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Health Care (London)

Volume 573: debated on Wednesday 8 January 2014

[Mrs Anne Main in the Chair]

I am grateful for the opportunity to speak on the subject of the NHS in London and delighted that so many colleagues from the four corners of London want to say something about the health service in their areas. I want to sketch out, with some specific reference to local issues, the momentous changes that are happening within London’s health care and the extent to which the Government have made necessary changes far more difficult to achieve than should have been the case. I fear the results.

When I applied for this debate before Christmas, I did not know that I would spend a large part of the next two weeks experiencing the health care system with a close relative, who was admitted to hospital on Christmas day. We went through the whole process of ringing 111, of paramedics, of the ambulance, of A and E and of spending two weeks in St Mary’s hospital. I can confidently say two things on the basis of that experience.

First, I have seen, and my relative has experienced, nothing but kind and efficient health care at St Mary’s and within the health care system in general. It is true that, over the years, there have been instances of the health care system falling far short of the standards that we expect, but it is also true that most health care professionals and auxiliaries are doing a stunningly good job for the people of London and the rest of England.

There is kindness and the effective delivery of health care everywhere we look in our health service. We must be careful not to succumb to the tendency—I see this too often from Government Members—to talk down the health service’s achievements. It is completely right that Sir Mike Richards of the Care Quality Commission said in his comments on the first wave of inspections that

“there are some very good hospitals in this country, and it is possible, within the NHS, to receive good, excellent, even outstanding care.”

Secondly, from my observations this past fortnight, I can say that the health service is under extraordinary pressure. One would expect not to have the level of staffing for the two-week period of Christmas and new year that one might have outside the holiday period, but it has been alarming to note instances of health care auxiliaries being two thirds below planned staffing levels and nursing being down by one third. Incidentally, I was also shocked to discover when talking to health care assistants that they sometimes work an 11-hour day for a £90 day rate, which is not the London living wage—it is the minimum wage. How can we expect people to provide the intensity and quality of care that we want when we do not pay them even the living wage? That causes me great concern.

Pulling back to the wider picture, as our experiences have demonstrated, the health service is under extraordinary pressure, particularly in the emergency service. Some of that is unsurprising in London, because the capital has the fastest-growing population and has had the fastest rise in the over-65 population of any region in the country. It also has the highest demands on mental health care services and an overwhelming concentration of rarer and more difficult conditions, including tuberculosis, which places particular pressures on London.

Unsurprisingly, those facts are showing themselves in A and E attendance and waiting times. Just before Christmas, the London assembly found that more than half of London’s A and E departments failed to meet their waiting time targets for more than half of last year. Across the capital, Londoners had to wait for more than four hours on 202,000 separate occasions. A and E attendance has soared in London since 2010 and is up by 47% at St George’s hospital in Tooting, 46% at St Bartholomew’s hospital, 33% at West Middlesex university hospital and 35% at Hillingdon hospital. For my own Imperial College Healthcare NHS Trust, even a relatively modest increase of 19% equates to an extra 44,812 people seen last year compared with 2010. Cancelled operations were running at a 12-year high even before the winter, owing to pressure on hospital beds. One London hospital, Barts, topped the national list with 649 elective operations cancelled in the first half of last year.

Vacancy rates are a particular concern in London. Regionally, 11% of nursing posts are vacant, compared with a national average of 6%. At some London trusts, the rate is more than 20%. The regional total represents more than 6,000 vacant nursing posts in London. The Royal College of Nursing, which kindly briefed me for this debate, says:

“Our worry is that the hard work of some trusts in protecting posts is being undermined by a lack of available, suitably qualified nurses to take vacant positions, raising obvious questions about whether training is being commissioned at the level needed.”

Given that pressure, it is beyond dispute that there is a need to carry on changing how health care is delivered, which we all accept and have accepted for many years. The broad principles mapped out by Lord Darzi in 2007, which were not new, proposed a greater concentration of high-level surgical services to save lives and better community and primary services to reduce unnecessary admissions and enable speedy hospital discharge. Both the demand side of the equation, which is driven by an ageing population and the challenge of chronic conditions, and the delivery side, which utilises the opportunities of new drugs and surgical techniques, push us to the same conclusion. There is clear agreement in principle that we need to carry on with the changes.

The central thrust of my argument, which will be echoed by colleagues, is that managing change of that scale requires that essential preconditions are met. Those preconditions are, however, not being met at the moment, and in some cases the means of delivering them are going into reverse. First—all are important, but this is the first—there must be public confidence in the process, and that confidence is so catastrophically lacking.

