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Changes to Health Services in London

Volume 569: debated on Wednesday 30 October 2013

With permission, Mr Speaker, I would like to make a statement on the “Shaping a healthier future” programme, a locally led review of NHS services across north-west London.

The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. The population of north-west London is growing and will reach approximately 2.15 million by 2018. About 300,000 people have a long-term condition. However, there is great variation in the quality of acute care. In 2011, there was a 10% higher mortality rate at weekends for emergency admissions, and the number of hospital re-admissions differs considerably across the area. The Independent Reconfiguration Panel expressed concerns that the status quo in north-west London was neither sustainable nor desirable, and might not even be stable.

In order to address these challenges, the NHS in London started the “Shaping a healthier future” programme in 2009. It proposed significant changes to services, including centralising accident and emergency services at five rather than nine hospitals; 24/7 urgent care centres at all nine hospitals; 24/7 consultant cover in all obstetric wards; a brand new trauma hospital at St Mary’s hospital, Paddington; brand new custom-built local hospitals at Ealing and Charing Cross; seven-day access to GP surgeries throughout north-west London; the creation of over 800 additional posts to improve out-of-hospital care, including a named, accountable clinician for all vulnerable and elderly patients with fully integrated provision by the health and social care systems; and increased investment in mental health and psychiatric liaison services.

These changes represent the most ambitious plans to transform care put forward by any NHS local area to date. They are forward-thinking and address many of the most pressing issues facing the NHS, including seven-day working, improved hospital safety and proactive out-of-hospital and GP services. The improvements in emergency care alone should save about 130 lives per annum and the transformation in out-of-hospital care many more, giving north-west London probably the best out-of-hospital care anywhere in the country.

The plans are supported by all eight clinical commissioning groups, the medical directors of all nine local NHS trusts, and all local councils except Ealing. It was as a result of a referral to me by Ealing council on 19 March 2013 that I asked the Independent Reconfiguration Panel to conduct a full review.

The panel submitted its comprehensive report to me on 13 September 2013 and I have considered it in detail alongside the referral from Ealing. I am today placing a copy of the panel’s report in the Library, alongside the strong letters of support for the changes that I received from all local CCGs and medical directors. The panel says that “Shaping a healthier future” provides

“the way forward for the future and that the proposals for change will enable the provision of safe, sustainable and accessible services.”

Today I have accepted the panel’s advice in full and it will be published on the panel’s website.

The panel also says that while the changes to A and E at Central Middlesex and Hammersmith hospitals should be implemented as soon as practicable, further work is required before a final decision can be made about the range of services to be provided from the Ealing and Charing Cross hospital sites.

Because the process to date has already taken four years, causing considerable and understandable local concern, I have today decided it is time to end the uncertainty. Therefore, while I accept the need for further work, as the IRP suggests, I have decided that the outcome should be that Ealing and Charing Cross hospitals should continue to offer an A and E service, even if it is a different shape or size from that currently offered.

Any changes implemented as part of “Shaping a healthier future” should be implemented by local commissioners following proper public engagement and in line with the emerging principles of the Keogh review of accident and emergency services.

I have today written to the chair and vice-chair of the health and adult social services standing scrutiny panel of the London borough of Ealing council, the chair of the IRP Lord Bernie Ribeiro, the chief executive of NHS England and local MPs, informing them of my decision.

These much-needed changes will put patients at the centre of their local NHS, with more accessible, 24/7 front-line care at home, in GP surgeries, in hospitals and in the community. More money will be spent on front-line care, which focuses on the patient. Less will be wasted on duplication and under-performing services.

Let me be clear that, in the joint words of the medical directors at hospitals affected, there is a

“very high level of clinical support for this programme across NW London”.

Local services will be designed by clinicians and local residents and will be based on the specific needs of the population.

None of these changes will take place until NHS England is convinced that the necessary increases in capacity in north-west London’s hospitals and primary and community services have taken place.

I want to put on the record my thanks to the IRP for its thorough advice. As the medical directors of all the local hospitals concerned said in their letter to me, these changes will

“save many lives each year and significantly improve patients care and experience of the NHS.”

When local doctors tell me that that is the prize, I will not duck a difficult decision.

I commend this statement to the House.

People at home will have listened carefully to what the Secretary of State has just said, and they will have one simple question in their mind: why is this man trying to close so many A and Es when we are in the middle of an A and E crisis? At least seven A and Es across the capital are under threat, at a time when all London A and Es are working flat out and are full to capacity. As we stand here, thousands of people are waiting to be seen, stuck on trolleys or held in the back of ambulances that are queuing outside A and E. When the A and Es we have are struggling to cope, how on earth can it be safe to close or downgrade so many?

