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health

Volume 550: debated on Tuesday 18 September 2012

One of my constituents, Mrs Collette Pridmore has three children, one of whom—her son, Jacob— suffers from a rare lung disease. Jacob is just eight years old. When Collette got in touch with me, she was extremely worried about her son’s future because she had discovered that the care Jacob receives at the Royal Brompton hospital in London was under threat. Because of the serious nature of his condition, little Jacob needs to spend many weeks each year at the Royal Brompton, where specialist clinical teams have the necessary skills to help him.

Collette suggested I visit Jacob at Royal Brompton and during my visit she arranged for me to meet the doctors and nurses who care for her son. To say that I was impressed would be an understatement. I am sure that many right hon. and hon. Members will know of the good work done by the Royal Brompton, but for those who do not, let me explain something about the services they provide.

The respiratory children’s unit at the Royal Brompton treats some of the most vulnerable children in our country—those with serious lung disease and breathing problems. The Royal Brompton is home to the country’s largest children’s cystic fibrosis unit and the hospital’s experts treat children with muscular dystrophies, severe drug-resistant asthma and a range of other respiratory conditions. These conditions are quite rare, but the concentration of clinical expertise in one place means that knowledge is accumulated and shared, creating the best possible conditions for the care of children such as Jacob. The hospital also carries out research with Imperial college constantly to improve the treatments available.

My visit to the Royal Brompton was inspirational. I saw the very best that the NHS has to offer—the best specialist skills and an incredibly caring environment. These services provided by the Royal Brompton, however, are now at risk. Why? In one word—reorganisation. The threat to close the Royal Brompton’s children’s respiratory services is really not the finest hour for health service reorganisations. This is not an academic exercise; it is about the future welfare of some pretty sick and vulnerable children such as Jacob.

Unfortunately, Jacob’s doctors do not think they will be able to carry on caring for him in the long term, because their intensive care unit is being closed. Without the back-up of intensive care, they will not be able to offer the expert services they do now, because they think it will be unsafe to do so. So why is the intensive care unit being closed? Is it to save money? Is it because it is not a very good unit? Is it because no one needs it? The answer is none of those.

On 4 July this year, a committee of primary care trust chief executives, as part of the reorganisation of children’s heart services in England, made the extraordinary decision to end children’s heart surgery and intensive care at the Royal Brompton. As one of the best-performing and largest centres in England, many Members will have had constituents who have been treated there. The proposed closure will have severe knock-on effects on children’s respiratory medicine.

Although not all Royal Brompton’s young patients need the intensive care unit, many do need it should they deteriorate very quickly. Sadly for Jacob, this has happened to him on several occasions. Jacob’s doctor, Dr Claire Hogg, told me that without an intensive care unit on site, her only option, if Jacob became particularly unwell, would be to try to get him to the specialist intensive care unit at another London hospital which, depending on traffic, could be up to an hour away. To a sick little boy or girl, this could be a lifetime away—quite literally.

A couple of weeks ago Collette Pridmore brought some of the Royal Brompton’s doctors to visit me here. I was shocked by what I learned. Dr Duncan Macrae has discovered that new figures published after the review of children’s heart services took place show that the rate of population increase, particularly the child population, is far greater than previously estimated, most specifically in London where the child population is increasing at almost twice the national average.

This decision, leaving just two centres to offer children’s heart surgery for London and the south-east, was taken using 2006-based national population projections, which have been shown greatly to underestimate the numbers. Equally worrying is the recent data from the UK central cardiac audit database, showing that the number of children having heart operations is increasing year on year. How, then, did the review of children’s heart surgery, using out-of-date statistics on both population growth and the number of children needing surgery, come to the conclusion that London and the south-east can manage with two rather than three children’s heart surgery centres?

The review decided that the Royal Brompton should close its specialist centre and intensive care unit, despite the fact that the hospital is one of the biggest and best centres in the country. Scandalously, the intensive care units and children’s heart units at the other two London centres do not currently have enough beds for Royal Brompton patients, and at least one of them will have to spend large sums of money building new facilities. At a time when the NHS is strapped for cash, that alone is a good reason for reversing the decision to close the Royal Brompton hospital.

The proposed closure is not the result of Government policy. That is not to say, however, that the new Health team, now led by the Secretary of State for Health, my right hon. Friend the Member for South West Surrey (Mr Hunt), cannot intervene. I very much hope that Ministers will agree to meet me and some of the medical staff from the Royal Brompton to discuss our concerns and to see what can be done to reverse this crass decision.

My local NHS says that it needs to reconfigure services because it has

“to deliver £370 million savings each year...a reduction of around 24% in…costs.”

As a result, it plans, through a programme ironically called “Better Services Better Value”, to close a wide range of services at my constituency’s local hospital, St Helier. Most of the controversy has focused on the closure of our A and E and maternity units, but we also face losing our intensive care unit, neonatal ICU and renal unit, as well as about 50% of St Helier’s 390 in- patient beds.

Since I last raised this subject in the House in July, a number of interesting things have happened. First, the right hon. Member for Sutton and Cheam (Paul Burstow)—whose constituency, like mine, is on the borders of St Helier—lost his job as a Health Minister and launched a withering attack on the plans, describing them as “dangerous and flawed”. As a Minister in the Department for Health, he would know; although I imagine that he wanted to stay and to continue to be collectively responsible for St Heller’s demise.

Then the right hon. Member for Carshalton and Wallington (Tom Brake), whose constituency contains St Helier, decided that he was so upset about the plans that he would take a principled stand by joining the Government as deputy to the man who is responsible for what has happened in the NHS over the past two years. Congratulations are due to him for showing his disapproval so strongly.

Ten days ago, Michelle Baker and Karen Russell, mums from my constituency and part of the Save St Helier campaign, organised a picnic with a purpose outside the hospital. Thousands of local residents joined in, and although it was billed as a fun day, we were deadly serious. The leader of Merton council, Councillor Stephen Alambritis, a former football referee, was cheered as he brandished a red card at the plans, while the medical director of “Better Services Better Value” was booed as he was handed our petition, signed by more than 30,000 people.

In other developments, it is becoming increasingly clear that, behind the scenes, the case for the closure is falling apart. NHS South West London was originally due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed at the last minute. Then, last month, the team proudly issued a press release stating that a decision would be made on 27 September and that

“the aim is for it to go out to public consultation from 1 October”.

Dr Finch said that he was

“excited by the huge potential of the BSBV programme.”

Now even that decision has been put off for at least another month. Perhaps the delay is connected to polls of GPs and patients that showed that a majority were against the closure, but I suspect that that it is mainly due to the publication of the National Clinical Advisory Team’s report on the plans.

NCAT reports represent a key step in any hospital reconfiguration and need to be properly scrutinised, so on 17 July I requested a copy of the report under the Freedom of Information Act. Under FOI rules, I should have received a copy by 14 August, but it was not until a week later that I received one, along with a press release claiming that NCAT had

“given the Better Services Better Value review the green light to move forward”,

and that

“we are very pleased that the NCAT team have agreed that our proposals should be supported”.

However, although the press release gave the impression that everything was running smoothly, that impression was extremely misleading.

The most fundamental criticism of the closure plan is that it is predicated on the assumption that 60%—yes, 60%—of emergency patients can use primary care instead of A and E services. Obviously, it is very much in GPs’ interests for BSBV to succeed. It is led by local GPs, and they clearly have an interest in ensuring that more patients use primary care rather than hospitals, whether or not that is what patients want, because the money follows the patient.