Labour colleagues who are facing the closure or downgrading of their A and Es will know what their own communities are telling them, which is that closing A and E units in the midst of an A and E crisis is utterly perverse and should not happen until and unless trusted alternatives are in place. In that context, clause 118 of the Care Bill confirms everyone’s worst fears, because, having failed to win public confidence in London and other parts of the country, Ministers want to give powers to special administrators to override local opposition.

I am most grateful to my hon. Friend for giving way, and I congratulate her on her brilliant speech, which hon. Members understand from our experiences.

If clause 118 of the Care Bill goes through, every hospital and potential patient in the country will be faced with a situation in which no regard is given to clinical standards or clinical needs. The service will be based entirely upon accountancy. That is what the challenge was in Lewisham hospital. That was what was overturned. The people who knew about it—the consultants, the patients and the commissioning groups—all utterly opposed the trust special administrator proposals. We were right and we won the case. With the new powers, however, all that would be set aside and no one would be heard.

Order. Before I call Ms Buck, I ask that interventions be brief. There will be time to make contributions later. This is a well attended debate and many Members have asked to speak.

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) is completely correct. Lewisham hospital brilliantly exemplifies the argument.

Secondly, there must be effective partnership working between hospitals, primary care providers and local authorities in the delivery of services. It was the failure even to inform partners that elective surgery had already moved from St Mary’s hospital to Charing Cross hospital that prompted my debate some weeks ago, to which the Minister replied, and which subsequently prompted an apology for the breakdown in communication. That was not only a matter of leaving someone off an e-mail circulation list, but a complete unwillingness to collaborate even within the national health service, let alone with outside bodies such as the local council, which is responsible for social care delivery.

Furthermore, those three boroughs—Kensington, Westminster and Hammersmith—are part of a pilot scheme to demonstrate integration, yet what happened in the relationship between the Imperial College trust and those local authorities could not have been further from integration—it was like something written for a comedy sketch.

Even worse, fundamental confusion remains about how north-west London hospitals are to be configured with Hammersmith—my hon. Friend the Member for Hammersmith (Mr Slaughter) is in his place and I am sure will comment—which has a different spin on its hospital provision from Westminster, even though they are joined in a tri-borough arrangement. Even after the Secretary of State has blessed the restructuring of west London hospitals, just weeks before Imperial concludes its outline business case, we cannot even have a clear agreement on the status of Charing Cross hospital or, by extension, of St Mary’s. That goes to the very heart of whether we can have confidence in the new structure of the national health service.

Thirdly, everyone needs to keep focused on the key issues, and that takes me to the devastating impact of the Government’s ill-considered reforms on the strategic management of London’s health service. The service should be focused like a laser on delivering the vision set out by Lord Darzi, but instead it has been fragmented, diverted and injected with rules on competition when integration should be the key objective.

The King’s Fund report of only some months ago, “Leading health care in London”, stated that the recent NHS reorganisation and the abolition of strategic health authorities and primary care trusts have resulted in an “absence” of health care system leadership in London. The report states:

“The NHS reforms have created a much larger number of organisations in London and their purposes are not always well aligned; the risks of incoherence and inconsistency are high…Reorganising the NHS in London in such a fundamental way has made a challenging situation much more difficult”.

That is so significant that the country’s top emergency doctor has said that the current A and E crisis could have been averted two years ago had the Government heeded warnings of a looming collapse in casualty ward staffing.

The president of the College of Emergency Medicine has said that Ministers and health chiefs were “tied in knots” by the challenges of implementing the coalition’s health reforms from 2011 onwards, leading them to ignore the first warnings from the college of imminent crisis—that the NHS was failing to recruit enough A and E doctors. Therefore, London, which possibly has the most complex challenges and the greatest need for integrated strategic leadership, actually has the least such leadership. Had leading health care managers and professionals been able to concentrate on dealing with such tasks, we might have had some opportunity to build public confidence, carry people with us and make the changes. In fact, the exact reverse has happened.

Finally, we need community and social care and other support services that minimise unnecessary admissions, especially for chronic conditions, and facilitate early discharge. Again, we can all agree on the principle. There are some excellent specific examples of integrated practice and of people working hard to deliver it, but there are also some harsh truths of individual experiences and the funding of social care.

The reality is illustrated in letters from my constituents in response to the moving of elective surgery from St Mary’s. One letter states:

“When I had my mastectomy I was sent to Charing Cross Hosp. After the operation I went home by bus and underground holding my drainage…bottle…from my operated breast. In the same way I travelled after my cardiac arrest on my second lumpectomy due to anaphylactic shock!”

