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Health Services (North-West)

Volume 566: debated on Thursday 11 July 2013

With permission, Mr Speaker, I would like to make a statement about changes at Trafford general hospital and, separately, about the provision of vascular services in Cumbria and Lancashire.

Our primary objective as a Government must be for the NHS to provide the best service for patients. Sometimes that means taking difficult decisions. Both of the decisions I am announcing today fall into that category, but both are necessary if we are to provide safe and sustainable health care in the north-west.

Let me first address the changes at Trafford general hospital. Greater Manchester is home to some of the best and most innovative health care in the country. The reconfiguration of acute stroke services in Manchester has contributed to an overall reduction in deaths of around 250 since the changes were implemented. Salford Royal and Wythenshawe are two of the finest hospitals in the country. The area is blazing a trail in the integration of primary, secondary and social care services, but more needs to be done to ensure that emergency care continues to be safe, which is why the local NHS proposed some important but difficult service changes, which affect A and E provision at Trafford general hospital.

On 8 February 2013, I received a letter from the chair of the joint health scrutiny committee for Trafford borough council and Manchester city council, formally referring proposals about the future delivery of health care services at Trafford general hospital. I then asked the Independent Reconfiguration Panel for its advice on the proposals, which I received on 27 March 2013. Today, I have accepted its advice, which will be published on the panel’s website, in full. I have also written to the chairs of the panel and of the joint health scrutiny committee and to local MPs, informing them of my decision.

The clinical case for change in Trafford general hospital is clear. It is one of the smallest hospitals in the country. Its accident and emergency department is the second smallest in the country. Between midnight and 8 o’clock in the morning, the A and E department sees on average only two patients an hour. Even at peak times, the unit sees on average only seven patients an hour. Over half of local residents already use accident and emergency services outside Trafford. Trafford clinical commissioning group’s chief clinical officer, Dr Nigel Guest, himself a local GP, said:

“This makes it difficult to attract new doctors, it means that services cost more than they should and it compromises our ability to ensure good clinical outcomes. In short, it means that for too long local people have not been getting the type of service they should and deserve to receive.”

The problems are not confined to A and E. The low number of patients using intensive care means it, too, is not sustainable, and is likely to become unsafe in the future. According to the Greater Manchester critical care network, the unit needs to treat a minimum of 200 patients a year to be safe, but it treats fewer than 100. Emergency surgical services are also not sustainable. The Royal College of Surgeons states that emergency surgery should serve a population of at least 300,000— ideally 450,000 to 500,000. Trafford general hospital serves a population of around 100,000.

Trafford is currently able to provide a range of high-quality clinical services. However, it is becoming increasingly difficult to safeguard those services in a way that is sustainable in the long term. As a result, the National Clinical Advisory Team of independent health professionals has advised me that there will be clinical and safety issues if the hospital continues practising as it currently does. I accept its advice.

Initially, the A and E at Trafford general hospital will be replaced by an urgent care centre. The A and E currently sees just 100 patients a day. The majority of those patients—around 75%—will continue to be seen at the urgent care centre. That means around 25 patients a day will be treated at the three neighbouring large university hospitals, all within a 10-mile radius. In the longer term, as services are developed over the next two to three years, the urgent care centre will become a minor injuries unit. Trafford general hospital will become a centre of excellence for elective orthopaedic surgery.  That will see all other in-patient surgery stop, but there will be an expansion of day surgery, such as ophthalmology and other vital local services.

On 24 January this year, the PCT cluster, NHS Greater Manchester, approved the implementation of these proposals subject to the prior fulfilment of six conditions. Those included addressing transport issues for local residents, accelerating the implementation of a local integrated care system and ensuring continued access to out-of-hours mental health services when the urgent care centre eventually closes. Progress will be assessed and evaluated throughout the transition by NHS England in conjunction with the local joint health scrutiny committee. Following the advice from the Independent Reconfiguration Panel, I am also satisfied that the four tests for reconfiguration have been met.