That brings me to what I see as the major flaw in what the Secretary of State has announced. These plans have been in development for four years, as he said. Four years ago, A and E was not in the crisis that it faces today. The reality on the ground in London has changed. In 2013, A and Es in London have been getting worse and worse and worse. Across London, 200,000 people have waited in A and E for longer than four hours in the past 12 months. Here is the statistic that should make people stop and think: taking all its major A and E units together, London has missed the Government’s A and E target in 48 of the last 52 weeks.

Any further changes to this fragile and overburdened system must proceed with the utmost caution. Will the Secretary of State give me a categorical assurance that he personally gave in-depth consideration to the latest evidence of the pressure on London A and Es and to the changed reality that 2013 has brought before making his decision? I understand how tough such decisions are. Sometimes, difficult changes need to be made, as I found when I reorganised stroke services in London before the last election. When he does the right thing, based on a clear clinical case that lives will be saved, we will support him, as we did on children’s heart surgery. The problem with the closure programme, as managers admitted to Members of the House at the outset, is that it is primarily about saving money, not saving lives.

Even though the Secretary of State has made some minor concessions today, he is still performing pretty brutal surgery on west London’s NHS. It is the single biggest hospital closure programme the NHS has ever seen. Has he considered the impact of the changes on people in those communities who are on low incomes? They will face much greater costs and journey times in getting to hospital.

Will the Secretary of State be straight with us on the much-loved Charing Cross and Ealing hospitals? I listened carefully to what he said. What is the “further work” that he referred to? He spoke of their A and Es being of a different size and shape. Is that not spin for saying that the units will be downgraded and become urgent care centres? Alternatively, is he giving those units a permanent reprieve today? If he cannot answer those questions directly, local people in those areas will take what he has said as weasel words.

The Secretary of State said that there will be investment in communities before the changes go ahead. He said that to the hon. Member for Enfield North (Nick de Bois) in respect of Chase Farm hospital, but he is closing that unit next month. What guarantee do people have that he will follow through on this promise, when he broke the promise that he made to his hon. Friend?

The Secretary of State has made a statement on London health services. People will not have missed the fact that he has failed to mention Lewisham hospital and what happened at the Court of Appeal yesterday. Is that not a staggering omission? The victory that was won by the people of Lewisham will give hope to people who are disappointed by today’s announcement.

The humiliation of the Secretary of State in court again raises major questions about his judgment and his ability to manage such important decisions. In the summer, we explicitly warned him to accept the first court ruling. Instead, he ploughed on, throwing around taxpayers’ money in a cavalier fashion, to protect his pride and defend the indefensible. I have a simple question: how much has he spent on appealing that decision? When he decided to appeal, did the official legal advice from the Government recommend an appeal or did he overrule it? Will he confirm today to this House and to the people of Lewisham that there will be no further appeal against the court’s ruling? Will he give the people of Lewisham and the staff who work at Lewisham hospital a commitment that their A and E and maternity services will be protected? Finally, will he apologise to the people of Lewisham for the unnecessary distress and worry he has put them through?

It will not have escaped people’s notice that the Secretary of State is trying to put powers through the House quite soon to grab further powers for himself and drive through financial closures of A and Es without proper consultation, so that in effect he can do what he tried to do to Lewisham to every community in England. That will send a chill wind through those communities that fear to lose their A and Es, and that is why we will oppose those powers when they are considered by the House.

In conclusion, the Government have come a long way since the Prime Minister stood outside Chase Farm hospital days after the last general election and promised a moratorium on all hospital changes. Local people in west London will not have forgotten the Prime Minister standing outside Ealing and Central Middlesex hospitals and promising the same. People are seeing through a Prime Minister whose broken promises on the NHS are catching up with him. Has it ever been clearer than it is today that people simply cannot trust the Tories with the NHS?

I am afraid the right hon. Gentleman is sounding more and more desperate. Today the Government have taken a difficult decision that will improve services for patients. It was a moment for him to show that he understood the challenges facing the NHS, but that was not to be. He said that we should not proceed with the changes given winter pressures on A and Es, but he should read the document. The proposals are for more emergency care doctors, more critical care doctors, and more psychiatric liaison support that helps A and E departments, and they are supported by the medical directors of all nine trusts affected. He said that if evidence can be produced to show that the proposals will save lives, Labour will support them. What more evidence does he want? He should be shouting from the rooftops to support the proposals, but instead he is putting politics before patients.

