly basis. Those reorganisations have caused bewilderment to the public and confusion to managers and staff, and they have inevitably affected both services and morale. It is confusing enough for Members and their staff to deal with those constant changes of structure and personnel, and it is near impossible for the general public.

Does my right hon. Friend share my concern that the independent sector treatment centres, which are one of the latest reorganisations forced on the health service, will take the more routine cases that cost much less than the more complex cases, and that those more complex and costly cases will be left with the general hospitals, so they will have to foot the bill for them? Does he think that the budgets of the respective organisations should be adjusted to reflect the actual costs of the cases with which they deal?

Yes I do; my hon. Friend’s point is valid.

NHS administrators are not a popular group, but they do an essential job. I know that their morale locally is low. It is unfair to expect people constantly to reapply for their own jobs—to give just one example of why morale is low. It is also wrong to blame managers for the consequences of ill-thought-out reorganisations pushed through by Ministers without proper consultation. A recent survey of civil servants in the Department of Health found that just 4 per cent. of senior officials think that the Department manages change well; 81 per cent. do not. Who on earth, one might ask, are the 4 per cent.? They must be so high in the stratosphere of Richmond house that they simply do not know what is going on. The Department has been disastrous at managing change, and all its senior managers ought to know that.

A further factor in the current difficulties is that these reorganisations and the confusion that they have created have led to a return to some of the slipshod practices that we thought we had left in the past. I was recently contacted by a constituent who had a post-operative appointment to see her surgeon after a hip operation in December. The lady, who is in her 80s, travelled from Petersfield to the hospital in Gosport last month, only to discover on arrival that her surgeon was off sick and his theatre list had been cancelled. No one had thought to warn the out-patient department that his clinic had also been cancelled. Despite being in pain, my constituent was then offered a new appointment in April. At that point she complained to me, and when I telephoned her she was in tears because she had just had another letter saying that her appointment had been put off until June. We have managed to sort things out, and she was seen last week. Such slip-ups might seem very minor to Ministers sitting in London and to officials in Richmond house, but they are crucial to the patients themselves. To judge by the number of letters that I receive about small but significant incidents of that kind, there is a deterioration in the NHS’s ability to deal with these matters.

Two other issues that are contributing to the current problems strike me as being of great concern. The first is the consequences of the introduction of the National Institute for Health and Clinical Excellence and its assessment of treatments. NICE’s creation has led primary care trusts and NHS trusts to argue that a particular treatment should not be provided, on the ground that it has not been approved by NICE. The Minister will quite fairly say that that is not Government policy. Trusts can prescribe medicines and treatments that have not been approved, on the basis of their own assessment, but in practice—this is what really matters—hospitals and PCTs do not generally prescribe drugs unless NICE has cleared them for general use across the NHS. There are examples of hospitals and PCTs approving individual items, but that simply demonstrates a return to the postcode lottery that I thought NICE was created to stop. The effect has been the stymieing of the introduction of new treatments that might have real—in some cases, life-saving—benefits for patients.

Secondly, such difficult cases are further complicated by existing NHS rules on the use of private treatment. There is a young father in my constituency who suffers from advanced colorectal cancer, for which a new drug is now available: Avastin. However, his local NHS trust will not prescribe it. He decided to pay privately for Avastin because he was told that it was the only way that he could prolong his quality of life and, indeed, his life itself. Now, he is obliged under NHS rules to pay for all the other NHS treatment that he needs as well. I can understand that the NHS does not want to become a provider of private sector services free of charge—that would make nonsense of the “free at the point of delivery” principle under which it has always operated—but in my constituent’s case, the rigid enforcement of these rules means that he is forced to pay not only for the drug Avastin, but for all the other treatment that he would otherwise be entitled to receive free. His consultant considers that scandalous. My constituent thinks it intolerable, and I and doubtless many others think it quite unacceptable.

I, too, have a constituent who needed Avastin, whom I saw at a constituency surgery on Saturday. Does my right hon. Friend agree that the cynicism that people feel about the NHS when they cannot get vital drugs and they see their local hospitals being closed boils down to the feeling that there has been boom and bust in the NHS since Labour came to power? That is the root cause of the problem that needs to be addressed.

That is the point that I have been trying to make, and my hon. Friend reinforces it.

There are two potential difficulties on the horizon. One of them, the move towards larger hospitals, could become a reality quite quickly. For more than 10 years, the Royal College of Surgeons has argued for a smaller number of larger hospitals. It is true that district general hospitals have emerged as a patchwork of provision, rather than in the systematic way originally intended. However, the public are deeply concerned by the notion of having fewer but larger hospitals further away from where patients live. That issue is especially important to those of us who have large rural areas in our constituencies, as many of my colleagues have mentioned. There is inevitably a delay in getting an ambulance to an urgent case in a rural area and, once the patient has been stabilised, in getting them to hospital.

Fewer but larger units may make sense in large urban areas, but much of England is a mixture of large market towns and smaller rural communities. Many of those towns have had district general hospitals that now face closure of the whole or part, such as the accident and emergency service, as many hon. Members have mentioned, and the transfer of services to larger and more distant regional units. That does not improve services for those of us in rural areas.

I simply warn the Minister that when my party set out, on the strong advice of the Royal College and other experts, to undertake such a reconfiguration of services in London, which might have made some sense, the Labour party used that as a stick to beat us with in election after election. To pursue a policy that could see three quarters of accident and emergency units in England closed would not only be of dubious medical value, but would be incredibly unpopular. Ministers can try to close only hospitals in Conservative-held seats, and some of my colleagues would claim that such a programme is already under way, but they should not imagine that they will get away with it.

The whirlwind of change of the past few years shows no sign of slowing down. Local maternity services are under threat again, local accident and emergency units are being questioned and long-established hospitals serving large catchment areas are—we are told—no longer big enough for the new NHS. The financial position of community hospitals remains uncertain. All that is happening without the support of many of the Government’s own Ministers, who—as we have seen—have taken to the streets to campaign against the effects of Government policies. That is a remarkable breakdown of collective responsibility.

Without a period of stability and continuity, the NHS threatens to go into a permanent decline, as it struggles to provide the care that patients need and for which they feel, as taxpayers, they have more than paid over the years. If Ministers think that they can carry on pushing change through the NHS regardless of public or political reaction, they are mistaken. No amount of careful planning with “heat maps” or other tricks will avoid the inevitable and disastrous consequences of the Government’s approach.

It is a pleasure to follow the right hon. Member for East Hampshire (Mr. Mates). I hope to introduce a note of amiability into the debate by agreeing with his comments on Avastin. The issue requires serious investigation and perhaps correction, but one needs the full facts. However, the hon. Gentleman’s comments on accident and emergency services are worthy of more corrective comment. In my view, it is crazy to have accident and emergency facilities open 24 hours a day if we do not have accidents and emergencies happening 24 hours a day. Therefore, we should have some form of scheduling. We have already had the comment from my right hon. Friend the Secretary of State that victims or casualties do not necessarily have to rely on road- borne ambulances. In the same way, we no longer rely on handcarts, as they did in the middle ages.