As a result of the changes I am supporting today, Trafford CCG will be able to reinvest an additional £3.5 million to deliver what local people have asked for—more choice, more preventive care and more services closer to home. That will include community matrons and a community geriatrician, a 72-hour rapid response team, as well as an in-reach team to A and E to support people with complex needs and mental health issues.

I know that the right hon. Member for Wythenshawe and Sale East (Paul Goggins), the hon. Member for Stretford and Urmston (Kate Green) and my hon. Friend the Member for Altrincham and Sale West (Mr Brady) have met the Under-Secretary of State for Health to raise their concerns. Others, including the right hon. Member for Leigh (Andy Burnham), have written to me directly. That is why I have wanted to reassure myself since receiving the advice that the NHS has arrangements in place to ensure patient safety is not compromised during the transition to new services. I can assure all Members that there will be a rigorous assurance process overseen by NHS England and that no changes will occur until unequivocal assurances have been given by a provider’s board or chief executive that their organisation can safely receive additional patients and activity, however small.

Because A and Es around the country have been under increased pressure over the past few months, I also make a commitment today that changes at Trafford will take place only if the three neighbouring A and Es that will need to treat additional patients are consistently meeting their waiting time standards. Progress will be assessed and evaluated throughout the transition by NHS England in conjunction with the local joint health scrutiny committee. The Department of Health has also set aside funds to support investment by the University Hospital of South Manchester NHS Foundation Trust in expanding Wythenshawe hospital’s A and E department. That application for funding will be treated as a priority.

I turn to the provision of vascular services in Cumbria and Lancashire. On 19 February, the chair of Cumbria’s health scrutiny committee wrote to me formally to refer proposals about the provision of vascular services in Cumbria and Lancashire. I subsequently asked the Independent Reconfiguration Panel for its advice, which I received on 19 April. Today I have accepted its advice in full, which will be published on the panel’s website. I have also written to the chair of the panel and of the Cumbria health scrutiny committee, as well as to local MPs, informing them of my decision.

The changes will concentrate vascular services in three specialist centres, in line with the IRP’s advice for a population of around 2.8 million people. More routine services will continue to be provided locally. Seven hospitals, including the three specialist centres, will continue to provide services such as screening, out-patient clinics, day surgery, diagnostic tests and rehabilitation services. The centres will be at North Cumbria University Hospitals NHS Trust in Carlisle, East Lancashire Hospitals NHS Trust in Blackburn, and Lancashire Teaching Hospitals NHS Foundation Trust in Preston. Day casework and out-patients will continue to be assessed and treated in local hospitals across the region.

The three centres will provide sufficient cover both for the sparsely populated north of the region and for the densely populated south, which includes significant pockets of deprivation and unmet health needs. The concentration of vascular services is in line with national policy, as recommended by the Vascular Society of Great Britain and Ireland. The move will give patients access to better care and treatment than is currently possible with vascular services spread more thinly across the region.

The IRP accepts, as do I, that an inevitable consequence of concentrating specialist services at centres of excellence, is that some patients will have to travel further for treatment. However, the IRP informs me that the evidence in favour of concentrating services is particularly strong in relation to vascular surgery and that there is a strong clinical consensus that doing so will improve outcomes for patients. I know that Members representing north Lancashire and south Cumbria are particularly concerned about the distance patients will need to travel for specialist treatment. I do sympathise, but in the end have taken the difficult decision that the clinical benefits of concentrating specialist services outweigh any disadvantages in terms of additional travel times. I add that the Royal Lancaster Infirmary along with six other hospitals will continue to provide more routine vascular services.

These changes offer an opportunity to provide significantly improved vascular services to the people of Cumbria and Lancashire. I am therefore asking NHS England, working with local NHS organisations, to address the outstanding concerns raised by Cumbria health scrutiny committee. Local people need to know that changes are indeed leading to improved outcomes and that reasonable steps are being taken to support those with further to travel. In line with the IRP’s advice, I also want to see a programme of public information about the changes.

The public are rightly concerned about any major changes to health provision, and I particularly recognise the concerns people have about having to travel further, which is significant not just for patients but for their families and friends. However, my priority, and the Government’s priority, has to be what offers the safest and best clinical outcomes and what will save the most lives. That is why, after careful consideration, I have accepted independent clinical advice on both these decisions. I have also accepted the view of the IRP that the process leading to the decisions has been the right one, and I thank it for its work on these decisions.