That is only one hazard of putting patients with no family far from where they live. A second letter states:

“They took my City of Westminster Taxi card from me and so I have to pay for taxis to take me to St Marys Hospital and…Charing Cross. I pay £6.50 there and the same coming home (£26 one way to Charing Cross). I cannot walk far”—

—she is unable to use public transport—

“as I get out of breath. I am 84 this year”,

diabetic and

“have had one breast removed with cancer.”

Another constituent told me:

“I have lost my…home help”—

due to the cuts in social care—

“If I’m ill, I wait for it to go away.”

London as a whole faces a £1.14 billion shortfall in social care funding as a consequence of the pressures on adult social care and of the extra costs likely to arise because of the cap—in principle, that is a good thing, but obviously revenue is necessary to fund social care costs. That situation is London-wide and has been set out clearly in a London Councils report. My local authority also set the situation out clearly in a report to the health and wellbeing board, which states:

“As a result of reductions in local government funding Adult Social Care…has to deliver substantial savings in 2013/14”—

£4.4 million in Hammersmith and Fulham, £2.1 million in Kensington and Chelsea, and £2.9 million in Westminster. The report continues:

“These are very large savings; the cumulative effects are much bigger than any other savings programme delivered in the local authorities in the past.”

That is on top of £8 million in cuts to the adult social care budget already coming into effect since 2011. The report states:

“Amongst big reductions to back office and support functions, the savings programmes also include reductions in the use of packages and placements, the greatest area of spend for ASC.”

Rather sweetly, it adds:

“Some of the savings projects may be difficult to deliver or may take longer than anticipated.”

It continues:

“Funding growth for packages and placements arises mainly in the Learning Disabilities, Mental Health and the Young Disabled care groups where client numbers are growing, but also in Older People, as people live longer and are supported in the community.”

There is an important point. There is an integration care fund, which is shifting money from the NHS into social care, but, as Westminster council’s report on the pressures on social care funding states, that funding will mainly be used for purposes that include:

“To sustain services, otherwise at risk from savings plans”.

We are in an extraordinary position. There is a transformation fund designed to put in place the services that would allow us to make changes in hospital care, with which in principle we agree—we would argue in some specific cases—but that funding is simply going to fill the gaps caused by the cuts in social care, which are the result of cuts to local authority budgets. In London, as we know, there has been a 25% cut in local authority funding, with a further 10% cut as a result of the Chancellor’s autumn statement. Much of that new money is simply sustaining services that would otherwise be at risk from savings.

Is my hon. Friend aware of the estimate made by London Councils for the future? Between 2016 and 2020, we might see adult social care departments facing budget pressures of £1.1 billion, owing to rising demand and some of the changes proposed by the Government. Does she agree that the future looks extremely bleak?

I agree totally. A thoughtful and planned process throughout London that would allow us to build up community and primary services, reduce unnecessary A and E admissions, speed up unnecessary discharges and concentrate some of our specialist services in fewer sites is sensible, but the means to realise it have been pulled out because of the pressures on social care funding. Furthermore, the strategic leadership that would allow us to make changes has been undermined by a completely unnecessary, £3-billion, top-down reorganisation that we were promised would not happen.

I entirely associate myself with the earlier comments about the quality of my hon. Friend’s address so far. She talks about trying to have a logical and sensible planning process. Is she aware that London boroughs such as Ealing, ably led by Councillor Julian Bell, have had to divert intense amounts of resources to oppose something that is the antithesis of good planning? That is an additional double whammy against responsible local authorities, which have to divert scarce resources and face up to a desperately uncertain future.

I totally agree. Local authorities are on the front line of delivering the social care made necessary by some of the planned hospital changes and they are under pressure. The councils have expertise and knowledge and they are, as my hon. Friend says, sensibly involved in planning services, so they are making thoughtful objections when they see that services cannot be delivered as we want. Indeed, they have to divert resources to make the case on behalf of their populations.

In conclusion, London’s NHS continues to save lives and to provide the same quality of care it currently provides. That is a tribute to tens of thousands of men and women on the front line, whether in the NHS or employed directly by local authorities, but it owes absolutely nothing to a Government who have let us down with a change process that we should have been able to work through. They have done that by the way they have treated local authorities and by the way that, through this unnecessary reorganisation, they have diverted attention and resources from the leadership that could ensure that London’s health care is delivered in line with the wishes of Londoners. The Government have let down London’s patients and the men and women who deliver health care to them.

