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Hospital Services (Sussex)

Volume 462: debated on Wednesday 4 July 2007

May I welcome you to the Chair this afternoon, Mr. Conway? I also welcome the Minister to her new position.

I am grateful to have secured this debate on an issue that is probably arousing more passion and concern in my constituency and throughout West Sussex than anything else. There are hon. Members here from East Sussex and West Sussex who are all affected by the proposed reconfiguration of hospitals. We are grateful for this opportunity to make the case on behalf of our constituents and for the fact that this debate has brought the Minister here to listen to those concerns, which I am sure she will do. I should like to focus on West Sussex, in which my constituency lies, but my hon. Friends and other hon. Members might refer to the situation in East Sussex. I shall also keep my remarks as brief as possible, to allow everyone here the opportunity to take part in this short debate.

The situation in West Sussex is that the newly created primary care trust proposes to downgrade our three acute hospitals to one, so that there will be only one major general hospital for the whole county. That affects every hon. Member in West Sussex and some in East Sussex, and it affects me particularly, because my constituents use all three hospitals. I am therefore in a position to see how the proposals would affect the whole county.

The first thing that I should like to say about our objections to how the primary care trust has handled the process is that the justification for the proposals has fundamentally changed. More than a year ago, we were eventually told—when the strategic health authority and then the primary care trust admitted it—that the overriding reason for downgrading our local hospitals was a financial deficit in the health care sector in West Sussex and that it would get worse. The principal justification for the measures that the PCT said were needed was that it would no longer be sustainable to retain three acute hospitals for a population the size of West Sussex.

It is true that some clinical justifications for the change were set out at the time, but the overriding justification was clearly financial. Indeed, as a former chief executive of the primary care trust, Steve Phoenix, wrote to the West Sussex Gazette on 30 August 2006:

“The financial issues for West Sussex are very serious. Although the NHS will get more money, we are already in debt and there are major challenges in the way we receive funding.”

He continued:

“if we do nothing, we will have a shortfall of £94 million by 2008/09. This an impossible scenario. Our plans will involve significant changes to major hospital services. We must invest our funding in direct patient care rather than expensive hospital buildings.”

He could not have been more plain that the principal driver of the changes was the lack of funding available to the primary care trust that he perceived. That position was reinforced by the strategic health authority. As the chief executive of the strategic health authority wrote to me and other hon. Members on 31 July 2006 on the issue of finance:

“It is much better, and more responsible, to plan for a clinically and financially sustainable healthcare system, as we are doing.”

The new Secretary of State, whom I welcome to his position, too, said in the debate on access to NHS services yesterday:

“These reconfigurations are being driven by local decisions in local NHS trusts, and they are driven by clinical need, not by any financial constraints.”—[Official Report, 3 July 2007; Vol. 462, c. 853.]

However, he cannot have been aware of the primary care trust’s original justification for the changes that are taking place.

Nevertheless, it now seems that the financial arguments for downgrading our local hospitals have simply evaporated. The latest case scenarios that the primary care trust has published, along with the plan for reconfiguration of our hospitals, actually show that in five years’ time, in 2012-13, the local health care economy—that is, the West Sussex and Brighton PCTs and the three acute trusts—will end up with an annual surplus of £52 million. Let us deal with the argument once and for all: there is no financial case for downgrading our hospitals in West Sussex. The Secretary of State has now also said that there is no financial case for doing so. That crucial part of the argument for change and how the PCT has approached it for the past year has gone, yet the trust persists in the changes that it wants to make.

Now the argument turns on whether there is a clinical case for downgrading our hospitals, but those arguments are strongly disputed. Locally, they are disputed by consultants, who disagree about whether there should be only one major general hospital in West Sussex—an issue to which I am sure my hon. Friends will turn their attention. Nationally, we are relying on the evidence of some of the royal colleges, on which the whole future of two major hospitals could turn, simply because it is argued that the most serious accident and emergency cases ought to be treated in major centres. Given that there is no financial imperative for reorganising those major hospitals, it does not seem to make sense to put at risk major and much-prized local facilities simply to address that concern.

The concern of my constituents and of the whole population of West Sussex is about accessibility. In my area of West Sussex, the question is not about the size of the population served by the three acute hospitals or about the catchment areas, in the narrow sense; it is about whether those hospitals are accessible to a community, many of whose members live in remote areas. From one village—it happens to be called Washington—right in the middle of my constituency, at the foot of the downs, the distance to Worthing general hospital, one of the three hospitals affected, is a very reasonable eight miles, with a travel time of 13 minutes. If Worthing general hospital is downgraded, which is one of the options that the primary care trust has set out, the travel time could increase by two and half or even up to five times if patients have to travel to Portsmouth, which is one of the potential effects of the changes.

Indeed, in the document that the primary care trust published when the proposals were launched, it conceded that

“a minority of people may have to travel further”

for what it called “improved services.” However, we are talking about a population that is relatively elderly. According to the 2001 census, just over one fifth of West Sussex’s population was aged 65 years or over, which compares with an average of 16 per cent. in England and Wales. It is extremely difficult for elderly people to make regular visits to health care facilities that are further away. We are not just talking about travel times and safety for A and E services; we are talking about people who have to travel further for visits to facilities that are currently much closer.

The other day I met an elderly constituent of mine who lives in Storrington, in the middle of constituency, who has to travel a number of times of week to Brighton for radiotherapy, making a round trip of 41 miles on each occasion, with a travel time of 76 minutes. There is a huge amount of fear locally that, far from there being a greater provision of local services, which we were promised as part of the reconfiguration, services will be taken further away from the local community.

We have not seen the redeveloped local services that were promised as part of the reconfiguration, or any proposals for them. No assurance have been given in relation to one community hospital in Arundel, in my constituency. It simply does not make sense to say that acute hospitals might be downgraded and simultaneously to be unable to give assurances about the provision of community hospitals, on which people will presumably rely for more local services.

The absence from the primary care trusts’ proposals of an option for at least two major hospitals, which is what many clinicians and the public have asked for, is a significant omission. It makes the consultation paper a flawed one, and we asked the PCT board, unsuccessfully, to withdraw the paper until it could present an option that we felt should be considered.

I should like to convey to the Minister the strength of feeling in support of the three hospitals in West Sussex—the Princess Royal hospital in Haywards Heath, Worthing and Southlands hospitals and St. Richard’s hospital in Chichester. Some 300,000 people in West Sussex have signed petitions against the closure of those hospitals, and 25,000 people have marched. The Prime Minister may stand on the steps of Downing street, as he did last week, and say that he will listen to people and make the NHS a priority, and the Government may espouse the notion of patient choice, but what can any of that mean if the Government and the PCTs are unwilling to listen to the almost unanimous view of local people?

There can be no better way to demonstrate how people feel about the potential downgrading of their hospitals than to consider the Princess Royal hospital in Haywards Heath, in the constituency of my hon. Friend the Member for Mid-Sussex (Mr. Soames), who has fought tirelessly to retain those facilities. The Princess Royal will be the hospital most affected by the proposals. Under any of the scenarios proposed by the PCT, it will be downgraded. Yet a consultation document published only in 2004 promised that, in reshaping A and E services and moving trauma cases to Brighton,

“It is important to emphasise that the vast majority of local people will continue to receive A&E services from their local hospital. So there is no threat to A&E at the Princess Royal.”

