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Smaller General Hospitals

Volume 464: debated on Wednesday 10 October 2007

I suspect that the Minister’s effective response to this debate will be short. In so far as the reconfiguration of local hospital services is concerned, I imagine that she will say, first, that such reconfiguration is a matter for local medical opinion, and, secondly, that Ministers will act in such matters on the advice of the independent reconfiguration panel. If the Minister were to say that, she would be wrong.

Local general practitioners are against the cuts, as are those hospital staff who have been able to speak out against them. Patients and local residents are petitioning and rallying against the cuts to general hospitals in their tens of thousands. In my constituency, local medical opinion is overwhelmingly against the proposed changes to services at Horton general hospital, but it has simply been ignored, and, although the existence of the IRP is welcome, it can, of course, only advise the Government within the policy parameters set by them.

For example, the Government have given some clear indications as to what they consider should be the minimum size of a consultant-led maternity unit, although it should be observed that our European neighbours safely manage consultant-led maternity units substantially smaller than those in the UK. Indeed, the existing maternity unit at the John Radcliffe in Oxford is already larger than practically every consultant-led maternity unit in Germany, France, Holland and Belgium.

I believe that everyone can understand, after the turmoil of the junior doctors’ training fiasco and the somewhat patronising approach of the previous Secretary of State, that when the present Secretary of State came to office, he was keen to give the impression of drawing a line in the sand and to institute a year-long review of the national health service. I suppose he hoped that that would buy him time to sort out what was going on in the NHS, to try to understand why so much extra investment has led to so little by way of improved outcomes and, in the meantime, to try to shuffle off any difficult decisions to the IRP. Indeed, a study published at the beginning of this month found that health services in the UK are some of the worst in Europe. The UK is in the same league as countries such as Slovenia and Hungary, which spend far less on health, and is languishing below Estonia and the Czech Republic in respect of health care.

Unfortunately for the Secretary of State and his ministerial colleagues, the approach of seeking to shuffle off decisions was completely undermined as soon as the present Prime Minister walked into No. 10, because one of his first actions was to appoint to the health ministerial team Professor Darzi, now Lord Darzi of Denham. On the day that Lord Darzi was appointed, he observed to The Guardian that:

“The days of the district general hospital…are over.”

Indeed, he went on to say in that interview that in the not too distant future there will be far fewer general hospitals in London, and that many of them would be replaced by what he described as “polyclinics”. Ministers have doubtless seen that the Government’s proposals for downgrading general hospitals in London and replacing them with polyclinics have been attacked by the British Medical Association. Dr. Hamish Meldrum, the BMA council chairman, recently observed that costly, unproven polyclinics could lead to

“a damaging fragmentation of care.”

Ministers would do well to reread Lord Darzi’s report, “Health care for London”. On page 26, he compares productivity in various types of hospital. He concludes that the best results outside London are achieved by small general hospitals. On page 49, in discussing the proposals for more midwife-led care, Lord Darzi states:

“Prompt transfers are vital—the Royal College of Obstetricians and Gynaecologists recommends that such transfers should ideally take fifteen to twenty minutes.”

Lord Darzi clearly has not considered the Oxford Radcliffe Hospitals NHS Trust’s proposals for the Horton.

It is not just in London that the Government are presiding over a damaging fragmentation of care of hospital NHS services, but in the rest of the country. Some 25 to 30 general hospitals in England are threatened by substantial downgrading, through which maternity services and accident and emergency services could close, or combinations of various services could be downgraded or closed. If such changes go ahead, hospitals will no longer be general hospitals but simply a collection of medical services.

On maternity services, does my hon. Friend and constituency neighbour agree that there is little chance indeed of making the journey with a complicated obstetric case from Banbury to the John Radcliffe in less than 40 minutes, even with the bells down and no traffic? Does he also agree that there is a wide rural hinterland in both our constituencies, from which transfers would be even farther and even more critically dangerous?

I entirely agree with my hon. Friend. We know the geography of north Oxfordshire. I was amazed today to discover that the Oxford Radcliffe trust had told Radio Oxford that it thought that a journey could be made in 30 minutes. I challenge the trust to organise a trial any time that it wants; I would happily take part. It is inconceivable that it could demonstrate to the local newspapers that it is possible to get from Banbury to Oxford in 30 minutes, even with a blue light. Everyone who lives in north Oxfordshire knows that that is just not possible—like so many other things, it is just totally aspirational.

As the Minister will doubtless observe, some changes have the support of some parts of the medical establishment, but that is very much a consequence of the Government’s substantially reducing the amount of time that junior doctors will spend in training. We are rapidly moving to a training-led NHS, rather than a patient-led NHS.

Does my hon. Friend share my dismay regarding the advisers whom the Government have chosen to take forward their proposals on the NHS? It is hardly surprising that the review is going in the direction that it is, with a focus on tertiary centres, as the advisers are Lord Darzi, Roger Boyle and George Alberti. Excellent though they are, they have no experience of primary or intermediate health care, and it is hardly surprising that general practitioners therefore feel that they are being marginalised in the Government’s plans, almost exclusively in the interests of highly specialist and tertiary centres.

I entirely agree with my hon. Friend. As I shall show the House, GPs feel that they are being not only marginalised but patronised as a result of the way in which the changes are taking place.

The medical establishment’s attitude, to which my hon. Friend the Member for Westbury (Dr. Murrison) just referred, was effectively demonstrated by the dean for medical training in the Thames valley, who gave evidence to the health overview and scrutiny committee on the proposed downgrading at the Horton hospital. The dean was asked by the committee why it would not be possible to send doctors who are in training on rotation from the John Radcliffe in Oxford to the Horton in Banbury. After all, both hospitals are in the same NHS hospital trust. The dean responded to the effect that it would be unreasonable to expect junior doctors to travel the 26 miles from Oxford to Banbury. I believe that the dean was somewhat surprised by the wry laughter around the council chamber in which the meeting took place. Everyone said, “Hang on a moment, the Oxford Radcliffe NHS trust is expecting huge numbers of patients and their families, sick children, concerned parents and mothers in labour to make the 26-mile journey from Banbury to Oxford.”

Indeed, on the trust’s own figures—putting its own best case—it is expecting as a consequence of its changes that hundreds of mothers in labour will have to be transferred from the Horton to the John Radcliffe. I am thinking of mothers such as my constituent Alison Bentley, who enjoyed a trouble-free pregnancy, but whose baby’s cord dropped beneath the neck during delivery. To prevent brain damage to the baby or death by oxygen starvation, Mrs. Bentley had to be placed on all fours while a midwife physically prevented the baby’s head from being delivered.

In future, such a mother in those circumstances would have to be put in an ambulance and sent on an hour’s journey to Oxford, so it is not surprising that the Royal College of Midwives is vigorously opposing the removal of consultant-led obstetric services at the Horton. It is not surprising that Judy Slessar, the regional organiser of the RCM, recently observed:

“The RCM does not consider the Oxford Radcliffe Hospitals Trust has provided a strong enough argument to transfer services to Oxford.”

What the Government are presiding over is a fragmentation of NHS hospital services. My straightforward question to the Minister is, how do the Government explain to my constituents and the constituents of many parliamentary colleagues how a comprehensive downgrading of services at the Horton in Banbury is in any way an improvement in NHS services for the hundreds of thousands of people from Oxfordshire, Warwickshire and Northamptonshire who look to it as their local general hospital? Of course, perhaps it would help Ministers to answer that question if they could be bothered to come to Banbury, or at least to understand that the Horton is a general hospital. I am glad to say that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, has taken the time and trouble to come to Banbury to talk to those who are concerned about the future of the Horton, as have my hon. Friends the Members for Eddisbury (Mr. O'Brien), and for Guildford (Anne Milton), who has recently joined the Conservative shadow health team.