NCAT has looked at the 60% target and, ever so politely, has laughed it off. The report says:

“The assumption that 60% of ED”—

emergency department—

“patients have conditions that can be managed by clinicians from primary care demands detailed… analysis. Elsewhere in the UK a consistent finding is…far lower, usually in the order of 15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

NCAT goes on to say:

“The ED consultants interviewed suggested that the primary care workload in their departments is in the order of 15-20%”

and that

“The estimate of 60% is often derived from coding data...patients who have no x-rays, no specific treatment, no follow up and are not admitted are regarded as ‘minor’ and therefore it is assumed that they could be seen by primary care clinicians. It is recognised throughout the NHS and particularly in emergency care, that such data lack reliability”.

The report also questions the assumptions behind the proposal that St Helier could be saved by becoming South West London’s elective hospital. It is hard to see why any patient would choose to travel so many miles from Croydon, Wandsworth or Kingston to a hospital that had lost so many services, to receive treatment that they could receive at their local hospitals, or why any ambitious staff member would want to work there.

NCAT says:

“The concept of a planned in-patient care or elective hospital serving the whole area was generally supported”

by clinicians. It continues:

“However there was no evidence that this would free enough in-hospital capacity to absorb the additional acute workload for the remaining three hospitals.”

The report adds:

“There was concern that the links between acute medical services and the community were not dependable.”

NCAT admits that, although most experts consider it a bad thing for maternity units to deliver more than 6,000 babies a year, South West London’s three remaining maternity units would have to deliver 6,500 babies each—in addition to the 2,500 babies delivered in midwife units and the 880 delivered at home.

NCAT concludes:

“Successful implementation…depends on a multitude of supporting improvements in primary care, community services and professional practice that are not well defined in the proposals.”

Worse, it admits:

“The reconfigurations are based on an optimistic view of capacity, recruitment, meeting increased demand in primary and community care and the challenges posed by the introduction of new ways of working.”

I could go on and on.

On the basis of such optimism, 200,000 people will have to make longer journeys to hospital in an emergency. An A and E department will close, although the number of A and E visits will rise by 20% in the next five years. Tens of thousands of women will have to worry about how they will give birth at hospitals further from home, and a maternity unit will close, although the number of births will rise by 10%. Thanks to the combination of cuts and GP commissioning, a flawed decision to close St Helier is about to happen. It will not work, and it must be stopped.

I am very pleased to have the chance to alert Ministers once again to the devastating plan, courtesy of NHS North West London, to close the A and E departments at the four hospitals that are closest to my constituency and my constituents. Unsurprisingly, there seems to be very little local support for the plan. As far as I am aware, no local GPs have spoken up in favour of it, other than the very few who are working alongside NHS North West London. I suspect that, like the rest of us, local GPs are highly doubtful about a plan that rests on the massive assumption that it is possible to dismantle four A and E departments in a small, concentrated part of London with little or no negative impact on the community that depends on them.

The plan envisages a scaled-down but super-efficient new system of care delivery. I think it fair to say that we would like that new system to be in place, up and running and serving the needs of our constituents, before supporting the dismantling of any of our A and E departments. There is cross-party agreement locally, in Hammersmith and Fulham as well as Ealing, that the plan is reckless and extreme. Last weekend, we held a rally on Ealing common at which all three parties spoke out against it.

Our main concern must be the increase in travel times. The proposals attempt to demonstrate that, at the very worst, just a few minutes might be added to some journeys made to hospitals further afield. I think that anyone who knows that part of London will be aware that those timings must have been conducted at 2 am rather than 2 pm, and I think that most of us would prefer slightly more realistic assessments to be carried out.

There must be real concern about adding to A and E queues at the hospitals that have been left to take up the patients who will no longer have access to A and E departments closer to home. Even if the new facilities work for some people—as I am sure that they will—many, many people will still want to go to straightforward A and E departments, particularly those that are familiar to them and that they know and love.

Those, obviously, are extremely important issues that will need to be considered, but we should also bear it in mind that Ealing has one of the fastest-growing populations in the country. It seems strange to us that anyone should consider dismantling important parts of the health infrastructure at a time when we expect to see a much larger local population.

The consultation will continue until 8 October, but, as I have said, the form is extremely long and tricky to fill in, and rather off-putting as a result. It takes a lot of time; indeed, it took me an hour and a half to fill it in, and I have spent a considerable amount of time focusing on this issue.

Naturally and unsurprisingly, in common with all other well-honed consultations, this consultation is designed to draw participants to its own desired conclusions—although with a bit of serious work and concentration, it is possible to avoid that. However, marching and filling in petitions is all very well and fine, but we must remember that it is only the responses to the consultation that legally count. The Conservatives had a stall on Ealing common last Saturday, and we handed out more than 500 consultation documents, because we felt that that was one way to help the campaign practically. We apologised to everybody in advance for the time that it was going to take to fill them in, of course.

I understand that the consultation received an award for its clarity of language, but the intention behind it is clear to us: to get its desired result, which is support for closing the four A and E services that are closest to my constituency. I hope that Ministers will resist any such recommendation.

I am very glad to have this opportunity to raise the important issue of the lack of maternity services in Berwick, and I hope that it will prove helpful that the Minister replying to the debate is a specialist in obstetrics and gynaecology.

Berwick is 50 miles from the district general hospital—although there is one that is slightly nearer on the Scottish side of the border, the Borders general, which we also use quite extensively. That is a long way to travel for a birth, but on 6 August all deliveries at the Berwick midwife-led maternity unit were suspended. Along with that went all overnight recovery stays for people who had given birth in the Wansbeck or Borders general hospitals. There are now no facilities to support home births in the area, which is contrary to National Institute for Health and Clinical Excellence guidelines, and no evening antenatal clinics because the unit is open only during the day.

Two reasons for the suspension of the services were cited. One was that staff were not getting enough experience of deliveries. That has been a long-standing problem, and a review was taking place to address it—and the problem could have been addressed. Reference was later made to two incidents that were seen as a reason for taking more urgent action. However, the details of those incidents have not been disclosed, probably because proceedings relating to them may still be taking place.

The announcement caused great distress to the midwives concerned, who are much respected locally, and caused fury in the local community. Plans for Berwick’s new hospital are being drawn up, and many people believe that the trust might be trying to avoid providing maternity services there. The trust has often assured me that that is not the case, but there is increasing suspicion. Meanwhile, these services are absent, so mothers have to travel 50 miles to give birth. That is not the only issue.

One mother told me she had been driven the 50 miles to the Wansbeck hospital and examined there, but the hospital staff said, “No, you’ve come here too soon. Go home.” She was then driven 50 miles home. Within an hour or two of arriving back, she became convinced labour was about to start, so she was again driven by car 50 miles to the Wansbeck, where she was examined and the staff said, “No, we think you should go home. There’s no need for you to be here at present.” She dug her heels in, however, and said, “No, I’m not going. I’m staying here.” Within the time it would have taken for her to return home again—taking her total journey to 200 miles—the baby was born at the Wansbeck infirmary. That story serves to illustrate that the issue is about not births alone, but all the associated journeys that may be involved. That is one of the reasons why we generally try to provide maternity services reasonably locally.

The review that is taking place should look at how we can ensure that we have maternity services in Berwick that have the full confidence of the trust and the clinical staff. The majority of local mothers initially opt for births at Berwick, but by the time of delivery, the majority of them have accepted advice to have delivery at Wansbeck or the Borders. One has to ask why that is the case. Any mother reading the NICE guidelines, which are given to mothers, will say, “Oh, ambulance transfer might happen after labour has begun!” An ambulance transfer takes two hours; that is the specified NHS time for an ambulance transfer from Berwick to Wansbeck infirmary. It is clear that doctors often feel that they do not want to take any risk at all, so they recommend that delivery should take place at the distant hospital.