I returned from Brussels this morning—I was on NATO Parliamentary Assembly business—and I was not sure that I would get a chance to contribute to this debate. I thought that we might have a sensible exchange about patient needs and community care, but for the most part—especially at the beginning of the debate—we have been treated to the standard Supply day swill-bucket that we were used to years ago. Frankly, that does no credit to the health service or the patients who require it, and it does discredit to the Opposition that they cannot marshal their arguments in better form or put them in a more presentable way.

Let me give some examples of what I mean. The hon. Member for Ribble Valley (Mr. Evans), who is not present in the Chamber at the moment, accosted the Secretary of State with the comment, “Were you right then, or are you right now? You can’t be both.” Well, of course she can. Times change. If someone says one thing three months ago and makes a comment on it today, times have changed in between, so they can be right on both occasions. But perhaps that logic is a bit deep for some of the characters on the Opposition Benches.

The hon. Member for South Cambridgeshire (Mr. Lansley) made a similar remark when he kindly referred to the hospital provision on Teesside. I am talking about the general hospital in Hartlepool and the University hospital of North Tees. He reminded the House of the comments of the then Secretary of State for Health and the then Prime Minister—he is still Prime Minister now, I ought to remind the hon. Gentleman. He commented that he did not know whether the report was right or wrong. I can tell him that it is in fact wrong. The comment that was made then is right, but the inference that he drew from it is wrong.

The report from the independent reconfiguration panel states that a third hospital will be provided. I ask the hon. Gentleman to put on his planning hat. If a third hospital is ultimately provided—at the moment the services that will be included in that hospital are still under consideration—as the services there develop and become established, that third hospital will withdraw specialisations from the other two. I hope that that principle is clear. I can see nodding, which is good. As those specialisations are withdrawn, the other two hospitals, in Stockton and Hartlepool, will reduce in size and so take on the character of less acute attentive clinics, which will enable the footprints of both those hospitals to decrease and therefore enable some of the property to be—

Yes, sold. One would hope that that will provide further finance for the development of the third hospital.

I suggest that my hon. Friend is mistaken in that. The independent reconfiguration panel says that the two hospitals in North Tees and Hartlepool should be closed to build a single-site hospital north of the Tees and that the surplus land would be used to fund that local hospital.

I am grateful for the intervention. My hon. Friend cited what the IRP said. I have had full discussions with the strategic health authority and its chairman, Peter Carr. He has confirmed to me that my version is correct and that the IRP and The Guardian report are inaccurate. I hope that my hon. Friend can accept my assurance on that fact. As far as being right or wrong is concerned, I hope that that clears it up.

It does not clear it up at all. The hon. Gentleman implied that I somehow misrepresented the situation. It is very straightforward. The Prime Minister went to Hartlepool. He said that there was no question of the general hospital in Hartlepool closing or being run down. The truth of the matter is that the North Tees review had proposed that it should be run down and eventually closed and that a new hospital should be built. The Department of Health put in Sir Ara Darzi, who seems to be its spokesman of choice for this purpose, in order to try to keep the hospital going. He said that it could be kept going. The matter then went to the IRP and the IRP went back to the North Tees review. According to the IRP, the hospital will be run down and then closed.

I accept the statement of opinion that is being given—[Laughter.] I do not find this amusing at all, funnily enough. Is the House simply interested in ridiculing the efforts that are being made to provide medical aid to patients?

Let us look at the principle: as one hospital builds up its services, the others will run down their services. That has got to happen. There will be in place primary care, with the paramedics, nurse practitioners and the general practitioners in their health clinics. Secondary care will be provided in the Stockton hospital of North Tees and Hartlepool general hospital, which will take care of less acute need. Tertiary specialist care will provided in the new hospital—[Hon. Members: “No.”] Well, that is what reconfiguration means in my head, and it makes sense to me.

The hon. Gentleman is being generous, but let me be absolutely clear about this: in health service terms, there is a clear distinction between secondary and tertiary care. Let me cite a single example. Under Sir Ara Darzi’s proposal, it was suggested that there would be a centre of excellence for children’s and maternity services at Hartlepool. That will not happen—it will be sited somewhere else. That is not tertiary care, but secondary care. Maternity care will not be provided in Hartlepool. One of the reasons why the IRP said that—it is straightforward and I understand it—was that it thought that patients would go not to Hartlepool, but across to James Cook hospital, and it did not think that maintaining maternity services at Hartlepool hospital would be sensible.

The hon. Gentleman seems insistent on reintroducing Professor Ara Darzi, although he was disposed of some time ago—not as a personality, but in the form of his report. The Opposition must get their head around the problem. The hon. Gentleman’s colleagues want a cardiologist on every corner. They seem to think that there should be every provision on every street so that people do not have to travel anywhere, but that is not possible in today’s times and with today’s needs. We should be providing for needs only where that is needed—it is as easy as that. We cannot have specialist provision in every village.

I am going on because I need to refer to the business of reconfiguration and poll tax, about which we heard from the Lib Dem spokesman, the hon. Member for North Norfolk (Norman Lamb). He complained that the Labour party did not mention reconfiguration in its manifesto, and said that if one googles those phrases, one finds that “reconfiguration” has been mixed with “poll tax”, as though that proved something. The only thing that it proves to me is that they have become mixed due to the kind of untruths—[Interruption.] I do not want to say lies.

Untruths, yes, and misleading statements that come from various agencies.

I noticed that the hon. Member for North Norfolk made no mention of the threat of closure in Hartlepool. The only time that there has been such a threat was when it was made at the time when the Liberal Democrats were fighting a by-election in which they were trying to ensure that my hon. Friend the Member for Hartlepool (Mr. Wright) did not arrive here. In fact, they failed, which just proves that even when they tell the right time, they are not believed.

I counsel some of my colleagues to be careful about how they use their arguments, for they might simply be doing damage by giving a hostage to fortune to those who would take their words and, as Kipling wrote, twist them like

“knaves to make a trap for fools”.

Well, that is all very clear. I am sure that we will be rewarded by a close study of Hansard tomorrow.

It is a privilege to speak again in a health debate after my right hon. Friend the Member for East Hampshire (Mr. Mates). He and I share a number of things in common, especially the fact that both our constituencies have been burdened since 1997 by several reviews of their local areas’ hospital services. In Mid-Sussex alone, there have been four such reviews since 1997, each with a more ludicrous name than the last. The penultimate one, “Best care, best place”, took place in 2004, and 18 months on, the whole health service in West Sussex has been thrown into confusion by another paper, “Creating an NHS fit for the future”.

Those reports were subsequent to a document commissioned by the West Sussex health authority, which, in 2000, faced growing fragmentation in health care provision, escalating and disproportionate management costs, and rapidly accumulating debts. The authority turned to Michael Taylor, a senior executive at the Oxfordshire health authority, and asked him to report back to it. Taylor exposed a series of top-heavy management structures in expensive premises, and duplication, replication and wastefulness. No one paid any attention to his warnings and the wilful mismanagement of the NHS in West Sussex continued, leading to colossal debts of over £100 million.