When the chair of the Oxford Radcliffe patient and public involvement forum wrote to the Secretary of State specifically inviting him to Banbury—we must bear it in mind that the Government set up such forums to be the voice for patients and the public—he could not be bothered to reply. Instead, a letter from an official in the Department’s events and visits unit wrote saying:

“Regrettably due to heavy diary and Ministerial commitments the Secretary of State is unable to accept your invitation.”

That is civil service-speak for saying that the Secretary of State could not be bothered to come to Banbury. Perhaps he did not want to face up to the local PPIF, which expressed on the record considerable concern at the lack of proper consultation by the trust. Jacqueline Pearce-Jervis, the chair of the forum, observed in a letter to me:

“The truth is, as we all know, consultation has been minimal…the public are telling us that no attempt whatsoever has been made to talk to young mothers or, older people.”

The Minister might like to invite the ambulance services to a party for all paramedics who have delivered babies before they could get the mothers to hospital, and then consider how many more would have to be invited if every maternity unit led by consultants in England were closed down.

I entirely agree with my hon. Friend, and with his early-day motion about births on the road. We are getting into a crazy situation in which our constituents must contemplate whether they will have their babies in a hospital or in an ambulance somewhere between their home and a hospital.

We on the Isle of Wight are lucky that we kept one district general hospital open. Low levels of maternity were observed following the threat to the island, yet we kept the hospital open. On the mainland, smaller hospitals have closed or are threatened, at least partly by the EU working directive. Does my hon. Friend agree that it is an unnecessary directive that adds to the problems faced by general hospitals?

Yes, but the Government must explain how, when every other country in the European Union is covered by the same directive, France, Germany, Belgium and Holland still manage to have consultant-led maternity units substantially smaller than those here, and are not setting an arbitrary figure for a minimum size for consultant-led midwife units.

Is my hon. Friend aware that in my area, despite overwhelming opposition from local people and all GPs bar one, who happens to work for the primary care trust, to proposals to downgrade maternity, those proposals are being proceeded with and the EU working time directive is often being quoted? Is my hon. Friend aware that, as I understand it, the Government would be well within their rights to apply for a derogation from that directive, at least until 2012, but have not lifted a finger to do so?

My hon. Friend makes two good points. First, the Government have made absolutely no attempt to obtain a derogation from the European working time directive. Secondly, Ministers say that reconfiguration of local services is a matter for local medical opinion—and then completely ignore the views of local general practitioners as though they simply do not exist.

Against that background of ministerial indifference and poor consultation, it is perhaps not surprising that as recently as a couple of weeks ago, during the Labour party conference, the hon. Member for Exeter (Mr. Bradshaw)—another Health Minister—was on the Bill Heine show on BBC Radio Oxford describing the Horton as “a small cottage hospital”. The Government’s intention may be that it becomes a small cottage hospital, but it has for many years been a general hospital, and everyone locally is determined to do everything possible to keep the Horton general.

I am conscious that a number of colleagues understandably wish to contribute to this debate, and I suspect that one and half hours is far too short to do justice to the importance of the issues. I want to focus briefly on the proposed changes to services at the Horton.

At the moment, the Horton has a 24/7 consultant-led children’s service to look after sick children. That came about following the tragic death of a little boy in the 1970s because, at the time, the Horton did not have the necessary facilities. That little boy’s death demonstrated that for a sick child, Oxford is often simply and tragically just too far away. Following his death, Barbara Castle set up a statutory public inquiry, which directed that there should be 24/7 children’s services at the Horton. What is now being proposed will take us back 40 years. What is now being proposed is that no sick child will be admitted as a patient to the Horton, and during evenings and weekends—bar about three hours on Sundays—there will no longer be any consultant-led children’s services at the Horton.

That will present every GP and every parent with a considerable conundrum: if they have a sick child, do they take their child to the Horton, which is nearby but might not be able to treat the sick child, or do they start the journey to Oxford? Ministers who are too busy to visit Banbury will probably not know that it contains three wards—Ruscote, Grimsbury and Neithrop— with some of the highest social needs in south-east England, and many people who simply do not have access to a car, so for them, getting a sick child to Oxford will be something of a nightmare.

An indication of the trust’s desperation is that in its most recent proposed service reconfiguration, it announced:

“Transition arrangements should include an education programme to advise parents and the public about the new service and what to do with a sick child out of hours.”

Will my constituents and those of neighbouring Members of Parliament be expected to recognise illnesses such as meningitis? How do the Government explain to local parents that the removal of those services is in some way an improvement in the NHS? Without 24/7 consultant-led paediatrics, there can no longer be a special care baby unit, and the trust is also proposing that the Horton will no longer have a consultant-led maternity unit, but that it will become the largest midwife-led maternity unit in the country.

Ministers make much play of the fact that the reconfiguration of medical services should be informed by local medical opinion. When the trust’s proposals were first promulgated, they were met with an excoriating response from the north Oxfordshire and south Northamptonshire general practitioner forum, with some 86 GPs supporting a joint submission in which they said:

“We remain opposed to the proposals on the grounds of safety, sustainability and the reduction of access to basic health care and choice for our patients, which will affect especially the most vulnerable. We have little confidence in the process of consultation and the spirit in which it was conducted.”

On paediatrics, the GPs observed that much of their discussions

“with the Oxford Consultants are centred around our genuine concerns about safety—we have highlighted these areas to them in a detailed and specific way. Their response has been a reactive and a rather inadequate ‘sticking plaster approach’ which would seem to confirm the fundamentally flawed nature of the proposed model in the first place. It would seem quite inappropriate to take forward such a flawed proposal.”

The GPs described the proposals for maternity services as inhumane, and said:

“Under the proposed model mothers who may fail to progress, or show signs of foetal distress in the second stage of labour, or who have prolapsed cord or haemorrhage would require very rapid transfer to Oxford. Given the numbers involved this would carry significant risk and would be inhumane…babies born in need of immediate resuscitation would incur a transit time of approximately one hour. The idea that paediatric cover could be provided safely from Oxford in these circumstances is false and dangerous.”

The GPs continued:

“Without 24 hour paediatric cover locally, the A&E Department could not continue to accept paediatric emergencies. If proposals to remove local emergency surgical services are carried through, it will also lack surgical cover for acutely ill surgical patients. The domino effect would lead to the result of downgrading to a minor injuries unit in the mid to longer term.”

There would be no accident and emergency department. The GPs concluded:

“We believe that these proposals and the tenor of discussions relating to them pose a risk to the overall integrity and sustainability of the Horton as a General Hospital. They undermine the morale of its staff and impact adversely on recruitment and retention of high quality personnel. Far from creating excellence in health care…they betray a lack of will, vision and imagination and consequently degrade it.”

Clearly, it was impossible for the trust to assert that it was introducing service changes at the Horton hospital on the grounds of safety, when every GP whose patients were within the Horton’s catchment area described the proposals as unsafe and inhumane. The trust took the original proposals off the table, ceased the consultation and established two clinical working parties. Somewhat bizarrely, it refused to disclose the names and professional qualifications of any of the members of the two working parties, which somewhat undermined any confidence in the integrity of their work. The changes consequent on the work done by the clinical working parties were fairly cosmetic, and if the clinical working parties were an exercise intended to persuade local GPs of the need for downgrading services, they failed.

Giving evidence to the health overview and scrutiny committee, Dr. Richard Lehman and Dr. Emma Haskew, representing the local GP forum, reported that they had carried out a further survey of the original 86 GPs. Some 56 remained clearly opposed to changes and they could find only three who supported them, and that was on the basis that they were the “least worst option”. I am not sure what that phrase means—how does the “least worst option” differ from the worst option? I do not want NHS hospital services for my constituents to be provided on the basis that they are the “least worst option”. The present views of local GPs on the changes were well summarised in a recent letter from Charles Perrott, the lead partner of the health centre in Brackley, which is in the constituency of my hon. Friend the Member for Daventry (Mr. Boswell). It states:

“Many of us have seen cases where delays in treatment would have resulted in death or disability had the Horton hospital not been available…It is true that for specialised conditions the outcomes in the specialist centres are better, but one has to be able to get to the hospital first. The overall population-based mortality rates (as opposed to hospital mortality rates) will rise if frontier hospitals such as the Horton General are not able to provide the full range of general services such as paediatrics and obstetrics.”