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate the hon. Member for Westminster North (Ms Buck) on securing this valuable debate. Although her conclusion was perhaps a little more hyperbolic than mine would have been in the circumstances, we work closely together, along with her hon. Friend, the hon. Member for Hammersmith (Mr Slaughter), to do our best for all our constituents. Over the past year or so, as we have tried to put our constituents first, we have had concerns about elements of the negotiations on this matter.

For all the lively debate about health care provision here in the capital, there is one thing on which we can all agree, as the hon. Lady made clear in her contribution: the pressures on the national health service here in London are huge and getting bigger. They are set to increase substantially, not only because the population is ageing but because of the hypermobility and hyperdiversity of that population. In the past, that was perhaps typical of inner London alone, but it now applies to the entirety of the capital.

At times, the national health service can seem a little like a national religion, whose traditions must not be questioned under any circumstance. In my view, if one good thing has come from the terrible events in Mid Staffordshire, it is that we can perhaps start to have a more honest and less ideological debate about where the NHS is performing well, where it is letting people down and how it can better tackle the future challenges to which the hon. Member for Westminster North referred.

I have enormous respect for the Secretary of State for unashamedly refocusing the NHS around patients rather than protecting the sanctity of the system. Thankfully, the patient experience at some of our central London hospitals is, as the hon. Lady rightly pointed out, a world away from what happened in Mid Staffordshire. The diversity of population and the presence of top-flight medical schools and universities, particularly in central London, inevitably draw global talent to our local hospitals.

I am often staggered by the quality of facilities here, whether the state-of-the-art birthing unit in St Mary’s or the Royal London, the beautiful Maggie’s cancer centre at Charing Cross or the brand new oncology unit at Barts in my constituency. Only yesterday, a constituent wrote to me about his young nephew’s recent stint in hospital. He said:

“Given it seems it is ‘in vogue’ to be ‘anti-NHS’ I wanted to let you know that my recent experiences with the high dependency unit at Chelsea and Westminster Hospital”—

that hospital is outside my constituency, but obviously caters for a lot of my constituents in the south of Westminster—

“were nothing short of exemplary. I am sure that my nephew’s speedy recovery was probably all down to the standard of care he received.”

More often in my constituency, non-emergency services fail to be so patient-focused. Londoners are spoilt for choice in so many aspects of their lives, and as a result they have the idea that they should expect to get a full choice in everything. Why should they not expect a similar consumer-driven, flexible and responsive system when it comes to primary care—one that allows them swift access to a GP or provides small surgical procedures outside hospital?

We have read a lot in recent days about the number of non-emergency cases being presented at A and E departments. I think that that is in part due to the hassle factor associated with the existing GP system. With the hypermobility of population in London, many people never bother to register with a GP, and those who do all too often find that they cannot get an appointment for days or at a time that is convenient for someone with a busy working life. It is therefore often a perfectly logical decision for those people to spend a few hours in A and E, where they are at least guaranteed to be seen.

Thankfully the story is rapidly improving for my constituents. The Central London clinical commissioning group has just extended its seven-day GP opening service from three practices to five. People are able to walk in and book a same-day appointment at those practices. They do not have to be a member of the practice to use the service, and registration with their own GP will not be affected. I also know that plans are afoot to locate more GPs within hospitals in London. That type of modern and practical response really needs to be rolled out more widely.

There are problems with the health service in central London, which my colleague the hon. Member for Westminster North has so carefully outlined. My own constituency will hopefully be affected for the better by the huge changes to be brought in by the “Shaping a healthier future” programme. That programme began some five years ago to respond to the challenges of a rapidly increasing population and the variation we were seeing in the quality of acute care. It has caused most controversy in its proposals to close a number of A and E departments.

My constituents are grateful, as are the hon. Lady’s, that St Mary’s hospital in Paddington has been confirmed as one of five north-west London hospitals to provide advanced comprehensive acute care. I am assured that there is a strong business case for even greater investment on that site and exciting plans are afoot in that regard.

The Minister needs to be aware, however, that there have been issues of communication over the relocation of elective surgery, as was raised earlier. I accept much of the wisdom in the reconfiguration of services in north-west London to allow for specialist centres, rather than having hospitals that are jacks of all trades.

I accept that that is easy for me to say, given that two local hospitals in my constituency, Chelsea and Westminster and St Mary’s Paddington, are not affected, and I know that the issue is a great concern for many Members, who are hearing such concerns from many constituents. But I suspect that the perceived success or failure of any reorganisation of this sort will come down to smaller things: how well plans are communicated; how quickly alternative, out-of-hospital services are in place; and how transportation is organised for patients, many of whom are impoverished or will have to travel further and rely on public transport.

