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London Hospitals

Volume 507: debated on Wednesday 17 March 2010

[Mr. George Howarth in the Chair]

It is a pleasure to stand before you this afternoon, Mr. Howarth. I am delighted to have secured this important debate on the vital issue of the future of London hospitals.

London is a world city, but its health care is not world class. It faces extreme health challenges, with the highest rates of child poverty, chlamydia, gonorrhoea and syphilis. It has 40 per cent. of the UK’s tuberculosis cases and 52 per cent. of its HIV cases, the highest number of dependent drug users, and the highest rates of teenage pregnancies. Sadly, London tops the list in many other areas as well.

NHS London has sweeping plans that would monumentally change the delivery of health care in London. Through the local prism what is happening in my sector—the north central London sector—and specifically around the Whittington hospital, I will demonstrate what is happening across London. The proposals are being fought across the capital by all parties. I have no doubt that my hon. Friends and other hon. Members will wish to put their local situations on the record.

Shocking health inequalities exist in London. For example, a man will live seven and a half years longer in Kensington than in Haringey. We have six infant deaths per 1,000 live births in Haringey, against a London average of 4.8 per cent. We desperately need better health care to address such inequalities, and we welcome the fact that a review is under way. However, we are worried about the way in which the review is being conducted, the work that is not being done, the use of wrong and dangerous assumptions, the appalling lack of proper or meaningful consultation with local people, the absence of real clinical evidence and the neglect of key aspects that impact on medical training. Despite such a flawed, unsafe and unsound process, the juggernaut proceeds relentlessly. No proper case is being made that demonstrates that our health inequalities in Haringey will be reduced by the proposals of the north central London sector review panel.

The first news of the potential closure of the Whittington accident and emergency department was revealed in a leaked letter from Rachel Tyndall, who chairs the review panel. That letter was sent to the chief executive officers and the medical directors of all the relevant hospitals in the sector. It proposed four options, each one of which included the closure of the Whittington hospital’s A and E department. It is an understatement to say that there was shock and horror at the possibility, let alone at the fact that no other possibility was proposed. In the public interest, I leaked the letter to everyone I could. How dare it be that that was the first that we in the sector knew of the proposal? In the furore that followed, the letter was hastily withdrawn, and we were told that no decisions had been made, and that various options and scenarios would be put to a public consultation next autumn.

That letter may have been withdrawn, but it showed us the way in which the thinking was going. A strategic plan has now been drawn up by north central, London. Seven draft options affect the Whittington hospital in three different ways. Under scenarios 1, 2 and 3, described disarmingly as the “do minimum” scenario, the Whittington loses in-patient paediatric services, and possibly obstetrics, too. Under scenarios 4 and 5, we also lose 24/7 A and E cover, and under scenarios 6 and 7 we lose A and E altogether.

I should like to talk today about the evidence base. The Minister himself said in debate:

“We need to see strong clinical evidence for any change to the status of the Whittington…unless the case for change is established, there will be no change…I do not see any justification for closure of the A and E at this time”.—[Official Report, 9 March 2010; Vol. 507, c. 171-172.]

I was jolly glad to hear that, as were colleagues across the House, I am sure. There is no clinical evidence at this point in time. Nor is there any evidence that the 45,000 people who could not be treated at any facility other than a proper A and E department could be dealt with by an alternative hospital.

The hon. Lady is making a tremendously powerful case about the situation in her area. Is she aware that in south-east London, a similar situation occurred, and the consultation there was just a sham?

I thank the hon. Gentleman for his comments, and yes, I am aware of that, because I attended a debate last week at which I heard hon. Members from across the House say how poor the consultation had been.

Is the hon. Lady aware that even though a consultation is taking place on cutting A and E and other services at King George’s hospital, which services my Ilford, North, constituency, wards are already being closed? There is allegedly a consultation going on in which people’s views are being listened to, but those responsible are trying to bring about the closures by stealth before the consultation has even finished.

I thank the hon. Gentleman for his intervention. Some of us think that decisions have been made behind closed doors.

I thank the hon. Lady for giving way and for securing this debate. I, like her, heard the Minister’s reply last week, and we have had a number of discussions and debates about the Whittington. Does she not think that it would be in everybody’s interest if the plan to downgrade the Whittington from a district general hospital with an A and E was simply dropped, and we were guaranteed the continuation of the hospital in its current very successful form?

That is an excellent suggestion, but I suspect that it will not be the instant reaction to this debate. I wish that it was.

As I was saying, there is no evidence that those 45,000 people who need A and E services could be treated elsewhere. There is no evidence of a business plan, or of other facilities in the community that could deal with the 40 per cent. of cases that the sector claims could be treated by other means. Moreover, there is no evidence of how people would get to the alternative A and E at the Royal Free hospital.

I have to say to the Minister that the proposal is one of the worst presented cases for change that I have ever seen. That is putting aside the magnitude of the change that is envisaged. There is no case for the closure of the A and E, paediatrics, obstetrics or maternity departments. If a medical or clinical practitioner wanted to make a change in procedures or practice, however small, no NHS trust would allow it unless it was evidence-based. Why on earth should health planners not have to operate to that same standard of evidence? We have reached a point at which the options suggest that the Whittington A and E could be closed without that evidence. Lord Darzi was quite clear that any change had to be evidence-based, and that nothing could or should change until other provision was in place.

I want to move on to the specific issue of the Whittington. First, the review is being carried out under a false premise. North central London bases its review on the premise that 40 per cent. of current A and E visits could be dealt with by other means, such as by GPs out of hours, urgent care centres and polyclinics. Even worse, NHS London says that 50 to 60 per cent. of cases do not need to go to A and E. That figure is false. The Department of Health commissioned a report, “Primary Care and Emergency Departments”, which has just been published; it is dated March 2010. Paragraph 1.2, under the heading “Main findings”, concluded:

“When we used a consistent definition and a consistent denominator of all emergency department cases we found that the proportion that could be classified as primary care cases (types that are regularly seen in general practice) was between 10 per cent. and 30 per cent.”

So it is not 40, 50, or 60 per cent. of people who go to A and E who can be treated by other means; it is between 10 and 30 per cent. Moreover, where there is a high level of deprivation, that figure moves towards the 10 per cent., rather than the 30 per cent. NCL is using data that we now know to be incorrect to support its proposal. Anything that follows that is based on that flawed data is unsound.

I really thank my hon. Friend for the points that she is making. Is she aware that many of the cases where people are identified as possible candidates for treatment in more of a primary care setting can only be put into that category after the person has gone through the high-level testing that is only available in the context of an A and E department? The number is also false from that perspective.

The point that my hon. Friend is making is incredibly important and relates to the problem of the secrecy that we have seen in this area. These assumptions, both in the primary care analysis that she is citing and in some of the financial evidence that we have seen in some of the leaked documents, must be challenged. However, because these documents are being kept secret, the public, Members of Parliament, elected councils and so on cannot scrutinise them properly and hold the people who produce them to account.

I thank my hon. Friend for that intervention and what he says is entirely the case. That is what is so mystifying about the process; why would these people not put these documents into the public domain, so that the documents can be scrutinised and challenged and so that these people can be held to account?

I congratulate the hon. Lady on securing this debate. She and her Liberal Democrat colleagues set the bar in terms of community politics.

Is not one of the reasons for the delay in the process the timing of the general election and the desire not to have a full discussion on this matter, so that voters cannot express their view on it? Is it not disappointing that the Labour party is very happy with the delay? Unfortunately, even the Conservative party proposed in a recent motion in the House that the consultation on the issue should be postponed until it was improved, which would further delay it until after the general election.