Senior local GPs are still making it clear that they believe that local mortality rates will rise and that delays in treatment will result in death and disability as a consequence of the changes.

Another group that the trust must persuade about the wisdom of the changes is the midwives at the Horton. After all, they will go from working in a consultant-led unit to working in the largest midwife-led unit in the country. That unit will be 26 miles and approximately one hour’s ambulance journey away from the nearest consultant obstetrician. The midwives at the Horton have made their views clear. The Banbury branch of the Royal College of Midwives, in a letter to the Banbury Guardian, stated:

“The branch wishes to make it clear that the majority of its midwife members have expressed their support for maintaining the full range of maternity and paediatric services at the Horton. The current service provides true choice for the benefit of women, their babies and families…The branch notes an article of August 30 which quotes comments made by the clinical working group that the proposals were the ‘safest option’…The branch does not consider the changes to be the safest option when compared with the present service. Over the past few weeks, it has been made clear through the Banbury Guardian by local women of the wide variety of situations that have been dealt with successfully by the Horton and that they wish the full coverage of the current service to continue.”

Since then, articles such as that by Professor James Drife in the British Medical Journal have been published. He is a specialist in obstetrics and gynaecology at Leeds university, and he has made it clear that the lives of women and babies will be put at risk under the Government’s plans to encourage births at midwife-led units. I am sure that the Minister has noted that Professor Drife observed in his article that thousands of women may need to be rushed to hospitals from such units if complications arise that put the lives of mother and child at risk.

The Minister wrote a letter to me in anticipation of this debate. It states that

“it is vital that the views of local people are taken into consideration which is why service improvement proposals are subject to full consultation.”

I must tell the Minister that local people have made their views extremely clear.

May I say something to my hon. Friend on the issue of consultation? I know that this debate is about the downgrading of a local general hospital. However, in the New Forest in Romsey, we have been fighting to save our community hospitals. We experienced all the techniques of bogus consultation options. Eventually, after huge public displeasure and demonstrations, which are almost unheard of in our part of the world, the PCT said that it had changed its mind. Even now, it is attempting to convert community hospitals into clinics—to do anything, rather than have in-patient beds. When it comes to democratic opinion, PCTs—sadly—have a great deal to learn.

My hon. Friend is correct that such service reconfigurations are characterised, almost universally, by bogus consultation.

Local people make their views clear. Some 35,000 local people signed a petition against the downgrading of the Horton, which was presented to No. 10 Downing street, and I presented a petition of some 15,000 signatures to the House. The Minister will find that the independent reconfiguration panel will receive hundreds, potentially thousands, of individual letters from local people setting out the reasons why the existing services at the Horton are valuable to them and why they wish to retain them.

Indeed, with the help of the “Keep the Horton General” campaign, ably led by George Parish, a local Labour district councillor, local people have done pretty well everything that it is permissible to do in a democratic society to demonstrate their almost total opposition to, and collective concern about, the proposals. Huge churches have been packed full, and there have been petitions, rallies and marches. We had “Hands around the Horton”, at which local people formed a huge chain of support around the hospital, but they do not believe that Ministers are listening. They cannot understand why the Secretary of State cannot be bothered to come to Banbury. They do not understand why the Minister of State, the hon. Member for Exeter, referred on Radio Oxford to the Horton as a “small cottage hospital”. If Ministers do not recognise general hospitals, there is a problem for us all.

Local people were totally bemused when the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) accused my right hon. Friend the Member for Witney (Mr. Cameron) of scaremongering by including the Horton on the list of general hospitals currently threatened by the Government. Even today, at Prime Minister’s questions, the Prime Minister suggested that there is no threat to the Horton. That is deeply insulting to local people, and the Prime Minister would do well to ensure that he is properly briefed by Ministers and officials before making such ludicrous assertions. When Ministers in the Department do not recognise that the Horton is being threatened by the Government, they are clearly not living in the real world but in some parallel universe.

Local people find it insulting when the Prime Minister starts talking about citizens’ juries, and when he clearly does not know what is going on. Why do we need citizens’ juries when local people have made clear their views in a 35,000-signature petition presented to Downing street, and in a 15,000-signature petition that I presented to the House?

A stakeholder group, including representatives of patient, community and public bodies, rejected the clinical group’s support for the trust’s proposals, saying that they

“represented a significant downgrading of access to services and a worsening of choice for women and children”.

Against the background of such comprehensive local and medical professional opposition to the trust’s proposals, it was perhaps not surprising that the trust could not find a single witness—other than members of its own staff—to give evidence to the health overview and scrutiny committee in support of the proposals, or that the committee unanimously decided that the proposals should be referred to the IRP. Incidentally, that is the first time in the four years of its existence that the committee has made such a recommendation, so it was clearly not lightly made.

One of the fundamental principles of the NHS is, rightly, equity of access, but if the Government’s proposed changes go ahead at the Horton and at other general hospitals, my constituents and thousands of other people in the country will not have equity of access. Intolerably, they are going to have services that are less safe.

Dr. Richard Lehman, the senior partner in one of Banbury’s fastest-growing GP practices, describes the trust’s proposals thus:

“It is as if a third of the mothers in my practice are being randomised without their informed consent to a kind of provision which has never been shown to be safe and on basic first principles is very unlikely to be safe. If somebody tried to carry this out as a clinical trial, I cannot believe that any Ethics Committee would give it a second look.”

Next year is the 60th anniversary of the founding of the NHS. If the Government continue to undermine general hospitals, they will be undermining a fundamental principle of the NHS.

There are concerns about whether the John Radcliffe hospital could cope with the increase in the number of sick children as a consequence of their no longer being treated at the Horton. Figures sent to me by staff at the Horton show that the children’s ward was used as a safety net for the John Radcliffe on 18 occasions during July. So for more than half of July, the JR was full so far as new admissions of sick children was concerned, and had to refer them to the Horton. Indeed, statistics show that the Horton children’s ward was also on call for Milton Keynes, Stoke Mandeville, and the Royal Berkshire and Kettering hospitals. July is not a winter month, when pressures are high. If there are no 24-hour children’s services at the Horton and if the John Radcliffe is unable to take them, where are the children who currently go to the Horton going to go? Will they go to Swindon or Reading?

On a weekly or sometimes daily basis, GPs all over north Oxfordshire are told that the John Radcliffe cannot cope and that they should refer patients to the Horton. For example, on Tuesday 2 October, Thames Valley Emergency Access sent an e-mail to many GP practices stating:

“We have been advised by the Ops Team at the JRH that capacity remains tight today in all areas especially in adult and paed. medicine. As a result of this they would like you to refer adult and paed. medical admissions to the Horton Hospital in Banbury.”

Exactly the same thing happened the next day, Wednesday 3 October, and again on Friday 5 October. On three out of the past five days in the last working week, the JR was unable to accept new admissions, and the Horton had to shoulder the burden.

What about this week? Yesterday, 9 October, exactly the same thing happened. JR wanted all adult and paediatric medical admissions to go to the Horton, and said that

“there are also issues with Gynae”,

so GPs were asked to

“refer Gynae patients to the Horton.”

Exactly the same thing happened today. On the day of this debate, the JR is asking adult and paediatric medical admissions to go to the Horton. That rather prompts the question: on what day is the John Radcliffe able to accept admissions? If downgrading of services goes ahead at the Horton, it will not be possible to send such patients there. Where are they going to go? Who will be responsible if things go wrong?