On the acceptability of reconfiguration, we should never forget that many communities in London have a strong emotional attachment to a hospital that could have been in existence in some shape or form since the middle ages. That is why reconfiguration must go forward carefully and on a purely medical basis if it is to succeed in London.

That is right to an extent. I know that the hon. Lady spoke in a debate that I led in the House almost a decade ago on Barts, which is located in my constituency and has a special place in the hearts of many millions of Londoners—and, indeed, of people throughout the United Kingdom. The truth is that at that juncture, the private finance initiative was the only funding game in town and we all went along with it, but that £1 billion PFI has now caused major financial issues that, I am afraid, affect not just Barts but hospitals throughout the north-east of London, as the hon. Lady is well aware. We all feel a bit depressed about that knock-on effect.

We have to accept that in London, broadly speaking, we do pretty well as far as hospital care is concerned. Being absolutely candid with everyone, because I know what it is like, in central London we have a very good service, and it is partly outer London that suffers as a result. That is because of the strength of the links to which the hon. Lady rightly referred—the passion that we have for our historic hospitals—and the amount of resource that is pushed into central London because the hospitals there are teaching hospitals with consultants, former consultants and alumni who are willing to make a strong case for the existence of those hospitals. Dare I say it, that makes it easier to make the case for Barts than for a hospital out in Romford or Whipps Cross, or one in the hon. Lady’s constituency.

We all have to face those issues. They have not arisen as a result of the reorganisation of the past three and a half years; this has been the situation in the capital for probably 40 or 50 years. I am aware that even in the latest reconfiguration there has been a sense that central London has got off slightly better than the middle portion of outer western London.

I turn to finance. There was a good outcome before Christmas for north-west London on commissioning allocations, as all of our CCGs received an uplift to offset inflation. However, I want to raise concerns about the funding formula used to determine allocation. The formula fails to take into account the needs of the large homeless population in Westminster, which places massive pressure on acute services. Rough sleepers are far more likely to attend accident and emergency; they attend six times more often than any normal member of the population. They are admitted to hospital four times more often and stay in hospital three times as long.

The formula also ignores the fact that CCGs are responsible for all attendances at urgent care centres or walk-in centres and for the costs of patients covered by reciprocal funding arrangements with other countries. Westminster welcomes more than 1 million commuters and visitors each and every day, many of whom will need health advice and care while they are here. It is important that a future funding formula recognises the impact of that on local health care services.

The proposed formula will exclude spending on community care. That cannot be correct considering the important move to provide more high-quality care at home and in the community rather than simply in hospitals. I welcome the Government’s assurances that the Advisory Council of Resource Allocation formula will not be accepted in its current state and that changes to the funding of CCGs will be fully consulted on in future.

I turn to public health spending. A draft formula for local authorities was set out in the “Healthy Lives, Healthy People” consultation, which was published on 14 June 2012 and recognised that further work was needed on adjustments for age, fixed costs and non-resident populations. However, initial modelling by London councils suggests that Westminster would have a drop of 57% in public health funding. Central London and Westminster have unique population characteristics that make it more difficult to make public health improvements. They include the age structure, with a greater focus on working age and children, and levels of mental health problems and homelessness. Those are not properly reflected in the current formula.

The formula also fails to take account of substance misuse services, many of which fall outside the pooled treatment budget, which focuses on opiates and crack treatment. It also ignores the wider health and local authority investment needed to manage the individual family and community impact of drugs and alcohol on health and well-being.

Westminster experiences a high level of population churn—I accept that many other London boroughs are in that boat—and that leads to additional demands for services, including NHS checks and other screening programmes.

Other hon. Members want to speak so, if the hon. Lady will forgive me, I will finish with a request to the Minister. I would welcome an indication from the Government of when we can expect more clarity on how future public health allocations will be determined. I would also appreciate confirmation that the formula consulted on in June 2012 will not be used to determine public health funding allocation in future.

I will call the Minister and shadow Opposition spokesman at 20 minutes to the hour. About five hon. Members want to speak. That means, bearing in mind time for interventions, about seven minutes for speeches. That is just a suggestion.

I will take the suggestion with the severity with which it was meant, Mrs Main. I congratulate my hon. Friend the hon. Member for Westminster North (Ms Buck) on securing this debate.