That promise was made not only in the consultation document, but to my hon. Friend on the Floor of the House by one of the Minister’s predecessors, the right hon. Member for Barrow and Furness (Mr. Hutton), now a Cabinet Minister. He told my hon. Friend on 16 March 2005:

“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.]

When the Prime Minister speaks, as he did yesterday, about rebuilding trust in politics and reconnecting people with the political process, what can those words mean if Ministers feel able to come to this place, give assurances to hon. Members about the future of A and E facilities—an issue that could hardly be of more concern to local people—and renege on those promises within two years? That produces a sense of anger in my constituency and throughout West Sussex about how local people are being treated. They have no voice and they are not being listened to, yet they are being told by the Government that they will be listened to and that the NHS is now the new concern. How can the Minister square that circle? I urge her to recognise local people’s concerns about the issue and how the justification for the downgrading of our local hospitals has shifted and been undermined.

I am grateful to the Minister for listening to my case. I hope that she will appreciate the strength of local feeling and that she or one of her colleagues will take the opportunity to come visit the hospitals. The previous Secretary of State visited the hospital at Brighton, but did not visit St. Richard’s, Worthing and Southlands or the Princess Royal. If Ministers were to visit one of them, they would understand not only that clinical opinion is certainly divided about the merits of moving to one hospital in a county of that size but also that local feeling is strong. People have paid their taxes, and they feel that they are entitled to high-quality, local and accessible services. I think that they deserve no less.

Order. Understandably, a large number of hon. Gentlemen wish to take part in the debate. The Minister and the Front Bench spokesmen have indicated that they are prepared to cut down their usual time. If subsequent speakers can finish on the right side of five minutes, we shall hopefully get everyone in, but that is in your hands.

There is very little difference between the hon. Member for Arundel and South Downs (Nick Herbert) and me on this issue. I congratulate him both on securing the debate and on how he put the case, and I welcome the Minister to her position.

My constituency is in the grip of a pincer movement of threatened loss of services. At the eastern end, maternity services at Eastbourne are under threat. Most seriously, we face the potential or likely loss of accident and emergency services at Haywards Heath, a hospital that many of my constituents in the north-west look to. My constituents are angry and bewildered that at a time when more money than ever before is going to the NHS—I congratulate the former Chancellor on his record on that matter—cuts of a hitherto unseen extent are being proposed. It is difficult to square that circle.

I must make it perfectly plain that not only has the case for removing A and E at the Princess Royal not been made, but it is exceedingly dangerous and will be counter-productive in its consequences for my constituents and those of other hon. Members present today. We are given three options in the consultation paper, all of which involve losing A and E services at the Princess Royal. The PCT is asking us whether we want to lose an arm, a leg or both. We are not given the option of losing none of the bits of our body.

I feel strongly that that is not what was agreed. When I had a meeting with the strategic health authority last year, I was promised that the options in the paper would include a status quo option, even if the PCT did not feel capable of recommending it. The option would be included, if only to allow the other options to be measured against it in terms of the clinical changes required and the financial costs. That has not been done. Similarly, with maternity services in Eastbourne, we were promised at an early stage that a status quo option would be included. It is only thanks to the hard work of campaigners who look to the Eastbourne district general hospital for services that a so-called option 5 is now being developed there.

The hon. Member for Arundel and South Downs referred to the financial case. He is right that the sands have shifted and the goalposts have moved on that matter, but it is worse than that, because there is a chance that what is proposed will cost the NHS money, not save it. The Princess Royal hospital in Haywards Heath is quite modern; it is about 15 years old. The Brighton hospital, which will be expected to take up the slack, dates from 1828. It is pre-Nightingale in how it was built and what it offers. Its car parking is insufficient; it is pretty inaccessible by public and indeed private transport. It is on the coast, so half its catchment area is in the English channel. It is not where one would put a hospital if one started from scratch, yet the proposal is effectively to close the emergency department in a hospital that is well situated in mid-Sussex and serves a wide population 360º around it, and to relocate services to Brighton.

That can be done only if money from the sale of land at the Princess Royal—it has been discussed—is used to provide new facilities at Brighton. But where is the sense in closing part of a recently constructed, 15-year-old facility and using it to bolster a hospital built almost two centuries ago with very little spare land, which it would cost a significant amount to develop? It makes no financial sense at all.

If we are to have any changes to our acute services and move towards community services, which is the Government’s intention—I accept that it is a sensible intention in so far as it can be delivered—that will cost money, too. We do not know how much that will cost. The hon. Gentleman is quite right that the community aspect has not been properly considered. I do not know what the proposals are for Lewes Victoria hospital—it is not clear what will be put there. If we are to have services taken away, we need to know before they are taken away and, as part of the consultation, what will be done to provide an alternative to the services that it is proposed will be removed from our acute hospitals.

The issue of accessibility, which is key, was also raised. I represent a rural area, including villages such as Newick, Chailey and Wivelsfield. My constituents are already concerned about the journey times to Haywards Heath, without taking into account additional journey times to Brighton. I am sure that the hon. Member for Wealden (Charles Hendry) will have a similar point to make about his patch. We talk about the golden hour in which to get people to hospitals. With the amount of traffic on the roads in east Sussex and the rural nature of many of the villages, I am not convinced that it could be guaranteed that people could get to Brighton within the hour. In clinical terms, it is simply not sensible to go down that route.

Public transport is pretty sparse in the rural areas, and the bus services that the Government want do not exist. Many of my constituents, who can ill afford it, end up taking extremely expensive taxi rides to get to hospital already. If they are going to be asked to take taxi rides to Brighton—or even to Hastings for maternity services—that will be an expensive business. It is not right to ask people to do that. I do not know the Government’s view on social exclusion, but they will make it worse through such proposals.

The pressure on the ambulance service has not been thought through, either. If we are to have people taken to hospitals that are much further away, by definition ambulances will be on the road far more, spending more time at each individual pick-up. Has the ambulance service been properly consulted? What will be the consequences for it? How many ambulances and ambulance drivers will we need? What is the cost of that? Has it been factored in? I do not think that it has.

I am not convinced by the clinical argument that we need to have these single centres and that it is not safe to have different centres. My constituents certainly believe that the arrangements are perfectly safe and are happy with them. In fact, many of them would rather go to the Princess Royal hospital in Haywards Heath than to Brighton, given half a chance. There is no question but that people in my constituency believe that the present arrangements are safe. If they are not safe, what happens in the north of Scotland, Cornwall or other places that are more sparsely populated? They seem to manage all right—with fewer people going through them as well, I say to the consultant who claimed that a certain critical mass of individuals was needed.

The matter crosses party lines. I am pleased to agree—I hope that I will—with the Conservative Members who will speak after me. It is good that we have seen a cross-party approach and I thank the hon. Members for Mid-Sussex (Mr. Soames) and for Arundel and South Downs for the way in which they have approached the matter. In the north-west of my constituency, that cross-party approach has worked quite well. We need to go forward on that basis.

I note that although we have a vast turnout of Conservative MPs and 100 per cent. of Liberal Democrat MPs for Sussex in this debate, it is sad that none of the five Labour MPs who represent Sussex are here—[Hon. Members: “One is.”] I beg hon. Members’ pardon; 20 per cent. of them are here. I hope that they will realise that it does not help Brighton and Hove if Haywards Heath is closed down and services are removed from there.