Catherine Hopkins, a qualified midwife who is now a solicitor in Oxford, has a practice that is devoted almost entirely to helping parents of children who have been brain-damaged during birth. She says:

“It is not sufficient to say that women will be carefully screened and high risk cases will be delivered at the consultant unit at the JR. How many emergency Caesarean sections were there at the Horton last year? I question what would have happened to those who would not have been assessed as having high risk pregnancies. If the current proposals are put in place, when a midwife at the proposed new unit decides a woman in her care needs emergency medical attention, the mother, possibly in an advanced stage of labour, will have to be transferred by ambulance to a consultant unit. The clinical Working Group found that an ambulance transfer from the Horton to the JR could be achieved in 48 minutes. This delay could lead to serious damage occurring to mother or child. As a former midwife and solicitor who acts for children brain-damaged in the course of their birth, I believe that (negligence) claims of this sort could rise as a result of this proposal.”

Interestingly, there appears to be no evidence of the Department of Health having done any work on the safety and risk of midwife-led units—no assessment of whether there are any greater risks to mothers and babies inherent in a midwife-led unit. In this instance, on the trust’s own figures, a significant number of mothers who start labour in the MLU will need to transfer during labour to a consultant-led unit. On the trust’s most optimistic figures, a significant number of mothers who start in the midwife-led unit will—not might but will—have to be transferred during labour some 26 miles to a consultant-led unit. It should not be forgotten there are many occasions when the M40 between Banbury and Oxford is closed, either due to bad weather such as fog or snow or due to road traffic accidents, which appear to be becoming, sadly, all too common between junctions nine and 10. As I said, I understand that the trust today told Radio Oxford that the journey could be achieved in 30 minutes—that is complete hogwash.

It is not only the Horton that faces this threat. I commend my hon. Friend the Member for Worthing, West (Peter Bottomley) for his early-day motion on births on the road. It is tragic that hon. Members are having to table early-day motions asking that the strategic health authority guide the local primary care trust in maintaining consultant-led maternity services at Worthing, with the aim of reducing the number of babies born before arrival at hospital. This is third-world medicine.

What is the degree and range of added risk to mothers and babies of such moves? GPs locally have reviewed all the major medical journals for the past nine years, and no work at all appears to have been done on considering whether and to what extent larger midwife-led units may increase risk to mothers and babies. Indeed, I understand that there will be no sound data on this matter until September 2009, when the National Perinatal Epidemiology Unit is due to report.

Will my hon. Friend accept, and will the Minister listen to, what is said by the Royal College of Obstetricians and Gynaecologists, which very clearly says that if there is to be a midwife-led unit, it ought to be through the wall from a consultant-led unit, not 20, 40 or 60 minutes away?

I entirely agree with my hon. Friend. It is significant that the largest midwife-led unit at present is next door to a consultant-led unit. The idea that it will now be some 26 miles away from a consultant is crazy.

In August, I wrote to the Secretary of State, asking a straightforward question:

“In these circumstances, how can the Government be confident that encouraging downgrading of Consultant-Led Units and replacing them in a number of instances with Midwife-Led Units is safe as the Government appears not to have done any work on this issue whatsoever?”

I am still awaiting a reply to that letter.

Ministers say that the changes are being driven in part by their having to implement the European Union working time directive, but other countries in Europe are also obviously equally covered by that directive. How are they managing to continue to have consultant-led maternity services in much smaller units?

Jim Thornton, professor of obstetrics and gynaecology at the university of Nottingham, has observed that

“Previous experience with mega mergers (of maternity units) like this has not been good”,

and that

“Previous experience with freestanding Midwife-Led Units created after Consultant-Led Units closed has not been good. Examples. Wakefield—on edge of closure, only open working hours. Hull—ditto. Southport—Midwife-Led Unit created when Consultant-Led Unit closed proved non viable and has now closed.”

Professor Thornton goes on to give examples of at least seven free-standing MLUs that have recently closed or are closing soon. Why are the Government intent on creating new large midwife-led units, when the experience is that many of the MLUs created when a consultant-led unit closed have proved unviable and are closing?

On the proposals to downgrade children’s services, what response are the Government giving to the report of the children’s surgical forum of the Royal College of Surgeons, which in July concluded:

“The current downward trend of provision of general paediatric surgery in General Hospitals needs to be halted and reversed”?

It is not just consultant-led maternity units across the country that the Government want to downgrade, but a significant number of accident and emergency units. Many of the same concerns apply. An academic study published in August by the medical care research unit at Sheffield university carefully collated statistical evidence for what might seem a blindingly obvious conclusion: that there is a direct correlation between the distance that emergency patients must travel to receive hospital treatment and an increased risk of mortality. Put bluntly, the further away a victim is from a hospital with accident and emergency provision, the more likely they are to die from their illness or injury. One might think that conclusion so obviously a matter of common sense that it is difficult to understand how any Minister can attempt to maintain that the closure of local accident and emergency departments in favour of regional—which is to say, fewer—centres for emergency treatment somehow benefits NHS patients. One cannot benefit from elite specialist care if one is dead on arrival.

The trust’s response to the concerns of professionals, patients and residents has been wholly inadequate. It is simply no substitute for consultant-led services to have, as the trust proposes in its revised proposals, a phone line for midwives in Banbury to call doctors in Oxford for advice in an emergency. General hospitals cannot be run like NHS Direct.

I hope that the Secretary of State, who is still comparatively new in his post, will sit down with Ministers and officials and look again at the collective impact of the Government’s policies on general hospitals. Unless he can be confident that patients will not be put at risk, the Horton and other general hospitals should not be downgraded. Medical science may have improved since the 1970s, but the journey to Oxford has not. We believe in general hospitals; the Government, seemingly, do not. GPs, nurses, midwives and patients all wish to see existing general hospitals thrive, and I simply want the Government to produce policies that enable us to keep the Horton general.

Order. I trust that it will be helpful to hon. Members to know that I intend to commence the winding-up speeches at 3.30 pm. A number of hon. Members wish to speak, so I trust that, when speeches are being made, that will be taken into account. I call Dr. Taylor.

Thank you, Dr. McCrea. I thank the hon. Member for Banbury (Tony Baldry) for raising this absolutely vital issue. I shall concentrate on generalities rather than specific cases.

I am sure that not many hon. Members read the British Journal of Healthcare Management, but I happened to be reading it on the train on the way home one day not that long ago and I nearly fell off my seat because the political commentator was suggesting to the Prime Minister that I should be the next Health Secretary. I have been waiting ever since to be asked for advice and I am about to give advice that I think will help the Minister in her response and that I know will help all the Opposition Members, because in the past few weeks, an absolutely vital paper has been published. The only people I am doing down are people such as me, who might want to stand for election again to protect their hospitals.

The Academy of Medical Royal Colleges is a group consisting of the presidents of all the royal colleges, including GPs, anaesthetists, physicians and surgeons. They have all come together with a working party and published a paper called “Acute Healthcare Services: Report of a Working Party”. To my amazement and pleasure, it is written in a patient-friendly, authoritative way. It goes away from the Royal College of Surgeons saying that every hospital has to serve populations of 500,000 people, which is quite impracticable. I shall talk briefly about the report, commending it to everybody to look at.

The foreword, on one of the introductory pages, states that the three main challenges to which the paper responds are to ensure that any change should be to improve safety and quality, to consider the impact of the European working time directive and to recognise the interdependency of acute services—if we take away one service, another is likely to fall down. The foreword goes on to state:

“There is evidence that for some very serious conditions, care in specialised units is associated with better outcomes.”

Nobody would argue with going to a specialist unit for a major head injury, a major chest injury or a ruptured aortic aneurism. The foreword goes on to say:

“However, these conditions together only account for a small percentage of acute care episodes. The evidence is much less clear for the majority of common conditions that make up 95 per cent. of acute care. There is evidence that larger emergency departments have longer waiting times. Big is not necessarily better.”