I want to reflect on some of what my hon. Friend said at the beginning of her speech and on the sentiments of a letter to The Guardian before Christmas from GPs, emergency doctors and nurses, midwives, physiotherapists, psychotherapists and NHS trusts. Their plea was for a page to be turned in the way we talk about the NHS. We need to talk about the failures in patient care, but we must also recognise that we have some extraordinary abilities in the NHS to reach and look after our communities as well as they do. Sadly, I have been close to the NHS in the past three years, and I have seen excellence and the pits. However, in general, the people who work in our hospitals do a fantastic job.

I wholeheartedly endorse the sentiments of that letter because I fear that the driver for the relentless daily trashing that the NHS receives comes from base political motivation—the softening up of public opinion so that marketisation and privatisation become acceptable. It will not be acceptable. It is not acceptable now and I do not believe it will ever be acceptable, so let us just stop it.

I am not the only one to mistrust the motivation and outcome of the coalition’s top-down, unwanted and wasteful reorganisation of the NHS. I did a survey of my constituents—I like to find out whether my impressions are the same as theirs—and 97% of those who responded said that the NHS would undoubtedly get worse under the new system. When they were asked about their main concern, 60% thought that the money intended for NHS staff and services would end up as profit for private companies. My constituents are very astute.

I want to turn to local circumstances before I am coughed at. In 2006-08, life expectancy for men in Newham was 75.8 years, lower than the London average of 78.2 years. In the same period, life expectancy for women was 2.3 years below the London average at 80.4 years. Even within my borough, there are variations that make the local situation much more complex and challenging. Life expectancy in some wards is 8.1 years shorter than in others. That is massive.

In primary care, the recommended ratio of GP provision is 1.8 GPs per 1,000 of population. In Newham, the ratio is appalling and equates to not much more than half that, at 0.56 of a GP per 1,000 of population. It is small wonder that in my survey, 35% of respondents reported that it is never easy to get a GP appointment, and just 10% said that it is always easy. Many practices—too many—are operated by single GPs, so it is no surprise that the patient experience in Newham is the worst in north-east London.

The primary care trust, before its abolition, had a clear plan for tackling that challenging situation and I enthusiastically endorsed and participated in it. Now, there are no mechanisms in place to root out poor practice and promote the best. I would like to hear from the Minister how she will ensure that Newham has the number of GPs to which we are entitled and that we have performance and outcomes that are the same as other areas of London.

Incidentally, I would be interested to hear whether other hon. Members here are experiencing the new phenomenon that we have in Newham: dial a diagnosis. When people contact their GP to arrange an appointment, they are initially offered a telephone conversation with the GP. Is that because GPs must bolster the failing 111 non-clinical service, which is now contributing to the difficulties of our A and E departments? Is it to save money, to sift out or deter patients or to ration GP time? Has there been a risk assessment of what that might entail, and does it contribute to the problems that my community is facing? Again, I would like to hear from the Minister about that.

Another statistic from Newham that should be good news is that the incidence rate for breast cancer is 104.6 per 100,000 of population, significantly lower than the UK average of 123.6. However, disturbingly and distressingly, the percentage of women alive five years after diagnosis—the five-year survival estimate—is, at 75%, also significantly lower than the UK average of 83.4%. The reason in part is the take-up rate of breast screening services, but there is anecdotal evidence of women who were part of Barts hospital’s preventative health services being encouraged to go away and become part of the general population, and to present sometime in the future. That encouragement not to continue to attend for breast screening gave a rosy picture of health needs.

The London Health Commission, under the chairmanship of Lord Darzi, has a remit that includes healthy lives and reducing health inequalities. I will be interested to hear what the Minister says in anticipation of the commission’s report, and what assurance she can give that the Government will act on health inequalities.

Let me refer to the Barts health care trust, which is the largest in the country and incorporates Barts, the Royal London, Whipps Cross and Newham general hospitals. Our patch is the growing part of London, with growth in population, complexity, the number of homes and, of course, opportunity. I was therefore grateful to hear the hon. Member for Cities of London and Westminster (Mark Field), who made a well balanced speech, talk about resources being sucked into the large university hospitals in the centre. Even though those of us on the far-flung borders of the east belong to the same trust as one of those hospitals, we experience the difficulties he talked about in relation to Romford.

Rumours abound at the moment that Newham general, as part of the Barts trust, is under threat of reconfiguration—a fascinating new word—to secure the viability of the trust as a whole. When I talked to the trust’s chief executive, he told me that the PFI represented only 10% of the trust’s entire budget and that, given that the budget was large, he did not see the PFI as having major consequences for the delivery of services.

However, there is an accusation that the trust is being a little disingenuous in its public statements that the A and E at Newham general will not be closed. Assurances have been sought that there will be no downgrading without full consultation, but those look weak in the face of a shortage of anaesthetists, for example, who are essential to support a viable emergency service.