The right hon. Gentleman mentioned A and E performance, and I am happy to tell him about that. On average a person now waits 50 minutes in A and E before they are seen; when he was Health Secretary it was 71 minutes. The number of patients seen in less than four hours every day is 57,000—nearly 2,000 more than when the right hon. Gentleman was Health Secretary. Our hospitals are performing extremely well under a great deal of pressure because we are taking difficult decisions of the kind that we are talking about today.

The right hon. Gentleman also talked about hospital closures. Again, he should read the proposals: a brand new trauma centre at St Mary’s hospital in Paddington; two brand new elective care centres at Ealing and Charing Cross; seven-day NHS care that will save lives; 24/7 obstetric care; 16 paediatric care centres. Those are big improvements in hospital care—[Interruption.] I will come on to Lewisham. I am acting to end uncertainty because I made the decision today that whatever the outcome of further discussions that the Independent Reconfiguration Panel recommends, there will remain an A and E at Ealing and Charing Cross. That is the best thing I can do for those residents.

The right hon. Gentleman mentioned Lewisham, but let us remember that the problem started because his Government saddled South London Healthcare NHS Trust with £150 million in private finance initiative costs. I judged that the right thing for patients was to sort out a problem that was diverting £1 million every week from the front line. Yes it is difficult, but I would rather lose a battle with the courts trying to do the right thing for patients than not try at all.

Finally, these are difficult decisions, but the party that really has NHS interests at heart is the one that is prepared to grip those decisions. We are gripping the problems in A and E, and in terms of hospital reconfigurations. That is why the NHS is safe in our hands and not safe in those of the Labour party.

Does my right hon. Friend agree that we tackle health inequalities, and improve health outcomes and access to accident and emergency departments, by facing up to the need to make difficult decisions to change the way care is delivered to keep it up to date? Does he further agree that today we have seen a Government who are prepared to face those challenges, and an Opposition spokesman who has demonstrated a determination to duck them? Who cares about the NHS?

I thank my right hon. Friend for that comment. He is right that this is about facing up to difficult decisions. One aspect of the proposals that is so exciting for people who want a transformation in services is that they involve employing 800 additional people for out-of-hospital care. The real way we will reduce pressure on A and E units is by ensuring that people, particularly the frail and elderly, are looked after better at home. That is what we must do. We must recognise that, fundamentally, the problems will not be solved by trying to pour in money in the way that it has always been poured in. We must rethink the model. This is a positive and ambitious programme. If the shadow Secretary of State were in my shoes, he would speak differently of the proposals, because they represent the way forward for the kind of integrated care he normally champions.

Let me remind the Secretary of State that the High Court ruled that his actions in trying to remove services from Lewisham hospital to save a separate failing trust were illegal. He then lost the appeal. Will he now stop throwing good public money after bad, leave Lewisham hospital alone, and learn to respect the views of the people who work in our hospital and those who use its services?

I respect those views and the right hon. Lady for her campaigning. I understand why the people of Lewisham were unhappy about those changes but, as Health Secretary, I had to take a decision in the interests of all patients in south London. That was the first time the powers—the trust special administrator powers—were used. My interpretation was different from the courts, but I respect them as the final arbiter of what the law means. However, when we have to make difficult decisions about turning round failing hospitals—south London has some of the most serious problems in the country—it is important that the local NHS can take a wider health economy view of what changes are necessary. As I have said, I will respect what the Court has decided, but it is important that I continue to battle for the right thing for patients.

The Secretary of State, his predecessor and the Prime Minister are well aware of my continued opposition to the decision to downgrade Chase Farm. However, today, will he join me in condemning the shadow Secretary of State, who has said that Chase Farm is closing? It is not closing. Against my wishes, there is a proposal to downgrade the A and E unit. The hypocrisy and politicking is worse because the previous Labour Government initiated the process and authorised the downgrade in the first place.

My hon. Friend speaks wisely. It is disappointing that we are not having a more intelligent debate. When Labour was in power, it closed or downgraded 12 A and E units in 13 years. The then Government realised that there were problems. He is right that they started the problem in Chase Farm. That is why, when we are facing such difficult decisions, it is important to have a responsible debate. I accept that MPs have views on their constituencies, but we have to start looking above the parapet to the wider interests of patients. That is a difficult thing to do, but I would have hoped for more leadership from the shadow Secretary of State, who used to be Health Secretary.

The Secretary of State is destroying services in four great London hospitals, two of which are in my constituency, in the biggest closure programme in the history of the NHS. Why is he closing A and Es in two of the most deprived communities in London—Brent and White City—and why, rather than certainty, is he installing chaos into Ealing and Charing Cross hospitals? What is happening to the 500 beds at Charing Cross? What is happening to the best stroke unit in the country? What does he mean by A and Es that are different in size and shape? When will he answer those questions? This is a cheap political fix. How can anyone have confidence in the Secretary of State—

Order. We understand the general drift of the observations—[Interruption.] Order. I understand how strongly the hon. Gentleman feels, but he should really ask one question. The Secretary of State is a man of dexterity and no doubt will meet the hon. Gentleman’s needs as he sees fit.