I commend this statement to the House.

I thank the Secretary of State for his statement on matters that are of major significance to the NHS in the north-west of England, but I am not the only north-west MP taken by surprise this morning by the lack of advance notice. My hon. Friend the Member for Stretford and Urmston (Kate Green), in whose constituency Trafford hospital lies, was heading home, but had to abandon her journey at Stoke and is now heading back down to try to get here. This is not just a major discourtesy to her and the House, Mr Speaker; it is an insult to the people of Trafford, and it is no way to treat people who have campaigned to save their A and E, and who should have rightly been able to expect that their voice be heard in this House today through their elected Member of Parliament.

It says a lot about this Secretary of State. His advisers could find time to get texts sent to the Murdochs with market-sensitive information before an earlier statement he made, but he could not find time to give a local MP advance notice of a statement about the closure of her accident and emergency department: disgraceful.

This is not just any A and E: 65 years and six days after Nye Bevan opened the NHS at Trafford hospital, we have the spectacle of this Secretary of State scurrying to the House to rush out an announcement without the scrutiny of local MPs about a major downgrade of the hospital. What clearer symbol could we have of a Government who disrespect and disregard the views of NHS staff, patients and local people?

My hon. Friend the Member for Stretford and Urmston is trusting that the west coast main line will get her back before the close of this statement, and I hope you will allow her to contribute, Mr Speaker, even though she has clearly missed the opening of this statement.

Let me now turn to the substance of what the Secretary of State has said. He is right to say that the IRP provides excellent support and advice to Ministers. It did so to me and my predecessors in the last Government, and I am sure it is doing the same for the current Government. Where it can be shown that changes will save lives and reduce disability, in my view all Members of this House have a moral obligation to support them. Changes to vascular services in Cumbria and Lancashire clearly fall into that category. The concentration of this highly specialised surgery on three sites will save and improve lives, but given the geography it is essential that people are supported with travel. The Secretary of State made a vague commitment, but can he be more specific about the support that will be made available to patients, particularly in the sparsely populated northern part of our region, who will now have to travel much further to receive this life-saving surgery?

Although we support the Secretary of State’s decision on Lancashire and Cumbria, we have much greater concerns about the process that has led to the decisions today about Trafford hospital. While the IRP has undoubtedly done what it has been asked to do, I wrote to the Secretary of State in November last year to express serious reservations about the Trafford review proceeding ahead of Healthier Together, a much wider review of acute and emergency services across Greater Manchester. Speaking as a Greater Manchester MP, I cannot see why it makes sense to pick off Trafford hospital ahead of this review without looking at things in the round. It does not feel to me that this is part of a coherent plan for the NHS in our city region, and I ask the Secretary of State today why his decision is justified, given that the wider considerations affecting health services in Greater Manchester have not yet been completed.

The Secretary of State claims that the patients affected by the closure of Trafford can be easily and safely absorbed by the neighbouring A and Es. How can he say that when all the A and Es that will now have to absorb extra patients missed his own A and E target for at least four months during the worst winter in the NHS for a decade? Have the Secretary of State and the IRP made their decision looking at the very latest evidence of growing pressure on A and E departments in Greater Manchester? He mentions extra funding for Wythenshawe, which is welcome, as the hospital was built for 70,000 patients a year and is currently seeing almost 100,000, but will other affected A and Es also receive additional funding?

Finally, Mr Speaker, the appalling mishandling of this statement today, which has left the people affected unable to put the Secretary of State under scrutiny, is just the latest example of the wider mishandling of hospital reconfiguration under the coalition, which has seriously damaged public trust in our ability to make changes to hospitals. Picking off Trafford ahead of a wider review broke the illusory moratorium on hospital changes announced just days after the general election outside Chase Farm hospital by the Secretary of State’s predecessor and the Prime Minister—incidentally, that hospital is also now downgraded.