Some of the problems and other characteristics of a small unit that might have led to this situation arising can be addressed. The experience issue can be dealt with by staff rotation, so giving them time in a busier hospital to maintain their experience. Having consultants on call, and ensuring they can get to the local hospital more quickly than a transfer can take place, is another necessary feature. Such matters need to be examined much more carefully. Also, there is a role for telemedicine and the practice of having a consultant at the larger centre make an early assessment of whether problems are arising that need to be dealt with. The number of births at our maternity unit have at times been very low because the majority of mothers have been advised to go elsewhere. There was an entire year in which there were only 13 births, but the numbers have increased again, and at the time when the closure took place, 40 women were booked in to have their births at Berwick.

My overriding concern is for the safety of mothers and children, but it ought to be possible for most births to be safely carried out locally. In our debates on this topic, many Members have referred to problems in transfers to hospitals 10 or 15 miles away, but I am talking about a transfer of 50 miles for every birth to a Berwick mother. The majority of mothers in the Berwick area want to have their babies born in Berwick, and they should be able to do so and have confidence that the necessary skills and support are in place.

At last week’s Prime Minister’s questions, the Prime Minister set out that changes in clinical services should not be made without these four conditions being satisfied: support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. Those conditions are not satisfied in what is happening in my constituency, and they certainly would not be satisfied by a total withdrawal of maternity services, including delivery, at Berwick. I seek the Minister’s assurance that those conditions remain relevant and that the attention of the health care and primary care trusts involved in taking decisions about maternity services in my area will be drawn to their significance. I hope that the Minister and Department will assist the trusts in any way that they can to work up a good scheme to ensure that people in my constituency can have confidence in their future maternity services at Berwick.

May I take this opportunity to welcome the new Health Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), to his post and wish him every success in his new role?

I want to draw the attention of the House and, in particular, the Minister to two key issues in relation to type 1 diabetes. Some Members may be aware that I spoke on this issue last week in a Westminster Hall debate, but today I want specifically to urge the new health ministerial team to support the artificial pancreas project that is being funded by the charity JDRF. If the Department can find any funding to assist the research, that would be very welcome.

I wish to ask the Department of Health to end the postcode lottery that exists in the NHS on access to insulin pumps. At present, there are no answers on what causes or how to cure type 1 diabetes. The only way to find a cure for type 1 is through greater investment in medical research. If additional funding can be made available to cure, treat and prevent type 1 diabetes, it will result in long-term cost efficiencies for the NHS. It will also help the UK to retain its position as a world leader in this type of medical research.

Type 1 diabetes is a chronic, life-threatening condition that has a life-long impact on those diagnosed and their families. It strikes children and adults, staying with them for the rest of their lives. It is usually diagnosed in childhood between the ages of 10 and 14, but more and more children are being diagnosed much earlier, from 18 months onwards. It is an auto-immune condition; it causes the body’s own immune system to turn on itself and destroy the beta cells in the pancreas, leaving the body unable to produce the life-essential hormone, insulin. Insulin pumps cost between £1,000 and £3,000. There are additional costs for the consumable attachments, infusion sets, batteries and pump reservoirs, for which patients might have to pay themselves. The cost of those consumables could amount to between £1,000 and £2,000 per annum for each patient.

By contrast, the Scottish Government announced in February 2012 that all eligible under-18s with type 1 diabetes in Scotland will now have access to insulin pumps. They have also said that the Government are committing funding of at least £1 million to help NHS boards deliver pumps to under-18s who need them, as well as tripling the amount of pumps available to all people with the condition in Scotland. That has been followed by a further boost of £1.5 million this April in Scotland to provide more young people with insulin pumps.

Type 1 diabetes is a very different, distinct condition from type 2 diabetes, as it is not linked to lifestyle issues, such as diet and exercise. People with the condition rely on a programme of finger-prick blood sugar tests and insulin pump infusions or injections up to 10 times a day to stay alive. Although these prolong life, they are not the cure. A child diagnosed with type 1 diabetes when they are five faces 19,000 injections by the time they are 18. People with the condition are at risk of devastating complications, including blindness, heart disease, amputation, strokes and kidney failure, to name but a few.

Type 1 diabetes reduces life expectancy by about 20 years and there is a small but very real chance of sudden death. The short-term complications include debilitating hypoglycaemia, which, if left untreated, can lead to unconsciousness, coma and occasionally even death. Children never escape the responsibility of checking their blood sugar level and parents never have a day off from worrying about their children, even at night, as the blood sugar level has to be checked. Parents cannot relax because one of them must get up at night to check that their child is okay—or even still alive.

JDRF has told me that about 500 people in each constituency have type 1 diabetes. Therefore, more than 26,000 children in the UK have type 1 diabetes, which is as many as one in every 700. Some 98.6% of the children and young people who have diabetes will have type 1. The incidence of type 1 diabetes is increasing by about 5% year on year.

The hon. Lady is making an excellent and powerful speech. I declare my interest as a sufferer of type 2 diabetes. I wish to emphasise the importance of prevention work. She has talked about type 1, which is difficult to prevent; but in general, the more money that is spent on preventing diabetes, the less money that will need to be spent by the NHS in the future.

I thank the right hon. Gentleman for that intervention, because he is a big champion of tackling diabetes, particularly type 2, and he will speak up at every opportunity. Good care for not only the young with type 1, but for older people who can try to prevent themselves from getting type 2 diabetes will, of course, save the health service a huge amount of money.

As I mentioned, JDRF funds a large research programme to develop a closed-loop artificial pancreas, to help children with type 1 diabetes to live a life without the constant need for painful finger-prick tests and multiple insulin injections every day just to stay alive. It would give people with type 1 diabetes the freedom from those injections every day and has the potential to prevent some of the devastating complications that can arise from the condition. It would also give parents peace of mind that their children are much more likely to have stable blood sugar results, thus keeping them out of hospital.

The project involves two pieces of equipment that are already available to people with type 1 diabetes: a continuous glucose monitor that measures blood glucose levels regularly; and an insulin pump, such as the one I am holding, that painlessly administers insulin. The main task is to develop a computer that can talk to the two components and calculate exactly how the insulin pump should react and when to administer the insulin. That would close the loop to make the device a functioning artificial pancreas. This artificial pancreas is not yet commercially available, although the research team have already completed trials of the artificial pancreas in a hospital setting and are now beginning trials where children take the artificial pancreas home to see how well it works in a real-life situation.

Will the Minister please give an undertaking to monitor this research carefully and, if possible, lend his full support to this piece of groundbreaking research, which could improve the quality of life for so many young people in my constituency and many thousands across the country—it could do more than that; it could transform their quality of life.

The second issue that I would like to raise briefly this afternoon is the inequality that exists in our NHS in getting access to an insulin pump. The Minister may be aware that the Medical Technology Group recently carried out a freedom of information survey of every primary care trust in England, publishing its findings in “Pump Action—A Review of Insulin Pump Uptake and NICE Guidance in English Primary Care Trusts”. The report shows significant inequality in the provision of insulin pumps across England and a lack of adherence to National Institute for Health and Clinical Excellence guidance, with low insulin pump usage compared to the NICE benchmark. The average rate of insulin pump provision for people with type 1 diabetes is 3.9%, compared with the 12% benchmark recommended by NICE; it is nowhere near the 33% recommended for children younger than 12.