The hon. Gentleman makes an excellent point about timing and the general election. I fear that, once this issue is kicked into the long grass on the other side of the election, things will go off the boil and the pressure points will not be quite so powerful.

The hon. Lady is being enormously generous in giving way so often. I need to respond to the comments that were made in the last intervention. The Conservative party’s position on this issue was made quite clear in the debate in the main Chamber that the hon. Member for Croydon, Central (Mr. Pelling) just referred to. It is that these documents should be made public now.

That is categorically our position. Most of the documents are in front of me now and they should be made public now. Then there should be a clinical debate from the bottom up, so that clinicians, GPs and patients, rather than the Department of Health bureaucracy next door in Richmond house, can decide what happens to the NHS in London.

I thank the hon. Gentleman, but I hear from sedentary remarks from my hon. Friend the Member for Richmond Park (Susan Kramer) behind me that that has not always been his view.

Anyway, as I was saying, NCL is using data to support its proposals that we now know to be incorrect, so everything that follows is unsound. I suggest to the Minister that on that basis alone NCL should be sent back to the drawing board, at the very least. Does he agree?

Looking at that statistical base for the Whittington, we now know that, out of the 83,000 people who visited its A and E department last year, 15,000 people were admitted to hospital and a further 30,000 people were examined, tested and released, which relates to the point made by my hon. Friend the Member for Richmond Park. Those 30,000 people could not have been released without first enjoying the facilities and receiving the care offered by a proper A and E department. Therefore, if NCL decides to close our local A and E department and replace it with urgent care centres or whatever, it will have to explain in detail how it proposes to care for 45,000 patients a year who need neither to be admitted to hospital as emergency cases nor to be subject to urgent investigations that are not within the scope of an urgent care centre. That statistic is evidence that our local population need an A and E department at the Whittington.

The aspiration to provide local health care services closer to people’s homes is admirable, but such services are not a replacement for A and E. Moreover, those services out in the community do not exist—they are nowhere near the required standard.

I am very grateful to the hon. Lady for giving way and I congratulate her on securing this debate. I am listening with care to her argument. I just want to be clear about one point. Does she think that there is merit in giving clinicians the ability to have a space in which to discuss what the best proposals are for London?

I am coming on to the issue of whether this process is clinically led or not. If I really believed that the clinicians had been consulted and had a full part in this process, I might accede to what the Minister is saying. However, every member of staff that I have spoken to, at every level of the Whittington, has told me that that is not the case. Based on my conversations with those staff, my understanding is that they are not at all happy with the proposals.

I am grateful to the hon. Lady for giving way again. I just want to be clear on one point. She seems to be saying that if clinicians were able to become involved in this process—I appreciate that she is saying that some of them may not be involved—and there was that policy space, she would favour giving them that space to have these discussions.

I wish that the clinicians had had that space before today. I hope that they will still be engaged, but we would not have arrived at this point if they had been involved in discussions before now.

I congratulate my hon. Friend on securing this debate, and she is most generous in giving way. Does she agree that what is concerning is that financial imperatives are driving the process—they come first—so that even if clinicians are involved, they are tied to dealing with the financial problem?

My hon. Friend makes a good point. One of the fears that stalk us all is that finance is driving the process and that the claim that better clinical outcomes will be delivered is all smoke and mirrors.

I was talking about the 40 per cent. of patients whom NCL say can be treated by other means; in other words, the non-emergency cases that are currently seen in the A and E. But where is the evidence to support that assertion by NCL? Where are the GPs who will field those 30,000 extra cases out of hours? The most recent NHS patient survey found that there is already widespread concern about the performance of out-of-hours services, particularly in Haringey, which is coming off worse than most other parts of London.

Polyclinics are central to NCL’s vision for London, but there is no statistical base on which to judge whether they will work or deliver improved health outcomes. The evaluation of polyclinics has barely commenced. The contract to carry out the evaluation of polyclinics was only awarded in January, and I understand that the specification is still being debated. The King’s Fund report, “Under One Roof: Will polyclinics deliver integrated care?” is sceptical about polyclinics. The report argues that

“a major centralisation of primary care is unlikely to be beneficial to patients”.

The report examines polyclinics abroad, as well as health centres that were created under the local improvement finance trusts. Dr. Laurence Buckman said:

“The report provides scientific, logical and international evidence that polyclinics won’t deliver the things the government believes they will”.

Is the Minister concerned not only that there is criticism of polyclinics but that, as yet, they have no evidential basis? There are no data sets and no proof that polyclinics will deliver beneficial outcomes, yet we already have draconian proposals. Moreover, a Department of Health spokesperson has said that it was not policy to impose polyclinics outside London. So will the Minister say whether it is policy to impose them in London?

I wonder whether the hon. Lady has found any confusion among her constituents about what a polyclinic is. Many people do not understand the term, and if they had something wrong with them, they would not be clear whether they were supposed to go to their GP, to A and E or to a polyclinic.

I am not sure that the clinicians or health powers, let alone ordinary people in my constituency, understand what a polyclinic is.

I thank the hon. Lady very much for giving way, and I congratulate her on securing this debate. Although there is consultation, the Government are insisting on a lot of these changes. Does she therefore agree that the primary concern is the morale of the ordinary staff? The ordinary doctors and nurses are already under pressure, and this process certainly does not help.

Indeed. That is why openness, accountability and transparency would be extremely helpful. I will now make progress, because other Members want to speak.

Urgent care centres are also central to NCL’s vision for London. Data suggest that Government plans to replace A and E departments with new urgent care centres run by GPs and nurses could actually swamp existing practices with unresolved cases. One of the first urgent care centres in the country to open is sending up to 40 per cent. of its patients back to their GPs. Such new centres are being developed as a gateway to emergency and urgent care, in a bid to free up A and E departments. However, GPs’ leaders have attacked those plans as lacking an evidence base. That follows a recent warning from the College of Emergency Medicine that it had “serious concerns” about urgent care centres, which it said were being imposed for reasons of cost and without evidence of “clinical or financial benefits”.

I now want to talk about the need for A and E, because why would anyone go to A and E if they did not need to? The answer is that the Whittington is situated in one of the most socially deprived areas in the United Kingdom. Many patients are not registered with a GP; many of them are probably not registered in this country. Many people who are not registered with a GP cannot get appointments. People get sick out of hours. Many people do not speak any English and many people are elderly or infirm. A and E staff know that, when people who are so disadvantaged get ill, they wait until their symptoms are extremely bad before they see a doctor. Consequently, when they present themselves, they are at a critical stage in their illness and need urgent care. The Whittington is there to give it to them, but they must go to A and E first.

Moreover, the north central sector is culturally and ethnically diverse. The 2001 Haringey census said that 51 per cent. of the population came from black and ethnic minority communities. That is important for health care, as many people from black and Mediterranean backgrounds can be affected by sickle-cell anaemia and thalassaemia; the Whittington hospital treats more people with those conditions than any hospital in the country. Access to A and E is essential for them, as those who go into crisis need urgent and appropriate attention. That is evidence that the Whittington A and E is vital.