We have discussed the subject before in similar debates, but the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) has given no answer on the issue. Sadly, as many colleagues would agree, when the “Best care, best place” consultation began in November 2004, it was regarded as a total sham in my constituency and elsewhere. Regrettably, West Sussex county council’s scrutiny committee failed to do its duty, and did not call it in. I want the Minister to understand that the management of the strategic health authority, and most specifically the primary care trust, represented the paper to my constituents and to me as the way ahead for the foreseeable future. Many of my constituents were deeply cynical about the Government’s motive, but they went along with it.

On 7 June 2005, at my suggestion, Professor Sir George Alberti, the Department of Health’s so-called accident and emergency tsar, came to a meeting in the boardroom of the Princess Royal hospital to discuss the changes put forward in “Best care, best place”, the penultimate reconfiguration that my constituents have been obliged to endure. In that meeting, he persuaded me, against my better judgment, that it was right to make the proposed changes to the accident and emergency services, and particularly to switch major trauma cases from Haywards Heath to a hospital in Brighton, because of the necessity of treating major traumas on a site where all the main services were present. I still believe that to be the case, but at the end of the meeting he made it absolutely plain—I have it in the minutes—that

“had he taken a blank piece of paper to design the services for the given location with the same geography, patient flows, he felt that the presented solution was the best fit and would have been the one that he came up with.”

Sir George went on to state in the same minutes that there were

“significant benefits to be gained from the reconfiguration,”

particularly for the Princess Royal hospital.

Many of my friends, and colleagues of all parties, who attended that meeting were deeply cynical about what Sir George Alberti said, but I supported it. I must report to the House, however, that, not 18 months later, it is probable that a further significant upheaval will be proposed. There will be further substantial changes, which may include the removal of an essential accident and emergency service at the Princess Royal hospital, to be replaced by a walk-in centre.

As I hope the Minister is aware, we are talking about a part of the United Kingdom that already suffers from serious infrastructure fatigue. The hon. Member for Staffordshire, Moorlands (Charlotte Atkins) spoke about the health service in her constituency, but what she describes sounds like Versailles compared to what we have in my constituency, and compared to the investment that has been made in health and wider infrastructure in Sussex. Mid-Sussex alone has a statutory duty to accommodate 7,000 new homes between 2006 and 2016, and that equates to about 45,000 extra people, yet there is talk of closing an accident and emergency department in a hospital not 5 miles from a major motorway. Gatwick airport—a major international airport—is up the road, and there is only one accident and emergency centre anywhere near it.

There is appalling traffic on the roads into Brighton, and the infrastructure and public transport system are entirely inadequate to support the change. That change was proposed despite the assurances that I was given on the Floor of the House in an Adjournment debate that I secured on 16 March 2005 by the Minister’s predecessor, the right hon. Member for Barrow and Furness (Mr. Hutton), now Secretary of State for Work and Pensions, who stated :

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

I urge the Minister to repeat that assurance on the Floor of the House. The removal of a full accident and emergency service is not right for my constituency or for my constituents and, between us, we will not permit it to happen. The “Support the Princess Royal hospital” campaign commands enormous local support, and it is an all-party cross-community effort that has attracted nearly 60,000 signatures. People have signed a petition to the effect that they will not tolerate the removal of their A and E, as they believe that it would be wrong to end that service. They want to preserve proper maternity services for a growing population, so it is essential that the Government listen to the clearly expressed views of large numbers of local people who believe that the proposals are completely wrong.

The “Keep Worthing and Southlands hospitals” campaign has attracted more than 100,000 signatures, and the St. Richards campaign in Chichester has attracted 134,500 signatures. Will the Minister confirm that consultations will be held in good faith and that the strong views of local people will be accorded the respect that they deserve, as failure to do so would be a recipe for profound resentment and indignation? My hon. Friend the Member for Arundel and South Downs (Nick Herbert), who has played a detailed and effective part in that campaign, and I both accept that change is required. Changes can and should be made, provided that the infrastructure is in place. We will support those changes, but we do not support the removal of A and E and maternity services.

It is the perception in our local health service and, I believe, in many other local health services, that our magnificent, hard-working nurses are engaged in a constant struggle to look after patients as a result of inadequate resources and facilities, yet local trusts appear to have limitless resources to hire more bureaucrats. Local people know that the local NHS operates in an Alice in Wonderland world of twisted targets and distorted figures, and I would not care to be the auditor who has to sign off NHS accounts. Doctors should play a far bigger role in patient care; it is they who should be in charge of that care, not managers. The proposals in the “Fit for the Future” document are not better for patient care, as they constitute an effort directed from London to resolve the appalling mismanagement which people failed to deal with or get to get to grips with in the past, and to absolve them of responsibility for the grotesque financial problems that have arisen as a result.

Finally, I have two important points to make. First, the accumulated historic deficits resulting from poor management over the years and a lack of grip, together with the merger of the Princess Royal hospital and the Royal Sussex county hospital in Brighton, inevitably led to a large overhanging debt. I have referred to that problem on many occasions in the House, and we need a better, more constructive and imaginative approach to deal with those debts, quite apart from the necessity of making sure that the hospital is run prudently and effectively. The trust management is doing its very best to meet those demanding targets, but the Minister should meet it half way, and I urge him to meet a delegation to discuss the matter. Secondly, the Government must review the funding formula in West Sussex—a subject on which my hon. Friend the Member for Chichester (Mr. Tyrie) has consistently made a detailed case. I know that the Minister discussed the matter the other day with my hon. Friend the Member for Arundel and South Downs.

The Princess Royal hospital is a first-class establishment and it has a highly skilled and dedicated work force that plays a vital role in the local NHS, in an area with vastly expanding requirements and inadequate general health infrastructure. There should be more services at the PRH to utilise fully this excellent local hospital, which would be in the best interests of local people and patients. Everyone knows that the hospital does an exceptional job, and with the right support and without the dead hand of Government with their arbitrary targets, that outstanding hospital could do even more. That is what I want to see, and I know that local people in Sussex share my view.

In conclusion, we understand the need for change, but local people know when change is going too far. Patient care must not be compromised for financial considerations.

I welcome today’s debate, not just because it gives us an opportunity to discuss the process and nature of hospital reconfiguration, but because it provides us with the opportunity to consider the wider question of what kind of role the acute general hospital ought to play in the 21st-century NHS.

I shall quote briefly from the NHS Confederation briefing, which states:

“Reconfiguration is needed to improve health outcomes. Changes are necessary whether or not there are NHS deficits. Indeed, in some cases the reason why trusts have run up deficits in the first place is because these decisions were not made earlier.”

The briefing goes on to say:

“We must start judging the NHS by the number of people we make better and keep well, not by the number of beds.”

That, to me, is perfect common sense. Much of the debate on reconfiguration tends to dwell, quite understandably, on the potential loss of local hospital services and the perceived reduction in the quality of local health care. That diverts attention from what ought to be our primary area of inquiry—why we continue to admit so many patients unnecessarily to hospital, and what we can do to prevent it.

As I have said on many occasions in the House, the vast majority of hospital admissions should be seen as a failure of health policy. Every day thousands of patients are admitted to hospital not because they are desperately ill or because they need the support that only a hospital can provide, but because we often do not have anywhere else to treat them. In most cases patients enter hospital as a direct consequence of our failure to spot potential problems, to prevent people from becoming ill in the first place, and to put in place effective care packages that would allow them to be treated properly at home.