There is, without doubt, a postcode lottery on insulin pump access. The percentage of people with type 1 diabetes using an insulin pump falls as low as 0.25% in Medway and 0.3% in Croydon. In my county of Derbyshire, the rate is 4.4%, with 120 people using an insulin pump out of the 2,746 people with type 1 diabetes in the area—that is well below the NICE guidelines. May I request that the Minister take urgent action as soon as possible to address this issue? It simply is not fair that people can be denied treatment just because they live in the wrong part of the country.

May I, too, welcome the Minister to his place? Last week, two decisions were taken affecting the Mid Staffordshire NHS Foundation Trust, which covers the Stafford and Cannock hospitals. The first was the decision by Monitor to undertake a review of the trust’s finances. The second was the decision of the commissioners not to reopen the accident and emergency department at night, although the trust had said that it was in a position to do so. What is common to both decisions is that there has been no consultation so far with my constituents or those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson). These are their health services, which is why I have established a working group specifically to look at Stafford hospital, so that my constituents can make their proposals and views clear, both to Monitor and to the commissioners.

As hon. Members will know, there has been a public inquiry into the failings of Stafford hospital, especially those in the period 2005 to 2009, although the failings go back much further. The Francis report in 2010 exposed shocking care, particularly of the elderly and vulnerable. The public inquiry, which looks at why the NHS and others failed to pick up these problems, is due to report later this year, so I will not comment on that. The time of publication will be the time for very careful and mature reflection on what happened and how the NHS must change in response. As a senior member of the Royal College of Physicians said to me, it is the most important inquiry into the NHS in two or three decades.

Standards at Stafford hospital have improved considerably in the past three years, although there is no room for complacency. The Care Quality Commission recently lifted all its remaining areas of concern and the accident and emergency waiting time target has been met for the first time in a long time. There remains a substantial financial deficit, however, with an operating deficit of some £16.5 million last year and one of £15 million predicted for this year. At this point, I thank the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), who is in his place as Leader of the House, and the former Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for their steadfast support for the trust as it sought to recover, as well as the staff of the hospital and those from the Ministry of Defence who helped out at A and E for a few weeks.

The financial problems facing the Mid Staffordshire trust that Monitor wishes to tackle arise, in my analysis, from three sources. The first is underuse of the estate in Stafford and Cannock. It is essential in my view, and that of my hon. Friend the Member for Cannock Chase, that both hospitals remain open, but the estate must be used efficiently as money that is needed for services is being spent on empty property.

Secondly, the consequences of the events at Stafford mean that patients who would normally attend Stafford no longer do so. Confidence in the hospital needs to return, and that confidence must be based on real progress. There are welcome signs that that is happening, but it will take time.

Thirdly, and most importantly by far, endemic problems face medium-sized acute trusts across the country. Mid Staffordshire is far from unique and that is where the Monitor review is vital as it has the chance to establish a sustainable model for district general hospitals around the country. There seems to be a view gaining currency that all medical care in the future will either be highly specialised or general, based in community hospitals, which will squeeze out the medium-sized acute hospitals. Not only does that not accord with the evidence, it goes against the wishes of the public.

I do not dispute the need to concentrate highly specialised care in larger hospitals where consultants in each specialty are available around the clock. That has happened for some time. However, there is an increasing and substantial need for emergency and acute care, particularly for the elderly, which is much better given as locally as possible and in close co-ordination with social care services. District general hospitals such as Stafford remain the best place for that.

Monitor therefore has an excellent opportunity to work together with the people of Stafford and Cannock to show how a medium-sized acute trust can flourish in the tough financial climate we face. Indeed, Monitor has a duty to do so under section 62 of the Health and Social Care Act 2012, which states that its main duty

“in exercising its functions is to protect and promote the interests of people who use health care services by promoting provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

It also states that:

“In carrying out its main duty, Monitor must have regard to the likely future demand for health care services.”

The last paragraph is very important as not only is the population of the area predicted to rise substantially in the coming years, but there will be a greater demand for acute care.

It may be argued that none of Monitor’s duties requires that services be provided locally. I reject that. To provide services locally is economic, efficient, effective and an intrinsic part of their quality, so Monitor has a duty to promote health care services that are as local as possible. We also need to be very careful in the definition of the word “services”. In the debate in Committee on what was then clause 69, I said that

“it is extremely important to have clarity on what constitutes a service. Services can be salami-sliced down to very small items or, as others have said, they can be an agglomeration. One could say that, in an acute hospital, a service is not only the accident and emergency, but some—not necessarily all—of the other wards associated with it. That might constitute a block of service or, under other definitions, several services. How will Monitor interpret that word?”––[Official Report, Health and Social Care Public Bill Committee, 22 March 2011; c. 943.]

Everyone in Staffordshire knows how hard my hon. Friend has fought on behalf of Stafford hospital. Does he agree that the closure of Stafford A and E at night will put an increasing burden on many other local hospitals, including New Cross hospital in Wolverhampton and the University hospital of North Staffordshire?

I entirely agree. Of course, the hon. Member for Walsall South (Valerie Vaz) has the Manor hospital in her constituency, too, and I pay tribute to the work done by her hospital, by my hon. Friend’s hospital in New Cross and by Stoke and Burton hospitals.

So, how will Monitor interpret the word “services”? To date, as far as I am aware, we do not know the answer to that question. I want to make a very clear case that Monitor must, in the case of emergency and acute services, view the matter in the round and not engage in accountancy-based salami slicing. One cannot separate an A and E from a medical admissions unit, a surgical admissions unit, a paediatric admissions unit, an intensive care unit and the related diagnostic and therapeutic services. They must be considered as a service block. Of course, there will be a difference between the block in a district general hospital and that in a major specialist hospital, as the latter will cover emergency and acute events that a district general hospital cannot.

That brings me to the question of the accident and emergency department at Stafford, which has been closed between 10pm and 8am since 1 December last year. Today a petition is being presented in Downing street to urge the reopening of the department at night. Up until Sunday 16 September, 4,381 patients who would have been treated at Stafford at night have gone to other hospitals. To put that in perspective, the A and E department treated 51,000 people in 2011-2012. That is more than 4,000 patients who could not use their local acute hospital in an emergency when previously they could. We need to see them back at Stafford.

The reason given for closing the A and E department at night was that it was not safe for 24/7 reopening. Subsequent events have proved that to be the right decision as the department was close to breaking point. However, a set of criteria were given for reopening and the trust considers that, after much hard work, they have now been met, although there are concerns about sustainability. The commissioners have decided not to go ahead with night-time reopening but instead to pursue what they call a model of 24/7 emergency and urgent care. My constituents and I were very disappointed with that, because, nearly 10 months after night-time closure, we still do not have an A and E 24/7 but also because we do not have details of what that emergency and urgent care model might be. What are the similarities and differences between emergency and urgent care and A and E as traditionally understood? That needs to be made clear, not just in Stafford and Cannock but everywhere such a model is proposed.

The commissioners’ statement made it clear that even while A and E was closed, children, maternity and GP cases continued to be received at Stafford at night. They are also working on how to bring back to Stafford the 15 or so patients who currently have to go elsewhere each night. That is welcome and sounds similar to the service prior to closure. So what is different? Can we not return to an open-door 24/7 service with effective triaging to filter out the unnecessary attendances that place a strain on emergency departments everywhere?

Mid Staffordshire trust may be exceptional in the long hard road it has to travel to regain the confidence of local people—and it has come a long way down that road—but it is not exceptional in the pressures it faces as a district general hospital. The Government have a chance to show how district general hospitals can thrive, providing emergency, acute and elective services to their people, working closely with social care and with the specialist hospitals in their neighbourhood.