Why damage University college London medical school? It is world-class: fifth in the UK, first in London and 20th in the world. If we want to make London a world-class city, what on earth are we doing destroying one part of it that is already world-class? Some 33 per cent. of UCL medical students are on the Whittington campus. The hospital is central to the university. We cannot teach the doctors of the future without A and E. If it goes, education at UCL medical school will be thrown into crisis, because students there cannot be pushed over to the Royal Free hospital or University college hospital. Where is the evaluation work on that aspect of the proposals? Does the Minister share my concern about what closing the A and E will do to the overall standing, status and education of our doctors of the future?

Why damage Middlesex university? It may be less well known, but the Whittington is also a key partner in that university, which teaches nurses, radiographers, dieticians and physiotherapists. The Whittington cannot function without those professionals, who work with the hospital in teams, and they cannot be taught without an A and E. If the hospital closes, that will all fall apart like a house of cards.

Why damage a hospital of national excellence? In national comparisons of hospitals, the Whittington has consistently performed superbly. In October 2009, the Care Quality Commission confirmed the Whittington’s good quality of service and excellent financial management. In November 2009, the Dr. Foster quality accounts, which rank every hospital in England, identified the Whittington as one of the safest hospitals in the country, giving it an overall rating of 21st out of 145. That is all evidence-based.

We are told that the situation is all about improved clinical outcomes and that it will be good for us. The sector points time after time to stroke and trauma specialist centres as evidence of improved outcomes. Those emergencies are relatively easily diagnosed, and we know that early intervention is critical and can make a difference. The problem comes when NHS bosses extrapolate from that across the A and E health spectrum. It is a complete red herring, as the vast majority of A and E patients do not present with clear symptoms; that is the whole point of A and E.

The volume and nature of cases currently arriving in our A and E departments demand that 24/7 A and E be continued on safety grounds. No one, least of all NHS London, has produced evidence of health care benefits to support the proposals. I have not met a single local person who does not think that closing the A and E is sheer madness.

To me, and seemingly to the entire population of Hornsey and Wood Green, the clue is in the title “emergency”. That means nearby, local and accessible, not only by ambulance. At no point when developing options has the sector team made proper use of the information it already holds or can access on the location of service users, the location of users of specific forms of delivery and delivery locations, users’ social and ethnic make-up and the accessibility of existing and proposed new delivery systems to public transport service users.

Using Google, the Highgate Society researched journey times from a wide number of postcodes where users would normally access the Whittington, and what those journeys would look like if those users had to transfer to the alternative A and E at the Royal Free hospital. Journey times for all but four of the 23 postcodes sampled were longer by up to 40 minutes. On the Transport for London route planner, Crouch End Broadway—not the most difficult part of my constituency from which to access the Whittington—is 21 minutes from the Whittington but 50 minutes from the Royal Free hospital and 39 minutes from UCH. The journey involves a bus, two tube lines and a six-minute walk at the end.

On that basis alone, any proposal to send A and E cases to the Royal Free hospital would threaten health outcomes, not improve them. In addition, the Royal Free hospital is already under pressure, with 90,000 cases of its own. It is on a confined site to which access by public transport is terrible. Parking is impossible, and even the London ambulance service does not like going there.

On finance, the Minister said in an Adjournment debate on 2 December:

“I have made it very clear to managers in the NHS that there should be no slash-and-burn cuts”.—[Official Report, 2 December 2009; Vol. 501, c. 1257.]

At the same time, NHS London is saying that savings of £355 million a year until 2017 are being required of the acute sector of north central London. Can the Minister confirm that? Have the Government made any other requests in terms of reducing costs or lowering funding?

The hon. Lady is being generous in giving way. To make it clear, we are seeking savings in order to reinvest them in NHS facilities. It is not about taking money out of the NHS; it is about finding savings within the system, particularly from back-office processes, to reinvest in front-line health care. The money will stay in the NHS.

I understand about seeking savings from back-office amalgamations across the deal, but the complexity of the new arrangements often eats up any savings made from the merger in the first place.

The 82-page “North Central London NHS Strategy Plan 2010-2014” barely touches on funding issues. At no point when developing the options does the team appear to have accessed information from the NHS regarding the unit costs of delivering different classes of service to service users, the aggregate costs of different service delivery units, the current account costs of disruption while personnel are reconfigured into new locations, teams and specialities or the capital costs of closing some facilities and opening others. Until those costs are known, it seems somewhat unprofessional not to include, at the very least as an option, leaving the current configuration as it is. For all we know, that might yield the best savings.

Nor has any serious analysis been made of how required savings will be found while improving quality of service, what savings might be garnered from the change to urgent care centres and polyclinics, how much it will cost to reconfigure services or what the potentially huge costs will be of re-engineering the Royal Free hospital and improving access for the London ambulance service, which would have to make an additional 120 journeys a day.

The report says nothing about where the resources will come from. There is no evidence that health care will be improved by any of the measures that I have mentioned. I have seen no work on what cost-benefit might be attributed to the well-being that a patient derives from being in a hospital near home, relatives and friends.

We in Hornsey and Wood Green are extremely cynical about consultation. Does the Minister agree that the much-vaunted public consultation by NCL, which comprised 80 people from across five boroughs, was derisory? It cannot possibly be considered of any value to consult 80 people from five boroughs. At no public meeting has any research been quoted regarding user preferences or user satisfaction. That is wholly contrary to practice in the commercial sector and the Government’s own guidelines on personalisation of public services. Collecting satisfaction data through diverse contact points should be a routine element of the management of service delivery.

At the public meeting I organised, which nearly 400 people attended, one questioner asked what would happen if everyone opposed the proposal to close the A and E. Richard Sumray, chair of Haringey PCT, refused to say that it would be enough to stop the process, answering that he could not say what would be in the consultation. No wonder we are cynical. Perhaps the Minister will be more direct. What volume of opposition does he consider necessary before he would be willing to uphold the wishes of local people?

In an answer to my early written questions to the Minister about the issue, I was told that it was a matter for local decision making. As a Liberal Democrat, I would love it if it actually were local decision making, but it is not. My hon. Friend the Member for North Norfolk (Norman Lamb), who leads on health for the Liberal Democrats, said in response to the Minister’s assertions that such decisions were local:

“Who are these local decisions taken by? They are taken by people who have no legitimacy; they have been appointed nationally, so there is no accountability to the communities”.—[Official Report, 9 March 2010; Vol. 507, c. 181.]

We want to be able to hold such organisations to proper account. We will oppose any loss of services imposed by unelected, unaccountable quangos. Such decisions should be local and determined openly and transparently by democratically accountable bodies. If it was up to us, we would simply stop the process dead in its tracks until that happened.

In conclusion, the process is critically flawed, untested, unwanted and dangerous. Does the Minister agree with me that time, energy and resources would be far better spent in finding ways to keep the Whittington A and E, paediatrics and maternity services open if local people want them, and that we should focus on delivering the health care that local people need, want and deserve?

Order. A number of people are trying to get in. I intend to call the two Front-Bench speakers for the winding-up speeches—[Hon. Members: “Three.”] Yes, at 3. Hon. Members who catch my eye and contribute to the debate must be as brief as possible to enable as many people as possible to speak.

It is good that we are discussing health, not education or maths. I will be brief, Mr. Howarth.

I congratulate the hon. Member for Hornsey and Wood Green (Lynne Featherstone) on securing this debate. She rightly concentrated on the local issues facing the Whittington hospital, which is in my constituency and serves many neighbouring areas. I will say a few words about it and make a couple of general points. I will be as brief as I can because other hon. Members wish to speak and it is important that they do.