Almost half of London trusts are struggling to achieve the 95% standard for patients waiting in A and E. Barts trust is just about achieving that target, but that is because Newham general performs well and helps the trust’s overall performance—a good example of how a local acute hospital catering for a place such as Newham can perform well, while larger hospitals struggle. Given that the future of Newham general’s A and E is under threat, the irony of the situation is not lost on me, and nor will it be lost on my constituents.

In that scenario, it is essential that we maintain Newham general as a fully functioning major acute hospital with a full range of services, including A and E and maternity. Given that we are seeing growth out to the east, it would be irresponsible and downright dangerous for us not to do that. It would also be a complete distraction from the absolute priority of putting in place improved, integrated care services in the community and in primary care.

Finally, I seek assurances from the Minister about the funding formula for CCGs being rolled out across England. In the London context, it is shifting resources from inner-London boroughs, with their younger populations, to boroughs further out, which have older populations.

Newham just happens to have the youngest population in the whole of Europe, apart from some tiny canton somewhere that is almost irrelevant. We will therefore lose substantial amounts, while London as a whole is losing 2.3% of its funding to other areas. I would like reassurance from the Minister that the funding formula will fully take account of deprivation, as the hon. Member for Cities of London and Westminster said, as well as of our population’s high mobility, with the health problems that brings with it, and diversity, with the specific demands that that puts on health care.

I congratulate the hon. Member for Westminster North (Ms Buck) on securing this important debate. I will keep my comments brief because I want to be fair to other Members who want to speak, not because I do not care deeply about this subject. Previous speakers have talked ably about a lot of the statistics, so I do not need to go over them.

I was actually born in a London hospital, across the river in St Thomas’. I was pleased to go there again recently to visit my hon. Friend the Member for Bournemouth East (Mr Ellwood)—I hasten to add that I was visiting the maternity ward because his wife had given birth to their new son, Oscar. It was lovely to be back at St Thomas’, albeit after so many decades.

Some important issues have been raised in the debate. Health care is critical to all of us—it touches each and every one of us, our loved ones and our constituents. It is crucially important and we must get it right. In London, there are specific problems, as has been said.

I was pleased that in 2010 the Government made £2.7 billion extra available in real terms in the NHS budget across the UK. That has allowed us to have 440,000 more clinical staff, and we also have 23,000 fewer administrative staff, including 7,700 fewer managers. That was absolutely the right approach and what the NHS needed.

The average stay in hospital is shorter than in 2010, although that puts pressure on community care, so we must make sure that that is dealt with. The cancer drugs fund is also critical to the debate, and we have helped more than 38,000 patients through it.

The debate is about London and the issues specific to this great city. In my constituency, in west London, the key health care issues tend to be focused on tuberculosis, obesity—including in children—diabetes and alcohol-related harm. As Members might expect, we have above average problems with healthy eating, given the issues with obesity. Other issues include smoking during pregnancy, smoking deaths and skin cancer. There are therefore specific issues in west London, and I will focus on them.

In my constituency, we have one main hospital—the West Middlesex university hospital, where two thirds of my constituents go when they need to. My Chiswick residents—about a third of my constituents—tend to go to Charing Cross hospital. I want to reiterate what previous speakers have said: we have some excellent patient care and services across our London hospitals, but there are, absolutely, also areas we should focus on.

The West Middlesex has outstanding maternity and midwifery services. One of the best parts of our job as Members of Parliament is rewarding people who have done incredible work in the health service, whether they are clinicians or support staff, and I recently handed out awards at the West Middlesex, which is ably led by Dame Jacqueline Docherty.

I also want to pay tribute to London’s air ambulance service. During the Christmas period, there was a fire and a massive explosion in Chiswick, and the air ambulance was called. The service deserves as much support as possible, because it serves 10 million residents in London, and it has only one helicopter. It is world class, providing high-trauma, acute care. Everywhere else around the country has one helicopter for 1.5 million people, but the figure in London is 10 million, so there is an absolute need for another helicopter. I would push everyone to support the London air ambulance service, which has its 25th anniversary tomorrow.

I entirely agree, and I think most of us would associate ourselves with the hon. Lady’s comments on the London air ambulance, but does she not agree that it might be better if it were run by the state, instead of relying so much on charity?

The London air ambulance service is an amazing organisation, so I would not change its structure. It rightly gets some funding from the NHS, but it also derives funding from many other sources, and it is important that we support that. The service does an incredible job, so if the hon. Gentleman knows anyone who can give it a spare helicopter, it would really appreciate that.