I recently spent the day out and about with the North West ambulance service and want briefly to cover my experiences with them.

The North West ambulance service is England’s largest ambulance service, with more than 5,200 staff, 109 ambulance stations and three control centres. It deals with more than 1 million emergency calls every year and although it also provides a non-emergency patient transport service, my day focused on the emergency medical response that it provides 24 hours a day, 365 days a year.

On Thursday 30 August I joined local paramedic Andy Swinburn in a rapid response vehicle that was responding to emergency calls across the Burnley and Pendle area. Although I am sure that many hon. Members would enjoy being in the passenger seat of an emergency services vehicle with the blue lights flashing, I wanted to witness the challenges faced daily by staff from the Barnoldswick, Nelson and Burnley ambulance stations.

During the shift, the vehicle I was in responded to nine blue-light emergencies, seven of which were in my constituency of Pendle. I am told that that was a quiet day, and it certainly was compared with the day before, when the air ambulance was called out twice to east Lancashire. For someone such as me, however, who had never spent any time with the ambulance service before, it certainly seemed anything but quiet.

During the day, the paramedic I was with dealt with everything from people having dizzy spells and epileptic fits to suspected heart attacks and someone who had serious-looking head injuries after falling from a ladder. In between calls and when I met other paramedics at the Nelson ambulance station, we discussed a range of issues from the classification of different emergency incidents and the value of the eight-minute response time through to problems caused locally by alcohol and drug misuse.

We also discussed the question of which hospital a patient is taken to, which has been an issue of much concern among people locally after Burnley general hospital’s A and E department was downgraded to an urgent care centre in 2007. The people involved in the calls we responded to during the shift were taken to Airedale, Burnley and Blackburn hospitals, depending on which was best placed to treat the individuals concerned.

We also discussed something of which I was previously unaware, which is that paramedics are currently unable to prescribe drugs. I would appreciate the Minister’s thoughts on that—I, too, welcome him to his new role. It seems entirely logical to me that if a senior paramedic can diagnose a problem while in someone’s home, they should be able to prescribe the required drugs rather than having to call out a GP or take the individual to hospital.

Another issue worth considering is the basis of commissioning of ambulance services. When asked about ambulance services, the public will invariably put the speed of response above all other concerns, including the quality of care. The eight-minute response performance indicator in part reflects what the public say they want. However, some of the paramedics I spoke to felt that if they were commissioned on the basis of being able to treat people with certain conditions at the scene, usually the person’s home, there could be considerable savings to the NHS. That links to my point about paramedics being able to prescribe the required drugs.

Although such a commissioning move would undoubtedly have a range of knock-on impacts, it was clear from the day I spent with the ambulance service that many people did not want to be admitted to hospital and would have much preferred to have stayed in their own home. I know that the Minister, given his background, will be acutely aware of not only the cost of hospital admissions, but the stress and other complications that such admissions can lead to.

Overall, I felt that the day gave me an invaluable insight into the work of our local paramedics and the ambulance service. Although I have never needed to use the ambulance service—thank God—it was hugely reassuring to see the professionalism and dedication of those who work in it. I will conclude simply by extending my thanks to the North West ambulance service, to Andy Swinburn, the senior paramedic I spent the day with, and to all our local paramedics for the remarkable job they do.

I rise to make a further contribution in this House on the deeply flawed decision by the Joint Committee of Primary Care Trusts, with regard to the Safe and Sustainable review of children’s heart services, to close the excellent Leeds children’s heart unit. I know that other colleagues will also speak about that today and that many across the House feel strongly about it. I welcome the new ministerial team to their posts and hope that they will now look at the matter.

To be absolutely clear, neither we nor the campaigners in Leeds challenge the premise of the national review, but the decision to close the Leeds unit is very questionable. One of the questions that has not been adequately scrutinised is whether the decision even concurs with the premise of the review, and I believe that it clearly does not. That is most patently a matter for ministerial interest, because a flawed and wrong decision is indeed the business of Ministers, so I hope that the Minister will take that away and reflect upon it.

I will just update the Minister and the House on the current situation. A referral is being prepared by the joint health overview and scrutiny committee for Yorkshire and the Humber, and that is part of the democratic process of scrutiny of our NHS, but it is being held up by the obstructionism of the JCPCT, which has made the decision. The JCPCT is refusing to hand over all the information requested, which is absolutely disgraceful. At the same time, implementation is being forced through as if there is an attempt to avoid the scrutiny that is essential in any major decision on the health service, and especially in so sensitive a case. Professor Deirdre Kelly, who chairs the implementation advisory group, has said:

“Implementing the decision on the future of children’s heart services is a top priority and we need the work to start now so that children can benefit during 2014.”

Sir Neil McKay, who chairs the JCPCT, has said—rather outrageously, considering the strength of feeling among children and families in Yorkshire and the Humber—that:

“Children and their families have waited far too long for these vital services to be changed”.

That is patently absurd when we consider that 600,000 people from the region have said that they do not wish the service to be closed and changed in the way that he and his committee propose.

Let me go further and say that the JCPCT secretariat is denying access to key documents needed to challenge the decision while at the same time releasing reams of largely irrelevant material. We do not yet have enough information on the weighting methodology used or detailed scoring information and assessment forms for each surgical centre, something that is crucial for determining whether the decision is as robust as Sir Neil McKay seems so desperate to tell us it is while trying to force it through. Councillor John Illingworth, who chairs the joint health overview and scrutiny committee, has said:

“This is completely unacceptable. JHOSC is the statutory body that should scrutinise the JCPCT decisions, but we cannot complete this process without a full disclosure by JCPCT. The reluctance of the JCPCT to release this non-confidential material is delaying the entire scrutiny process.”

The simple and outrageous reality that I want the Minister to take away—he is conferring with the former Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), but I hope that he will listen to this point—is that the JCPCT is deliberately denying the joint health overview and scrutiny committee access to the documents in an effort to block any real scrutiny of this flawed process. That is disgraceful, because that is the proper process. We need full disclosure, because this is a democratically referred renewal, as Ministers have explained from the Dispatch Box previously.

I must also bring into focus the rather unsavoury role being played by the Children’s Heart Federation. As a charity, it is being used to try to force the pace of implementation of a decision that has not yet been formally approved and ratified. Its chief executive, Anne Keatley-Clarke, has said:

“Further possible delays in implementing the planned improvements to children’s heart services across England would be extremely worrying and would also cause a great deal of further uncertainty and distress for parents right across the country.”

That is a dishonest suggestion, frankly, considering the distress that those parents and families across the country, and in our case in Yorkshire and the Humber, are already feeling as a result of the decision. To try to force it through and undermine the Leeds unit before the decision has been finalised is something that a charity should simply not be doing. It is an arrogant and insensitive thing to say and, in my opinion, brings the charity into disrepute. The reality is, to quote my constituent Steph Ward, the mother of Lyall Cookward, who has relied on the Leeds unit:

“The Children’s Heart Federation have acted in a disgraceful manner. Anne Keatley-Clarke and her organisation think it is perfectly acceptable to completely ignore the views of 600,000 people, so how dare they call themselves a national organisation when they are prepared to ignore such a large section of the country?”