We debated this matter in the House last week, and I secured an Adjournment debate on the Whittington hospital not long ago. The Minister has acknowledged that he is fully aware of the huge strength of local feeling from all sections of the community, all political parties and all leading opinion formers in the relevant boroughs of Camden, Islington and Haringey on the plans for the Whittington hospital and the north London area. There have been two public meetings in my constituency with an aggregate attendance of about 700 or 750. The hon. Lady held a meeting attended by 400 people and 5,000 people attended a public demonstration in March.

On the march, all sections of the community, all ages and a huge variety of political opinions were represented. There was a genuine feeling of support and affection for the local hospital, and a feeling that the way in which the NHS operates is not accountable to the public, local representatives or anybody else. I am sure the Minister sometimes feels that decisions are made in the NHS without the degree of accountability that there would be in a local authority. There is no feeling that those who make the decisions will be held to account for what they do. That sense of frustration is behind a great deal of what is being said and done locally.

The health situation in my borough is difficult. It is not the most prosperous part of the country, despite what the media and popular press say about the Islington lifestyle, with the restaurants, coffee bars and the pine furniture around Tufnell Park.

Well, in my area, we are talking about Labour voters. My point is that the borough is one of the most deprived in London, and is therefore one of the most deprived parts of the country. Its image belies a great deal of poverty. The same can be said about most parts of London, which is an interesting microcosm of the world in that rich and poor live side by side and there is desperate poverty alongside huge personal disposable wealth.

I thank the Government for recognising since 1997 the link between poverty and ill health. As Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) recognised the importance of putting more money into deprived areas, putting more effort into improving public health through anti-smoking campaigns and obesity campaigns, giving instant cancer treatment where possible and all the other improvements that have been introduced. There have been tangible improvements: the death rate, the infant mortality rate and the instance of many notifiable diseases have done down as a result of those campaigns. They have gone down everywhere, although not anywhere near fast enough.

We still have huge problems with alcohol, substance misuse, teenage pregnancy, hypertension, obesity, cancer and heart disease. There are a series of issues to be dealt with. Improving people’s living standards, housing conditions, diet and health knowledge are key in improving the health of the nation. I am sure there is common ground on that point. It is also important that we have a national health service that is fully accessible.

I have been the Member of Parliament for Islington, North since 1983, an elected representative in Haringey or Islington since 1974 and have been in and out of the Whittington hospital on hundreds of occasions. I know the place very well and I know many of the local health services and facilities very well. We have been through difficult times: parts of the Whittington hospital have been closed, various wards were closed because of funding crises in the 1980s and early 1990s, and we have been through a desperate shortage of GPs. Those things have changed and the health service has improved—I am the first to recognise that.

I have read with great interest the plans for changes in health care in London. Obviously, we want everyone to go to a local health centre where possible and to be treated and dealt with appropriately. We all want a better public health system. I have here a copy of the weighty north central London strategic plan. It outlines the kind of changes the health authorities want to develop. I agree with the hon. Lady that the plans seem to have been developed behind closed doors by planners without obvious signs of clinical support from anybody. That is the point I make to the Minister.

Hordes of GPs have not been telling me that they want the Whittington hospital to be downgraded, that they want A and E facilities to be concentrated at University College hospital and North Middlesex hospital, or that other matters should be transferred to regional trauma centres. I have not come across that, but I have come across professors in various departments, surgeons, consultants, administrators and many others who have the deepest concern about what is going on and want transparency and openness in the process. They correctly feel that if the Whittington A and E department is closed, the large population of 80,000 people who use it every year will have nowhere to go. That compares with 70,000 people who use the Royal Free, 100,000 who use UCH and a large number who use North Middlesex. If the Whittington A and E department closes, there will be no A and E department in the boroughs of Haringey and Islington.

The former chief executive of Islington primary care trust, who is now chief executive of the north central health authority, said that there would be waking-hours surgeries in place of the services that are lost. That conjures up the image of people ensuring that they have heart attacks before 8 o’clock at night because after that they would have to go somewhere else. People are given the illusion that there is an A and E department when it is not there all the time. In my book, either there is a blue-light 24/7 department or there is no A and E department at all. I hope that the Minister will acknowledge that. I am sure he understands the point I am making.

The consultation was not due to start until the summer. I had an Adjournment debate in the House, which provoked flurries of letters from people in various parts. We had the demonstration, which provoked a statement on the NHS Islington website acknowledging that a large number of people were upset about the proposals and inviting further comments. That was good, although it is a pity it did not happen some months before. I understand that some kind of consultation is going on today, although I am rather unclear about who has been invited to it or how they got invited.

It is simply not good enough to take a semi-secret approach to developing plans and to spring them on the public at a later date; local people’s wishes are out in the open now. I have no problem whatever with improving GP services, and I have no problem with developing regional trauma centres, because I can see the sense in high-quality treatment for people with serious, major conditions, but such things should not be an alternative to an A and E department.

I am told that, behind all that, the proposals are all to do with saving £500 million from the north central area health authority budget. I do not know where that figure has come from; it has not come from the Minister or the Treasury, and nobody, as far as I am aware, says that a Government source has said it is the figure we must work from. Somebody somewhere is second-guessing the future, deciding what the expenditure will be and developing plans to fit in with it, and that is not good enough.

We live in a democracy, so we expect public officials to be accountable and public services to be developed in the public interest. As elected Members of Parliament, we expect those responsible to make their plans open to the public, just as elected councillors would expect local authorities to do. We expect the public to respond to the plans and we expect that decisions will ultimately be made, presumably in Parliament. However, it sometimes seems to me, as a local MP, that we do not really know what is going on and that the secrecy applies just as much to MPs as it does to anybody else.

Whatever the outcome of this process, I hope that the big lesson learned across the whole of London is that we want much more effective accountability for how the NHS plans and develops its services. The development of borough scrutiny committees is a good thing, as is the development of borough to local PCT scrutiny in cases where boundaries are coterminous. Such things work well, but we also have regional groupings in London, which have no parallel scrutiny whatever, unless all the local authorities—five in this case—successfully get together to set up a wider scrutiny arrangement. So far, that has not happened, although there are suggestions that it might.

I am proud to represent my area in Parliament. I am proud of the work that has been done at the Whittington hospital. I am proud of the amount of money that has been put into the hospital over the past 10 years—the new wards, the new facilities, the new equipment and the increased staff numbers. The hospital has a very good performance record on treating casualties, on maternity, on the children’s A and E department and on all the specialties that go with that. If the A and E is closed, however, the hospital is dead, because it will not be a general hospital any more.

I appeal to the Minister to look carefully into this issue. If there is some way in which he can intervene and say, “We are not going to destroy this valuable A and E department and, with it, the hospital,” I would be very happy. Above all, however, tens of thousands of people across north London, who do not have access to cars and who cannot easily go to a local hospital because there is none, will feel a lot happier and a lot more secure. We have a rising, increasingly young and diverse population, and we have a yawning gap between the rich and the poor. The NHS is our NHS, and it should be accountable to us, not anybody else.

It is a pleasure to follow the hon. Member for Islington, North (Jeremy Corbyn), because we have similar problems in south-east London. If the A and E at Queen Mary’s, Sidcup, is closed, Bexley will be the only borough in the area with no A and E.

I congratulate the hon. Member for Hornsey and Wood Green (Lynne Featherstone) on securing the debate. The issue is of real concern across the whole of our capital city. In my part of south-east London, the health care trust is amalgamating three hospitals—the Princess Royal University hospital in Bromley, the Queen Elizabeth in Woolwich and Queen Mary’s—for financial reasons, not for reasons of clinical need. The Minister is well aware of the problems in my area, although he does not take them on board. Often, he just trots out public relations spin. His response in last week’s debate was rather regrettable, because he did not deal with the concerns of people in my area. There are four key issues. I will be brief, Mr. Howarth, in view of your strictures on getting as many people as possible into the debate.