One in four emergency admissions consists of people with chronic conditions who yo-yo in and out of hospital three or sometimes four times in a single year. That adds up to 1 million unnecessary hospital admissions each year, costing the NHS in excess of £2 billion. This catastrophic waste of money rarely does patients any particular good. Not only do patients not want to be in hospital, but in many cases they would make a quicker and more complete recovery in their own homes and certainly in their own communities, supported by an appropriate care package close to where they live.

Most policy makers and commentators understand that and sometimes even talk about the need to reduce unnecessary hospital admissions, yet progress is painfully slow, given the sensitive nature of reform. As we have heard this afternoon, too often the reason is thinly veiled political self-interest on the part of Members who understandably but, in my view, misguidedly try desperately to talk up their own area and their own interest, often to the detriment of the wider health service. We must try to redress that tendency.

We are making some progress. Patients are discharged back into the community far more quickly than they would have been a generation ago, thanks to the increased use of less invasive procedures and the huge increase in day surgery. Today’s hospitals require far fewer beds, as we have heard in the debate, and patients requiring minor procedures are increasingly being treated elsewhere. However, I believe that the model of acute care that we had in place is no longer fit for purpose, and we need to rethink radically the way in which the acute system, and the district general hospital in particular, is operated.

We should start by asking which services must be provided at acute district hospital level. Although there is a range of services to which patients in each area need access, including trauma, accident and emergency, orthopaedics, paediatrics, obstetrics, gynaecology and many others, there is no reason why all these specialties should be provided at each and every acute hospital in a particular region.

I respect the hon. Gentleman’s approach, but does he not acknowledge that when a consortium of GPs in my area opposes reconfiguration on the basis that it does not deliver the best health care, we should listen to the views of those GPs as well as his own views?

As I am not an expert on the hon. Lady’s constituency, I cannot possibly comment on what the local GPs want. I am making much wider points about the direction that the NHS should be taking.

The duplication of services is vastly costly, and makes it far more difficult for individual hospitals to build up the specialties and expertise that they need. Would Members rather be treated by a unit that dealt with 10 cancers in a year, or by one that dealt with 200 in a year? I think the answer is fairly obvious. Why, then, do we need specialist cancer services in each hospital? I am merely making the general point that if services are configured in a way that concentrates the most expertise where that expertise is best delivered, everybody will benefit. We will avoid duplication, staff can build up much more expertise, and ultimately patients will receive a far better service. Such an approach would enable us to rationalise the number of beds significantly, and to save each trust hundreds of thousands if not millions of pounds without jeopardising patient care in any way. After all, a stay in hospital does not come cheap: it can cost up to £500 a night for someone to stay in an acute unit.

There will obviously be some obstacles to the process that I wish to see. The way in which hospitals are financed and set up will have a bearing on the configuration that will be possible over the next few years, and I think we must look carefully at the way in which we establish and pay hospitals to ensure maximum flexibility. I make no secret of my belief that the “payment by results” system has sometimes presented an obstacle. It often makes reconfiguration quite difficult, because paying hospitals according to activity rather than results may give them an incentive to provide care that, in my opinion, would be far better provided elsewhere.

As the House knows, I am a GP who continues to practise a certain amount. GPs have been given control of their budgets under the practice-based commissioning scheme, and in theory they can control their use of secondary services to a large extent, but the reality is very different. Many patients still attend A and E units off their own bat, and are treated, admitted and referred to consultants without any consultation with their GPs. Most of that treatment may be justified and necessary, but it is not possible for the primary care sector to have any control over it.

I have been looking at the Dr. Foster data that is sent to my practice every month. What I have here is a month of data from my practice alone. It is extraordinarily difficult to make any sense of it. I asked my practice manager, an extremely experienced man, to try to do so. He told me that it had taken one member of staff three days merely to establish whether the patients on the list were registered with the practice, and that it was impossible to conduct any meaningful analysis of the data on a monthly basis. Ministers should bear in mind the fact that if we are to have access to data to help us make decisions, there must be a possibility of our understanding it.

An elderly patient was taken to A and E with a nosebleed, which cost the practice £1,500. The practice was recently charged more than £200 for a hospital appointment that had been cancelled by the acute trust. Then there are patients whom we choose to refer to hospital for specific reasons, and who are then treated for completely different reasons. A patient whom we sent to hospital for a routine back operation surfaced 141 days later at a cost of £38,000 to the practice. I am not saying that that was not justified; what I am saying is that there was no way in which the practice could have had any input into the management of the patient, or any say in alternative pathways of care.

I would go as far as to say that rather than there being a Berlin wall between primary and secondary care, there is a black hole. Not only do hospitals suck in enormous amounts of resources, but very little light emerges. We must look carefully at the interface between primary and secondary care to ensure that enormous amounts of information do not overwhelm our ability to ensure that patients are given the best possible treatment. I believe that the only solution is to provide more vertical integration between the primary and acute sectors. That, I think, is the only way in which to establish a meaningful dialogue between GPs and hospital-based consultants, and prevent hospitals from simply using the system for their own ends.

I think that we have a lot to learn in that respect from the Kaiser Permanente scheme, which was cited in the White Paper as a successful example of integrated prevention-oriented health care. The Kaiser model owes much of its success in reducing acute sector activity to its decision to invest in a network of community-based specialty clinics in which primary care professionals work alongside specialists. The clinics have the facilities to cater for more or less every step of the patient’s journey, from initial assessment, through diagnosis and treatment, and eventually to follow-up. The most important part is that, unlike in the NHS, there are no structural distinctions between the primary and secondary care sectors. Not only is the model vertically integrated, but the ethos is based on prevention, integrated working and the belief that the most effective and cost-effective care is that which is given as close to the patient’s home as possible.

It is highly questionable whether we can get the same benefits in this country without looking at a similar model of health care. We should give serious consideration to integrating primary and secondary care under the aegis of a single, discrete care trust. That must involve a radical change and is far more than just a rebranding exercise. We certainly cannot reduce hospital activity without looking at the incentives and how hospitals are managed at the moment to ensure that they are not driven simply by financial needs, rather than patient outcomes.

We would need integrated care teams and properly set up community teams to ensure that most care is given close to the patient’s home; the vast majority of cases can be treated in that way. We would need professional executive committees that were powerful enough to make those decisions without being swayed by individual pleading. We would have to ensure that we avoided acute admissions as far as possible and that we did everything possible at primary care level to avoid the need for people to go into hospital with acute needs in the first place.

I believe that all those things are perfectly doable, but only with a radical rethink. On top of that, I am also calling for the setting up of polyclinic-style clinics in each community. If we integrate the primary care sector with secondary care specialists, nurses, physiotherapists, occupational therapists and so on, most care can be provided at that level without necessarily having any acute in-patient beds in such clinics, which could do a lot of procedural investigations and minor surgery, again avoiding the need for acute hospital admissions. That would free up the hospital sector to provide the care that only it can provide. I believe that that would be a far more coherent structure for the health service.