Will the Minister give us a clear assurance today that implementation will not be forced through until the proper process has been followed and there has been full, proper and honest disclosure of all the material necessary to scrutinise the decision? We do not have that. I hope that he can at least give us that assurance today. In the end, we all accept that the review was commissioned. We can have an argument about the number of operations that should be carried out—incidentally, we still have the ludicrous situation in which Glasgow will be permitted to carry out only 300 operations a year but will be deemed safe and sustainable, yet Leeds, which can carry out many more operations, will not be. We have still had no word about that, but organisations, particularly the JCPCT, are trying to force through the decision as if it is finalised. It is not finalised, and the democratic body that is there to scrutinise the decision on behalf of us all has so far been denied the very documents it needs. If that is not sinister, I do not know what is. We must have full disclosure, we must have an open and transparent process, and we must have that now.

I cannot resist the opportunity in the time available to raise the same issue as that which my hon. Friend the Member for Leeds North West (Greg Mulholland) has just addressed, particularly given the fact that we now have a new ministerial team. I am delighted to see the new Minister on the Front Bench.

I realise that the Safe and Sustainable review is independent of Government, as the former Health Minister, my right hon. Friend the Member for Chelmsford (Mr Burns), told me on many occasions. It is clear, however, that there is a problem with the decision, particularly in the north-east of England, and I hope that we can try to find a solution today.

It is worth restating the issue. Despite claims by some, right hon. and hon. Members on both sides of the House, parents, the charity and clinicians are fully supportive of the review’s objectives. It has never been in doubt that safer and more sustainable units are the way ahead, but we are concerned that the outcome does not meet the review’s objectives. It goes against logical health planning, patient choice and clinical preferences. The fact is that patients in Yorkshire, Humberside and north Lincolnshire will simply be offered a poorer service.

Patient choice has been totally disregarded. A survey of patients showed that those in the major postcode areas would go not to Newcastle, but to Liverpool, Birmingham or, indeed, London instead. At the decision-making meeting, it was said that those patients would be influenced by referring doctors. The assumption was made that they would be pointed towards Newcastle, but no justification has been given for that assumption. Indeed, all of the 20 referring clinicians in the Leeds network, whose views were never sought by the Safe and Sustainable review, have said that they would not refer patients there for surgical treatment.

It is a pleasure to carry on campaigning with my hon. Friend on this issue and we will continue to do so. Does he still agree with what we have said before, namely that the reason the Leeds unit is to be closed is the flawed assumption that that will allow Newcastle to reach the target of 400 operations, even though it will not? The unit is being sacrificed for something that will not even happen.

I am grateful for that intervention, which brings me on to exactly that point. The review’s decision said that 25% of Leeds, Wakefield, Doncaster and Sheffield patients would go to Newcastle, when its own evidence said that they simply would not. Funnily enough, if 25% of those patients go to Newcastle, guess what? Suddenly, 403 patients a year will have surgical operations in Newcastle, which is just three more than the magic figure of 400. I do not believe that that 25% will exist, so Newcastle will miss the target of 400 operations, which is a key plank of the whole review.

We have heard about how public opinion has been discounted. A petition signed by more than 600,000 people was brought down to Downing street. That is an enormous number for one region, yet the review counted it as just one response. On the other hand, 22,000 text messages received in support of Birmingham were counted as 22,000 separate responses, which is blatantly unfair.

One of the most important issues is the co-location of services. What has impressed me about the Leeds unit is that it is part of the Leeds children’s hospital. All other surgeons get there within minutes, if needed. We are asking our patients in our constituencies to go to Newcastle, where all other services are some 3 miles away from the heart surgery unit. That is simply not acceptable and goes against the advice of the key recommendation of the Bristol inquiry, which was backed by the British Congenital Cardiac Association. The inquiry said:

“For these services at each centre to remain sustainable in the long term, co-location of key clinical services on one site is essential.”

It is important that we do not forget that.

The fact is that, allowing for patient choice and without the flow of patients from the populous areas of Yorkshire, as evidenced by the PricewaterhouseCoopers research, Newcastle will not reach the target of 400 surgical procedures. In 2010-11, Leeds delivered 336 procedures against Newcastle’s 271.

The impact assessment also showed that the options that included Leeds would have fewer negative impacts and that option B, which included Newcastle, would be particularly damaging for paediatric intensive care in Yorkshire and Humber.

It is also important to ask why Birmingham was chosen because of its density of population and Leeds was not, given the fact that we have a high south Asian population who, statistically, are more likely to need the service. As we have said time and again, doctors should go where the patients are, not the other way around.

Sheffield parents whom I have met at the unit travel three times a day to visit their children in hospital, because they have other children at home. We have to think about the impact this has on families.

I congratulate my hon. Friend on his work on this issue. His point about distance is particularly relevant to my constituency. Cleethorpes is about 85 miles from Leeds and the parents will not travel to Newcastle, so it will not reach that figure of 403.

I am grateful to my hon. Friend for the support that he has given to the campaign by meeting his own constituents who, he is right to say, will not travel to Newcastle. His comments further highlight the ludicrous nature of the decision.

I have presented the problem, so what is the solution? I recognise that the review is independent of Government, but we have to tackle the problem—it will not go away, because we as Yorkshire, Lincolnshire and Humberside MPs will not let it. Our view is that the review could happily be implemented elsewhere, that both Leeds and Newcastle should be kept open and that a decision on their future should be delayed until April 2014. That would provide an opportunity for patients and parents who require the services to exercise their constitutional right to patient choice and to determine which centre they wish to access. By the end of that period, each centre would have to demonstrate that they were fully compliant with all the standards set by the Safe and Sustainable review.

This solution would amount to only a one-year pause. Given that legal proceedings are likely to take place, there will be a one-year pause in any case. The reconfiguration of all children’s heart surgery centres in England is not due to commence until April 2014 and a decision taken at that time on Leeds and Newcastle could be implemented in 2015. The definition of a centre that delivers a sustainable service is that it should have a minimum of four surgeons, so if, after the one-year pause, commissioners did not think that the Newcastle unit had a sufficient work load, the Leeds unit could explore how it could provide support in conjunction with Newcastle.

If either of the centres did not meet the standards, it would, frankly, let itself down. This solution gives them the opportunity to provide the services that families are so desperate to keep. There are many benefits to the solution: it would avoid the risk of a costly judicial action from supporters of either unit, which could sink the review in its entirety; it would give Leeds and Newcastle the opportunity to demonstrate their compliance with the safe and sustainable standards, which is what we all want; it would allow the less controversial decisions made by the JCPCT to proceed elsewhere in the country; and it would show, frankly, that the Government are listening to the concerns of the 600,000 people who signed our petition, and I am sure that the public would respond accordingly.

I know that this is not an easy decision, but there is a great deal of concern and anxiety in our region. I hope that the Government will not just give us the line that this is a review independent of Government, but acknowledge that there are serious concerns and great anxiety among our patients and families, and that it is time to look at the issue in detail, to listen and to act.

I am grateful for the opportunity to speak about community health services in Milton Keynes. Before I outline the issue that is causing concern locally, I will set out the background.

Milton Keynes council, the primary care trust and Milton Keynes Community Health Services have a 12-year history of working collaboratively to deliver jointly commissioned and provided services to the citizens of Milton Keynes. That has been possible because the three organisations share a common vision and common values, and are committed to the principle of local services for local people. The collaboration has supported a transformational approach, which has delivered financial efficiencies and good quality outcomes for people. There is a single joint management structure, which manages combined budgets and resources, and works to a single operational policy.

The collaboration covers mental health and learning disability services, intermediate care services for older people and community equipment. Additionally, there is an integrated pathway involving adult community nursing, end-of-life care, community matrons and social workers. I put on the record my deep appreciation of the invaluable role that those dedicated professionals play in our communities. They often go unsung, so I would like to take this opportunity to record my gratitude.