Thank you, Mr Speaker. I will. The hon. Gentleman does no credit to himself or his party with such hyperbole. Let me remind him that the leaders of the clinical commissioning groups, including the ones in his area, which are there to look after his constituents, have said that

“delivering the Shaping a Healthier Future recommendations in full will save many lives each year and significantly improve patients’ care and experience of the NHS.”

That is what the doctors are saying, which is what I want to follow.

At the Central Middlesex hospital, we have well qualified doctors and nurses waiting for patients to arrive but, at the same time, we have long queues at Northwick Park hospital. That makes no sense. Will my right hon. Friend assure me that any reduced resources at Central Middlesex hospital will be transferred in full to Northwick Park so that patients can be seen far more quickly and in a far better manner?

I assure my hon. Friend that the resources taken out of some acute services will be used to give better, safer and more high-quality services to his constituents. Northwick Park is one of the best examples of that. Stroke services in the north-west London area were centralised in Charing Cross and Northwick Park. As a result of those changes, which were introduced by the right hon. Member for Leigh (Andy Burnham), stroke mortality rates in London have halved. That is a very good example of why it makes sense to centralise certain more specialist and complex services if we are to get the best results for patients.

The Secretary of State talked about putting politics before patients, but I remind him that the Prime Minister, when he was Leader of the Opposition, went to Chase Farm to say that the Conservatives would stop all configurations. That simply has not happened, but yet the Secretary of State continues to have a role. Patients and local residents are firmly opposed to the reconfiguration at that hospital and he will end up in court very soon over the matter. There is still time for him to reconsider that decision.

We did not agree with how the previous Government went about reconfigurations. I have announced a better way of achieving them, with better public and clinical support. My predecessor as Health Secretary paused on reconfigurations because he wanted to introduce a better structure, including the four tests, one of which was the need for local clinical support, and another of which was the need for effective public engagement. That is why we are in a better place today than we were with the previous Government’s reconfigurations.

My constituents in Brent will be very disappointed with the Secretary of State’s announcement of the A and E closure at Central Middlesex hospital. However, given that the hospital trust began moving acute services out to Northwick Park hospital many years before the process began, they will probably not be surprised. Does he agree that there is an urgent need for health managers to work closely with Transport for London to ensure good transport links for my constituents in Harlesden to get to Northwick Park? It is currently extremely difficult to do so. Will he write to health managers to express that view?

The hon. Lady makes an important point. I accept that there will be changes in transport arrangements. I am happy to work with her and to talk to TfL about how improvements can be made in respect of the changes I have announced today.

I hope that the hon. Lady talks to her constituents about the positive aspects of the proposals. Hers will be the first part of the country in which all GP surgeries are open seven days a week—at least, there will be seven-day access to GP surgeries throughout her constituency and north-west London. North-west London will be the first part of the country where we have full seven-day working and we eliminate the fact that mortality rates are 10% higher if people are admitted in an emergency at the weekend. The positive aspects of the proposals will mean that her constituents find that they get better, safer care and live for longer.

I represent wards with some of the highest morbidity and lowest life expectancy in north-west London. Clinical support for reform and restructuring was based on adequate funding during the period. Hillingdon clinical commissioning group has written to the Secretary of State to express its concern about the current funding formula, which could undermine service delivery unless there are additional resources. Will he meet representatives from the CCG and Hillingdon hospital, which he has denied additional winter money this year, to talk about the long-term future of our health economy?

Hillingdon CCG supports the changes because it recognises the profound impact they could have in addressing health inequalities. I know that that is precisely what concerns the hon. Gentleman. His constituents will be big beneficiaries of the changes we are announcing today. The funding formula is an extremely difficult issue. We have decided to depoliticise it by making it a matter for NHS England—it is decided at arm’s length from politicians because we believe it is very important that things are decided on the basis of an independent formula.

I thank my right hon. Friend for his statement. We in Hillingdon are very pleased for our near neighbours in Ealing and in Charing Cross for this reprieve—rather than stay of execution—and it will take pressure off our residents. I echo the words of the hon. Member for Hayes and Harlington (John McDonnell), however, about the pressures we are facing in Hillingdon. Perhaps we could have a meeting with my right hon. Friend to discuss some of these issues, including the funding formula and the winter pressures.