I ask the Minister to listen to public opinion, which is strong in all our constituencies. If she does, she will come to the conclusion that the options that have been put forward, for the Princess Royal hospital in particular, simply do not wash.

I echo what the hon. Member for Lewes (Norman Baker) said. I am glad that this is a non-party, all-party campaign and I am sure that the hon. Member for Crawley (Laura Moffatt) would join us in our debate, were she in a position to do so. In Worthing, the local Labour party, Liberal party, Conservatives, the non-political and the media—the Worthing Herald and Splash FM in the lead, with the support of The Argus and the other papershave done a great job. I do not know how often the Minister has called a meeting of local residents to find that 6,500 people have turned up, and called another meeting to find that 8,500 have turned up—at a conservative estimate—but that is how keen people are to take part in the debate and to ensure that their voices are heard properly. Even more important than the popular voice and that of the patients are those of the doctors, nurses and support staff in our hospitals.

I shall make reference to one detailed paper that the Department of Health has seen. In the agenda contained in the primary care trust board papers for a meeting on 25 June, item 7 includes the heading “Financial Implications of reconfiguration documents”. Page 7 gives information that is not referred to by the primary care trust in any other paper that I have seen. That is a scandal, and I want the Minister to tell the strategic health authority and the primary care trust to reissue the consultation documents spelling out that under options 1 and 3 there will be savings to the national health service, which have not been taken account of, of up to £24 million even when scaled back by a factor of 50 per cent. It is shocking and misleading, and it is either a mistake or it is deliberate.

I want the Minister, if she can in the next hour or so, to get page 7 of the annexe to item 7 of the agenda paper on financial implications. If we are told that there are calculated figures of £13 million here or minus £18 million there, and a £24 million saving to the health service is missed out because it happens to affect a hospital outside Sussex and Brighton and Hove—Portsmouth, in Hampshire—that should be taken account of. If the Minister reads pages 1 to 6 on the financial implications, she will see no other reference to that information. It is contained in one box on page 7 and I bet that 999 in 1,000 will never have spotted it. I do not believe that the independent directors of the primary care trust board or the strategic health authority knew it. My local papers did not spot it, and neither did the experts who considered the options. That is not fair or plain dealing, and I hope that the Minister will ask the chairmen of the SHA and the PCT whether they knew it or whether it was known by the people on the executive side. Did the lead director know it and, if so, why was it not mentioned at the PCT’s public meeting? That is not right.

I now switch to a health meeting held in the House of Commons this morning. The health economist who attended said that there was no evidence that moving to massive acute hospitals makes a significant difference to outcomes. If the Minister asks the chief executive of the SHA, Candy Morris, for her recent exchange with Mark Signy, an acute medical specialist at Worthing, she will find a couple of things. First, when the clinical reference advisory group summed up what Mark Signy said in reference to acute medical admissions, it stated:

“Only 1 per cent. of admissions require a primary angioplasty and therefore this procedure would not influence reconfiguration.”

The chief executive put it out as:

“Only 1 per cent. of medical admissions require a primary angioplasty (indicated for a particular type of heart attack known as a ST elevated Myocardial Infarction) and therefore this procedure would by itself have a direct influence on local acute hospital configuration”—

a direct contradiction. We have to assume that it was merely a mistake, and the word “not” was left out. However, given the number of people who will have read that letter from the chief executive of the SHA, she should write a press notice to say that she agrees with the specialist that the procedure does not have that influence.

The Prime Minister has quoted Professor Sir George Alberti and Roger Boyle as saying that the fact that 500 lives a year might be saved around the country means that one life might be saved every eight months in Worthing and district. I argue for at least two acute hospitals in West Sussex. I am not arguing about whether the one hospital should be in Worthing or Chichester, but for two hospitals. The Minister should require the SHA to re-consult on the option for at least two hospitals, with accident and emergency and maternity departments, so that the public can be consulted on that. At the moment, we are left with good grounds for judicial review, which the Secretary of State must know about. From the beginning, the SHA wanted a review and said so. The lead director said so. I am grateful to Derek Waller of Arundel, who has made that rather plain in his analysis of the East Sussex and West Sussex papers.

I could say a great deal more to the Minister, but I will make this point briefly. No hospital in Germany that I know of has more than 3,500 births a year and yet our plans are to have 4,000 or 6,000 in one—a baby factory for West Sussex. I know of no argument that all the babies born in Worthing should be moved to Brighton. In fact, a lot of the movement seems to be the other way. The Minister ought to ask the SHA and the PCT whether they have consulted mothers and mothers-to-be on that and what the trends are.

On accident and emergency, if significant numbers of clinicians at Worthing hospital—I think that the same would apply at Chichester—believe that it is not just saving one life every eight months that matters but avoiding losing two or three lives a month because of people having to go on journeys, that is all the better.

I end with something rather personal. I came back on the day of the state opening of Parliament to find my wife in pain. A GP dropped his surgery and diagnosed an ectopic, and we got to St. Thomas’s hospital in eight minutes. If that had happened in Worthing after the plans had been carried through, my wife would have died. I do not think that I care about her more than other people, whatever their age, care about their spouses, partners, friends or neighbours. I want the Minister to make the PCT consult again on the two accident and emergency departments and two maternity departments and get the financial figures out in the open.

I intend to be brief, because my hon. Friend the Member for Arundel and South Downs (Nick Herbert) set out the basic case clearly and many other colleagues wish to speak. The hon. Member for Lewes (Norman Baker) is a welcome supporter and has made a powerful case for the Princess Royal hospital.

This is the fourth time in seven years that the Princess Royal hospital has come up for review. That is no way to run a health service or look after patients, and above all, it is no way to treat the staff. The staff of the Princess Royal know perfectly well that there is absolutely no clinical evidence for the changes, although they have to be cautious in saying so.

On the face of it, the proposals are genuinely absurd. The Princess Royal is 15 miles south of one of the biggest international airports in the world and five miles or less from a busy motorway. It is in the centre of one of the fastest-growing parts of the United Kingdom, which has a rapidly increasing and increasingly young population. It sits in West Sussex, which, I do not have to remind the Minister, covers more than 770 square miles and has more than 750,000 people, a struggling transport infrastructure and a growing ageing population.

Infrastructure is about more than roads, railways, sewers and health and social services. It underpins national and local well-being. People in my constituency and elsewhere know that, and a powerful case will be made to the Minister, to whom I am grateful for saying that she would receive a delegation to talk about the matter. We will fight this every inch of the way.

Most importantly, the people in mid-Sussex, who have been through an awful lot with the health services in the past seven years, want an assurance from the Minister, if the so-called consultation is to be seen to be real—I know that she will intend it to be real—that the powerful, detailed and sustained views expressed locally will be listened to and paid attention to when it comes to the shake-up at the end of the process.

Finally, I urge the Minister to understand that there is nothing synthetic about the anger and disappointment that is felt not only in mid-Sussex but across the whole of Sussex. I hope that she will acknowledge that.

The debate is timely and I congratulate my hon. Friend the Member for Arundel and South Downs (Nick Herbert) on securing it. In the long period during which I have been a Member of Parliament, I have never had so many complaints and concerns and so much anger expressed to me about the state of hospital services as in the past few years—that is as they are today in West Sussex, let alone how they would be after the Government’s plans were put into action.