What is more—this is the most important part—if such polyclinics were set up properly, it would be obvious to the patients that they were situated in their communities and that people were getting much better care much closer to home. Such an arrangement would also reduce the need for patients to travel to hospitals. It would not only be much more cost-effective for the health service, but would gain the consent of patients. Indeed, at the end of the day, if we are going to reform the health service, it can be done only with the informed consent of the public. After all, it is they who pay for, use and benefit from the service, and we must ensure that they see the benefit for themselves.

That is why I propose a radical rethink of the health service involving much more vertical integration and providing far more services far closer to home, based around the primary care unit. I think that such an approach would meet all our Government objectives, achieve good financial management and good husbandry, and use resources to the maximum benefit.

At the beginning of this debate, I listened to the Secretary of State in utter disbelief. Either she lives on a different planet or she has never set foot in Surrey. [Hon. Members: “Both.”] Indeed, although perhaps there is another factor: she spends so much of her time trying to buy votes by building things in Labour marginals. Whatever the reason, however, I simply did not recognise the world that she inhabits, and my constituents do not recognise it either.

When I was first elected, my constituency had its own district general hospital and accident and emergency department. In fact, a Conservative Government virtually rebuilt the whole of Ashford hospital. Since 1997, however, cut after cut has decimated that hospital. Let me take but one example of what my constituents have had to put up with—accident and emergency. First, a Labour Government decided that they would axe accident and emergency, which led one of the consultants in the hospital to say of my constituents that some patients would suffer and some would die because of what the Government were doing. They gave us an emergency department for a bit, thinking that that would shut us up, but then they axed it. Then they thought that they would try to keep us quiet by giving us a walk-in centre with a telephone that people could ring at night for a doctors’ deputising service. Recently they have decided to insult us further by saying, “Don’t take wounds or sick children to that walk-in centre, because it won’t treat them.” That is what my constituents have had to put up with.

Since 1997, more and more of my constituents, some seriously ill and many in pain, have been forced to travel across the Thames, and sometimes down a gridlocked M25, to St. Peter’s hospital in Chertsey. The Government have the nerve to try to justify making them do that by saying that they are bringing services closer to the people. That is a sick joke.

As a final insult to my constituents, the Government have spent the past three years trying to give away the remaining theatres and wards to a private company from Sweden. In 1997, when the Labour party came to power, Labour Members had the nerve to accuse us of wanting to privatise the NHS, yet this Government have spent three years trying to privatise my local hospital. That is hypocrisy and humbug.

The NHS crisis in Surrey gives the lie to the Government’s claim that cuts and closures are improving services. Last March, the then acting chief executive of Surrey primary care trust told me and my Surrey colleagues that it was £120 million in debt, that it had been ordered by the Government to eliminate that debt before the end of the financial year, and that the only way he could do that was by closing a hospital—not just an A and E department but an entire hospital, including its A and E department.

Not satisfied with that, last November the Government decided that they would launch a review of the funding formula because, they said, Surrey receives £135 million too much. In other words, they are demanding that we cut not only £120 million but £135 million. Curiously, I happen to agree with them that the funding formula has nonsensical elements. Morbidity plays a part, because the younger that people in a community die, the more money is necessary there. I understand that argument. However, the Government do not seem to understand that because people over the age of 65 need the NHS most and cost the NHS most, the more of them there are, the greater the demand on the service; and for some reason people in my constituency live longer than most.

Poverty also plays a part in how the Government decide that the money should be distributed. Under the funding formula, the figure for poverty is based on the national average wage. I am delighted that, on average, my constituents earn a great deal more than the national average wage—that is how things are in Surrey. However, it has not dawned on the Government that in an area where people earn more, they have to spend more because the cost of living is so high.

I cannot help concluding that the Government want me to tell my constituents that if they want a decent health service they should die younger and earn less. Are the Government proud of that? They should be ashamed of themselves.

It is not rubbish. If one distributes money according to the age at which people die without taking account of the fact that my constituents live longer, and according to a poverty factor that takes no account of the cost of living in my constituency, what other message can I give them?

It is not nonsense; it is the truth. If the hon. Lady would care to come to Surrey, we would explain it to her, but she keeps refusing to meet us.

After 10 years of Labour mismanagement, Surrey residents now face cuts of £120 million and £135 million. The result is that, last year, we were caught up in discussions about closing one of Surrey’s hospitals and an accident and emergency department. Now, 10 months later, we are caught up in discussions about closing more than one hospital and shutting all the A and E departments in Surrey except one. What else will we be faced with?

I am listening to the hon. Gentleman in amazement. Would he care to enlighten the House as to what the state of the health service in his area would be if his vote against the extra funding for the NHS through the national insurance increase had been carried? What vista would he see if he had got his way and the money had been denied the health service?

The Government have a script. [Interruption.] I remember the arguments at the time and the way that I voted. If a Government and a country can afford to spend more, I am prepared to support that, but my constituents—[Interruption.]

Order. I am sorry to interrupt the hon. Gentleman but the debate must be conducted with one person speaking at a time.

If we can afford to spend the extra money, my constituents are pleased and relaxed about it, but they do not care for the fact that it is wasted. What is better in Surrey, given that more money has been spent? The Minister asks whether we support spending more money, but he should ask whether we support spending money sensibly.

The Minister will keep going on about the point. Given the circumstances at the time and the arguments that the Government used, I do not regret what I did. Subsequent experience justifies my reservations. The Government said that they would spend more money and they have blown it. There is no improvement. Indeed, there is a worse service in my constituency. It is all very well for the Minister to shake his head. Of course there is a better service in Labour marginal seats—that is what it was all about.

Does my hon. Friend agree that the two Ministers present clearly need to visit Surrey to see for themselves? They have no conception of what is going on there. If all the money has gone into health, it is not getting through to our Surrey residents.

My hon. Friend is right. I repeat the invitation to Ministers: come and talk to us, see the position for yourselves and try to justify it. Given events in Surrey, it beggars belief that the Government have the nerve to claim that the sort of review that we face is about improving services. That is an insult to my constituents’ intelligence. Surrey PCT is running around, presumably at the Government’s behest, waving documents called “Clinical case for change”, and telling people, “Forget what we said last year; this is the justification for the cuts.” That is a pathetic smokescreen.

As I said earlier, last March we were told that a hospital and an A and E department had to be shut to save money, but the document that is now waved about claiming that there is a clinical case for shutting A and E was not even commissioned till nine months after we were told the truth about the reason for the cuts. The documents are a smokescreen. They may contain some substance for the future, but if the debate is about improving services, why did it not start with the documents?

If the debate is about clinical services, and there is to be genuine consultation, I invite the Minister to confirm in his winding-up speech that it will, indeed, be genuine and that he disowns the chairman of Surrey PCT when he goes around telling people that we can have as many petitions and demonstrations as we like, but they will have no effect because he has to make cuts. Will the Minister state that the consultation will be genuine and tell the chairman of Surrey PCT not to make such remarks, if they are untrue?

I have always tried to conduct my politics here as calmly as possible. However, the Government have treated my constituents outrageously. I am angry on their behalf. I do not want them to suffer or die, but, rather than improving care, the Government increase suffering, according to consultants in my constituency. According to a consultant, rather than extending life for my constituents, the Government are putting their lives at risk.