Sir David Nicholson has today said:

“If a political manifesto does not say that service change is absolutely essential and that you need to concentrate and centralise services—it will not be being straight forward with the British people.”

Might he just have had the last Conservative manifesto in mind when he made that statement? Will the Secretary of State today admit that this false moratorium was a cynical and dishonest policy designed to win votes in marginal seats, and will he commit never to repeat it?

Worse still, the Secretary of State’s officials have been in court in the past few days trying to justify the indefensible: a decision to rob a local community in south London of a successful A and E to solve problems in another trust that were not of its making. Is all this not causing severe damage to trust in how these decisions are made? Will he give a commitment to the House today that if the court finds against him, he will abandon his plans to downgrade Lewisham A and E? Labour Members will support changes where they are clinically justified, but where communities are picked off unfairly by this arrogant Government we will stand with them and fight for fairness.

Many members of the public are understandably concerned about these decisions, but from someone who was Health Secretary and who argued the case many times for changing services what we have heard today is not sensible argument, but political opportunism.

Let us examine what the right hon. Gentleman said only last week in Hastings. He said that people like him have a moral imperative to support the doctors who are making these decisions. Well, these changes are supported by the Trafford clinical commissioning group, Greater Manchester critical care network, the Royal College of Surgeons and many other doctors. How many doctors does he need to support this decision before he actually does what he said he would do last Friday, which is support doctors making difficult decisions? On the very day that NHS England is talking about the need to protect services for patients by facing up to difficult decisions, his approach is more than inconsistent—it is irresponsible, and he knows it. Let us examine what he said about changes in Trafford when he was Health Secretary—

Order. We must have order from those on the Opposition Front Bench, and I know that the Secretary of State will want to respond to the questions asked of him. I just remind the House that it is not a generalised debate; it is a statement and a response to questions.

Absolutely, Mr Speaker. I think that it is very important that on both sides of this House we have consistent arguments. It is very important to the questions that I was asked that I remind the right hon. Gentleman of what he said when he was Health Secretary. “I am disappointed,” he said, that politicians

“are going around Greater Manchester undermining the clinically-led process”.—[Official Report, 30 March 2010; Vol. 508, c. 620.]

The local medical director says that these changes will save—[Interruption.]

Order. The temperature needs to fall. This is a very highly charged matter, there is considerable sensitivity about it, it is extremely important and we want to hear what the Secretary of State has to say. When he has said it, everybody will get a chance to come in, but please let us lower the decibel level. We certainly do not want to imitate what happened to the considerable discredit of the House yesterday.

The other point the right hon. Member for Leigh (Andy Burnham) made was that we should not make these changes to A and E services when those in other hospitals are under pressure. It is important that I remind the House of what he did when he was Health Secretary. After 2004-05, Labour missed its A and E targets in 12 quarters but closed or downgraded 12 A and Es. Now, in Wales, the A and E target has not been met since 2009, yet Labour is embarking on a big reconfiguration programme with his full support. So it is one policy when Labour is in opposition, another when it is in power. There is one person who agrees with the right hon. Gentleman, and he was campaigning in Trafford on Friday—Len McCluskey. When it comes to a choice between supporting local doctors or the unions, the Opposition support the unions.

Order. We cannot have points of order in the middle of a statement. The Secretary of State has been asked specific questions and I know that he will now respond without any delay to those specific questions and nothing more. Other Members wish to contribute and there is other business. The Secretary of State is an extremely important man, of course, but there are a lot of other people involved, too, and we need to get on and hear them. I call the Secretary of State to respond briefly.

Thank you for that rare compliment, Mr Speaker.

The right hon. Member for Leigh asked a specific question about travel and I will ask the local NHS trusts to work closely with the overview and scrutiny committees to ensure that proper arrangements are put in place for people who have to travel further. He asked me about deferring the decision until the Healthier Together programme for the whole of Greater Manchester was decided, but the IRP specifically said that it would be wrong to defer the decision—the point is that local doctors are saying that doing so would not be safe for patients, and that is why I am accepting the advice.

The NHS is a great institution, but we have to take difficult decisions sometimes. The proposals will help patients, but I am afraid that the right hon. Gentleman is interested only in politics.

