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Accident and Emergency Departments

Volume 463: debated on Tuesday 24 July 2007

5. How many accident and emergency departments are planned to be downgraded; and if he will make a statement. (151793)

Any proposals for major changes to services are for the national health service locally and are designed to improve care for patients.

There is a well-established and well-understood process for managing consultations on such proposals so that patients, staff, the public and other local stakeholders can have their say and help to inform decisions.

I am grateful to the Minister for that reply. Will he therefore undertake to publish the clinical basis on which the Government justify their decision to increase the minimum catchment area for an accident and emergency department from 300,000, as recommended by the Royal College of Surgeons, to 450,000, as recommended apparently by no one apart from his own Department, and explain how, by coincidence, that fits in with the proposed population that would arise if the accident and emergency department at Queen Mary’s Sidcup were to be closed, as revealed in a memo that was written by NHS officials and not by any Member of the House?

I suggest that the hon. Gentleman wait for the proposals that we are expecting from his local area. I am sure that once local health managers in his area publish those proposals, they will justify them on clinical grounds. A recent statement from the British Association of Emergency Medicine recommended that, in order to provide safe emergency services around the clock,

“there needs to be immediate access to intensive care, anaesthetics, acute medicine, general surgery and orthopaedic trauma”.

For the best use of resources, a figure of 450,000 was indeed mentioned, but this is not a one-size-fits-all issue. It will depend on the local circumstances. He should wait for the local consultation.

My hon. Friend may be aware that a not very sophisticated game is going on, with some members of some political parties in this House announcing that A and E departments are going to close when there is no question of them even being considered for closure. Immediately after an election, however, those same hon. Members suddenly announce that the departments have been saved. I hope that my hon. Friend will be a little less magisterial and a little more political and tell us firmly which A and E departments are going to close and which are unquestionably not going to. In that way, he will be doing us all a favour.

I do not think that I have ever been described as magisterial before, and I am always happy to be as political as Mr. Speaker will allow. Many of these decisions are made at local level and not by me, as my right hon. Friend the Secretary of State has made clear, but my hon. Friend is absolutely right to draw attention to the fact that an awful lot of stir-mongering and scaremongering is going on out there. I could quote a number of examples, such as the A and E department at the Hinchingbrooke health care trust in Huntingdon. The hon. Member for South Cambridgeshire (Mr. Lansley) confidently predicted that that facility would close but, following recent consultation, a decision has been taken not to close it.

Will the Minister acknowledge that there has been no scaremongering in respect of the Princess Royal hospital in Haywards Heath, which is part of the West Sussex PCT? It has been proposed that the hospital’s A and E department be closed and its maternity services withdrawn. Clinicians and local GPs feel that that would be unsafe and unwise, although they accept that other reconfigurations need to be made. Therefore, will he assure me that the PCT will be forbidden from going ahead with the proposals?

My right hon. Friend the Secretary of State has said already that he will pass on to the independent review panel any proposed changes referred to by local scrutiny committees. He and I have both said that it is very important for patients and local Members of Parliament to engage in the consultation process, and that clinical concerns about proposals should be made plain. However, the driving force behind all the changes is the objective of improving care for patients. The technology is changing and, to save lives, local care should be given where that is possible and necessary.

My hon. Friend is no doubt aware of last Friday’s shocking decision by the University Hospitals of Leicester NHS Trust to withdraw from the Pathway project, which will have a devastating effect on service provision in Leicestershire. What steps is he taking to reassure the public and local Members of Parliament that services will be protected? When was he told of the decision, and will he meet a delegation of hon. Members to discuss this very important matter?

I should be happy to meet such a delegation, and I have already offered to meet my hon. Friend and the former Secretary of State for Health, my right hon. Friend the Member for Leicester, West (Ms Hewitt). The decision is shocking, yes, but perhaps not so surprising, given that the project’s projected costs had spiralled considerably. I can well understand the concern that he expresses on behalf of the people of Leicester, but I am assured by the local health service management that the funds originally proposed to be spent on the project will still be available to improve services in Leicester, and I look forward to examining, with my hon. Friend and others, how that can best be done for the future.

I cannot even start to describe how angry doctors, nurses, unions and patients in Scarborough are after last week’s announcement of 600 job losses at Scarborough hospital. That is one third of the hospital’s staff. Will the Minister come to Scarborough this summer to see for himself the effects that the cuts are going to have, and to let us convince him that we need to maintain full A and E cover at that hospital?

As far as I understand it, discussions on the proposals that the hon. Gentleman mentions have not even begun yet, but I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who is responsible for the heath service in the north-east, would be happy to meet the hon. Gentleman and the delegation to discuss the issue. As we said earlier, a difficult, tough decision was taken last year by our predecessor team. For years and years, we had a system in which a small number of health trusts were allowed simply to roll over deficits from one year to another, and well-performing trusts had to bail them out from year to year, but that is not acceptable or sustainable. Tough and painful decisions have had to be made in some areas, but I am sure that my hon. Friend the Under-Secretary will be happy to discuss them with the hon. Gentleman.

Will my hon. Friend confirm that the emerging strategy used in some parts of the country, and particularly in the capital city, is for health authorities to require the diversion of trauma and complex emergency cases away from accident and emergency departments to private hospitals and elsewhere? That kicks the feet away from accident and emergency departments that are already threatened, and brings about the closures that the bureaucrats want.

No—and the decisions are best left to the people whose job it is to deliver high-quality care, at value, to their local communities in a safe and appropriate way. If my hon. Friend wants to write to me with any examples of cases where there are such fears, and where that is having an impact on the quality of patient care, I will gladly respond to him.