It is the first time I have responded to a question from my right hon. Friend, so I shall take the opportunity to congratulate him on his knighthood. I am more than happy to meet him and his neighbour as long as they understand that the funding formula is not in my gift—it is decided by an independent body. As for the winter pressures money, the allocation was not decided by Ministers: it was decided by the people who are responsible for making sure that we head off winter pressures. They decided to concentrate resources in the third of the country where the problems were most severe, and that is how that selection was made.

The whole House knows that all the medical directors in the hospitals involved in north-west London support the reconfiguration. Does the Secretary of State really understand the importance of bringing ordinary people with him? Londoners are especially cautious about these reconfigurations because of the historic problems with access to GPs and the many excluded communities for whom A and E is their primary care, and because these institutions are often major employers in their area and people identify with them. Does he realise that unless he brings ordinary people and patients with him on these reconfigurations, Londoners will continue to fight them and, as in the case of Lewisham, they will continue to win?

Apart from the very last sentence, I actually agree with what the hon. Lady says. It is important to carry the public with us in these reconfigurations. Governments of both parties have struggled to do that in these difficult reconfigurations, which is why the new structures that we have introduced will put doctors in the front line to argue for changes. It is not just the medical directors of trusts supporting them, but the CCG leaders, who are all local GPs, making that case. That is why there is much stronger support for these changes. All the elected representatives on the local councils, apart from Ealing, supported these changes, and that is a very big change from what we have seen previously. I agree with the hon. Lady: we need to do more work and it is very important to carry people with us.

It is fair to say that today’s announcement leaves my constituents in a much better place than they were over a year ago when we set out to save our four local A and Es. Obviously, there is disappointment about the loss of the A and Es at Hammersmith and Central Middlesex, but huge relief that the bigger A and Es at Ealing and Charing Cross will be saved. My right hon. Friend says, rightly, that it will be for the local CCGs to take responsibility for the future of these A and Es. Can he give us a little more detail on how he sees the services being delivered and improved by the CCGs, and can he reconfirm that the A and Es at Ealing and Charing Cross will be saved as A and Es?

I can absolutely confirm that A and Es will remain at Charing Cross and Ealing hospitals, thanks in no small part to the remarkable campaigning that my hon. Friend has done for her constituents, both in public and in private. I commend her for that. The process that has to happen is clearly set out in what the IRP says and in my reply. There must be full consultation. There will be changes to the way in which services are provided, but they will be changes made in the interests of patients. Whatever those changes are, A and Es will remain at those two hospitals.

It is a bit rich for the Secretary of State to accuse the Opposition of being desperate when he has been told by the court not once, but twice that he acted unlawfully in relation to Lewisham. The Secretary of State’s amendment to the Care Bill would enable him to do to other hospitals what the courts said yesterday he could not do in south London. Will he admit that under those changes no hospital would be safe, and that in fact he wants to inflict the blatant injustice that he tried to inflict on Lewisham on hospitals not only across London, but up and down the country?

I understand why the hon. Lady is rightly representing the concerns of her constituents, but she must also understand that I have to look at their interests as patients, as well as at the interests of the broader south London population. It is important to make that amendment to the Care Bill because hospitals are not islands on their own. We have a very interconnected health economy, and what happens in Lewisham has a direct impact on what happens in Woolwich and vice versa. If we are to turn around failing hospitals quickly—something that the last Government sadly did not do—we need to have the ability to look at the whole health economy, not at problems in isolation.

Will my right hon. Friend look again at Barking, Havering and Redbridge trust? As he knows, the difficulties that Queen’s hospital has had simply meant that, in its own admission, it would not be able to cope without an A and E at King George hospital for many years to come.

I commend my hon. Friend for raising this issue with me consistently. I know his very real concern is to make sure that when those changes are made they do not have an adverse impact on his constituents. I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.

Why does the Secretary of State find it so difficult to realise that he is not above the law? Both the Court of Appeal and the High Court have made it plain that his flagrant disregard for the law in trying to destroy Lewisham hospital cannot stand. Why does he not have the decency to abandon his proposals; apologise to the people of Lewisham and the staff and users of Lewisham hospital; and share his humiliation with the Leader of the House, the previous Secretary of State, who launched this illegal programme in the first place?

There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.

Are there not three lessons to learn from the Secretary of State’s statement and the response from the shadow Secretary of State? First, we should listen to the opinions of local doctors. Secondly, delay puts at risk patient safety. Thirdly, we should not play politics. For Enfield, is it not the case that we should recognise that local doctors have united to say that we need to get on and implement changes, because delay would put at risk patient safety this winter, not least at our new, expanded North Middlesex hospital in Enfield? The future of Chase Farm is secure, but it could also be put at risk if we do not allow the implementation of good changes. We should not play politics, but Enfield council is doing so by trying to challenge the changes.