Many people will be disappointed, of course, by the decision on Trafford general, but I thank my right hon. Friend and his ministerial team for their openness in hearing the concerns of local Members and Trafford council in building up to what has obviously been a serious and carefully made decision. I thank him for the extra investment for Wythenshawe and for making the changes contingent on ensuring that the capacity is there in surrounding hospitals to ensure that this is safe. Will he also give us an assurance that the Trafford health economy will not suffer financially if those contingencies are not met in time?

I thank my hon. Friend for the constructive approach he has taken in this process. I assure him that this will help the local Trafford economy. Three major teaching hospitals are used by the people of Trafford. Two of the three are meeting their A and E targets and one is not. These proposals will help the one that is not meeting its target to do so. They will also mean that an extra £3.5 million can be invested in community and prevention services, including local geriatricians and community matrons. That will be of huge benefit to my hon. Friend’s constituents and to many other people in the local area.

May I first ask the Secretary of State to respond to the issue raised by my right hon. Friend the Member for Leigh (Andy Burnham) about the lack of notice of the statement? I have had good news for my constituency from the Secretary of State, but many of my colleagues have had bad news and it is genuinely discourteous for the House not to have been informed. This is not a market-sensitive issue, after all, and we could have been told yesterday or earlier.

Secondly, on the merits of the concentration of vascular services in Lancashire and Cumbria, may I thank the right hon. Gentleman for the decision that he has made, not least in respect of East Lancashire Hospitals Trust in Blackburn? This is an important vote of confidence in the excellence of the facilities in Blackburn at a time when many of the clinicians and others have been under great anxiety because they have been subject to the Keogh review. I think all my constituents recognise that sometimes they will have to travel, as mine have had to travel to Blackpool for many years, for very serious cardiovascular surgery. Provided the outcomes are much better where there is a concentration of resources, and assistance with travel is given in appropriate cases, I think my public and that across the north-west will accept these decisions.

I thank the right hon. Gentleman for his wise words. If we level with the public about these difficult changes, they do understand that there are times when they get a better outcome even if they have to travel further. Perhaps the most dramatic example of that has been how trauma services have been centralised on fewer hospitals. Even after incidents as dramatic and dangerous as road traffic accidents, people are not necessarily taken to their nearest A and E. They are stabilised and then they are taken to an A and E that has the equipment that is necessary to give them the treatment that is most likely to save their lives. The right hon. Gentleman is right to say that.

I absolutely followed and would always want to follow the procedures of the House with respect to advance notice of statements. The request for a statement went in only last night. The Speaker made his decision this morning. I am delighted that the hon. Member for Stretford and Urmston (Kate Green) is here and I hope she is allowed to speak. I said to her on the phone this morning that I am willing to meet her separately to go through any concerns that she has. [Interruption.]

Order. I thank the Secretary of State for his courtesy. I know the right hon. Gentleman well, and I know that he would not seek for one moment to mislead the House. He was trying candidly to respond to the right hon. Member for Blackburn (Mr Straw). For the avoidance of doubt, let us be absolutely clear. I can quite accept that the Secretary of State requested, within the Government machine, permission to make a statement today. However, the House will wish to be aware that I myself was aware of the request to make a statement only this morning. Let us be clear about that.

There is a strong clinical case for the concentration of vascular services in Cumbria and Lancashire at three sites, but is it not ludicrous that the three that have been chosen are so geographically located that one is virtually on the Scottish border, then there is a gap of almost 100 miles, and then there are two that are nine miles apart? Does not that leave south Cumbria and north Lancashire dangerously under-provided for? Given the current difficulties, shall we say, at Morecambe Bay, does not robbing Morecambe Bay of those skills and that expertise make a difficult situation potentially even worse?

I know that my hon. Friend has campaigned, rightly, to represent the concerns of his constituents about the extra travel that they will have to undertake. I would like to reassure him that we considered that issue very carefully. The Independent Reconfiguration Panel recognises that travel is a consideration, but also believes that for his constituents, even for the people who have to travel further, there will be better clinical outcomes for specialist vascular surgery. We are not talking about routine surgery, diagnosis or rehabilitation work but about conditions such as aneurysms and carotid artery disease which require specialist care. Patients can get much better help if that is concentrated in specialist centres.