I have named him many times as Dr. Bellamy, who was an accident and emergency consultant. He is on public record as saying exactly that some people will suffer and some will die.

The Minister does not need to try and sack him; because of the way he was treated, he has already retired—but there we go.

At the start of the debate, we heard a smug speech from a Secretary of State who lives in a fantasy world. I am appalled at what she had to say this afternoon. I am appalled at what the Government are doing to my constituents. The Secretary of State, Ministers on the Front Bench and the Government as a whole should be ashamed of themselves.

I start by thanking the Opposition for choosing this subject for today’s debate, although I have to tell them that the national health service that we have heard described this afternoon is not one that the people of Dudley would recognise, as extra investment and new ways of working have delivered real improvements for patients.

Over the past four years, Dudley PCT and the Dudley group of hospitals have radically reshaped the way that health services are delivered in Dudley. Our flagship £200 million hospital, incidentally, does not serve only my constituents in Dudley, North, as it provides a first-class service to residents of villages such as Kinver, Wombourne and Swindon—in South Staffordshire, which is represented by an Opposition Member—and, indeed, to residents of Bromsgrove. The idea that the services are improved only in Labour constituencies is completely false. The new £200 million hospital is at the centre of the modernisation of health services in Dudley and has been matched by a far-reaching reform of community services to ensure that more and more personalised care can be delivered outside hospital.

A range of new services has been introduced, which, along with existing services, is changing the way that care is provided. Many services have been expanded with new rapid care teams, and a pathways service for hip and knee patients has been expanded to take account of other services. Care closer to home is now proving effective, providing treatments traditionally found only in hospital in the comfort of patients’ own homes. We also have new outreach teams working more closely with mental health patients in the community.

New nurse consultants are a key part of our new model of care—working, for example, with the 100 people who return to hospital most frequently. They intervene earlier and provide preventive care closer to home. As a result, a sample of 14 patients analysed shortly after the service was introduced showed 98 bed-day savings. The latest figures show that the average length of stay has reduced by more than a fifth.

New case managers prevent admissions into hospital and speed up returns to the community. Those nursing teams are reducing emergency admissions to the acute services. As we heard earlier, one case manager alone prevented 88 admissions to hospital in just an eight-month period last year. Our new pathways service shows how partnership working between health and social services can provide high-quality care, starting and finishing in the community, for patients awaiting elective surgery. It has reduced inefficiencies in the system, ensuring that the patient is treated in the most appropriate place by the right person.

We also have a new community heart failure team. Under the leadership of Rachel Harris, the chair of Dudley Beacon and Castle PCT, new community-based services and a new community-based palliative care team for patients with heart failure have been introduced. The team provides new services in health centres and clinics and an additional team of five nurses visits patients in their own homes.

Those new services have resulted in emergency admissions avoidance for heart failure patients. Across Dudley we saw an 8 per cent. drop in heart failure emergency admissions in the last two quarters of last year compared with the last half of the previous year. The PCT has reduced heart failure admissions by 16 per cent. and a neighbouring PCT, which did not implement a similar team, saw a rise of 10 per cent. over the same period. When it introduced a heart failure team based on ours, it saw a 23 per cent. reduction in the first year.

That is not to say that everything in Dudley is perfect—of course not. Things can never be perfect in every case and there are issues, for example, with chiropody services in the community. However, the truth is that none of the improvements that we have seen could have been achieved without the extra investment delivered by the Government and the new ways of working that the Government have introduced.

Despite the Conservatives’ warm words on the Order Paper about the NHS, it is impossible to say that they believe in the NHS or that they would adequately fund it in the future. The motion, which stands in the name of the Leader of the Opposition, claims to recognise

“the need to develop and improve acute hospital services”

and calls for more commissioning, yet the Conservatives voted against the extra investment that is paying for the 109 new hospitals that the Government are delivering. Indeed, the Leader of the Opposition said at the time that the investment needed to pay for those hospitals represented “fiscal irresponsibility”. He has committed his party to a new fiscal rule: the proceeds of growth rule.

Whatever the Conservatives say in the motion today, that rule represents a pledge to cut public spending year in, year out. If that rule were introduced this year, spending would be lower than it is under the Government’s plans. This year, the difference between the Opposition’s plans and the Government’s plans would be £17 billion, and the gap would be bigger next year and in every subsequent year. Given that health service spending accounts for almost 20 per cent. of total managed expenditure, a £17 billion cut in public spending applied across the board would mean cuts to the NHS of at least £3 billion this year. That would mean fewer new hospitals than the 109 new hospitals that have been opened or are currently being built. It would mean a £150 million cut in the £750 million investment in the new community hospitals and services being built over the next five years.

Hon. Members need not take my word for this. Whatever the Conservatives say today, let us remember what the Leader of the Opposition said about the proceeds of growth rule this year. He said:

“As that money comes in, let’s share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government.”

He also said that he wanted to replace public services for the poor with

“a profound increase in voluntary and community support”.

So all this talk about a new modern Tory party is simply empty rhetoric. It is making the old Conservative commitment to a small state and cuts in spending, with charities stepping in to help the most vulnerable. That is why the Tories cannot promise that they will not cut funding for the NHS.

We should not be surprised about that; it is not a secret. Every Tory speech reveals the truth. They will not give us the details of which taxes they want to cut, which services they would cut to pay for that, or which bits of what they constantly call the big state they would cut. All the rebranding in the world cannot hide the fact that they are the same old Tories committed to the same old spending cuts. They would run down the NHS using the same old prescription of cuts, charges and privatisation.

The truth is that investment in the NHS has doubled nationally since 1997, and that it will treble by 2008. There are now 32,000 more doctors and 85,000 more nurses. We now have the best-paid nurses in Europe, and by 2010 there will be more than 100 new hospitals. Nobody should wait for more than 26 weeks for an operation—a transformation from the situation under the Tories.

I thank my hon. Friend for allowing me to intervene during his excellent speech. When he was explaining the Conservatives’ fiscal proposals, did he notice that many Conservative Members were nodding in agreement? They obviously thought that they were good proposals.

I did not notice that, but I did notice that not one of them has got up to deny that the effect of their policies would be to cut public spending, which is what they believe in. They cannot deny that. It is an absolute fact that the effect of the proceeds of growth rule would be to cut public—[Interruption.] Well, if the hon. Member for Hemel Hempstead (Mike Penning) would like to intervene on me to deny that the effect of the proceeds of growth rule would be to cut public spending, I would be more than happy to give way. Does he want to—[Interruption.]

Order. May I suggest that the hon. Member for Dudley, North (Mr. Austin) should not tout for business in that way? I must also ask the hon. Member for Hemel Hempstead (Mike Penning) not to make any more sedentary interventions.

I apologise, Mr. Deputy Speaker.

The truth about today’s NHS is that 99 per cent. of cancer patients are seen by a specialist within two weeks, and 19 in 20 patients are seen, treated and discharged from accident and emergency departments within four hours. New facilities, technologies, treatments and drugs, and the investment needed to pay for them, mean that people now survive conditions that would have killed them just a few years ago. Doctors and other professionals say that some services need to be concentrated in centres of excellence, so that clinicians with the right expertise, experience and equipment can treat the sickest patients safely and conveniently. I have seen that at first hand in the case of patients receiving angioplasty for heart problems at the new facilities in Wolverhampton. Expanding such facilities nationwide would mean about 500 fewer deaths a year and about 1,000 fewer heart attacks. New technologies in the health service mean that patients who would have had to go into hospital for lengthy treatment can now have treatment in local health centres and GP surgeries.