To achieve such a locally tailored, integrated model is one of the admirable aims of the Government’s health and social care reforms yet, oddly, our successful local model may be at risk because of administrative factors. I hope that common sense can prevail.

Last year, it was hoped that there would be a managed transfer of the community health services to Milton Keynes Hospital NHS Foundation Trust. However, that was not achievable within the required timetable and the PCT enacted a temporary divestment to Bedford Hospital NHS Trust, in full agreement with the strategic health authority and in full knowledge of the anticipated later divestment to the foundation trust. That is an acceptable hosting arrangement that will allow the integrated model to continue.

On 14 December last year, the PCT wrote to the foundation trust, inviting it to submit a proposal for the managed transfer of the community health services, which was to be considered by the PCT board at the end of February this year. However, on 22 February, the cluster PCT received e-mail communication from the head of provider development at NHS East Midlands, which advised that it should follow an open tendering process.

On 11 April, following strong representations from the council and local health partners, a positive meeting was held with Bob Ricketts at the Department of Health, where it was indicated that a managed transfer of the community health services to the hospital would be possible, subject to SHA assurance. However—the situation gets more complicated—a letter from Sir Neil McKay, of NHS Midlands and East, advised that the transfer was no longer possible and that the PCT should proceed towards a competitive tendering process for NHS providers only.

On 12 June, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and I raised questions in the House on this issue. In response, the then Secretary of State for Health urged the PCT and the SHA to ensure that any decision was in the best clinical interests of patients. He stated that it must meet the views of clinical commissioners of the future and those of the public, not least as expressed through the local authority.

Following that, NHS Midlands and East met Milton Keynes council and its partners to discuss the position adopted by the SHA. It was agreed that a meeting should be convened to assess the case for an integrated care organisation. However, it was also agreed that the cluster PCT should continue with a twin-track approach, including an expressions-of-interest process.

Finally, on 11 September, NHS Milton Keynes and Northamptonshire cluster PCT received advice from the NHS Midlands and East SHA to progress with an NHS-only competitive procurement for the services currently provided by Milton Keynes Community Health Services. There has, therefore, been a sequence of contradictory advice from different parts of the NHS, which has thwarted the ambitions of the council, local health partners and patients’ representatives to achieve the best local solution for our citizens—an integrated care organisation in Milton Keynes.

All that is happening at a time when the NHS landscape is changing. The SHA and PCT will be wound up next year, and there is an acute services review that may change the configuration of the local hospitals. My call, and that of my hon. Friend the Member for Milton Keynes North and many local people, is quite simple: the temporary hosting arrangement should continue for the time being, until the new NHS landscape is settled and a sensible permanent arrangement can be found. My hon. Friend and I have raised this matter with the Secretary of State. In welcoming the Minister to his new role, I hope that he will ask the Department to intervene in any way that it can to achieve the common-sense solution, for which there is much local appetite.

I thank hon. Members for their kind comments. A lot of ground has been covered in this debate and many good points have been raised about local NHS services. I hope that hon. Members will forgive me if I cannot give comprehensive answers about everything that has been raised, but I will do my best in the time that is available.

It was clear from all the points that were made in the debate that every hon. Member sees the NHS through the prism of the patient. That is the right way to regard how NHS services are delivered. Patients are the priority for our NHS services and for the Government, and they were the priority for the former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), in his decision to push ahead with the NHS reforms. The basis of the “No decision about me without me” policy is that patients are the most important thing. They are why doctors and nurses do their work and why all Governments endeavour to fight for a better NHS.

I turn now to the concerns of individual Members. I believe that I am right to wish my hon. Friend the Member for Milton Keynes South (Iain Stewart) a happy birthday. A number of hon. Members have concerns about the competitive procurement processes for community health services in Milton Keynes. He mentioned the concerns of my hon. Friend the Member for Milton Keynes North (Mark Lancaster). Our policy is clear that it is for the local NHS, and the primary care trust in particular, to look at the options for different procurement procedures and to decide what is best for local people. The local strategic health authority has played an important role in assuring the PCT’s decisions. Whichever option is chosen, it must be possible to put it in place before 31 March 2013, to avoid the continuing and damaging uncertainty for staff. I am happy to meet my hon. Friend the Member for Milton Keynes South and other hon. Friends to discuss the matter further.

My right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith) talked about maternity services, which is a matter close to my heart. This morning, I visited Newham university hospital, which faces different challenges in maternity care. I looked at the fantastic new unit that has been opened at Newham, which will meet those challenges and provide high-quality maternity care to that part of London.

My right hon. Friend was right to point out that the challenges for maternity services—indeed, for all health care services—in more rural areas such as Berwick-upon-Tweed are different from those in more urban parts of the country, such as London. Women and families in Berwick, like women and families everywhere, deserve maternity services that focus on improving the delivering of high-quality health care for women and babies, and on improving women’s experience of care.

The decision temporarily to close the midwifery-led maternity unit and in-patient post-natal services at the Berwick infirmary, to which my right hon. Friend alluded, was difficult for the local trust to make. He is right to say that in making such decisions there should be regard to the rurality of the area. He made good suggestions about the potential for rotating staff to support rural maternity units. I understand that the decision was made to protect the quality and safety of maternity services in the area and, in particular, to protect the quality of care and safety of women in labour.

I have been assured that the trust is working closely with commissioners to look at the future of maternity services in Berwick. The review will be completed in the coming months. My right hon. Friend may be aware of the recent birthplace study, which discusses good and bad practice in supporting smaller maternity units. I am sure that the commissioners will have regard to that study in making decisions about the future of the unit in his area. He should be assured that I will take a close interest in the matter and support his advocacy on behalf of his constituents.

My hon. Friend the Member for Ealing Central and Acton (Angie Bray) made some points about the service reconfiguration of health care services in London. The hon. Member for Mitcham and Morden (Siobhain McDonagh) also mentioned that issue, and I am sure she would like to pay tribute—as I do—to my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), for their work over the years campaigning for services at St Helier hospital.

Key tests must be passed to ensure that clinical services are suitable for reconfiguration. First, there must be support from local clinicians, and, secondly, arrangements for public and patient engagement and consultation—including with local authorities—must be strengthened and put in place. Thirdly, we need greater clarity on the clinical evidence bases underpinning proposals, and, finally, any proposals should take into account the need to develop and support patient choice.

The reconfiguration of front-line health services is up to the local NHS, and no decisions will be taken until there has been a full public consultation. St Helier hospital is part of the south-west London reconfiguration scheme “Better Services, Better Value”, which is in its pre-consultation stage and is led by local GPs, nurses, acute clinicians, other health care professionals and patient representatives. Under “Better Services, Better Value”, the number of accident and emergency and maternity units will be reduced from four to three, and the likely recommendation is for St Helier to become a local hospital with an urgent care centre.

Ealing hospital is part of the “Shaping a healthier future” scheme in north-west London. Proposals for that scheme include centralising A and E units, and having maternity facilities on fewer sites. However, I reassure my hon. Friend the Member for Ealing Central and Acton that there are no plans to close any hospitals, and certainly not Ealing hospital. As she said, a full public consultation began on 2 July this year and will finish no earlier than 8 October, and I encourage my hon. Friend and her constituents to continue engaging with that process. She outlined the good campaign that she has been running to encourage local engagement, and I am sure she will continue with that so that local voices can be heard when health care decisions are made in the area.

The issue of children’s congenital heart surgery was raised by a number of hon. Members, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew). My hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) spoke passionately about Jacob, the son of one of his constituents.