I feel that I need to interrupt the hon. Gentleman, because I was not spouting spin, as he put it. I criticised the Conservative party for having absolutely no policy of any seriousness on the NHS in London other than that of taking budgets from GPs. That is just an abdication of responsibility, and that is what the hon. Gentleman did not like to hear.

That is absolute nonsense. I was raising the position in south-east London, which the Minister will not address with any vigour, although he should. That is lamentable.

There are four issues: accountability, consultation, secrecy and the adequate provision of health care—all issues that concern my part of south-east London. On all counts, the Government, the Minister and the people in NHS London making the decisions following the setting out of the Darzi vision, or whatever it was called, have been found wanting.

We recently had a letter from Ruth Carnall suggesting that polyclinics were the answer, and that a polyclinic would go on the site of Queen Mary’s, Sidcup. As we know, Labour is downgrading the hospital’s A and E and its maternity and children’s services, and there are real concerns about that. There was recently an outbreak of norovirus at a nearby hospital, which forced the hospital to send more A and E patients to Queen Mary’s. If Queen Mary’s did not have an A and E, where would such patients go? That is a real concern in my area. Under the provisions, people will have to travel further to access emergency care.

I very much regret the proposal to have a polyclinic on the site of Queen Mary’s. As the hon. Member for Islington, North, said, once we start downgrading services, a hospital is no longer really the proper hospital that people in our areas need, but a local facility. I commend the hon. Member for Hornsey and Wood Green on her exposition of the situation in her area; that situation is, regrettably, replicated in mine.

Since the introduction of the Licensing Act 2003, which allowed 24-hour drinking, the number of hospital admissions due to acute alcohol intoxication has doubled, and the number of admissions wholly attributable to alcohol has increased by 70 per cent. That, too, is having an impact on A and E, particularly during the night, when, under the proposals, hospital A and E departments would not be available to take people in, as the hon. Member for Islington, North said.

I am really concerned that we are rushing through changes without sensible thought, consultation and discussion. I have respect for the Minister, and some of his work has been commendable, but he is, regrettably, blinkered on this issue. He will not look at the whole issue of secrecy and consultation. The proposals for change in my area are not clinically led, but financially led, because Queen Mary’s, Sidcup, is the only hospital in the group that did not come under the private finance initiative. Why have the costs for the PFI-funded Queen Elizabeth hospital in Woolwich spiralled to £799 million, when the building’s estimated cost was £96 million? That issue also needs to be looked at. I am really concerned that we are reducing the number of hospital beds across most of the capital, and particularly in my area, when increasing numbers of patients are seeking A and E treatment, and when numbers of emergency admissions are rising.

If an open consultation had taken place, a different decision would have resulted. As in the case mentioned by the hon. Member for Hornsey and Wood Green, there was a consultation, but as I said in my intervention on her, it was a sham, because the decisions had already been made before the consultation took place, and the Minister must take that on board. It appears that the decisions taken were those proposed in the first place. We had four alternative proposals, but one of them—keeping Queen Mary’s, Sidcup, open—was not on the agenda.

So we did not have a proper consultation at all in our area on the future of our local hospital. I very much regret that an issue so critical for the whole of London is being quickly swept under the carpet so that the Government can move on without considering patients’ needs, real care and the availability of services in the area. Of course we welcome the opportunity to have dialysis and cancer treatment services at Queen Mary’s, Sidcup, but not if that is at the expense of a valuable, vital local service. If that is lost, we shall not get it back, and the patients will be the ones to suffer.

The debate so far has been useful. I hope—I beg—that the Minister will consider my area, and that he will not give the party political line that he did when he intervened on me, but will consider the issues of patients and care, and the concerns about secrecy, accountability and consultation. I ask him to respond to those issues—I know that he can, as an honourable chap—for the sake of people in my area who feel that the Government do not care.

My arithmetic suggests that I have three minutes and 20 seconds. It is important for me to take part in the debate; I feel that I owe my return to good health to the NHS. There is great loyalty to the NHS, and all parties will reflect that.

The consultation process is a matter of concern. We often had debates 30 years ago about how the ability to influence education was a secret garden. In some ways, perhaps that is applicable to the consultation process that we are considering, which has in many ways already taken place internally, within the NHS. We political representatives are sceptical and wonder whether decisions have already been made. As the hon. Member for Hornsey and Wood Green (Lynne Featherstone) said, people probably feel “consulted out”; they are consulted, but that is an empty process.

That feeling that the process is an empty one is highlighted by the way in which the Government seem happy for the issue to be delayed until after the election. The Opposition Front-Bench spokesman may think that I am being irksome, but I was surprised that, in the motion that went before the House, the Opposition suggested that there should be a delay in the consultation until the proposals that were being pushed forward were cancelled. It would be unfortunate if that led the Conservative party to say that there should be a delay until after the election. It is important that the consultation should happen as part of the election process; that is the real empowerment of electors.

The debate would be helped by a realisation that the work done by Lord Darzi relied on quite a small database to justify the centres of excellence approach. In many medical matters, it is much better to be treated quickly by a medically qualified person than to be taken miles across busy suburban London to be treated.

I now come to how we could inform the debate, given the suggestion that there is to be a significant change in provision. It was not the case when I was at Oxford, but students these days are often required to include academic references when they make certain propositions. The Government seem not to be doing that. They are not willing to publish the McKinsey report, but even Labour Ministers and Members are calling for it to be brought forward. There have also been freedom of information requests. Will the Minister of State say now that the report can be published?

Many of us have copies of the proposals, which we have been given in confidence. Bearing in mind that they have now been widely circulated, is it not best for the Minister to give the London NHS some guidance? Please may we now be allowed formally to publish the proposals, so that the quality of debate can be higher?

The hon. Gentleman makes a good point. We had an Opposition day debate last week; perhaps there could have been better communication after it, but nothing has really happened as a result of raising those concerns.

That is an excellent point, and I am sure that other hon. Members have excellent points to make, so I shall finish my remarks there.

I congratulate my hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone), who is an excellent campaigner for her constituents on this issue. What is happening in the area that she and the hon. Member for Islington, North (Jeremy Corbyn) represent should be a warning to the rest of London about what could happen if we do not campaign cross-party and work against such threats, and for greater openness.

This is the third debate in the past two months in which my hon. Friend the Member for Richmond Park (Susan Kramer) and I have argued the case against the threats to Kingston’s accident and emergency and maternity services—and, indeed, its in-patient paediatrics, and potentially its elective surgery services, too. I make no apology for wanting to speak on the subject again, because yesterday we took a petition of more than 15,000 signatures to Downing street to try to make our points to No. 10.

We want to keep raising the issue for three major reasons. First, when we raised it initially we were accused by our political opponents of scaremongering. The evidence that we have now heard from hon. Members across the House is that that is not true. I wish that those who made the accusation would apologise, so we could get on with the campaign and work in a cross-party way in Kingston.