My hon. Friends have described vividly our concerns about the proposed depletion of hospital services, particularly in West Sussex. I do not want to repeat them, but I add that the model being proposed for the southern end of West Sussex has already been put into effect in the north end. Over the past 10 years or so, Crawley hospital has effectively been downgraded from an acute to a community hospital. Way back in 1998, a joint health care NHS trust was formed between Crawley and the East Surrey hospital at Redhill, specifically to provide synergy and specialisation.

We were assured that small amounts of care would be transferred from Crawley to Redhill and that that would be it—no more salami slicing. But then the salami slicer got to work again, and gradually more and more services have been taken away from Crawley. Now the only hospital that serves much of my constituency and the whole of Crawley is at Redhill.

It is no criticism of the wonderful staff at Redhill to say that it is a hospital in crisis. I have a sheaf of complaints, cases and concerns from relatives of patients who have died there in appalling circumstances. Its staff are utterly demoralised and it is in crisis. To meet the Government’s top-down targets, ambulances have been queuing outside A and E, so as not to get patients into the A and E queues, to make the numbers look better. The situation is intolerable and should not be allowed to continue. The proposals would make it much worse.

My hon. Friends the Members for Mid-Sussex (Mr. Soames) and for Arundel and South Downs and the hon. Member for Lewes (Norman Baker) made a strong case for maintaining the Princess Royal as an acute hospital, and I totally support that. It serves some of the villages and communities at the eastern end of my constituency. Even as it is, it cannot serve constituents who live in the Horsham area, Crawley or villages as far away as Billingshurst, which are already uniquely inconvenienced in their lack of access to acute hospital care. Under any of the options proposed by the SHA and the PCT, that would get worse.

I wish to make a quick point about accessibility. We always hear the same thing when such proposals are mooted—that what is crucial is not how far away the hospital is and how long it takes to get there, but how quickly paramedics can reach people. That is true in some cases, such as cardiac cases, but it just is not true in others, such as strokes. A stroke is caused by either a clot or a bleed, and the treatments are diametrically opposed in the two cases. The critical thing in avoiding a person being permanently damaged is the speed with which they can be got to hospital and scanned. If a stroke is caused by a clot, as most are, and anti-clotting agents are introduced quickly, a stroke can be almost completely or, in many cases, completely reversed. Think of the savings in the cost to the NHS and society as well as the human cost of so many stroke patients not needing continuing care.

Accessibility really matters. If my constituents become totally dependent on East Surrey hospital and, I suppose, the Royal Sussex at Brighton, they will find them both inaccessible. A constituent of mine in Billingshurst who sustained a serious injury had to wait 45 minutes before the ambulance got there, and it then took another hour and a half to get from Billingshurst to Redhill to the A and E. Time was not critical in that case, but there are plenty of cases in which it is. I am told that the air ambulance cannot even land in Brighton, so the difficulties are not overcome by air access. The matter is serious.

My case is not only that we need to keep what exists but that we need more. We need to reverse the ill-judged changes that have seriously affected the Horsham and Crawley area. I would make the case for a new hospital to serve Horsham and Crawley. As the Government should know, much more housing is being imposed on the area. Indeed, the Prime Minister talks generally about imposing more houses, and none of us is against more housing development, but we do insist that there is a proper assessment of infrastructure needs, and hospital services are central to that. The case for not only keeping what we have, but reversing some of the changes that have been made is therefore increasingly powerful.

I urge the Minister to take this issue seriously. Several hon. Members have said that we are taking a non-partisan approach, and that is absolutely right. Other parties—particularly local Liberal Democrats—have supported the campaign against hospital closures and the case for a new hospital to serve Horsham and Crawley. I do not wish to make a particularly partisan point, but the local Labour party in both Horsham and Crawley has been conspicuous by its absence and silence, and that causes concern. I therefore urge the Minister to listen. The new Prime Minister has made much of his willingness to listen, and the Minister has a good opportunity to get brownie points with him—if I can put it like that—by showing that she is willing to look again at the course to which the Government are apparently committed, but which will be very damaging for a large part of West Sussex.

Order. Just to help those hon. Members who still want to speak, let me say that the winding-up speeches should really start at 3.30 pm, but my intention is that they will start at 3.40 pm, which might help those who still want to catch my eye.

I congratulate my hon. Friend the Member for Arundel and South Downs (Nick Herbert) on securing the debate and on the way in which he introduced it. I agree very much with everything that he said and with other hon. Members who have spoken. I hope that the Minister will already be in no doubt that our constituents are confused and baffled. They hear the whole time that the health service is awash with money and that extra money is going in, but they see that health service provision in Sussex will potentially be devastated.

However, our constituents are more than confused—they are angry as well. They are partly angry about the process that has been adopted. In East Sussex, we have already gone through most of the consultation exercise, so we have a good idea of what will happen in West Sussex. What has happened has not been adequate. There is anger, for example, among the 15,000 constituents in and around Uckfield who get their health service provision in West Sussex. When the public meeting came to Uckfield, they could talk about provision only in Hastings and Eastbourne, which none of them access, rather than at the Princess Royal hospital. If they were to lose the Princess Royal, they would rather that their facilities were transferred to Eastbourne, but that option is not being made available. A completely arbitrary and unsatisfactory divide has therefore been created, when the issue should have been dealt with holistically across the county.

People are also angry at the presumption of closure. There is cynicism because they believe that the decisions have already been made and that, regardless of how strong their case is or how persuasively they make it, the decision will ultimately be to downgrade or close units at these important hospitals. There is also anger that the status quo is not being included, as it should be. We have had to fight for option 5 to be included at Eastbourne and Hastings, and there is now the whole issue of whether the status quo should be an option in West Sussex. I therefore hope that the Minister will take away with her the real sense of anger at the way in which things are being handled.

I also hope that the Minister will be seized of the fact that the proposals will have a devastating effect on many of our constituents. People at the southern end of my constituency face the loss or significant downgrading of maternity services at Eastbourne and the potential loss of the accident and emergency and maternity units at Haywards Heath. Those who live in the town of Uckfield can get to Haywards Heath in 15 minutes—that would certainly be no problem by ambulance—but it could easily take them one hour to get to Brighton. When I last went to Brighton, it took half an hour to get to the outskirts and 45 minutes—in absolutely dense traffic on clogged roads—to do the final three or four miles, and even an ambulance would be hard pressed to improve significantly on that time. We also face the loss of the homeopathic hospital in Tunbridge Wells, which serves many of our constituents in East Sussex.

We are moving in entirely the wrong direction. We are seeing pressure for new housing as never before, but those responsible are taking account only of known new housing and not of new housing that is inevitable, but which has not yet been allocated space. In Wealden, for example, we will be expected to accommodate 400 new houses every year for the next 20 years, but that is not being taken into account in the calculations. Based on such miscalculations, it is assumed that the number of people who will wish to access maternity services in Eastbourne will decline. That approach is fundamentally flawed and needs to be looked at again.

We must also be in no doubt about the consequences of expecting people to travel to Brighton, rather than to the Princess Royal in Haywards Heath. That extra hour or 45 minutes will, as colleagues have said, mean the difference between people surviving or dying. We recently had an impressive presentation by the head of the South East Coast Ambulance Service NHS Trust, who said that the ambulance service is brilliant at dealing with road traffic accidents, strokes and cardiac cases, but that it is not good at dealing with pregnancies involving difficulties. There are serious concerns that, if staff end up having to sort out a complicated pregnancy on a journey that is longer than would otherwise have been necessary, the well-being of the infant and the mother will be put at risk.