As so often, my hon. Friend speaks wisely. It is very important that in all this we do the right thing for patients. My view on all these big changes is that once we have decided what to do, it should be done as quickly as possible, but within the bounds of what is clinically safe. It is very important that safeguards are in place and I would always follow the advice of local doctors as to the right moment to proceed with an important change in safety.

Will the Secretary of State commit to doing better against the four-hour A and E waiting target in London in the future? Will he put on the record today his acknowledgement of the value of the contribution being made by those A and E units—too few at the moment—that are doing well against that target at the moment?

There are a number of hospitals that are doing extremely well, and we are doing everything we can to support those that are in difficulty. I absolutely recognise how hard front-line NHS staff are working: we are working with them in an incredibly detailed way on a hospital-by-hospital basis, not just in London but across the country, to see what additional support we can give to people as we go through a difficult winter. We have already announced £250 million of support for the third of trusts in the greatest difficulty, and we are looking at what other, non-financial means we can use to support other trusts. The search continues, because we recognise how challenging winters are for the NHS under this Government as under previous ones.

Given the difficult legacy of the financial arrangements in London and south-east London in particular, and the Court of Appeal judgment yesterday, will the Secretary of State give an assurance that in future decisions will have the support of GPs in the areas affected; will not put at risk other viable and successful parts of the London health family; and will not suddenly impose new management structures and create huge disruption—for example, at King’s College hospital, Guy’s hospital and St Thomas’s hospital—as London health partners appear to be suggesting?

I certainly agree with two of the three points. I do not think it is credible to say that we will not make any changes to the NHS, even if they are in the interests of patients, unless there is unanimous support from local GPs. The reality is that that would always be difficult to achieve. We would end up with paralysis, which would be against the interests of patients. However, I do think that GPs should be in the driving seat and be the advocates of these changes, and we should listen to them above all people on whether to proceed with the changes. The whole purpose of the Government’s reforms to the NHS is to create less bureaucracy not more, so I would be concerned if there was any suggestion that more was being created.

We must always ensure that changes do not have an adverse impact on successful neighbouring areas. However, we need to encourage all areas to work together, because we have an interconnected health economy, particularly in London.

I cannot find the words to express how disappointed the residents in my constituency, and elsewhere in west London, will be on hearing the statement. We are not clear about what will happen to Ealing hospital. You are not clear in your statement, before the final decision is made, about the range of services that will be provided from Ealing and Charing Cross hospitals. What work will be done? Will you consider or ignore, like you totally ignored the thousands of people who marched in the rain outside Ealing hospital in west London two weeks ago—

Order. I am extremely grateful to the hon. Gentleman, but may I just say to him that I will not be doing any of the things that he suggested? I think his inquiry was directed at the Secretary of State, rather then me. I have no responsibility for health services in London or anywhere else.

I am disappointed that the hon. Gentleman is disappointed. I am interested to know what his definition of “totally ignored” means, because we have decided that we will not close Ealing A and E, and that is a big decision. With respect to how his constituents feel, I completely understand that many people will be nervous about any changes. I hope he will become a big advocate of these changes, because his constituents will be among the first in the country to have seven-day access to GPs and a seven-day NHS, which means there will not be a higher mortality rate for admission to hospitals at the weekends and that there will be 24/7 consultant obstetric cover for people who need it when giving birth. They are big and important changes that will benefit his constituents.

Order. I should just say to the House, almost as a courtesy, that I am prioritising London Members. However, non-London Members should take heart. If they exercise their knee muscles they may have an opportunity in due course.

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was absolutely spot on in her question to the Secretary of State, not least with regard to variability and accessibility of GP services. A few months ago, I asked him whether he would make it a requirement for plans to expand out-of-hospital care to be in place before hospital changes occur. Can I take it from his statement that it is his intention that, when recommendations from the Independent Reconfiguration Panel are before him, he will require plans to build capability for community health services and primary care services to be in place before they go ahead?

The right hon. Gentleman campaigns assiduously for his constituents. I recognise that there are worries about potential changes in his constituency, an issue he often raises. Yes, we must ensure, if there are transitions or changes, that proper plans are in place to ensure they can be made safely. If he reads the report, he will derive a great deal of comfort from the stress the IRP puts on the necessity of having proper alternative provision in place before any changes are made.

