The future of acute hospital services increasingly lies in high-quality, independently regulated and locally accountable NHS foundation trusts, such as Frimley Park in the hon. Gentleman’s constituency.
The Minister is aware that accident and emergency units in hospitals that serve my constituents are threatened with closure. What she may not know is that the so-called clinical evidence base justifying these cuts on medical grounds has been drawn up by someone who is not even a doctor, and the officials executing the cuts refuse to make improving clinical outcomes one of the aims of their work. Is it not clear that the cuts have nothing to do with helping people in pain and everything to do with ministerial mismanagement?
The hon. Gentleman is talking absolute nonsense. Hospitals are changing because medicine is changing, and there are discussions going on in Surrey and other parts of the country about how to improve services—in some cases by giving more treatment closer to patients’ homes in health centres, community hospitals or GP surgeries, but also about how to ensure, for instance, that for people who have suffered a heart attack or stroke, specialist life-saving care is available in specialist centres. That will not be the case in every single local hospital—but no formal proposals have been made yet on service improvements and changes in Surrey. They will be made in due course, and consultation on them will not start until the summer. That is the appropriate time to have a debate about how services in Surrey can be improved to give people better care and a better chance of having their lives saved.
The Secretary of State knows that there has been a promise of new money for Leicester—£700 million for the pathway project. Although there will be a delay in the application for foundation status, will she reiterate the Government’s full support for the rebuilding of the hospitals that was promised under pathway, including refurbishment of the Leicester general hospital, so that in Leicester we can provide the best possible care in the best hospitals in the country?
My right hon. Friend and I have taken a close interest in this matter over several years, and I am delighted to say that last year the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who has responsibility for reform and delivery, announced a private finance initiative rebuild across the three hospitals of the University Hospitals of Leicester NHS Trust. My understanding is that, following some discussions with the private sector partner about the cost, a review is taking place, but I have no doubt that that investment will continue for the benefit of people not just in Leicester but across Leicestershire and other parts of the east midlands.
Does the Secretary of State agree with the Department of Health document “Keeping the NHS local: a new direction of travel”, which in referring to smaller acute general hospital reconfigurations states:
“The objective is to provide at a minimum a ‘first port of call’…a service able to receive and provide assessment, initial treatment and transfer where necessary”?
As the hon. Gentleman knows, we have recently published a series of reports from the clinical directors—the tsars—on, for instance, accident and emergency medicine, heart attacks and stroke. He will also be aware that, because of the rapid changes taking place in medicine, we now have an opportunity to ensure that some of those assessment and diagnostic services to which he refers can be provided even more conveniently than in a local district hospital—for example, in a walk-in centre, a GP centre or an urgent care centre—but also that some of the more specialist services need to be provided in specialist centres with enough patients to ensure that the doctors and other staff there can provide the best possible care. However, as I recently saw at Harrogate district hospital—one of the two best hospitals in the country, according to the Healthcare Commission—it is very possible for a small hospital that has made itself the focal point for a wider network of care to provide outstanding services to patients within its community.
My right hon. Friend’s visit to the Manor hospital in Walsall was very welcome. Apart from the reduction in waiting times, was she shown the extensive building plans, the largest development of the hospital since it was built in the 19th century, which was the subject of an Adjournment debate of mine last June to which the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis) replied? As I say, I am pleased that she did visit.
My hon. Friend has been rock solid in his support for Manor hospital and the trust, and the substantial investment programme for the new hospital, which is so badly needed on the Manor hospital site. I congratulate the staff at Manor hospital and the local primary care trust. It will be one of the first hospitals in the country to ensure that for almost every patient with almost every condition there will be a maximum of 18 weeks—and far less than that, for many of them—between GP referral and hospital operation by the end of this year, one year earlier than we pledged in our manifesto. That kind of excellent, fast, safe care was never delivered in hospitals around the country under the Conservative party. It is now being delivered, thanks to the investment and reforms that we are making.