A little later, the report lists 15 key issues, and I shall read just one or two of them:

“Patients should have good access to emergency care but for some serious acute conditions they and their relatives may have to travel further…The population and patients should be involved in shaping proposals to change services at an early stage. This will need an honest discussion of the real reasons for change”—

not the sort of spin that we are used to in consultations. Most importantly, the report says:

“Plans to redesign services which involve moving services from a particular site must not be fully implemented until replacement services are established and their safety audited.”

That did not happen in my area, despite requests that it should. Elsewhere in the list, the report repeats:

“Although there is evidence to suggest that the centralisation of services to deal with complex or specialised work provides better outcomes for patients, evidence for centralisation of non-complex and high volume cases does not exist.”

The report also goes into the difficulties that payment by results may produce and the effect of losing some elective work to other providers, which may put a strain on acute general hospital services.

The report does not shy away from politics. Recently, many medical commentators have said, “Let’s get politics out of hospital reconfigurations,” but the report says:

“The reorganisation of services always provokes intense public and political interest. This is completely understandable.”

Of course it is understandable, because we all represent our own people.

Crucially, the report then gives a spectrum of proposed acute and emergency care services, which is supremely sensible. The first level, obviously, is primary care. Then there are community hospital and urgent care centres. The report then goes on to local hospitals, which is the group into which Kidderminster used to fit, although it does not now. Banbury certainly fits into that group and so, too, amazingly, do some tiny hospitals that have been changed, such as the Montagu hospital in Mexborough, which has precisely 115 beds, and Hexham in Northumberland, which has only 98 beds. Local hospitals provide 24-hour services, including A and E, acute medicine, including computed tomography, laboratory services and level-3 critical care. That is what local people want and need. Of course Lord Darzi can recommend changes in London, because it is unique and there probably are far too many hospitals, but he cannot do the same thing in country areas.

The report later says that medical emergencies mostly involve those over 65 years. Such people represent the largest group of patients admitted to hospital and they all require rapid access to care, with only a small percentage needing specialist services.

There are qualms about the possibility that it may not be safe for a hospital that loses acute emergency surgery to have unselected medical admissions. I am sorry that the hon. Member for Grantham and Stamford (Mr. Davies) is not here, because Grantham has bitten the bullet in that respect. Its A and E department has been slightly downgraded and it has produced an entirely sensible list of exclusions—people who should not go there. Referring to those who should go there, the department’s document says, in heavy type:

“A patient may be brought to Grantham and District Hospital if they require immediate Airway and/or Breathing resuscitation.”

It is essential for everybody to have that on their doorstep.

Will the hon. Gentleman join me politely in asking the Minister and every strategic health authority to produce a list of the conditions where they agree with what he has just said?

I thank the hon. Gentleman for that intervention. In fact, the paper from Grantham—it is on the internet, and I got it only yesterday—is exemplary. The Academy of Medical Royal Colleges goes on to say that there will obviously be local changes, because different places will need slightly different arrangements.

I must mention clinical networks, because they are essential. Where we are combining the work of certain hospitals, they must work together. If we are to get networks going, there must be a high level of leadership from clinicians, and clinicians must agree to the proposals. The report says:

“Successful networks cannot be imposed from above”—

they must be the wish of those involved.

Let me say a quick word about paediatrics, because paediatrics and obstetrics are special cases, and they are discussed to a degree in the report. Speaking of paediatrics, the report says that, even at the lowest level—the urgent care centre in a community hospital—

“Staff should be competent in the initial assessment of children, including recognition of the sick child”.

The first thing that a doctor or nurse must learn is how to tell when somebody is really ill.

The report puts into stark perspective the myths about cardiac and stroke care that Ministers and national directors have promulgated. Only a small minority of hospitals can do urgent coronary angioplasty, while only a minuscule proportion can give thrombolytic drugs to people with acute strokes, and the report lists them.

To finish, the report is hugely important. At last, there is a blueprint for acute health care services, including acute general hospital services, which has been written with staff and patient input. It gives the independent reconfiguration panel an absolute standard to work to when faced with controversial, contested reconfigurations. The Secretary of State has promised to refer all such cases to the panel, and if its recommendations agree with the report, I hope that he will support them.

I am pleased to support my hon. Friend the Member for Banbury (Tony Baldry) in this debate, which is central to the interests of all our constituents. He covered an enormous amount of ground at great speed—indeed, if he were a horse, I would breed from him.

The Prime Minister speaks about rebuilding trust in politics and reconnecting people with the political process, but what can those words mean when Ministers have given me and other hon. Members assurances on the Floor of the House in the recent past about the future of A and E facilities at the Princess Royal hospital in Haywards Heath and elsewhere—an issue that could hardly be of more importance and concern to our people—and then reneged on those promises within two years? The Government should be truly ashamed of treating people in that way.

The proposals for the future of the Princess Royal hospital in my constituency include downgrading the A and E and the loss of all elective surgery and of our wonderful maternity services. The proposals across West Sussex more widely, which cover the Princess Royal hospital, the Worthing hospitals and St. Richard’s hospital in Chichester, are wholly unacceptable and unsuitable and would undermine the safety and accessibility of acute services in West Sussex. I take great heart from what the hon. Member for Wyre Forest (Dr. Taylor) said. I have indeed read the paper that he mentioned and I very much hope that the Government will pay close attention to what it says.

Tens of thousands of people have made their views on this matter known in the only way they know how. More than 300,000 people have signed petitions and 25,000 have marched. This weekend, in Haywards Heath, the support the Princess Royal campaign will have a march, which 10,000 people will, I hope, attend. People feel, rightly, that they have paid their taxes and that they are entitled to high-quality local and accessible services.

I know that the Minister is an excellent person, and I hope that she will not be got to, because I trust her judgment. However, I hope that she understands that 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 to look after patients. Above all, it is no way to treat the staff. The staff at the Princess Royal know perfectly well that there is no clinical evidence in support of the changes, although they must of course be cautious about saying so.

On the face of it, the proposals are absurd. The Princess Royal is 15 miles south of one of the biggest international airports in the world, 5 miles from a very busy motorway, and at the centre of one of the fastest-growing places in the United Kingdom, which has an 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 a population of more than 750,000 people, a struggling transport infrastructure and a growing and ageing population.

As the hon. Gentleman said in a speech in the House of Commons just before the House rose for the summer recess, to which I paid particular attention, infrastructure is about more than roads, railways, sewers and health and social services. It underpins national and local well-being, and people in my constituency, and elsewhere, know that and will make a powerful case to the Minister. Most importantly, the people in Mid-Sussex, and across the county of West 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 hope that she intends it to be real—that the powerful, detailed and knowledgeable views expressed locally will be listened to, and that attention will be paid to them when it comes to the shake-up at the end of the process.

I speak this afternoon on behalf of my hon. Friends the Members for Worthing, West (Peter Bottomley), for East Worthing and Shoreham (Tim Loughton), for Arundel and South Downs (Nick Herbert), for Wealden (Charles Hendry) and for Chichester (Mr. Tyrie) and the hon. Member for Lewes (Norman Baker). All the campaigns in West Sussex to save our hospitals are emphatically all-party, and they embrace all shades and none of political and social opinion. They are not to be despised by a slippery and thoroughly unreliable Government.

Finally, I should like the Government to know that Dr. Herry Ashby, a magnificent and inspirational GP in Newick in East Sussex, has 180 letters from GPs in the Mid-Sussex and Lewes area, representing 300,000 patients, saying that they believe that the proposals relating to the Princess Royal, and other wider changes, are untenable and clinically unsafe, and that they will not support them. Across Worthing and Chichester, opinion is just the same. We look to the Government to resolve those matters in a way that is serviceable and reliable to our constituents; perhaps the hon. Member for Wyre Forest has given the Government a good signpost.