The Secretary of State’s statement has left us even less clear than we were on the implications for hospital services for Westminster residents. Frankly, that is quite an achievement. Planned non-emergency hospital services have already moved away from St Mary’s Paddington to pre-empt the closure programmes that he is now telling us will not happen. That was done on the basis that St Mary’s would become the premier emergency hospital for west London, so where does that leave the provision of additional emergency services? Will that leave my constituents having to travel to Hammersmith, Ealing and Central Middlesex hospitals for their treatment, something the local authority was not even consulted on? Many GPs did not even know where their patients were being treated.

I hope that I have provided clarity by saying that there will remain an A and E at Ealing and Charing Cross, and that I support what the report says, which is that there should be five major A and E centres, of which St Mary’s Paddington will probably become the most pre-eminent trauma centre in the country. This is a big step for the hon. Lady’s constituents who use St Mary’s, and I think that they will be pleased with what I have said today.

I congratulate the Health Secretary on his important announcement regarding the A and Es at Charing Cross and Ealing. My constituents in Chiswick will feel reassured about the ongoing service at Charing Cross, and I thank him for that. Does he agree it is important that at the centre of any decision he makes about health care are improved patient care and saving lives across London?

My hon. Friend is absolutely right. When the dust settles on these decisions—there is rightly so much local passion, concern and uncertainty relating to hospitals, such as Charing Cross, which has a great tradition—what people will notice is whether their local NHS services are getting better. I am afraid that one of the legacies from the previous Government was the abolition of named GPs in 2004 and a sense that it has become more difficult to access one’s local GP. The proposals mean that her constituents will be some of the first in the country to have seven-day GP services, a big step forward that her constituents will welcome.

Will the Secretary of State give me an assurance, following the huge debate that took place over the future of the A and E department of the Whittington hospital—and, by extension, the neighbouring Royal Free hospital—that its future is secure and that he will not try to reconfigure services once again in north London? Does he recognise that during that debate, my right hon. Friend the Member for Leigh (Andy Burnham), who was then Secretary of State, intervened to assure the future of the Whittington A and E department? I would like the same assurance from the Secretary of State, if that is possible.

I think the best reassurance I can give the hon. Gentleman is that, unlike when the Labour party was in power, the Secretary of State does not sit behind his desk planning reconfigurations in every part of the country. This is a locally driven process. We have put in place safeguards to ensure that, where there is a reconfiguration proposal from a local NHS, it meets certain criteria. It has to be supported by local GPs and there has to be proper engagement with the public. If his constituents are worried, I hope they will take heart from the thoroughness of the process that has happened today. It is the right process and a good process, and it will lead to better outcomes for the people involved.

My own general hospital, in keeping with many throughout the country, has come in for unfair criticism owing to the increasing pressures exerted on its A and E department. What does the Secretary of State think has caused those pressures, and will he reassure my constituents by telling us what he is doing to help relieve A and E departments?

My hon. Friend is right to draw attention to the pressures. I am sure that most A and E departments, including his own one in Northampton, would say that the biggest single cause has been the increase in the frail elderly population and the inadequacy of the care those people receive outside hospital. We are trying to put that right by having named, accountable GPs responsible for out-of-hospital care, reversing the historic mistake made in 2004, when that personal link between GP and patient was abolished.

This decision is devastating for my constituents. The Secretary of State will know that in the last winter period, Northwick Park hospital and Central Middlesex hospital, which comprise the North West London Hospitals Trust, were the worst-performing hospitals when it came to meeting A and E targets not only in London, but in the country. The trust scored 81.03%. That is an appalling record. What he has done today, by announcing the almost immediate closure of Central Middlesex, can only make that much worse. The College of Emergency Medicine has said that his reconfigured hospitals should have at least 16 consultants in their emergency departments, but his decision will give them 10—and that is not for major trauma centres. Will he elaborate on what he will do to bring the number of consultants up to the level required by the college?

Has the hon. Gentleman, who is so against these proposals, not noticed the proposals for more emergency care doctors, more critical care doctors and more psychiatric liaison support for A and E departments, which will reduce pressure on A and Es and mean that people admitted through A and Es for emergency care will not have a 10% higher chance of mortality if they are admitted at weekends? His constituents will be among the first to benefit from that. I would caution him, therefore, against saying that this is devastating for his constituents. We were reminded in Prime Minister’s questions earlier of how Labour suffered from predicting massive job losses, when in fact there was an increase in jobs. This announcement is good news for the hon. Gentleman’s constituents, and he should welcome it.

Does my right hon. Friend agree that, difficult though it may be, all NHS trusts will have to live within their budgets, because, with both Front Benches effectively having agreed public spending limits for several years to come, the amount of money that can be spent on the NHS will be finite whoever is in government?