Secondly, as the hon. Member for Croydon, Central (Mr. Pelling) said, the documents that set out the detail of what is going on need to be put in the public domain. My hon. Friend the Member for Richmond Park and I have benefited from leaks from senior NHS people, which we have made public. We have put them on our websites to show the sorts of threats that are faced in south-west London by Kingston hospital, Mayday University hospital in Croydon, and St. Helier hospital in Carshalton. They are clear about those threats. We have heard that there is much more: we have heard about the McKinsey report, and those documents should be put in the public domain. My hon. Friend the Member for Richmond Park has tried 57 freedom of information requests, but the Government and various elements of the health service refuse to publish the documents. The Minister should put his foot down today and show leadership. He should ask NHS London to publish those important documents.

We also need to make things clear to the public. The consultation timetable in many areas is relatively short. My hon. Friend the Member for Richmond Park and I attended a briefing with two senior NHS executives last week, and they talked about putting their shortlist of closure proposals into the public domain in October, with the formal consultation concluding by next January. Those things are upon us. The assumptions behind the work and the proposals that are to come out in the autumn are already there, but we cannot challenge them. As I have said, some of those assumptions deserve to be challenged, because they are flawed.

The third reason why I want to keep arguing the case is the excellent services at Kingston hospital. I have said from the start that it is unthinkable that they should be closed, because they are so good, whether that is judged by reports from independent groups such as Dr. Foster, or by NHS inspectors. It is not that we resist change. In my area—at least on the Surbiton site—polyclinics are being introduced not to undermine the hospital, but to support health services locally. The polyclinic that is proposed for Surbiton hospital is really an excuse for us locally to put modern investment into the site; it will not replace services at Kingston, but take some of the excess pressure from it.

The number of attendances at A and E goes up year by year, and that is very difficult for the Kingston site. With a rebuilt polyclinic on the Surbiton hospital site, we can get better GP premises and more investment in primary care services. That makes sense and would work if we kept Kingston hospital. Kingston hospital’s chief executive and board are happy with the proposal for the polyclinic at Surbiton hospital, and see it as something that could improve their services. I accept that things may be different elsewhere, because all areas are different, but the polyclinic on the Surbiton hospital site could support the future of Kingston hospital.

Other hon. Members may want to contribute quickly, so I shall keep my final remarks short, but I want to question the Minister. He says that the proposal should be clinically led, and we wish it was, but clearly it is not. It is financially led. In all the documents that we have seen, and at all the meetings that we have held, the arguments have not been made on a clinical basis at all. They are very different from the arguments made for centralisation of stroke and cardiac provision, or for polyclinics. The arguments in this secret exercise are not clinical, and it is about time that the Minister faced up to that.

I shall use my minute as best I can. It is a shame that we have to rush these things, because the issue is obviously of great importance to everyone in London. I notice from the annunciator that the business in the main Chamber seems to be about to finish. It is a shame that three hours will be wasted there, when we could be discussing this matter in the main Chamber.

When we have these debates, it becomes very clear that our hospitals in London are much loved and much used. Yes, there will sometimes be criticism—we all have criticisms that something has gone wrong here and there—but our hospitals are much loved and much used.

There have been some excellent speeches, and I agree with everything that has been said, but one thing we must think about is whether we are dealing with the issue from the viewpoint of what people want. In other words, we want to keep the good local hospitals we have, and we should be considering how we can maintain them, not how we can get rid of some of them. I have no problem with the concept of stroke and major trauma departments going to specialist hospitals, but I do have a problem with accident and emergency and possibly maternity departments disappearing from all those hospitals—regardless of where they are in London—because once they go, the viability of that hospital will go.

I say to the Minister that we know what our constituents want, what we want and what the country wants. We and the NHS have a duty to try to continue to use the hospitals we have. It is no good trying to cover the issue up in some way and saying that it is a wonderful exercise, because that simply will not wash with the general population.

I echo the remarks of the hon. Member for Uxbridge (Mr. Randall): we need more time to debate the issue properly, so that the expressions of concern can go further and we can dwell on the detail. An awful lot of detail needs to be challenged and, frankly, exposed. I congratulate my hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone) on securing the debate, and all hon. Members who have taken part.

The speeches made today have demonstrated the clamour among local communities for greater accountability. There is a demand for full disclosure and an absolute belief that we should have genuine, robust public consultation that is not just about rubber-stamping an outcome, but about influencing an outcome, so that people feel some ownership of the decisions that are being made. None of that is happening in the processes that hon. Members have described today. Undoubtedly, that is driving their concerns about the real threats that are articulated in documents, such as the one from Kingston. Such threats would lead to the closure of A and E departments and maternities around London.

My first point is a local one. I thank the Minister for the very engaging and engaged way in which he has taken forward the outline business case for investment in a patient wing at St. Helier hospital. My hon. Friend the Member for Carshalton and Wallington (Tom Brake) and the hon. Member for Mitcham and Morden (Siobhain McDonagh) also appreciate that. It has demonstrated what Ministers can do when they engage with strategic health authorities and local NHS organisations. That leads us to ask why the same thing does not appear to have happened in relation to the wider genuine concern welling up in communities around London that the processes of consideration—dressed up in clinical language—about how to make the books balance are about to lead to deep and damaging cuts in services.

The clinical language itself shows the falsity of the approach. There is talk of a 70 per cent. reduction in A and E visits and a 30 per cent. reduction in visits to GPs. Surely that is just unobtainable.

That is a fair point. One of the frustrating things is that Ministers understandably tell us that decisions about budgets and how services are organised are local decisions. My hon. Friend the Member for Hornsey and Wood Green and others who have contributed to the debate pointed out that, therefore, the argument is made that Ministers are not directly accountable for those things. Yet how can we have genuine local accountability when primary care trusts are made up of people who are nationally appointed and who are largely, if not entirely, unknown by the communities that they are meant to serve? As a consequence, PCTs cannot offer genuine and meaningful accountability for the choices they make about the allocated resources that they are spending.

A good example is the £150 million that was trumpeted by the Minister of State, the hon. Member for Corby (Phil Hope) to pay for respite breaks for carers. Hon. Members were challenged to go back to our PCTs and dig out the figures. It was impossible to find those figures; many PCTs were reluctant to provide them. The same is true when it comes to the proposals for the reconfiguration and reorganisation of services. We are finding that it is difficult to get the detail on to the public agenda and out into the public domain, so that people can start to ask meaningful questions.

My hon. Friend the Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats on these issues, is genuinely concerned about the lack of accountability and transparency surrounding the whole process. After reading last week’s debate and the exchanges between the Minister and my hon. Friend, I am led to ask whether the Minister or his ministerial colleagues have authorised the processes that are going on in London. Is he aware of them in any detail, and can he say what the strategic health authority, which he oversees, is telling him about those processes and what the timetable is? Alternatively, is the Minister being kept in the dark like the rest of us? Have NHS managers gone AWOL and decided to take control of the matter, as seems to be suggested in the NHS Confederation pamphlet that came out this week. That document states:

“The NHS cannot and should not wait for government action to respond to the financial challenge.”

Have we lost political control of the NHS and, therefore, accountability for it? Will the Minister give us some reassurance that he and his colleagues are still ultimately accountable and in charge? If not, and if we are simply constantly reassured that clinicians are involved in the process, my hon. Friends and I fear that clinicians are being held hostage to a process that is about budgets. That is not good enough. Yes, the process should be clinically led; but, it has to be clinically led solely on the basis of clinical judgments. Even when the process is carried out on the basis of clinical judgments, the public deserve the right to be able to test the assumptions. That is what has been missing until now; we need the ability to test the assumptions.