It is a pleasure to follow my hon. Friend the Member for Mid-Sussex (Mr. Soames). We have had two powerful speeches about saving hospitals, and I congratulate my hon. Friend the Member for Banbury (Tony Baldry) on securing such an important debate. I also feel very sorry for the Minister. I know that she is an excellent Minister, but not a single Labour Back-Bench MP has bothered to turn up to support her in the debate, whereas there are Conservatives, Liberals and independent Members in the Chamber today.

I will not, the Minister will be pleased to hear, campaign today to save a hospital. There are hundreds of thousands of my constituents in Wellingborough, Rushton and east Northamptonshire who do not have a hospital. It takes them the best part of 40 minutes to get to the nearest hospital, and if one were to travel by public transport, it would take up to two hours. The hospitals that they must go to are at Kettering and Northampton. They are full to bursting point. There is no room for them to expand. Yet the Government have said that Wellingborough must be at the heart of a growth area, with 52,000 new houses to be built in the next 10 years or so. Even the Government, in their policy document, say that there should be a new general hospital in the area. There are no plans for such a hospital. Yet the same Government, who say that Northamptonshire should have a certain amount of money for its primary care trust, have, every year since the formula was devised, deliberately underfunded Northamptonshire. I am saying to the Government: take the money that you should have given Northamptonshire, build the hospital for Wellingborough and Rushton and relieve the pressure on the other two hospitals, in Northampton and Kettering.

I have a listening to Wellingborough and Rushton campaign. The idea is to discuss local issues. Unofficially, two weeks ago, I launched a campaign for a hospital in our area. I have had more than 1,000 letters—people bothering to write to me, put on a stamp, and post their letters—before we have even launched the campaign. I hope that the Minister will consider the issue and realise that in a growth area it is really necessary to have a hospital to serve the people.

Several hon. Members rose—

Order. I am trying to allow as many hon. Members as possible to speak in the debate. The last two to speak have been very considerate in the time that they have taken, and I should deeply appreciate it if others would bear that in mind.

I congratulate the hon. Member for Banbury (Tony Baldry) on an excellent exposé of some of the issues that have affected all of us when reconfigurations and district general hospitals have been under consideration. Rochdale infirmary has just been through such a process. Our hospital is being downgraded. We are losing maternity, paediatrics, acute medical and acute surgical services, and our accident and emergency is being downgraded to an urgent care centre. The hospital is situated in a ward where the average morbidity rate is the fifth highest in the country, the average lifespan being 68 years of age. The changes are from a Government who talk about delivering services locally, where people need them. We are losing those services. A petition against the proposals has been signed by 44,000 people, all in vain.

I want to talk about the process that we went through. When he was appointed, the Prime Minister talked about restoring trust in politics. If the way in which we were treated is an example, he is even more cynical than his predecessor. The decision to downgrade Rochdale was announced on the Friday before the August bank holiday. At 4.30 on that evening I got through to someone at the Minister’s office, who refused to confirm to me that a statement was to be made the following morning, even though I had an e-mail that had been sent out to the press and media inviting them to the press conference. That is a disgraceful way to behave. It is totally contrary to the way in which Members of the House should be treated, but it is typically cynical. The fact that there are no Labour Members present illustrates that point. As the hon. Member for Wyre Forest (Dr. Taylor) eloquently said, there are alternative methods and ways. The Government need to start listening, because the people are not satisfied, and will not put up with this disgraceful way of running the health service.

May I briefly make a small correction to something that was said earlier; there are Labour Members here. The Minister and her Parliamentary Private Secretary the hon. Member for Crawley (Laura Moffatt) are here, and the Minister will be as concerned about what is happening in the county as the rest of us are.

I have two points to add. First, in my part of West Sussex the chief executive of the primary care trust has constantly said that there is clinical support for the proposals. We asked whether GPs had been consulted. The answer appears to be no. We put out non-judgmental questions to GPs. Of the first to respond, one said that he could see the point of the proposals, but wanted to remain anonymous, and 50 said that they opposed them, and gave their names. When we asked the consultants and other medical staff at the hospital, and midwives—who are also clinicians—they opposed the proposals.

At the primary care trust meeting on Monday in Worthing, at the Pavilion theatre, at 7 pm, probably nine out of 10 of those who attend will not be able to get in. Nine hundred will be able to attend. I expect up to 10,000 will not be able to. I hope that those who are there will hear the primary care trust announce that it will put to Sir Graham Catto proposals developed by clinicians in Worthing and the district—with, hopefully, people in Chichester as well—which can be considered on all fours with the three inadequate proposals that have been considered up to now.

The consultation has so far been nearly a disaster. It can be rescued; if the Minister has a chance, will she tell the strategic health authority and the primary care trust to take the representations of councils, clinicians and Members of Parliament seriously? They speak with the people who will try to be at that meeting.

In the little time that remains, I shall simply add from the perspective of my west Cornwall constituency—

Order. With the agreement of Members, the Front-Bench spokesman will allow you a few more minutes, but please do not push it too far.

I shall not. Perhaps I should have been told afterwards, Dr. McCrea, but I shall be brief in any case. I am grateful to the Front-Bench spokesman for allowing me to speak, as we are now over the allotted time.

Within my constituency, which comprises west Cornwall and the Isles of Scilly, we have been in campaign mode for a very long time—in fact, we have been in perpetual campaign mode for many years on behalf of West Cornwall hospital in Penzance and St. Michael’s hospital in Hayle. That is one of the inevitable consequences for Members of Parliament who represent areas with small general hospitals.

I appreciate fully that it is neither possible nor appropriate for Ministers or the Government to micro-manage the delivery of health services in local areas, but they do set the context in which such decisions are taken. The Royal Cornwall Hospitals NHS Trust, within which West Cornwall and St. Michael’s hospitals fall, faced financial difficulties last year. Depending on how it is defined, the trust faced a deficit of up to £58 million for which it had to find solutions. Inevitably, panic-laden and highly regrettable decisions were taken at the time. Under effectively new management and a new primary care trust, things are turning around. I welcome some of the Royal Cornwall Hospitals NHS Trust’s proposals to reconfigure and put right some of the decisions taken last year to downgrade services at West Cornwall and St. Michael’s hospitals.

It is worth making a more general point. Listening to the points made by the hon. Member for Banbury (Tony Baldry) respecting obstetric services in his constituency, one can understand the situation in remote rural areas. For example, if things go wrong in the delivery suite at St. Mary’s hospital on the Isles of Scilly due to the unpredictability of such circumstances, there are massive challenges in removing the mother to the nearest obstetric unit, which is more than 60 miles away, with more than 25 miles of sea between St. Mary’s and the mainland. The Government must not presuppose that we live in semi-suburban, landlocked middle England. Many of us represent areas for which suburban solutions involving the closure of small general hospitals do not apply—the remoter areas of the United Kingdom.

In December, the Government redefined the term “accident and emergency”. Minor injury units can now be defined as accident and emergency units. I feel that that is perhaps a cynical ploy to allow the Government to say that they have kept A and E units open simply by redefining them as level 1, 2 and 3 A and E units. I am worried that that ploy might be used.

The terminology in this debate must be reflected on. I hope that the Government will give us some stability on that and recognise that in some areas, the trade-off between emergency services and planned surgical events is often used to allow—or rather persuade—a local community to accept the downgrading of its services. Although I accept that the Government’s role is limited in many ways, they can recognise the difficulties in many areas in their funding formula, provide clarity and stability in definitions and acknowledge that the country is not a single homogenous suburb.

I congratulate the hon. Member for Banbury (Tony Baldry) on securing this debate. We have a lot more in common than one might think—not simply charm and good looks—as we were the only two candidates in the last election who were opposed by the independent Your party, backed by Martin Bell. I do not know quite why we were selected, but the candidate opposing me stood as a hospital campaigner, spending appreciable sums in doing so.