This country already does badly in terms of the survival rate for cardiacs. In Seattle or Finland, 50 per cent. of those who have a heart attack out of hospital are alive two years later, but the figure in this country is 6 per cent. The figure in Sussex and the south-east is starting to pick up, and we are seeing an improvement for the first time, but there is real concern in the ambulance service, which gave us those figures, that the figures will decline if people are expected to be treated in ambulances, rather than in the hospital closest to them.

If the Minister does come to Brighton, I hope that she will do so not just in the middle of the day, but on a Saturday night. I have been to the accident and emergency unit at 1, 2 and 3 o’clock in the morning, and I was appalled by the conditions. Transporting people for an hour more than is necessary to a massively overcrowded hospital in a busy city centre is not the right way to deal with people in emergencies. I hope that the Minister will respond to those issues. I know that she cannot give us the response that we want and say that the proposals will be put on hold, but I hope that she will say that our views will be listened to.

I was in the main Chamber a little while ago to hear the Secretary of State setting out the details of the health review, and what came out of that was a determination to listen. If the Minister listens to the doctors and clinicians in Sussex, rather than to the managers, she will find that there is no support for the measures that we are discussing; if she talks to the public, she will find that there is no support for them either. I therefore hope that she will say that any decisions must be put on hold while the Government carry out their protracted new review. I hope that she will tell us that any decisions must be based on what is wanted and needed locally and that, at the end of the day, they must truly be based on clinical need, rather than financial circumstances.

I shall try to keep my remarks as short as possible, given the throng of colleagues who want to contribute to the debate. I pay tribute to the save the district general hospital campaign, which I and others started 18 months or so ago. In particular, I pay tribute to Liz Walke and Monica Corrina-Kavakli, who are just ordinary mums who feel angry and upset about what is being proposed and who want the best for their children and for other mums who will have children in my constituency in due course. I should also stress the cross-party nature of the campaign, both here today and in Eastbourne; it includes all parties, as well as Churches and community organisations, all of which want the same thing. Thousands of local people have joined marches and demonstrations and signed our petition.

I want to make two or three quick points to the Minister, whom I welcome to her new role—she will be spending money for a change, rather than preventing others from spending it. First, there is the consultation process. There is a real danger that it is totally flawed and that it will end up in front of a High Court judge in due course. The clinical director of my local hospitals trust made it clear in November last year that the trust was looking at one maternity unit in either Eastbourne or Hastings—that decision had already been made. There is therefore a real worry within the campaign that the decisions were made long ago and that everything else is mere window dressing.

Secondly, there is the fact that the consultation in East Sussex went ahead, unlike the one in West Sussex, which was stopped for the local election campaign. We cannot understand what the difference was, given that we also had local elections in our neck of the woods.

Thirdly, there are the options: 1 to 4. Again, despite past promises, the four options all conceivably include shutting a maternity unit, either in Eastbourne or Hastings. We have been putting forward option 5, as the hon. Member for Lewes (Norman Baker) mentioned. All too often that option 5, produced by the campaigners and based on advice from clinicians—properly costed and thought through—has been treated as the poor relation. The PCTs have sent details of options 1 to 4 to GPs’ surgeries, but, alas, they have not so far sent option 5. As I asked on Monday at a public meeting held as part of the so-called consultation, if, as I believe, the overwhelming response of local people is for option 5, rather than options 1 to 4, will they be listened to? Will that make any difference to the final decisions?

My hon. Friend the Member for Arundel and South Downs (Nick Herbert) mentioned in his speech the way in which the arguments have shifted. Money used to be the prime argument. Now we are told that the proposal is all based on safety. It is also being alleged locally that it is based on the support of clinicians. I am having real difficulty finding any clinician locally who supports the NHS proposals. Indeed, one of our leading local consultants effectively changed sides and said that he was unconvinced by the safety arguments.

The local GPs in Eastbourne have recently voted overwhelmingly against the options that are being proposed. It is total nonsense to suggest that the proposals have the backing of clinicians. Indeed, only in August 2004 a detailed clinical services review within the local hospitals trust for Eastbourne and Hastings concluded that a two-site maternity presence should be retained for those hospitals. The acid test should be, it seems to me, to ask the clinicians whether, if money were no object, a one-site solution would be safer than the present arrangements or something like them. I doubt whether any clinician could claim that things would be safer on that basis.

Accessibility has already been raised by one or two of the hon. Members who have spoken. I am told that the gold standard for the interval between deciding to perform a caesarean operation and actually performing it is about half an hour, according to the Royal College of Obstetricians and Gynaecologists. It can take an hour and a half, on average, or more, to get a pregnant mum from Eastbourne to Hastings or from Hastings to Eastbourne. At present we have two units—in Eastbourne and in Hastings—and they are as safe as any in the country. Why change a system that works well already and delivers safe, reliable services to families and mothers?

Finally, I want to touch on what has been called the domino effect. At the moment, the only thing that has been consulted on in my area is the future of maternity services, but hidden in the small print is the promise of future changes to paediatrics and possibly to accident and emergency services. As we know, once consultant-led maternity and paediatrics have been lost, it becomes difficult to hang on to a proper A and E department. My deep suspicion is that the powers that be in the NHS are waiting to see how much fuss there will be about closing one of the maternity units in our area, before they move on to paediatrics and A and E. I am deeply suspicious about the motives in all that is happening.

I cannot stress too much to the Minister, with her new responsibility, the strength of local feeling on this matter. People are incensed in a way that I have not seen in my 15 years as the local Member of Parliament. They are worried and concerned, and deeply supportive of the idea of retaining core services, including maternity, at Eastbourne district general hospital. They also take the view that people in Hastings should continue to have the same services in their hospital.

I congratulate my hon. Friend the Member for Arundel and South Downs (Nick Herbert) on securing this important debate, and I welcome the Minister to her new position, blinking in the sunlight after 10 arduous years in the dark corridors of the Treasury.

The more I learn about the NHS the more convinced I become that the principal problem facing the health service is the quality of its management. It is that poor-quality management that has led us, in the southern half of West Sussex, to the absurd position in which the West Sussex PCT proposes to decimate one of two leading major hospitals, either St. Richard’s hospital in Chichester, or Worthing hospital. Both hospitals rank among some of the most efficient in the country, and both have strong reputations for clinical excellence.

Nothing, however, demonstrates the poor management I have spoken of better than the financial arguments deployed by the West Sussex PCT and the strategic health authority. We were told in January 2006 on page 11 of the document “Creating an NHS fit for the Future”:

“Healthcare in Surrey and Sussex is not financially sustainable”.

The document went on to say:

“The NHS in Surrey and Sussex had an underlying deficit of about £100 m in 2004/5”

and the

“underlying position is likely to worsen after 2007/8.”

The graph showed a forecast deficit of something like £250 million by 2009-10. The S4 review—it stands for sustainable services for Surrey and Sussex; the NHS never misses an opportunity to create a new piece of jargon—demonstrated that

“the financial situation will get worse over the next few years if it is not addressed as the demand for healthcare continues to increase”.