As was mentioned by the hon. Member for Croydon, Central (Mr. Pelling), requests were made for the publication of the McKinsey report in exchanges last week. The Minister indicated that Ruth Carnall, chief executive of NHS London, would, of course, be listening to the debate and would act on the basis of what she had heard. As has been said, in the week since that debate, nothing has been published, nothing has been said and nothing has changed in relation to the nature of the process that is going on. That report should have been published. Although the Minister may feel unable to instruct, I hope he will ask NHS London to put the report into the public domain, because we ought to have the opportunity to see what it has to say.

This is an important debate about the very essence of what we should expect of a public service. Such a service should be open and transparent, so we need full disclosure. Those involved should understand that consultation must be held at a formative stage and that it is not just an end-of-process thing done to tick a box before implementing what they had decided would be done anyway. Such a service should be accountable to us in this place and, more important, to those who send us here. It should be accountable at the ballot box; it is not now, but it needs to be in the future, as that is the only sure-fire way of ensuring we have an NHS that people are confident in and that will deliver the services we demand.

As other Members have said, it is a pleasure to take part in a third debate on the future of NHS London. I reiterate the comments commending the hon. Member for Hornsey and Wood Green (Lynne Featherstone) for securing the debate. I also commend her for the tone in which she made her speech on behalf of her constituents, which was eminently sensible.

Like many of the discussions we have had on the subject, this debate is about trust and whether people can trust us as politicians and the Government to produce for them the health service that they deserve in the 21st century. The NHS has £110 billion of taxpayers’ money, but can people feel safe that the NHS around them is free at the point of delivery and that their needs and those of GPs will be understood?

The Minister has said today and on several other occasions that the reviews are being clinically led. He said that because the public trust clinicians a lot more than politicians. That is eminently sensible. However, the truth is that the process is not being led by clinicians.

The debate started with Lord Darzi’s earlier report on his vision for the future of the NHS in London. I spoke with him before he became a peer when he was an adviser to the Health Committee, of which I had the honour of being a member. He is a highly intelligent and highly skilled surgeon, but when I pushed him on his report bits of it started to flake off, because it was a vision. When he gave evidence to the Committee on the report we asked him how much of the estate in London would go under his vision, but he gave no answer, even though I pushed him extensively.

We have not spoken about the fact that 15 per cent. of the NHS estate in London is currently sitting empty. That is where some of the savings could be made tomorrow morning and where some income could come in straight away. I know the economic climate out there is difficult, but instead of leaving the estate to become even more decrepit and for some developer to come along, let us be forward-thinking about it.

I am afraid that the clinician argument is fundamentally flawed, which is shown on page 3 of NHS London’s document “Delivering Healthcare for London”, the whole premise of which is the shortfall in funding. Several assumptions are made in that document, the final one being that there will be a shortfall of between £1.5 billion and £1.7 billon in 2016-17. I have no confidence in the document, because when one reads it one finds that it is not only fundamentally flawed in its assumptions, but flawed simply in its maths. It assumes funding growth of 2.3 per cent., but that figure is actually a cut of 2.3 per cent., because the minus sign has been left out. That does not give my constituents, or any others, much faith.

I mention my constituents because we have always come into London for specialist services. With the demise of some of the hospitals in my area, it is obvious that more and more of those services will be required in London.

The hon. Member for Islington, North (Jeremy Corbyn) and others raised concerns about the consultation and about whether the public are being duped. Are we being asked to take part in a consultation on something that has already been decided? That is happening in my constituency, where 82 per cent. of my constituents said no to the closure of the A and E, but it went ahead. As several Members have said, if one loses the A and E, one loses the hospital. Let us have no illusions about that, because the hospital loses its intensive care, its high-dependency unit, its beds and its theatres. Those will all go if the A and E goes, because that is the back-up a hospital requires for an A and E.

My hon. Friend the Member for Bexleyheath and Crayford (Mr. Evennett) alluded to the worries in south-east London. He has every right to be concerned, because if those sorts of cuts are made to the front of A and E, the services behind it will go immediately.

Does the hon. Gentleman acknowledge that often plans are drawn up for health service changes from which clinicians themselves feel excluded? The changes seem to have some motor of their own that pushes them along until they eventually reach the light of day without support from anyone, and yet somehow they end up becoming fact.

The hon. Gentleman has touched on an important point. Clinicians are not only often excluded, but gagged and not allowed to tell the people they serve about their concerns. If they do, their careers are put at risk. That has happened in my constituency and it is happening today. Some of the clinicians who have been speaking to me have been leaking documents to me that the Minister says he has not seen. If he indicates that he would like me to supply them to him I will be happy to do so. I have all of them but one, for the whole of London. I would have hoped that he had seen them, because the Government cannot exclude themselves from a report from NHS London that is based on deficits in the funding supplied by the Government and the assumptions based on that, which mean cuts proposed for London.

I will not give way because I want to give the Minister sufficient time to respond. When we go further into the document, we find the assumption that hospitals can only stop—it is stop—people going to an A and E and get them to go elsewhere by physically closing the A and E, because when one is open people will invariably go to it. Some of the assumptions are dramatic, such as the one that polyclinics in the primary care sector could take up to 60 per cent. of A and E attendances. Funding models have been based on that assumption.

However, attendances at A and E increased last year, even in areas where polyclinics are open. In areas of London represented by Members who are not here today, but which I have visited in recent weeks—such as areas of north-west London—A and E attendances went up by 15 per cent. last year alone, even though some of those hospitals have bolted on GP-led triage at the front so that they can get some of the people who we would all accept should not be going to A and E to another triage point.

The point is that the public trust an A and E. They will go to an A and E. We can sometimes address the problems of access to GPs, which can be why people go to A and Es, but to assume that we can get 60 per cent. of the public who need services to decide not to go to an A and E is beyond belief.

One document that has not been withheld is the Government’s own report, “Primary Care and Emergency Departments”, which they commissioned from David Carson, Henry Clay and Rick Stern. Their assumptions are astonishing, because they actually agree with what our constituents are saying:

“We were surprised to find that there is no evidence that providing primary care in emergency departments could tackle rising costs to help to avoid unnecessary admissions.”

That is just one excerpt from the press release for that report. In it, the experts and clinicians state that proposals to try to close A and E departments and get people into primary care fundamentally will not work. The Government want to bury that conclusion. They did not want it to come out or to have the debates we have had for the past three weeks.

Should the policy go ahead? No, it must be stopped in its tracks because the whole premise is fundamentally flawed, as shown in the Government’s own documentation. As the shadow Health Minister and the shadow Secretary of State have told NHS London, we have promised a real-terms growth in NHS funding. The Government are not reinvesting money elsewhere in the NHS, which is what the Minister has said they will do. They assume that there will be cuts in NHS funding, and that is stated on page 3, right at the start of the document “Delivering Healthcare for London”. It is imperative that the Minister does not shirk his responsibilities.

The hon. Member for Sutton and Cheam (Mr. Burstow), the Liberal Democrat spokesman, said that Ministers cannot tell NHS London to publish those documents, but they can and they should because they are paid to take responsibility. They should tell NHS London to publish the documents so that we know what the proposals are and can debate them. We could then robustly refute most of the assumptions and look at what is best for the constituents of London, from the bottom up, from GPs and patients, rather than from the top down.

It is not a case of scaring people. I have visited many hospitals in the past few weeks and I know that NHS staff are really worried. They do a fantastic job, but at the moment their morale is low and they are genuinely worried that they will be unable to deliver the sort of care London deserves. We must not scare people, and I am afraid that I have to reiterate the point that the Liberal Democrats have been scaring people in Kingston, which is fundamentally wrong. We should have a proper debate so that the clinicians feel comfortable about telling us publicly what London needs. We should listen to them, rather than to the top-down Treasury officials who are trying to cut money from the NHS, which is what the Government want to do.