As to why those particular centres were chosen, it was a genuinely difficult decision. There is a bigger concentration of population in the south of the region and there is also more social deprivation and more unmet need. I know it was a difficult decision, but it was decided that that would be best for the 2.8 million people in the area and also better for my hon. Friend’s constituents.

I am very grateful to you, Mr Speaker, for allowing me to ask a question, and I apologise for missing the opening statements. As you know, I think, it was only when we saw this morning’s Order Paper that we knew that a statement would be made this morning, and I was on the way to Manchester at the time to meet constituents. I am very grateful indeed for the opportunity to ask the Secretary of State a question. My constituents would be horrified were I not in the Chamber this morning to do so.

This has been one of the most contentious and difficult issues facing the health economy in Trafford since my election. Although I welcome the Secretary of State’s offer to meet me and I was grateful for his time on the phone this morning, he will understand that people are concerned that doubts and fears about the future of Trafford general hospital are already leading to a downward spiral in people going to that hospital and the level of staffing and service that they receive there. What absolute guarantees can he give my constituents that there will be no diminution whatsoever of the service they receive during what may have to be a very protracted transition process, and that in particular there will be no repeat of our experiences over the most recent winter months, when neither Manchester Royal infirmary nor Wythenshawe A and Es were able to meet the accident and emergency waiting time targets on more than 15% of occasions?

I recognise that the hon. Lady would have liked to have been here for the statement, and indeed that she made a huge effort to get here. As I told her on the phone this morning, I am more than happy to meet her separately to discuss her concerns. With regard to her concern about a downward spiral, I hope today to reassure her constituents that a clear decision has been taken that will secure the hospital’s future as a successful and important hospital, a centre of excellence for elective orthopaedic work, and a hospital that has a very important role to play in the local health economy. We are making huge efforts to ensure that there will be no diminution of services but that services will improve. Of the three major teaching hospitals that will now provide A and E services for her constituency, one—Central Manchester university hospital—is not meeting its A and E targets. The measures announced today will help it meet those targets and make it more likely that her constituents will get a better service in A and E. However, as I made absolutely clear in my statement, I will not allow the changes to be made until all three hospitals are consistently meeting their A and E targets.

Can my right hon. Friend reassure my constituents that the decision on Trafford general hospital should not be seen as putting the provision of A and E services at Fairfield hospital at risk?

This decision is about Trafford general hospital’s A and E services. What we are considering in this decision is whether the other hospitals can absorb the extra patients who will come to them as a result. We think that the neighbouring A and Es will initially have to absorb only about 25 patients in total. It is not a decision about the future of other A and Es.

The new service in Cumbria will have to be managed, and part of the problem in Cumbria is poor management, yet we have been waiting for two and a half years for Northumbria Healthcare NHS Foundation Trust to take over in Cumbria. When will we see that acquisition?

I am keen to resolve that issue as soon as possible. Indeed, I think that it is really important, given what we heard this morning from NHS England about the big challenges facing the NHS, that we try to take these difficult decisions much more quickly than normally happens. When we have paralysis and decisions being put on hold, that creates uncertainty and the worries that the hon. Member for Stretford and Urmston (Kate Green) talked about, so I want to ensure that we decide these things as quickly as possible.

Dr Nigel Guest, chief clinical officer at Trafford clinical commissioning group, has said that making these changes to services at Trafford general hospital

“is vital to secure a long and vibrant future for the hospital.”

Can my right hon. Friend reassure the House that that will be the case?

Yes, and I hope that what we have announced today will give my hon. Friend that reassurance. We have announced a future for Trafford general hospital as a centre of excellence for elective orthopaedic work. We have also announced a significant increase in investment in community services, an extra £3.5 million that will pay for community matrons, community geriatricians, a 72-hour rapid response team and better support in A and Es for people with mental health needs. This is a very big step forward, but it is part of the country that has gone further and faster than many others in delivering integrated care. This announcement will take that further and will mean that it stands out as a beacon of what good care can look like in an ageing society.