My hon. Friend speaks wisely. Let us bear in mind the challenges facing north-west London, which are similar to those across the country, including in Oxfordshire. In the next two decades, its population is predicted to increase by 7%, and life expectancy has risen by three years in the last decade alone. Furthermore, the uncertainty over public finances means that the trust cannot bank on substantial increases in the NHS budget, so it has to do the responsible thing and look for better, smarter, more efficient ways to use that money to help more people. It has been brave and bold in doing this, and I think that many other parts of the country will take heart from what has happened today and come forward with equally bold plans.

Your House, Mr Speaker, is being made dizzy this afternoon by the surfeit of spin we are suffering. We are being asked to believe that this benevolent Government are partly motivated by a desire to end uncertainty. The death sentence ends the uncertainty of life, but it is not necessarily something I would recommend. Will the Secretary of State please provide a little information about what exactly a different shape and size A and E department looks like? The people of Ealing deserve to be told precisely what it means, otherwise they will think the worst.

I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.

Clinically led, evidence-based changes to services save lives. That is straightforward and clear. It is also clear that we have to make these changes happen if we are to live within our means and the health service budget. How are we going to make reconfigurations such as this one more straightforward, because the cost and time are unacceptable? Likewise with mergers, how are we going to streamline this process?

My hon. Friend speaks wisely. It concerns me, as it does her, that these processes take so long. When it comes to changes in A and E and maternity services, exhaustive public consultation is necessary, because they cause such great public concern, but we also need to deal with these issues in a much more timely way, particularly when it involves sorting out the problems of failing hospitals. I agree with her, therefore, and I am looking at what can be done to speed up all these processes, while retaining the appropriate consultation with the public.

Does the Secretary of State have any idea of the concern he is causing up and down the country? In Wigan, we value our 24-hour A and E service; we do not want it downgraded, and we do not want it closed. Will he clarify his proposal for the future of Ealing A and E? Is he proposing a type 1 service? Also, will he give me a cast-iron guarantee that any future decision about our local hospital will be made on the basis of people’s lives, not cost?

I can assure the hon. Lady that decisions about the future of A and Es will be based on what is best for patients and on what will save lives and get the best outcomes—that will apply in her constituency, as it will in mine and every other constituency—but that will sometimes mean a difficult decision if we have a change that doctors strongly support, but about which members of the public are anxious. I have said that services at Ealing will change, but that there will be proper public consultation and that at the end of the process there will still be an A and E. The recommendation from the process was that the A and E should close, but I said, “No, I think there should be an A and E at the end of the process.” I am injecting that much certainty, therefore, but I am not going to micro-manage the local NHS by saying precisely what those services should be.

It is not only A and E units in London that are under pressure; Derriford hospital’s A and E unit is also under pressure, because of our night-time economy. Is my right hon. Friend willing to meet me and potentially representatives from the English Pharmacy Board and my own Devon pharmacists to discuss how they can help to relieve some of the pressure on A and E units, especially down in Devon?

I would be more than happy to meet my hon. Friend and his local pharmacists. There is a lot that pharmacists can do. One change we are making that could make a big difference, where proper protections are in place for patients, is allowing pharmacists to access GP records so that they can give people the correct medicines, know about people’s allergies and things like that. There are lots of other things as well, though, and I look forward to the discussion.

The statement has broader implications beyond London, although I accept that colleagues from Islington and Ealing want to ensure they have their A and E facilities. On smaller A and E facilities outside London, however, the Secretary of State said there would be no political fixes, yet when he announced additional moneys to deal with winter pressures on 53 NHS trusts, there were none in the north-east of England. What assurance can he give my constituents that hospitals in the north-east will have sufficient resources to meet the demands placed on them in winter?

The decision on where to allocate the extra help was based on where the need was greatest, and it was taken not by Ministers, but on the basis of recommendations from people working in the NHS and dealing with these problems. They chose the 53 local health economies where they thought the pressures were greatest. The fact that nowhere in the north-east was selected indicates that A and E performance is better in the north-east of England than in other parts of the country.

When the Secretary of State is not leading the smear campaign against my right hon. Friend the Member for Leigh (Andy Burnham), he is continually being dragged into the Chamber to react to events that he should be in control of. When will he finally get a grip on the problems in our A and Es across the country?

I completely reject what the hon. Gentleman says. There are 1.2 million more people using A and E every year than there were under the last Government, yet people are waiting for a shorter time, with more people being seen within the four-hour target. But we are doing something else. We are addressing the long-term problems of A and E, including the patent failures of the last Government over the GP contract, social care integration and the working time directive. All those things have made the pressures worse, but we are sorting them out.