On that basis, the whole reconfiguration pre-consultation process was started. It was the argument put forward by every NHS spokesman at the plethora of public meetings that were held in West Sussex in the past year. We were told that we had to live within our means, that the financial position was unsustainable and that we could not afford two major general hospitals with a full A and E service. It is odd, then, that when the West Sussex PCT board papers were published on Monday 25 June, we could, as my hon. Friend the Member for Arundel and South Downs said, find no reference to ongoing deficits or the unsustainable financial position. Indeed, in the key document, “West Sussex Health Economy: Investment plan”, the figures show a surplus of £12 million for 2007-08 and a surplus of £29 million in 2008-09, rising to £52 million by 2012-13. Those are calculated on the assumption of the status quo, with no downgrading of either Worthing or St. Richard’s. Of course, there have been efficiency savings at both hospitals in the past year, but such savings do not turn a growing and large deficit into a surplus of the order of £52 million.

The problem is compounded by the issue of Littlehampton community hospital. That well-loved and supported community hospital is now a pile of rubble surrounded by a tall blue security fence. It was knocked down to build a 40-bed state-of-the-art community hospital, after a long and protracted consultation process and a detailed business plan that made it clear that such a hospital was needed and was financially viable. As a result of the projected deficit, which we were told about in January 2006, the rebuilding plan was halted, and the future of Arun’s community hospital was put in jeopardy and made dependent on the outcome of the West Sussex NHS reconfiguration. However, of course, there is no deficit. Yet there is no Arun community hospital in Littlehampton.

I ask the Minister to look into the case of that community hospital. We are told that it is Government policy to move health care closer to people’s homes. A huge amount of time and effort went into planning and designing the rebuild. The project is ready to go and it has just been put on hold because of the review, but it would be absurd if a review one of whose objectives is to move care closer to people’s homes were to conclude that Littlehampton and Worthing should have one less community hospital.

To conclude, I urge the Minister not to allow any of the three options proposed by the PCT. St. Richard’s and Worthing hospitals are excellent and efficient hospitals in an area with an increasing population and congested roads. They are loved by everyone who uses them or thinks that they might use them. People will not accept the downgrading of either hospital, and I urge the Government to overrule any such decision taken by the PCT in West Sussex.

A great number of extremely important points have been made this afternoon. It is very rare that one can stand up near the end of a debate and say that one agrees with just about every word that has been said, but in this case, across parties, I do. It is important that the Minister should understand that this is not a case of MPs going through the motions. It is an issue of deep concern to all our constituents, quite out of proportion to anything else that I have come across in the 10 years for which I have been an MP.

I want to add just a few extra points to those that have been made. First, who is really taking the decision? We were told 24 hours ago by the Prime Minister that

“power must…rest with local communities”

and that individuals and communities should not be

“passive recipients of services provided by the state.”

Today in the House, the Secretary of State for Health reinforced that. He said:

“Patients must have the chance to shape the kind of NHS they want, to say how they wish to access services”.

That is exactly what we are all demanding for our constituents in West Sussex and East Sussex.

It seems extraordinary that the Secretary of State can make remarks like that at a time when it is so clear in our part of the country that an overwhelming number of people do not want the reconfiguration to go ahead. We will find out whether the words of the Prime Minister and the Secretary of State are just window dressing. If they are not, 140,000 signatures on a petition for St. Richard’s hospital alone tell us immediately what the answer of any local community power would be. They would see no reason why Worthing hospital should not retain its accident and emergency; they would see no reason why it should not continue as it is. Let us find out in the next 18 weeks whether the words of the Secretary of State and the Prime Minister mean anything.

Let us take St. Richard’s hospital as an example. It is a fantastic hospital. Morale has held up very well, despite the pressure that staff have been put under in the past 18 months with the pig’s ear of a consultation process that we have had. Those in the local community feel that the hospital is theirs. There is a sense of ownership, which is a remarkable thing that should not be tampered with casually. St. Richard’s was identified as the best hospital in the south-east last year, and in the top 10 for low mortality this year. Its financial improvement last year was the best of any trust in the country. The latest in-patient survey by the Healthcare Commission placed it in the top 20 per cent. in the country, and its reference cost—if costs were the issue—is the lowest of any acute trust in the south-east.

What is the case for reconfiguration? What logic could there possibly be for downgrading a hospital of that class? My hon. Friends the Members for East Worthing and Shoreham (Tim Loughton) and for Worthing, West (Peter Bottomley) could make a similarly strong case for Worthing hospital, too.

My second major point is about evidence for all the reconfiguration. A goodly number of my colleagues have already alluded to it. The financial case has been dissected by my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb), and my hon. Friend the Member for Arundel and South Downs (Nick Herbert) accurately pointed to how the campaign by the primary care trust to close one or more of the hospitals has been retargeted around clinical evidence. But I believe we all know the truth, which is that demand will be managed downwards—that is, rationed by restricting supply. Fewer accident and emergency departments mean fewer people presenting. Ultimately, the reconfiguration is about money. We all know that that is the truth.

While we are on the case for reconfiguration, I would be grateful if the Minister defined in detail, in writing, what an urgent care centre is. I quite understand that she will not be able to do that today as she is new in her post. We sat opposite one another through the consideration of many Finance Bills. I welcome her, as my hon. Friend the Member for Bognor Regis and Littlehampton put it, into the sunlight of a spending Department rather than the drudgery of the Treasury.

Part of the so-called clinical case is that all our constituents will be better treated in the new urgent care centres, but a clinician said to me only recently, “We ask constantly for a definition of them but we discover that the emperor has no clothes. The PCT has no idea what an urgent care centre really is.”

My third point is about the criteria for the decision. What methodology will be used? I have heard scarcely a word about that. We talk in vague terms about access, cost, feasibility, quality, staffing needs and clinical needs. Again, I know that the Minister cannot supply this today, but it is essential that we should have at the outset of the consultation process the weighting that the PCT will ascribe to the different outcomes so that we can orientate our campaigns to save our hospitals around the weighting that the Government will direct—it will be the case that they will direct—the PCT to make in respect of each of the various key headings. Without knowing the weighting, we might find that we win the argument on, say, five headings, but because the PCT arbitrarily decides to give a 90 per cent. weighting to one of the others, our arguments will count for nothing at all. It is essential that we have that analysis of the methodology.

My last point is about my constituents and our campaign. The reaction in my local community to the threat of closure of St. Richard’s hospital has been quite amazing. It is extremely unusual for thousands of people to come on to the streets of Chichester about anything. They certainly did about this issue.

I do not think that they came on to the streets of Chichester about the poll tax, but that was before my time. I take the Minister’s point, but she may find that it acts like a boomerang. If she thinks the poll tax was a big issue, she will find that this is a far bigger issue than the poll tax ever was.

My constituents simply do not believe Ministers when they say that finance is not the issue, and that the decision will be taken on the basis of clinical evidence. They are absolutely convinced that finance is the issue and that many clinical concerns and all their wishes will be set aside. When I find so many volunteers such as one of the lead campaigners, Abigail Rowe, and so many clinicians such as my co-chairman on the campaign, Dr. Marjorie Greig, who are prepared to give up so much of their free time to work together on a campaign for St. Richard’s, and when I see the groundswell of support, I know that if local consultation means anything at all, St. Richard’s will stay open as now. I have absolutely no doubt that the same can be said for Worthing hospital as well.

I congratulate the hon. Member for Arundel and South Downs (Nick Herbert) on initiating this debate and all hon. Members on having spoken so eloquently about the problem in Sussex. I welcome the Minister and congratulate her on being released after years of selfless and penitential toil on behalf of the nation’s finances.