May I echo the comments of right hon. and hon. Friends about the lack of notice? It really is outrageous that Members with a constituency interest were not given adequate notice.

May I ask the Secretary of State specifically about the funds that he says have been earmarked for the expansion of the A and E department at Wythenshawe hospital? That is essential, because at least another 4,500 patients will be coming to the A and E following his decision. Can he confirm absolutely this morning that that funding will be made available in full, in advance of any changes? How will the funding be made available? University Hospital of South Manchester is a foundation trust, which means that it cannot receive NHS capital, and it has already borrowed to the limit.

First, let me say to the right hon. Gentleman that 25 extra patients a day will have to be absorbed by the three neighbouring hospitals to Trafford, so it is not a large number. We want to make sure that all hospitals, including Wythenshawe, which I have visited—it is a superb hospital—are able to absorb that capacity. It is currently meeting its A and E target. The application that has been made for extra capital grant to help it to expand its A and E department will be treated as a priority.

Safety should always be paramount, but public confidence is also important. As the Secretary of State faces further tough decisions on reconfiguration in the coming years, will he assure me and other Members of this House of two things: that he will be conscious of not applying urban solutions to rural areas; and that where alternative pathways of care can be put in place, that will happen before changes take place?

My hon. Friend makes two important points. I explicitly said that we will not proceed with any of these changes until neighbouring hospitals have been consistently meeting their A and E standards and any necessary changes have been put in place so that we can be sure that they will improve care for patients. That is really important if we are going to maintain confidence.

On my hon. Friend’s point about urban versus rural, part of the underlying reason for these changes is that we need to get more care out of big hospitals, which are often in urban areas, and into the community—into settings near people’s homes. That is very important for rural communities where there are often large concentrations of older people. Today’s decision will mean an additional investment in those community services. As we look at the big changes we need to make in the NHS, we will need to make more decisions that allow more to be invested in out-of-hospital care if we are to prevent the illnesses that ultimately put so much pressure on our A and E departments.

Is any consideration being given within the Secretary of State’s Department or NHS England to reconfiguring the A and E services between St Helens and Whiston hospitals and Warrington and Halton hospitals? He might not be aware that the chief executive of Warrington and Halton hospitals and the chair of its trust board recently told me and my hon. Friend the Member for Warrington North (Helen Jones) that they think they will run out of money in about 18 months’ time such are the pressures that they have at the moment. Will the Secretary of State investigate this and tell me whether any consideration of that reconfiguration is taking place?

With regard to pressures on A and E, we are working very hard with A and Es across the country to make sure that they learn the lessons from what happened last winter and are properly prepared for this winter. Those discussions will include the A and E departments that serve his constituents. He will know that any decisions about service changes or reconfigurations are a matter for the local NHS; they come to me only if they are referred to me following a formal proposal by a local health overview and scrutiny committee, and that has not happened in this case.

Like other Members across the House—I speak particularly on behalf of my hon. Friend the Member for Barrow and Furness (John Woodcock)—I condemn the poltroonish way in which this statement has been handled. Will the Secretary of State concede that instability is corroding health services right across Cumbria? Will he guarantee that when North Cumbria University Hospitals Trust is acquired by Northumbria Trust this decision will not be yet again reconsidered?

Today is a sitting Thursday and we have followed parliamentary procedures. I am doing everything I can to help the hon. Member for Stretford and Urmston (Kate Green) to have as much engagement as she needs given that she was not able to be here at the start of the process. With regard to stability, the hon. Gentleman cannot have it both ways. If he wants stability and wants decisions to be taken decisively, then he has to support the Government when they take difficult decisions like today’s and not be opportunistic, in the way that the shadow Secretary of State was.

I agree with my right hon. Friend the Member for Blackburn (Mr Straw) about the apparent benefits of relocating to Blackburn and concentrating resources, but despite seemingly being a beneficiary of this reconfiguration, I am worried about the treatment of Lancashire and Cumbria MPs. What notification was given to those Members, and what consultation took place with them on the decision?