I had a lot of sympathy for that person, because what he fears could, despite ministerial protestations, come to pass. It happened in my constituency back in 2003, and it was proposed earlier this year. I was confronted with the reconfiguration of two hospitals. There were maternity statistics, which meant certain things to clinicians, and arguments about doctors’ hours and the working time directive. Maternity went. When maternity went, paediatrics went, and then, most shamefully, so did children’s A and E. Every child in the large seaside town I represent, as well as their anxious parents, must travel out of town along a winding road to receive any assurance or help from the NHS. As the hon. Member for Banbury observed in his speech, the midwife-led unit went shortly after; it was regarded as uneconomical.

That is what happened. The local primary care trust now finds it wholly anomalous and may do something about it, but there are general issues for any local district general hospital. Working patterns have changed. Junior doctors are an issue, as is the working time directive. Patient stays have shortened, expectations have been raised and finances have been stretched. An issue of clinical efficiency approaches us from two directions. It is argued that routine services are better delivered in the community, and it is argued from the other direction that many high-tech services are better delivered in less local specialist hospitals.

Some of those considerations undoubtedly have substance, but there is also strong support everywhere for district general hospitals. How much a politician is prepared to take on board the suggested implications in any one case tends to vary inversely with a DGH’s geographical proximity to his constituency boundaries. Ministers are no exception in that respect; they behave in precisely the same way.

I have two points to make. One is that many suggested implications of the balance of consideration are false and do not follow—I am following the same line as the hon. Member for Wyre Forest (Dr. Taylor). The other is that the dilemma of the DGH that confronts us is a legitimate matter for genuine democratic decision and not decision by quango.

To address the first point, delivery in the community, which the Government talk about and most people seem broadly to support, does not mean not delivering in the DGH. The new renal dialysis unit in my constituency, about which I recently wrote to the Minister, will be on the DGH site, which is a wholly welcome development for patients. On the other hand, blood tests have been moved away from the infirmary and into the community clinic. It so happens that the community clinic is right at the end of my constituency, and people must now travel further to have blood tests. That is not ideal.

A district general hospital, as my examples prove, often represents a critical clinical mass where a variety of services can be accessed, cross-fertilisation of disciplines can occur and support services, which are quite important to most patients, can congregate. The clinics, which seem to be the new solution on the block, are the equivalent of the NHS corner shop—and the rise of the supermarket should tell us something about general public preference.

On the second point, patients need no encouragement to seek the best cure wherever they can find it, but ill people have no particular incentive to travel any further than is necessary. Clinicians are another matter. I am worried when the Government say constantly that the matter will all be decided by clinicians; historically, clinicians have been blissfully uninterested in the patient’s journey. The Shields report, which reconfigured my hospital’s services, said that the reconfiguration would involve severe transport problems, but that is simply not a matter for the NHS; it is for somebody else to resolve. I tried to add to the recent Local Government and Public Involvement in Health Bill a clause saying that any consultation about reconfiguration should necessarily also be a consultation with transport authorities, but the Government resisted that proposal.

The wider patient experience is constantly neglected. Consultants’ time is regarded as precious and patients’ as infinitely expendable. We have all had the experience of turning up at an outpatient surgery at 10 o’clock, finding that about 40 other people have turned up for the same appointment and waiting for two hours. Everyone knows that realistically, highly specialist care needs highly specialist hospitals, which cannot be everywhere. Patients in my neck of the woods do not hesitate to travel further for cancer care, for example. However, good secondary medical care should be available in most towns; it should be networked with specialist units and care, and act as a filter and a resource to back up those units. We ought to make a case for district general hospitals being supported by and supporting the local community.

We have to accept that there is a trade-off to be made between clinical excellence and availability. I make my position clear: clinicians and hospital and PCT executives have important advice to offer on how that trade-off is to be managed. Ultimately, however, the matter should be negotiated by local democratic bodies; it should not be the local decision making of which the Government speak, which is essentially decision making by appointees. As the people of Banbury have witnessed, that is profoundly alienating and ultimately profoundly insulting.

Lord Darzi has put PCTs across the country into consultation mode. My worry is that unless something is done about the accountability of decision makers, we may get the kind of consultation that gives consultation itself a bad name. That frustration will be so strong and so marked that it will certainly deny the Labour party any prospect of a fourth term. I listened with interest to the Secretary of State speaking earlier today of increased accountability. He was questioned on the matter, but his responses were enigmatic. In no sense were they precise. It is on that issue that things need to be made clear and changed radically.

I congratulate my hon. Friend the Member for Banbury (Tony Baldry) on acquiring this debate. It is on a subject close to my heart, and those who know me will know that I have been banging on about the future of the Hemel hospital for a lot longer than I have been a Member of the House. For those who do not know, this is my first outing on the Front Bench—a fact of which I am very proud. I am also proud to see so many of my Conservative colleagues here today, along with members of other parties. One of my colleagues said earlier that there was a Labour MP on the Back Benches, but I think that she has to be here; the Minister needs someone to hold her hand. It is obvious that the people of Banbury are not alone. I am pleased that they understand so much about the hospital’s future, and having such an excellent MP to represent them is so important.

The Health Committee, a Labour-dominated Committee of which I am still a member, issued a report not long ago saying that the devastation in the NHS and the cuts in hospitals were due not only to clinical concerns. Actually, there was little clinical argument; in most parts of the country they were the result of financial deficits, due to the Government’s inability to ensure that nearly £100 billion of taxpayers’ money got to the front line.

Lord Darzi may have been handed a poisoned chalice, but the Government want him to try to help them understand better the needs of hospitals, A and E departments and other specialist health facilities. However, he seems to be at loggerheads with his Front-Bench colleagues. For some time—since long before this Government came to power—there has been a push in the NHS for “big is beautiful”. I note that the Secretary of State was recently in Basildon. Basildon hospital has been hugely expanded, but the nearby Orsett A and E hospital was closed to fund it. I know that because I was brought up in that part of the country.

Lord Darzi says that there does not have to be a population of about 500,000, but that it could be as low as 200,000 or 250,000. If so, we have a real concern about what has already happened. So many facilities, not least in Kidderminster and Hertfordshire, have already been closed on the basis that big is beautiful and that we need facilities to deal with populations of about 500,000. I have to say to my hon. Friend the Member for Banbury that this may be only the start; his concern about the closure of maternity units and A and E units is that they tend to be the first of the problems. Sadly, if they go other facilities will go with them.

The clinicians will argue that if there is no consultant-led maternity ward and the hospital could cope with a birthing unit, it will become unsafe. I cite the example of the Hemel Hempstead general hospital in my constituency. Our consultant-led birthing unit was closed, which left those needing the unit with a 12-mile journey to Watford. We were then given a shiny, brand new birthing unit, but 18 months later it was closed because it was not safe.

If we lose acute A and E, what do we lose with it? We are highly likely to lose acute cardiac units—that has already happened in my hospital—and we will also lose stroke units and almost certainly intensive care beds. Then those involved start looking at elective surgery—but what happens if something goes wrong during elective surgery? We need the acute back-up. I hate to be the bearer of bad tidings, but that is happening across the country.

Many hon. Members have articulated their concerns about their areas, and about specialist provision in their communities. They have shown that one size does not fit all. It is not physically possible. We are not talking only about the southern tip of Cornwall or the top of Scotland—even if we could, given that it is a devolved matter. We are talking about community and district hospitals and about acute A and E hospitals across the country, all of which are very worried.

One factor that concerns me is that the public do engage. I have presented petitions, as so many hon. Members have done. Thousands upon thousands of people have signed petitions and marched the streets, some pushing hospital beds. We have participated in consultation. We were asked, “What do you want to happen?” Our comment was, “Leave us alone.” Indeed, 86 per cent. of the consultees in the West Hertfordshire Hospitals NHS Trust consultation said no to closure, but what happened? They closed it.

What point is there in having bogus consultations? Why do the Government lead the public up the garden path by saying that there will be consultation? What point is there in having independent reconfiguration panels if they can do only what the Government tell them to do? There is no point. Anything to do with such specialist areas must be clinically driven. It must be driven by those who know best. Politicians of whatever party do not know best when it comes to the future of the NHS.