Traditionally, hospitals grew up as a result of local need, philanthropy and pride, and only sometimes through strategic planning. Services evolved in hospitals usually as a result of a change in the requirements of the patients or the national health service. Much of that change, to be fair, has been relatively painless—I think of the closure of tuberculosis hospitals and the like—but we now live in an age of rapid and painful reconfiguration, which is reflected in debates in this Chamber. Recently, we have had debates about Hertfordshire, Teesside and now Sussex. The story is not only about closures. There have been some new and much-needed developments as well in some of the reconfigurations.

In essence, there are normally only four drivers for change, three of which are legitimate and one is clearly not. The three legitimate drivers are clinical, financial and demographic. The clearly non-legitimate driver is party political interest and things such as heat maps. Sussex illustrates all of them. It also illustrates—quite clearly, on the basis of the contributions of hon. Members—the pain, protest, anxiety and downright huge amount of political trouble caused when reconfiguration comes in sight.

Sussex is almost a textbook example not of how to do reconfiguration but of how things turn out under the current circumstances. All the classic ingredients are there. There are financial pressures and debts, which are clearly accentuated in many places by trusts running services on multiple sites. There are clinical arguments about neonatal mortality, accident and emergency services and the trade-offs between distance, capacity and sophistication, with which I am sure hon. Members are fairly familiar. Institutional rivalry and town pride are at play, and professionals and politicians are backing different outcomes. That was obvious in the comments made by the hon. Member for Arundel and South Downs in introducing the debate.

However, ultimately, the inevitable solution—not the ideal solution—will be a decision by quango. Forget the consultation, whether it is good or bad. As hon. Members clearly believe, I accept that that process is often a sham, but even when it is not a sham, it is seldom decisive and is essentially ruled by quango. That is what the Government call local decision making, or decision making by local trusts.

On the consultation paper, does my hon. Friend agree that it is difficult for people in the east of my constituency and in Eastbourne to make a rational judgment about maternity services for Eastbourne and Hastings when they are unaware of what the proposals are for maternity services in Haywards Heath?

My hon. Friend is pointing out the weaknesses in the consultation process; often consultation is simply a preamble to do what people will do anyway.

Trusts are, in a sense, a slight misnomer because, although they are staffed by perfectly decent and qualified people, they are rarely ever trusted. Trusts in Sussex seem to fit the bill in that respect, as they span more than one community, which is always a difficulty, and answer to different masters and pressures. As is evident from the contributions made, the trusts do not reflect the democratic will, and it seems as though the NHS is deemed too complex for democratic decision making.

The hon. Member for Hastings and Rye (Michael Jabez Foster), who is not here, put these matters rather well in a quote that I read recently. He said:

“You can’t close local hospitals. People would rather have slightly inferior services that are local”.

To some extent, he has hit a raw and pertinent nerve in that comment. I know about the statistics on neonatal death, the shortage of paediatricians, the working time directives and the various pressures linked to that, the sophistication of first responders, the reduction in bed requirements, the cost of high-tech medicine and the preferences of the royal colleges. All of those factors are part of the debate. However, we Members of Parliament also know that communities want an easily accessible accident and emergency department, maternity care within reach and access problems addressed. In other words, there is a balance of consideration.

We are not calling for decisions to be made according to untutored populism or simple nostalgia, but we want an informed public debate and a democratically accountable decision made. Democratically accountable decisions can be tough—I do not think that is an oxymoron—but people would prefer to make decisions, rather than to have decisions imposed on them.

Essentially, we want decision making in which clinical outcomes are tested and scrutinised. We also want transport links and patient journeys to be reviewed, financial arrangements to be fairly and transparently laid out and patients’ preferences to be clearly identified. Catastrophically for Sussex, there is no mechanism whereby that can be done and that is the essential point of this debate.

The Government are calling for a review by Dr. Darzi, as they think it will be a kind of solution, but it is not a sure solution. I have been involved in debates in this Chamber about recommendations made by Dr. Darzi for Teeside that led to internecine warfare between Labour Members. I believe that Conservatives are promoting the proposal that the ultimate decision-making body should be the NHS board supported by HealthWatch, making representations on behalf of patients.

My personal view is that that is simply not good enough for the people of Brighton, Eastbourne, Worthing, Haywards Heath, Lewes or Bognor Regis. Those people have a right to a decisive voice in how their local services are configured, along with the responsibilities that that involves. I really believe that if people had a voice, this and so many issues that do not get much further than debate would not come to this Chamber, but would be resolved democratically at a local level, and we would not have to debate reconfiguration time after time, in relation to area after area. However, for the moment, we are doomed to go on doing so for quite some time.

I congratulate my hon. Friend the Member for Arundel and South Downs (Nick Herbert) on initiating this important debate and welcome the Minister to her new position on the health team. This could be our first and last debate opposite each other.

I think that it is unprecedented for every single Member of Parliament for West Sussex to be present and to have taken part in a debate on this issue, apart from the hon. Member for Crawley (Laura Moffatt) who is rather straitjacketed by her position and is unable to do so. This is undoubtedly the largest single issue affecting every MP and every constituent in the whole of Sussex. It is unfortunate that the three Members for the Brighton and Hove area who are not constrained by being on the Government payroll, but who are affected by these consultations have not come here to add their comments on behalf of their constituents.

My hon. Friend the Member for Arundel and South Downs made it absolutely clear that the whole consultation has been shambolic and is based on a shifting justification. There is now no serious financial basis for the consultation and it appears that the £37 million projected surplus over the next few year for West Sussex primary care trust will not be spent on the health of patients in West Sussex. I strongly echo my hon. Friend’s calls for the Secretary of State or some of his Ministers to visit our hospitals and see our patients who are under threat.

The hon. Member for Lewes (Norman Baker) reinforced the cross-party consensus of all the campaigns and, as he said, it is dangerous that these proposals are being put forward. My hon. Friend the Member for Worthing, West (Peter Bottomley) made it clear that the financial assumptions in the consultation are, in any case, seriously flawed. Every time we challenge the figures, we are not given a good response as to why such massive reorganisation is in the interests of our patients. Larger hospitals do not always make better hospitals, either from a clinical or financial point of view.

My hon. Friend the Member for Mid-Sussex (Mr. Soames) described the proposals as genuinely absurd and pointed out the proximity of Gatwick and the other pressures that exist in the densely populated county that West Sussex has become. My right hon. Friend the Member for Horsham (Mr. Maude) mentioned the downgrading of Crawley, in which the hon. Member for Crawley was herself complicit. When services were transferred to Redhill, the residents around Redhill may have cheered the extra capital investment. However, they are now finding that the extra pressures of numbers on that hospital means that they cannot get into their own hospital because it simply cannot cope. If West Sussex loses some of these services, I fear that the same thing will happen in Brighton. The infrastructure needs that we have in West Sussex are severe and we should ensure that the infrastructure is there before we commit to taking on extra house building and experience the population pressures that result from that.

My hon. Friend the Member for Wealden (Charles Hendry) rightly pointed out the cynicism that accompanies these consultations and the fear that decisions have already been made. He certainly made a good point about travel times and the complications for problem pregnancies that could lead to very real dangers for the mothers involved. My hon. Friend the Member for Eastbourne (Mr. Waterson) pointed out that it is ordinary people who have set up these campaigns of resistance. He mentioned the four options that people had in Eastbourne. We did not even have four options; we were restricted to three. There seems to be a commonality of missing options between the different consultations.

My hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb) challenged the financial savings and the statement that the deficits will not exist in a few years’ time. My hon. Friend the Member for Chichester (Mr. Tyrie), who has led the campaign to save St. Richard’s from the front with great skill and aplomb, asked who is taking these decisions. Is it just managers who are doing the Government’s bidding and a case of the managers who wear the Government’s clothes having no clothes—to use the analogy of the Emperor.

The document that was produced last week and started the debate is flawed. It was nine months late and did not have a fourth option, which we were promised would consider the possibility of keeping two main hospitals in West Sussex with at least accident and emergency and maternity departments or the status quo. The representations made by Members of Parliament, councillors, patients and constituents to the PCT asked for that option, which was ignored with breathtaking arrogance by the PCT. We wrote a letter that was signed by every Conservative Member in West Sussex and by every leader, mayor and chairman of every council in West Sussex and most Opposition leaders. The letter pointed out that the consultation was flawed and asked for it to be suspended until the fourth option was restored. Arrogantly, the PCT completely and utterly disregarded the letter when, interestingly, most of the non-executive directors of the PCT sent their apologies when the vital decisions were being made.

Henry Smith, the leader of West Sussex council, has made the county council’s view absolutely clear. He says

“This is a bleak picture of the future for health services in West Sussex, and the County Council rejects it totally.”

It is no surprise that we have such strong campaigns to save St. Richard’s, the Princess Royal in Haywards Heath and Worthing and Southlands hospitals. It is crazy that we are looking to downgrade hospitals in a county the size of West Sussex, which has 750,000 people and special needs for elderly people, in particular; some 4.6 per cent of the population of Worthing is over the age of 85—such people have additional needs.

I believe that, last week, the Brighton hospital had been on divert for nine days running simply because it could not cope with the pressure of patients arriving in ambulances. Regularly, there are ambulance queues outside that hospital, and it is a nightmare travelling to it. Yet the Royal Sussex county hospital in Brighton will be the major beneficiary of the downgrading of West Sussex hospitals, particularly the Worthing and Princess Royal hospitals. Despite the excellent efforts and hard work of the Brighton hospital’s managers and staff, it is struggling under the pressure of work. Can it make sense to apply further pressure?

Last year, some 63,000 people went to the accident and emergency department in Worthing, of which a large number were admitted to hospital. They did not need just a plaster; they needed serious attention. How can Brighton and Hove cope with those extra 63,000 people? It is also interesting that Worthing hospital will this year deliver some 3,000 births, and most of the increase is from mothers from Brighton and Hove having their babies delivered there.

Worthing and Southlands hospital, the Princess Royal hospital and St. Richard’s hospital, in Chichester, are good, cost-effective, and, as has been mentioned, well-liked hospitals. If it ain’t bust, don’t fix it, particularly given that we do not have a clue what will be put in its place. And neither do we know the displacement costs of the extra community activity that we have been promised. It is death by a thousands cuts! It is dishonest and unfair, particularly on the 3,200 staff at Worthing and Southlands hospital, and on those at other hospitals, over whose jobs there has been uncertainty in recent years. That is bad for local businesses, as the chairman of the South East England Development Agency said when he came to Worthing. Furthermore, it is bad for patients, staff and the NHS in Sussex. The “fit for the future” consultation document, which started all of this, is not fit for the future of our constituents. It is said that Sussex people won’t be druv. Well, we will not be druv; we will fight for the future of our hospitals. I hope that the Minister listens.

I congratulate the hon. Member for Arundel and South Downs (Nick Herbert) on securing this very important debate and on his new position on his party’s Front Bench. I hope that hon. Members who have spoken will forgive me if I do not refer directly to them in the short time available. Clearly, there are issues of great significance here that affect not only his constituents, but those of all hon. Members who have spoken.

Issues raised by Members are always of great concern. Potential change can provoke very strong reactions, and striving to further improve services for local people can involve such proposals for change. That can be uncomfortable for many at first. We must ensure that while acknowledging the difficulties and tensions involved, we do not lose sight of the ultimate goals of the NHS at a local level when it introduces proposals to improve services. All Members want to improve clinical outcomes in our communities, which sometimes means making difficult choices. When we talk about reorganisation and improvement, we are talking about saving more lives, providing better and safer services, getting the best clinical outcomes for our communities and consulting with the relevant people.

The hon. Member for Arundel and South Downs is quite right: this is not about finance or saving money; it must be about providing safe, high-quality care. Changes are being proposed to reflect and respond to what the public are telling their local NHS. They want more convenient and appropriate services available at times and in places more convenient to them. The NHS must respond to a variety of drivers for change and ensure that it keeps up with changes in services. Those changes are not imposed by the Government, but are proposals for improvements made by the local NHS, based on local knowledge, experience and clinical expertise. When developing proposals, such vast consultation processes, which are necessary, must involve everyone fully, particularly, in this case, clinicians. Regardless of what hon. Members say, that is what has happened in this case.

The overwhelming clinical case for change has been made by independent experts, such as Sir George Alberti, the national director for emergency access. However, I recognise what the hon. Member for Worthing, West (Peter Bottomley) said when he quoted other views and referred me to other clinicians. Of course, people have very strong views. We are trying to determine locally how to produce the best outcomes and services and how to ensure that our constituents have the best chances, in terms of convenience and emergency care.

On a point of order, Mr. Conway. Is it in order for the Minister to quote Sir George Alberti, who, at a meeting with Sussex MPs, said that he would fight for two major hospitals in West Sussex, but then went back on that—for balance, I should say both?

I am saddened by the hon. Gentleman’s intervention and his aggressive pose in this debate. I have tried genuinely to listen very carefully to all the points that have been made. Any proposals for change that are a matter for the local NHS must, as is clear from today, have a message about the importance of making services relevant to local needs. Public consultation with all interested parties and stakeholders must take place in an informed and constructive way.

As the hon. Member for Mid-Sussex (Mr. Soames) said clearly, the proposals have now been put forward and are based on local priorities, but now is the time for local people to have their say. Those proposals and that consultation, when it closes, will bring forward results and outcomes for discussion in public in the autumn. All of the complex proposals for Sussex need to be developed in partnership with a wide variety of people, including doctors, nurses, other health professionals, local authorities, voluntary groups and local people and patients.

No, I shall not give way. I have been very generous and this is a very complicated debate. In a very short period, I am trying to give a steer on how I intend to take the matter forward. The future of the proposals and the development of the service in the area are in local hands. The consultation and serious debate need to take place now and must deal with points raised by the hon. Member for Arundel and South Downs. I take note also of the specific points made by the hon. Member for Chichester (Mr. Tyrie).

Will the Minister undertake to supply in detail written definitions of “urgent care centres” and “weighted criteria” on the basis of which the decision will be taken?

I intend to look at every single point made today, including those of the hon. Gentleman, and to respond appropriately. I have listened carefully to the debate. I know the strength of feeling that hon. Members have clearly and effectively expressed today. However, I find it a little odd that, in a debate in which Opposition Members have spoken about defending their current hospitals, the right hon. Member for Horsham (Mr. Maude) made a bid for another hospital, with no regard to the possible impact on hospitals such as the Princess Royal. We need to think carefully about this matter and take it forward with consultation in order to reach the right conclusions for those who live in the area.