The process has taken a long time because we have consulted extensively with the local community and local Members. There have been debates in the House about it, and Members have regularly asked about it during oral questions. I asked for hon. Members to be given advance notice of today’s statement. Consultation is important, and we asked for advice from the Independent Reconfiguration Panel—

I follow the procedures of the House, and the right hon. Gentleman should know that we did nothing different from what he did when he was Health Secretary.

The Secretary of State cites social deprivation as a justification for his decision on the configuration for Cumbria and Lancashire. I fully support that principle, so will he take it further by ensuring that those of us who represent constituencies in which health outcomes are much worse than those in the south of England, for example, get larger allocations of cash in future distributions of moneys? If he is going to use the principle once, he must do so consistently.

That is already built into the funding formula. We made reducing health inequalities a duty of NHS England in the NHS mandate, and that needs to be done in a way that is also fair to socially deprived people living in the countryside, in rural areas and even in the fringes of affluent areas. We have to find a way of ensuring that the process is fair to everyone who is socially deprived and to do what we can to reduce health inequalities.

No one should be in any doubt that there will be huge shock back home in Greater Manchester at the announcement about Trafford. The conurbation has specific problems with its hospitals, such as mine in Tameside, where we have finally changed the management. We have the Healthier Together process, which is reviewing practically everything, and we are still coping with the impact of the reorganisation with which the whole country has to contend, and now we turn up at Parliament on a Thursday morning to hear the unilateral announcement that Trafford is going. Given the scope of the Healthier Together process, how can the Secretary of State honour the assurances that he gave in his statement? He could not answer the question asked by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) about foundation trusts and capital at all. What further changes to hospitals in Greater Manchester is he going to spring on us in the future?

Foundation trusts can apply for a capital grant, and I said in my statement that, as soon as we get a business case, we will give that a high priority. We are sympathetic to awarding it, but we have to wait for the business case to be presented.

In a period in which the NHS faces huge pressures, it is important to show leadership, and that means local MPs understanding that difficult decisions sometimes need to be taken that are in the interests of their constituents, as a number of Members have done today. It also involves supporting what local doctors have been arguing for over many years, but taking the line of the right hon. Member for Leigh (Andy Burnham) by supporting the unions, not the doctors, is totally irresponsible.

Order. May I say to the hon. Member for Lewisham East (Heidi Alexander) that I am sure that she would not seek to use this statement as a back-door method of talking about health services in Lewisham? If she wishes to expatiate on health services in the north-west, we will hear from her.

I am grateful, Mr Speaker.

The Health Secretary repeatedly said that changes will be made at Trafford only if the neighbouring hospitals that have to take additional patients are consistently meeting their waiting time targets for A and E. Will he define “consistently” and clarify exactly what he means by that? Will it apply to all A and E reconfigurations throughout the country?

We are absolutely clear that we will not proceed with A and E reconfigurations unless the outcome will be an improvement in clinical care. That applies across the country as well as in Trafford.

I say to the hon. Lady that it is only exceptionally that points of order are taken between statements, and if they are taken they must relate to the matter just discussed, which I rather suspect hers will. I am not going to have a general debate; I shall take one point of order from the hon. Lady.

I am grateful to you, Mr Speaker. Is it in order for a Secretary of State for Health to announce the closure of another Member’s A and E, which is a very serious matter for all MPs, without making any effort whatsoever to even advise the Member concerned that they might wish to attend the Chamber the following day?

It is quite simple. The short answer is that nothing disorderly has taken place. The Secretary of State is entitled to come to the House and make a statement at a time of his choosing. I have experienced a great many Ministers in my time in the House. Different Ministers adopt different approaches. In some cases Ministers have conversations with Members in advance—I know that the Secretary of State himself has done so on other occasions—and signal an intention to make a statement, or the possibility of a statement, at a particular time, but on other occasions they do not do so. On the strict question of whether it is in order, I can confirm that the Secretary of State’s conduct is not disorderly. Beyond that, it is for hon. and right hon. Members to make their own assessment of the handling of the matter. There is scope, as with so many matters, for different points of view. I think that is the fairest thing I can say.