I begin by congratulating the hon. Member for Hornsey and Wood Green (Lynne Featherstone) on securing the debate and on recognising the hard work and dedication of clinicians and staff leading the changes to the NHS in that constituency and across the rest of the capital. Her constituents deserve the very best of health care, and that is what we want to ensure they are provided with. Despite the best efforts of NHS staff, I do not believe that they are currently getting the very best.

Until recently, London had some of the worst health care provision in the country. In 2007, London was performing poorly on waiting times, mortality rates and patient experience, relative to other strategic health authority areas. According to a MORI poll conducted in 2009, 37 per cent. of Londoners were unhappy with the time it takes to see a GP. Another result found that Londoners relied disproportionately on A and E. A recent study of unscheduled care concluded that 87 per cent. of children and young people attending A and E could have been better treated in a primary or community care setting. That is simply not an acceptable way for things to continue in our capital city.

The policy that we have set out in “Healthcare for London” is about giving Londoners what they deserve in terms of better health care and high-quality, clinically appropriate treatment when they need it. But change is difficult. It makes people feel insecure. After the 1980s, when everything was based on cuts, the assumption was that the NHS was all financially driven, and then a bunch of politicians stand up and say, “Of course it is, because it is the Labour party.” That is not the basis of what Lord Darzi set out, nor the basis upon which he got clinicians all around the capital and, indeed, the country to support his approach.

I will give way in just a moment.

Lord Darzi did that by engaging clinicians on the quality of care, and that is the basis upon which change must be made. However, let us be clear about this and, just for once, be honest with our constituents. It is important that hon. Members are honest with their constituents. Change does require change. It requires that hospitals and what people have been used to in the past must change, and that means—[Interruption.] Perhaps the hon. Member for Croydon, Central (Mr. Pelling) should settle down. I have said that I will give way in a moment, if he will just calm down a little. He is chuntering from a sedentary position. I realise that he is now independent, and I can see why his party would want him—

Order. The Minister has indicated that he intends to give way. The hon. Gentleman should accept that assurance and await the opportunity to speak.

Perhaps a little less aggression from the hon. Gentleman might be in order on this occasion.

It is important that NHS provision in London is clinically based on quality, and not financially driven. I have been very clear with managers in London and around the country that the NHS has priorities. The first priority is patient safety and patient care, and the second relates to targets and finance—in that order.

Today, thanks to major improvements in A and E and waiting times and, for example, the inclusion of cancer scores as of last summer, NHS London has improved significantly. Not only are 28 new hospital schemes, worth £1.8 billion, already open to patients and another three, worth £1.2 billion, under construction, but we are also seeing improvements in the constituency of the hon. Member for Hornsey and Wood Green at University College hospital in north central London and with the £30 million scheme at the Whittington, which I shall return to in a moment.

In January, only three people waited more than 13 weeks for an out-patient appointment, down from more than 40,000—indeed, 43,639—in 1998. That is a massive improvement in health care in London. We have also seen improvements in terms of strokes and heart attacks. Significant changes are taking place in London.

I promised to give way to the hon. Gentleman. He has now calmed down and let the vibrations settle a little, so I shall give way to him.

I think that the Minister is quite wrong to describe my behaviour as aggressive, and I greatly resent the suggestion.

The Minister is being very earnest, and I believe that the electorate understand and appreciate that approach. Nevertheless, would it not be right to say that the information that we are not allowed to share strongly leads with the financial concerns of NHS London? It is unfair to state that the changes are not driven by finance. The officials’ papers that we are not allowed to discuss deal with the significant financial pressures that the London NHS faces. Therefore, finance is a significant driver of the changes. Does he accept that?

I have not said that managers should be unconcerned about finance—that would be ridiculous. One expects managers and clinicians to care, first and foremost, about the quality of health care in London. Secondly, and in that order, finances and how care is delivered come into it. The taxpayer does not have unlimited money, nor does the NHS. Perhaps we all wish that it did, but at the same time, such issues have to be looked at in terms of priorities.

The Minister is being very sincere about the fact that we cannot have change without change—I totally accept that—but the thesis of my 25-minute contribution was that there is no evidential base in the public domain on which to argue for that change or to bring people along with it. That is the point that the Minister needs to answer.

I have already said that health care in London is improving. I should add that NHS budgets for PCTs are increasing by 5.5 per cent. overall this year and by 5.5 per cent. next year, if this Government are re-elected. I cannot speak for the other lot, if they were to get in. Things are improving.

I can also tell the hon. Lady that it is clear that clinicians are behind the process of change. A number of eminent clinicians have today written a letter calling for “Healthcare for London” to be developed and become the basis on which change takes place. They say that it is

“the best opportunity for a generation to truly transform the NHS. It is now or never.”

The messages in the letter, which is signed by leading clinicians, are clear: the NHS must invest in prevention, not just treatment, and concentrate specialist expertise for those who are ill in centres of excellence; people who do not need to be treated in hospital should be treated as close to home as possible; and clinicians should be at the heart of all decision making. Londoners endorsed the overall vision in an extensive consultation, with more than 40,000 people attending meetings and roadshows, and visiting the website.

The letter has been signed by eminent clinicians such as Adrian Newland, the professor of haematology at Barts; Dr. Daghni Rajasingham, consultant obstetrician; Denise Chaffer, the director of nursing at the Mayday Healthcare NHS Trust; Professor Dame Donna Kinnair, director of nursing at NHS Southwark; Dr. Fionna Moore, the medical director of the London Ambulance Service; Dr. Geraldine Strathdee, consultant psychiatrist and director of clinical services at Oxleas NHS Foundation Trust; Matt Thompson, professor of vascular surgery—[Interruption.] I could go on. This is a long list of eminent clinicians who are anxious that the attempt by some politicians to frustrate the process for short-term political purposes should not be allowed to happen.

No, I have only a few minutes, so I hope that the hon. Lady will forgive me. I appreciate that this is her debate, but I want to deal with her suggestion that somehow there is secrecy.

We have tried to give clinicians a space where they can debate some of these issues and discuss what is best for London. They do not want to engage in public controversy. That takes time and energy, which they would rather spend on their patients. We need to give them the ability to discuss what is best for London, and how best to deliver health care. If every time they have a discussion and put something on paper, or there is a minute of a meeting or a report, it has to be put out in the public arena, so that Liberal Democrat MPs can attack them over their lack of evidence and so on, they will withdraw from engaging in the discussion of health care for London. The result will be that patients in London—patients whom the hon. Lady and her colleagues represent—will suffer because they will not have input from those clinicians.

Clinicians are asking for that space and for the ability to discuss and come forward with reasonable proposals. That was the basis on which Darzi put together his proposals, and it is on that basis that we are trying to ensure that clinicians have the space to have discussions. I hope that the beneficiaries of that will be people in London, who are looking for good health care.

I have only a few seconds, and I want to say something about the Whittington. We have invested £30 million in it, and we want to ensure that the hospital continues to develop. I have seen no evidence that A and E at Whittington should close. I would want to see a good clinical case—I have never seen one—for closing it. We have invested money in the hospital, and we want to ensure that it can continue to develop for the people of London. We will ensure that any case is looked at with care. I am sceptical about closing A and E at Whittington, and I would find it difficult to accept the case for that to occur.