Again, hon. Members should not just take my word for it. Let me tell them about the experience of my constituent, Mr. Albert Williams, a 79-year-old war veteran who now suffers from two terminal illnesses. He wrote to me:

“The care that I have received in my home is a great example of the way the health service can treat people in the community, be visited by nurses, enabling them to live at home and free up hospital beds for other patients.”

He is now able to be treated in the home that he loves, surrounded by his family and friends, and in as much comfort as possible. That would never have been possible without the changes introduced by this Government.

This debate takes place in the context of health, but the backdrop is trust. The Minister should not be surprised at the treatment of the Secretary of State’s speech by Conservative Members, as it reflects the sense of complete distrust for anything that she says about what is happening in the NHS.

The Government are hoist by their own petard. We have not forgotten how the Labour party treated the health service in the run-up to the 1997 election. We have not forgotten the treatment by then Labour Members and parliamentary candidates of attempts to modernise the health service to assist patients, or reductions in beds. We have not forgotten the screeching in the House about the prospect of privatisation. Ten years on, people have seen what is happening to the health service under Labour, and how the Government have turned on their head to put into practice the same things that they complained about in opposition.

It is no wonder that there is a sense of complete distrust about what the Government do. That is the reason for the general distrust about the fiddling of waiting list figures. No one believes the waiting list figures in this country any more, because every doctor in the country, at both primary and secondary level, knows how the figures are manipulated so that the Government can then spout them.

Sadly, that is the context in which debates on the health service take place, and it is a shame. I want to say good things about what has been happening in Bedford, and to relate that to the debate on the acute services review. I start from a position of having a father and a brother who work in the health service, and of having no private health insurance. The NHS really matters to me, and I am concerned about its future and how it is dealt with.

In Bedford, the debate about reconfiguration takes place against a historical deficit of £11.9 million—an arbitrary calculation, to which I shall return later. There are difficulties in the eastern area, where, strangely, we seem to have a preponderance of poor managers, given the preponderance of health service deficits that do not appear in urban areas. According to the Secretary of State, that is all due to management, when we know that that cannot be the case.

Bedford hospital has done well despite what the Government have done, rather than because of what they have done. The chairman of the Bedford Hospital NHS Trust, Helen Nellis, is standing down. She has given excellent service to the area. She is a loyal, committed woman who has worked her socks off to do what the Government wanted to bring the hospital up to the highest possible standards. Despite her efforts, she has seen the hospital’s finances messed around with constantly. Cancer care outputs are extremely good at Bedford, partly due to the Primrose cancer unit, which was built by the community, not by the Government. Cardiac care at Bedford hospital is excellent. Both my mother and father have recently sampled that care and been tremendously well treated.

Throughout the health service, we will find examples of good practice and improvement. That has happened year on year since the 1940s. It is bound to happen. Trying to make out that one Government stop all improvement, and that another Government create it, is nonsensical. However, recognising good care, good practice and hard work by Bedford hospital, nurses, doctors and all other staff, and that there are improvements, does not stop us from asking key questions about whether all the investment that the Government have put into the health service has produced the results that it should have produced, whether money is properly spent throughout the system and whether it is distributed fairly around the country.

The acute services review puts into sharp focus the problems that hospitals such as Bedford hospital have in fighting with one hand tied behind their back because of the constant changes in the health service and its structure and finance, to which my right hon. Friend the Member for East Hampshire (Mr. Mates) referred. That makes it so difficult for any stability or continuity to occur. It makes it difficult to drive forward change with any sense that what happens today will be recognised in three or four years and be given a chance to work.

My constituents are determined to ensure that the current acute services review in the eastern area is dealt with from the bottom up, not the top down, and that medical and clinical need take priority rather than the rather strange economics that affect the region. Let me give three particular reasons why the review is a matter of some concern. First, there is general scepticism. In Hertfordshire, three years were spent on the massive document “Investing In Your Health”, involving the whole community and producing the idea of a new hospital. That was overturned overnight. More than that, the new hospital was said to be outdated before it even got going. What system could produce such a nonsensical review and take such an amount of time? Therefore, no one has any confidence that the current review will necessarily produce anything different.

As my hon. Friend rightly says, most people accepted “Investing In Your Health” and the promise of a new super-hospital. In fact, it was widely touted—Ministers were saying all around the constituency that it was going to happen. Now we have seen the demise of the super-hospital, we cannot seem to get any explanation of the mess that my hon. Friend has just described. The Government have not explained why it was all going wildly and wonderfully in 2005, yet the minute that the then Minister for Public Health, the former Member for Welwyn Hatfield, and the MP who represented St. Albans both disappeared off the map, the hospital went with them. There is a degree of cynicism among my constituents.

My hon. Friend puts it well. Who knows what the current acute services review will produce and, once it has produced an answer, whether it will last and anyone will take any notice of it?

Secondly, there is concern about the distribution of funding in rural and semi-rural areas. The Government have been presented with evidence of how that works. The concern is not that there are not problems in urban areas, but that problems in rural and semi-rural areas are treated much more lightly and not given the consideration that they should be given. That is why expenditure per head is lower. That is why, even though there is a lower number of hospitals per head of the population in the eastern area, there will be no attempt to rebalance that by producing new hospitals in our area, and the same degree of relative deprivation will continue.

The hon. Gentleman is well placed to comment on these matters because he previously represented a Greater Manchester constituency. Does he therefore accept that, for example, there are more GPs per head of the population in his current constituency than in his former constituency, and that the difference is considerable?

There is a difficulty in pulling just one statistic out of the hat. Statistically, I am sure that the Minister speaks the truth, but the point is that it is noticeable that, over time, the illnesses and problems that my constituents have are treated less seriously and given less funding and support than those in urban areas. I do not regard the illnesses or difficulties of my constituents as any less serious than anything that happens in urban areas. Why are the majority of trusts in balance found in urban areas and the majority in deficit in semi-rural and rural areas? Are all the bad managers concentrated in the rural areas of Britain? No; it is the way the funding formula works.

The Minister says from a sedentary position that that is not true, but the Health Committee, which is dominated by Labour Members, said in a recent report that it is true.

Yes, it is true. I cannot spend any more time now on that point, but the Minister will have a chance to deal with it in his winding-up speech.

What I have said is true, and that creates a concern: if the same pattern of funding underpins the acute services review in our region, how can we be sure that decisions about where hospitals will be placed will not be made on the basis of the economics of the area rather than on the clinical needs of my constituents?

We also want to be sure that after the review is concluded hospitals and trusts will be able to get on with doing their job without the Government breathing down their necks and constantly making decisions about their funding and how they should spend money. The Minister knows about the current situation at Bedford hospital. There is a deficit of £11.9 million. That forces the trust to do some remarkable things that waste still more money.