The Secretary of State will be aware that in Surrey the accident and emergency provision at St. Peter’s hospital and at the Royal Surrey county hospital are under threat. My hon. Friends take the view, as I do, that this will be deeply damaging. Is the Secretary of State worried that although the proposals have been floated since last year, the promised consultation document did not come out at Christmas, in January or in March, as we were led to believe, and is now promised for some time in June? Can the right hon. Lady guarantee that this suspense for the people of Surrey will not be dragged out much longer? It is a great burden for them at present.
I understand the uncertainty that is inevitably caused when the local NHS considers how best to improve services. As I have just said to the hon. Member for Surrey Heath (Michael Gove), there will be a consultation on specific proposals in relation to hospital and other services in Surrey, and the commitment is that that will start in the summer. The important thing is to ensure that the proposals are right and clinically based, and now that the NHS is back in balance and the NHS in the hon. Gentleman’s part of the country has made such enormous progress in getting on top of the financial problems that have arisen, I hope that he and his constituents will accept that the changes proposed will be driven by the need to improve clinical outcomes for patients, not the need to balance the books.
Will my right hon. Friend join me in welcoming the action taken by my local hospital, the Queen Elizabeth hospital in Gateshead, which is another of the 13 early adopter sites? That will ensure that the 18-week target is hit by this December—one year early, as she said in reply to my hon. Friend the Member for Walsall, North (Mr. Winnick).
I am grateful to my hon. Friend for giving me the opportunity to thank and congratulate the staff at that Gateshead hospital and others. Eighteen hospitals will expect to achieve that 18-week target one year ahead of time by the end of this year. Staff at Gateshead, Walsall and other hospitals are reorganising services. For instance, in the case of orthopaedic patients at Walsall, the staff found that it was taking 200 hours of staff time, much of it administrative, to take a patient from initial receipt of the GP referral through to the hip replacement or other operation. By reorganising the way in which they worked—not by putting in more money—they reduced that to just 30 hours, enabling them to transform the lives of between six and seven people in the time they had previously taken to treat just one. That is the kind of improvement that we are seeing, thanks to NHS staff.
Is the Secretary of State aware of a document called “Squaring the Triangle”, which is intended to be the basis for the reconfiguration of acute hospital services in west Surrey? It says:
“Current Department of Health and Strategic Health Authority guidance suggests that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people. On this basis only two full A&E Departments (rather than the existing three) will be viable for the West Surrey population in the future.”
Is the Secretary of State aware of that? Does she endorse or reject that reference to Department of Health guidance?
As I have said, there are as yet no settled proposals for service improvements in west Surrey—or, indeed, in east Surrey. As the hon. Gentleman will be aware from Professor Sir George Alberti’s recent report on emergency medicine, there is already a very wide range of different kinds of A and E departments, from those providing the full range of trauma centres down to those providing—[Interruption.]
Order. The hon. Member for Surrey Heath (Michael Gove) must be quiet. A question has been asked and it is courteous to listen.
Thank you, Mr. Speaker.
There is already a very wide range of services provided by different A and E departments. I hope that the hon. Member for South Cambridgeshire (Mr. Lansley) would be as focused as we are on ensuring that A and E services give the best possible care to every patient, whether they need it locally, much closer to home, or in a specialist centre, possibly slightly further away, in order to save their lives.
The Secretary of State is not answering the question. I am focusing on both specialisation and access, and quality of services includes the issue of access. Will she answer the question? Does she endorse or reject the reference to Department of Health guidance? If this is acted on in west Surrey, the implication is that an A and E department will shut. If it were to be acted upon in the north-west of England, where there is one type 1 A and E department to every 207,000 people, half the A and E departments in that region would have to shut. Why do not we not see that happening in the north-west of England, when my colleagues in Surrey see their A and E departments threatened, apparently on the basis of Department of Health guidance?
I think that we can all see the next Conservative party campaign coming, with the misleading propaganda that we have come to expect from it on health. The hon. Gentleman completely misses the point that different A and E departments will offer different sorts of services. For the most specialist services, including stroke services, about which I know he has a long-standing concern, a larger population is required to ensure that specialist staff are available 24 hours a day, seven days a week to deal with the patients who need that care. Different A and E departments will provide a different range of services. That will be one of the key themes of the guidelines and proposals on urgent and emergency care that the Department will publish shortly.