A number of hon. Members are concerned about the “Safe and Sustainable” review of specialist paediatric services, and particularly its focus on the reconfiguration of heart surgery services. However, as was made clear in a number of contributions, its findings were based on Professor Kennedy’s review of paediatric heart services at Bristol after the heart scandal there, and the “Safe and Sustainable” review is independent of the Government, as it should be. In those circumstances, and given the notice of legal proceedings and referrals to the Secretary of State, it is not appropriate for me to comment further on that review or its outcome, and that stands for my statement on the Floor of the House as well as for my correspondence with constituents. I know that my hon. Friend the Member for Leeds North West has written to the Department on this matter, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied with details of how anyone who wishes to raise concerns about the review can get their voices heard.

I commend the Minister for his professionalism in both his previous career and his current role. Although I accept what he says, does he agree that our statutory process must be allowed to look at whether this review is, as we believe, a dodgy decision, or, as the Joint Committee of Primary Care Trusts contends, a fair one? Does the Minister at least agree that such scrutiny should take place, and that the fact that it is being prevented because documents have not been released is wrong and must be rectified? That is all I ask him to say today.

As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.

On that point, and in the light of the way this legislation has been redressed over the past year and half, does the Minister accept that before the legislation was introduced, and now, ultimate responsibility and accountability for all matters affecting the health service turned on the duties, accountability and statutory responsibilities of the Secretary of State? That is why the Minister is now at the Dispatch Box, just as the Secretary of State would be in other circumstances.

I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.

Does the Minister accept that local people wanted Royal Brompton hospital to be kept open, and that the decision to remove the intensive care unit was not taken by local people? The Minister is arguing against himself.

The initial process for the reconfiguration was started, I believe, by John Reid when he was Secretary of State in 2002, after listening to evidence at the time. We should remind ourselves why we are discussing congenital heart services. All speakers have accepted the principle that there is good clinical evidence—acknowledged by doctors and specialists—that having fewer units actually delivers better care for patients. That was accepted by my hon. Friend the Member for Pudsey. I am not going to go into the rights and wrongs of individual units as that is under judicial review and I will not be drawn further on that point today.

I have been very generous and indulgent but I must make some progress. The process was led by doctors and nurses, and there is an ongoing consultation to engage with, review and reflect on decisions at a local level. That came out clearly in comments by my hon. Friend the Member for Leeds North West, but some of those processes are under judicial review and I will not, therefore, be able to comment further. I hope that my hon. Friend the Member for Sittingbourne and Sheppey will accept my reassurance that these reviews are carried out on good clinical grounds that take into account local factors such as whether local health care services are well designed. The important thing is that they are being led and developed by local doctors and nurses. We need such clinical leaders in the NHS, because they are the best advocates of patients’ needs.

My hon. Friend the Member for Stafford (Jeremy Lefroy) has been a strong advocate of the needs of his constituents and the staff of Mid Staffordshire NHS Foundation Trust. I know that we will be meeting tomorrow to discuss his concerns further, and I will also meet my hon. Friend the Member for Stone (Mr Cash), who has sadly now left the Chamber. We will talk about a number of issues, and I reassure my hon. Friend the Member for Stafford in advance of that meeting that I and other Ministers will continue to do all that we can, as our predecessors did. He rightly paid a full tribute to my right hon. Friend the Leader of the House for all the work that he did as Secretary of State for Health to support staff of that trust and ensure that there are good outcomes for patients. On behalf of all members of the Health team, I commend my hon. Friend the Member for Stafford for his work as a strong advocate of the needs of local patients, and I look forward to meeting him tomorrow.

My hon. Friend the Member for Pendle (Andrew Stephenson) rightly raised the issue of paramedic prescribing. He talked about the need for more flexibility in urgent and emergency care services, on the basis that it is better to have prevention than cure. We know that paramedics do a great job every day of looking after people and providing essential care on the spot and in the ambulance that saves lives before people get to hospital. The more we can do to support paramedics in providing preventive care in the community, the better for patients.

As well as allowing flexibility in urgent care services, paramedic prescribing would allow eligible paramedics to deliver more treatment in the home and the community where appropriate. That should prevent hospital admissions and reduce demand on the system. At the moment, paramedics can administer a range of medicines, but they cannot write prescriptions for patients. A new system of paramedic prescribing should benefit both patients and the NHS. Due to resource and capacity issues it has not been possible to take forward that work yet, but it will be considered within the new architecture of the NHS Commissioning Board along with other work programmes on resources and capacity. I shall certainly raise the matter, and the good points that my hon. Friend made, with ministerial colleagues.

My hon. Friend the Member for Mid Derbyshire (Pauline Latham) talked about diabetes care, particularly for type 1 diabetes. It is commendable that a lot of her focus was on younger people with diabetes. The number of patients with type 1 diabetes and known to be on insulin pumps has increased. At the moment, at least 3,700 children and more than 10,000 adults are on insulin pumps, and they are particularly important for younger people who may find it more difficult to control their diabetes. However, they are important for all people who have difficulty with their insulin and their diabetes control.

We want people to lead more independent lives, and we want to support people with long-term conditions to enjoy the same life as anybody else, so it is right that we do more to support people with type 1 diabetes. Those with difficult diabetes control have to be mindful of their disease on a daily basis, and if we can do more to ensure that their diabetes is not a factor in how they live their lives, that has to be a good thing.

The NHS operating framework for 2011-12 highlights the need to do more to make insulin pumps available. The NHS Diabetes insulin pump network is promoting good practice, but as we have discussed, pump therapy is not suitable for everybody. We are waiting for the conclusion of the first ever national insulin pump audit early next year, which will give us a clearer picture of the number of pumps provided and the services that are available. Importantly, it will also include the first investigation of how services are provided compared with the guidance issued by NICE in 2008 and updated in 2011, which my hon. Friend outlined.

My hon. Friend also raised the issue of artificial pancreases. There is small-scale use of them in children, but the clinical trials are not yet conclusive as to their effectiveness and ease of use and there are currently no NICE guidelines on the subject. We need to use the commissioning process to address the disparities in NHS care and better reflect good medical practice, and nowhere is that more true than in diabetes care. We need to ensure that where there are NICE guidelines on good practice, that practice is carried out.

Finally, I wish to reflect on service reconfiguration and social care, which my hon. Friends the Members for Pudsey and for Milton Keynes South raised. Social care reform is important, and we need an integrated approach to health and social care. We must ensure that we reflect the health care needs of local populations and do more to support people with long-term conditions. That is a key driving force behind the vision for the NHS that my right hon. Friend the Leader of the House outlined in 2010 when he was Secretary of State for Health. It drives what should happen, and what does happen, at local level every day as doctors and nurses look after their patients.

Decisions about integration and what it means to have good joined-up care, particularly for older people and those with diabetes, chronic obstructive pulmonary disease, asthma, dementia and other long-term conditions, need to be made at local level, drawing on the best of local health care provision. The Government will ensure that the NHS Commissioning Board’s mandate includes guidance on what is good commissioning. I am sure that from 2013, when the Government’s reforms have gone through and we have an NHS that is truly locally led, there will be properly joined-up and integrated care that better looks after people with long-term conditions, focuses on prevention rather than cure and particularly focuses on looking after older people better.

Order. Before I call the first Back Bencher in the general debate, I inform Members that the time limit is going to change to 12 minutes, as the number wanting to participate has reduced. May I ask that if you do not need 12 minutes, you do not take it? That time limit will probably enable us to get everyone in in the time that we have.