Last summer, the trust decided that it could not replace an orthopaedic surgeon, but the flow of orthopaedic work did not diminish as expected. At Christmas time, staff were made redundant and wards were closed—that happened under Labour, I remind the Minister. Now, in the new year, it suddenly appears that there is so much orthopaedic work to be done that patients’ waiting times will hit the cliff edge of the new 18-week target that has been agreed, so more money has been found in order to make sure that that does not happen.

In fact, the treatments proposed will be more expensive than would have been the case if the trust had been able to replace the consultant and follow a normal pattern of work from summer until the end of the year. More money will go into the private sector, and money will be spent on evening operations if the staff can be found to do them, because Bedford Hospital NHS Trust is now readvertising for staff whom they sacked just a few weeks ago in the round of cuts at Christmas time. If the Minister can sit before us and think that he is presiding over an efficient and effective national health service as far as economics and financing are concerned, I am extremely surprised at him. He has a mess in those regards, which he must deal with. How can we have any confidence in the review if that is the economic basis underpinning it, under which hospitals will run?

If the movement of services into the community is to work, the GPs in an area must be able to take on the extra capacity and do the job required of them. I presume that the Minister agrees that that is the case. However, I recently spoke with Dr. Peter Graves, the chief executive of Bedfordshire and Hertfordshire Local Medical Committee Ltd, and he has passed on to me a series of concerns about GPs and the primary care service not being ready to meet the extra demands placed on them by the Government.

First, GPs need to be trained to become GPs with special interests. Unfortunately, the resources for that are not available, so GPs cannot get the training that they need in order to take on those specialties. Secondly, there is an issue to do with training multi-skilled professionals—the further training of other clinical professionals to cover the GP while he or she is carrying out semi-specialist services. Dr. Graves says:

“It remains very difficult to find appropriate training for nurses and other staff, and indeed difficult to find the nurses willing to undertake such training in the first place. In order to deliver Secondary Care services in Primary Care a multi-skilled workforce is essential.”

Thirdly, he talks about premises:

“The third aspect of this issue is around practice premises. Whilst there are some large purpose built premises in Central Bedford, which might have the equipment and space to undertake further services (should the staff capacity be available) many practices around the outskirts of Bedford and in North Bedfordshire remain totally inappropriate. We are reliably told that there is money available for the development of premises and yet we are having enormous difficulty accessing this and finding the necessary support to develop premises.”

My constituents’ perception of the acute services review is, first, that it is underpinned by dodgy economics, as reflected in rural and semi-rural areas, and secondly, that there is an issue to do with the way in which the finance is handled, as hospital administrators are forced to work with one hand tied behind their back, never knowing what their financial regime will be almost month to month. During the course of this financial year, some of them had to make £4 million-worth of savings and they were handed an extra £500,000-worth of savings in October because of a decision that involved deficits throughout the rest of the region.

There is also the question of whether such decisions will be made from the top down, or whether clinicians and doctors will be involved. As my hon. Friend the Member for Hemel Hempstead (Mike Penning) said, a lot of clinicians feel that they are out of the loop. Doctors and clinicians are not going to take these decisions; they will be taken from above, by administrators and people directed from Whitehall.

There is another problem. Once services have been reconfigured—once the decision has been taken to take them from the hospital and place them in primary care— who is going to do this work if the GPs have not been trained to do it and they do not have the necessary premises and staff capacity? We are heading toward a repeat of what we have seen in the past 10 years: well-intentioned efforts by the Government and huge sums of money being spent, but a real mess on the ground. As a result, their efforts simply are not effective.

Unless the Government stop living in a fantasy land in which there is no criticism and the Secretary of State believes that everything is working as she wants it to work, there will be no real delivery for patients, doctors and our constituents. All that we Conservatives are trying to do is to point out those problems, and that the health service and the people who work in it deserve rather better leadership all round than their hard work, efforts and determination are receiving.

Probably no other subject strikes as much terror in the hearts of Members as learning that there is to be a review of acute services in their area. I live in a constituency where that has happened and I want to share some of the experiences of the people of Crawley, and to tell Members that there is life after reconfiguration and there are excellent services to be had—if Members are prepared to be open-minded about what these services are about.

We in this House are in a privileged position, in that we have access to information that our constituents would love to have. We have a responsibility to share that knowledge so that our constituents can understand what the drivers for a review of services are. I was very interested to hear the hon. Member for North-East Bedfordshire (Alistair Burt) argue that pre-1997, the then Labour Opposition were preventing the reconfiguration and modernisation of the health service. I wish that the then Conservative Government had taken the bull by the horns, realised that Crawley hospital was in desperate trouble and addressed the issues of underfunding, accreditation and the hospital’s general decline. They have now been properly addressed, and in sharing such experiences I want to show that the interests of our constituents must come first.

I completely understand that, as I said, such reviews strike terror in our hearts, but our constituents’ interests must of course be firmly at the heart of our efforts. We have had review after review in my local area. I have heard many Members say, “I am in favour of modernising, reconfiguring and providing a better service,” but most are thinking, “But don’t do it in my patch, if you don’t mind, because I don’t want the hassle of dealing with the consequences.” Unless Members are mature enough to tackle this issue, which has emerged time and again in contribution after contribution, the way in which politicians will be perceived will be a worry. We have a responsibility to understand the clinical drivers behind the proposed changes, even though we might not like them or want to accept them.

The hon. Lady is right to say that hon. Members should consider all the issues when a review of acute services is taking place. One size does not fit all. In my constituency, the Westmorland general hospital faces closure of its heart unit because of the acute services review. There are clinical arguments for that, but there are also strong arguments for providing emergency services close to where people live. There is no point in having an all-bells-and-whistles centre of excellence an hour away from where someone lives, so that they die before reaching that fantastic centre.

I hope that the hon. Gentleman has his press release already written, and I am glad that he had the opportunity to mention his local difficulty. We have a responsibility to understand the implications of the times that ambulances need to get to patients. We no longer pick people up off the road and run to the front door of the nearest hospital. All the factors are important in determining whether people live or die, and that is the reality behind many of the reconfigurations.

I have heard many claims that if a certain local facility is closed people will die before they reach one that is further away. Hon. Members need to think carefully and do their homework before they make such statements, either in their constituencies or in the House, because there is no evidence to support such views. There is evidence of the effect of 24-hour consultant cover and of a cardiac unit that regularly performs angioplasty and can do one immediately a patient is admitted. There is also evidence of the benefits of surgeons getting practice by regularly performing a range of surgeries for the 500,000 people in an area. That is where the evidence lies and we have a responsibility to ensure that we convey that information to our constituents.

The hon. Member for South Cambridgeshire (Mr. Lansley) said that he was not opposed to progress in acute services. If that is so, we all have a responsibility to consider each individual reconfiguration and take a view on it, as difficult as that may be. I bear the scars of having a majority of 37 for that very reason. I worked in the NHS for 25 years before entering the House and I knew that things were not right with the health service and my local hospital. I knew that it had difficulties that needed to be addressed, but which had not been addressed for many years.

I was one of the first Members of Parliament to face a review of acute services, which puts paid to the lie—recently put to me by local journalists—that only Conservative Members are having to go through that. That is absolute nonsense. The reviews are taking place where they are needed.