I pay respect to Lord Darzi. He is a consultant. He does not know best for the entire the NHS. He is a specialist in a specific area. Even he has admitted that there are areas where he does not have expertise. Why not listen to the clinicians, the experts and the GPs? Hundreds of GPs are writing from West Sussex saying, “Leave our hospital alone.” Why do the Government not listen? Is it not the job of the Government to listen to those who know?

What is a local general hospital? I am greatly concerned that we are leaving the public in a dangerous situation. Those who drive through my constituency of Hemel Hempstead will see signs everywhere saying, “Hospital: A and E”. There is no A and E; it is a minor injuries unit. If those with acute conditions drive there, the hospital will do its best, but the patients will then be transferred by ambulance to the nearest acute hospital, perhaps to Watford. However, if a blue-light ambulance comes from Hemel with a patient who has an acute need, it will go immediately to Watford. It is wrong to allow any trust—or any politician—to mislead the public into thinking that a hospital has certain facilities when it does not. It will cost lives. It is fundamentally wrong.

It is a crying shame that we are not having a general election. If we had had one, a Conservative Government would have led a moratorium on those closures. We would have been able to protect the services that our constituents so rightly deserve.

I congratulate the hon. Member for Hemel Hempstead (Mike Penning) on his appointment and I welcome him to the Opposition Front Bench. I look forward very much to working with him. I thank all hon. Members who participated in the debate. With your permission, Dr. McCrea, I acknowledge the presence of those in the Public Gallery.

I congratulate the hon. Member for Banbury (Tony Baldry) on his success in the Speaker’s ballot and on initiating this debate on the future of smaller hospitals. I know that he will understand that, as he mentioned at the beginning of his contribution, the matter concerning the Horton General hospital is now with the independent reconfiguration panel and I am personally unable to acknowledge those comments. He will understand that I cannot do so because, as was mentioned, we want to take the politics out of the decision making; that is the purpose of what we are doing.

It is a testament to the popularity and success of the NHS that we have such beloved institutions that are held so dear by the people whom they serve. That is a huge compliment to the national health service locally and all the people who work in it, who provide the best possible care for patients. It is obvious from the numbers of Opposition Members who are in attendance today that they are committed to the NHS—to its funding and its structure in its modern format. As a former nurse who worked in the NHS for more than 25 years, it is extremely encouraging for me to see Opposition Members who are so committed to the NHS and its future. I say to the hon. Members for Wyre Forest (Dr. Taylor), for Mid-Sussex (Mr. Soames) and for Wellingborough (Mr. Bone), who were so complimentary, that I am listening; the Government are listening. That is the whole purpose of the review. The hon. Member for Banbury quoted Lord Darzi and what was quoted or rather misquoted in the newspapers. It is important that I put on record what Lord Darzi actually said:

“I have been widely quoted as saying the “days of the District General Hospital are over”. Let me be clear about what I did and did not say. The days of a one size fits all provider, repeated over and over again in a Metropolitan Capital are over. This does not represent the world-class service that a world-class city deserves. However, in my Report I did describe a key role for “Local Hospitals”. This is where the future of District General Hospital lies.”

It is important that we put that matter to bed once and for all and that we accept what Lord Darzi actually said.

When people talk about the reorganisation of services they think that it is about money, but it is not; it is about safety, quality and what is more convenient. That is why the consultation is taking place with clinicians, patients and user groups across the areas that the local health service serves. Lifestyles, society, medicine, technology and the NHS itself have all changed over the past 60 years, and I am sure that all hon. Members would agree with that. Change is certainly nothing new in the national health service. The NHS has always responded to change and the latest treatments by organising itself to deliver that care. We are responding to a variety of drivers for change. The change that we are asking all clinicians, patients and communities to consider is about clinical practice, clinical safety and delivering services to the user in the best possible quality way. It is not about reorganising staff or health authorities.

As a former nurse, I make no apology for why some of these changes are essential. If we do not keep up with the times, services will not keep on improving. Today we are reaping the benefits of new medical technologies and safer surgery, which means quicker recovery times for patients and shorter lengths of stay in hospital. For example, years ago, in cardiology we had to have beds for patients suffering from heart attacks. Patients were kept in coronary care units for two or three weeks at a time and surgery was not possible. We have advanced our surgery and bypass techniques to the extent that we can look into the coronary arteries on a day-case basis and provide a surgical procedure through the coronary artery. We can also now provide drugs, such as statins, to stop cholesterol building up in the coronary arteries. Thousands and thousands of lives have been saved and with the cessation of smoking people can look forward to having a healthier heart and lifestyle. We look forward to that change; it is a massive change. The needs and the way in which we care for cardiac patients will always change. Medicine is and always should be dynamic.

We need to consider the issue of inappropriate buildings. We love our buildings. I for one was brought into the House to save my local hospital, so I empathise with everybody who has come to this debate. That hospital was to be closed and the land sold off. The issue was not about acquiring services locally and nobody consulted the people in that constituency and community about where we could have services. Such a consultation is what is being suggested in the present format of reconfiguration; it is documented that that is how it is being delivered. The Government, Lord Darzi and myself are committed to that process; it is being clinically led. Now we have an independent review looking at some areas in the country. I do not think that we could be fairer than that.

There was a history of widespread hospital closures in the 80s and that is why people fear the existing consultation. Yes, there is mistrust of the past and people would be right to mistrust what happened in the 80s and 90s. They would be right to mistrust a period when people had to collect money for urgent hospital equipment. People do not have to do that today. We have just seen a settlement to the NHS that is 4 per cent. above what was expected. We know that there is a sense of safety in relation to the health service. Everyone of us who represents a constituency has a duty to ensure that that message is put across because the fear is damaging. The hon. Member for Mid-Sussex mentioned the stress of constant change. I recognise that that is not good for staff or for delivering services. I urge managers and those who are conducting consultations to do so in a manner that reduces stress as far as possible.

We have modernised facilities. We have 54 major new hospitals, more than 2,500 refurbished or replaced GP surgeries, 520 new one-stop centres and more than 60 walk-in centres. We are considering every district general hospital and every area that delivers an aspect of the health service, every area that has specialist nurses and every area that has maternity services, which were mentioned today. I ask all hon. Members to debate with the Royal College of Midwives on having a midwifery-led centre that is in fact safe. Midwife consultants are safe. Yes, different measures of maternity care are required and will require different levels of either obstetrician or midwifery-led care, but that does not mean to say that we should not discuss that issue.

When someone takes an ambulance journey, the practice of paramedics means that it is a very different experience from 10 or 15 years ago. That is because of the knowledge of our paramedics. I would like hon. Members to acknowledge the knowledge that paramedics have and the advancements that we have made in waiting times in accident and emergency departments. Patients are expected in accident and emergency on a controlled arrival because their journey has been controlled by many expert paramedics. That is different from what we offered patients some years ago; it is an advancement, and I hope that all hon. Members recognise the difference.

Yes, there is always anxiety about any change. Yes, there are always problems with consultation. Also, it is not easy to get practitioners to change their practice. Sometimes we have to encourage our peer group to accept change. That is not easy, and that is why the wide scope of Lord Darzi’s review includes all staff and patients; not just the top docs, but everybody concerned. The role and expansion of the primary care team must also be considered. The GPs who are the real backbone of our services and who are willing in many instances to look at change would be grateful for the consultation not to be dealt with in a manner that spreads fear because to do so is unfair. Some 60 years ago Aneurin Bevan said that the NHS will always have to change. Aneurin Bevan asked us to look towards the professions and people of responsibility to consider that change.

I thank everybody for their contribution today. I will listen. I have listened. I will go away and consider what has been said, and in the future, I hope that there will be a consultation process that hon. Members and their constituents can accept.