My local CCG is chaired by Dr Nicola Burbidge. It started early, it has been absolutely focused on patients and it has been very responsive to any issues I have raised with it.

On reconfiguration, I was recently thankful when, after a lot of campaigning by my hon. Friend the Member for Chelsea and Fulham (Greg Hands) and others, the Secretary of State announced that the A and E at Charing Cross hospital would not be closed, thus helping residents in my part of London. Saving lives and improving patient care is paramount.

I apologise for not being here for the opening speech. Does my hon. Friend agree that one challenge now facing London is the increasing complexity of diseases and the treatments that are required, which means that additional money and expertise are needed? Such diseases often cannot be dealt with at a local level; they must be dealt with nationally. Although we have supported those suffering from cancer and other diseases, much more complex diseases remain to be resolved.

My hon. Friend makes a good point. I hope the Minister will respond to the issue of how we take up such challenges in London and get the necessary funding.

I shall list some issues on which I would like more improvement. We heard how difficult it is to get appointments at general practices—we call up and know that the answer is going to be no before we say anything. There are also issues with getting to see a specialist as quickly as possible. We want an effective complaints process in hospitals, changing the culture to allow people, whether staff or patients, to complain. There is an issue with how patients are moved around London, and the hon. Member for Westminster North made an important point about having to use public transport to get home. Mental health and community public health are other important issues.

My final comment is about dementia, which is a growing concern in London, as it is across the country. About 30% of patients who go into the West Middlesex hospital have dementia. They do not go there because of dementia, but they have it. There is a lot to be done, and the West Middlesex hospital has just opened a new dementia ward. There needs to be a greater focus on dementia, given our ageing population nationally, and the size of the population in London. We must ensure that we work together to support those who really need and deserve care and support in London. That will improve the NHS for us all.

Order. Four speakers have risen to speak, all from the Opposition, so hopefully they will be mindful of their colleagues.

Given the time constraints, I shall limit myself to one issue, which is the current threat to the emergency hospitals in my constituency, but I begin by congratulating my hon. Friend the Member for Westminster North (Ms Buck) on securing this timely debate. She made her arguments very well.

This morning, I received an e-mail from the Secretary of State that is pertinent to the debate. There was an agreement for him to meet the three Ealing MPs, two of whom—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—are here, and me next Monday evening. The Secretary of State has withdrawn from that meeting, pleading other engagements, and asked us to meet officials instead. I hope that he will reconsider. The meeting is specifically about the threat to two of London’s major hospitals, Charing Cross and Ealing, and I hope that the comments I am about to make will lead the Minister to intervene and ask that the meeting go ahead. We understand that the Secretary of State has pressures on his time, but it is entirely unacceptable for him not to meet Members on an issue of such crucial and central importance.

It is sad news, but we know—

I would rather not because of the time. I am sorry.

We know what is happening with Hammersmith hospital because it has been announced that the A and E department there is going to close after the winter crisis—as if the crisis is not a continuing one. I have been told informally that it will close two weeks after the local elections to avoid any embarrassment to the Government. We were also told that there might not even be an urgent care centre there; it may be moving. That would mean no emergency access to Hammersmith hospital, unless it is still to receive emergency blue-light coronary cases. At least Hammersmith hospital will continue as a major specialist hospital, and a very fine hospital it is indeed.

The situation regarding Charing Cross hospital is far less clear. I will précis where we are and explain the matters that we wish the Secretary of State to deal with. In February last year, the decision, which is still extant, was made to close completely and sell off the Charing Cross hospital site, leaving an urgent care centre on 3% of the site. At the same time, there was to be an outline business case, to report in October last year, that might preserve 13% of the facilities and 40% of the site. That business case is now due in March, but we understand—through the Imperial College Healthcare foundation trust process, not any other process—that there will also be elective surgery on the site. That might mean there will be elective surgery as well as primary care and treatment facilities, and some form of emergency centre on the site, with perhaps 50% of the land preserved. That gain, in so far as it is a gain, is St Mary’s loss, because we understand that 50% of its site will be sold in any event. Of course, any amelioration in the position is to be welcomed.

I praise the cross-party Save Our Hospitals group for campaigning tirelessly in both my borough and Ealing on the issues I have mentioned. However, the point it would want me to make very clearly is that what I have described is not what we want. Of course we want good elective care, primary care and treatment services, but the issue of capacity must be addressed.

It is not feasible to close two of the largest emergency hospitals. I use the word “close” advisedly. As emergency hospitals, they are closing: there will be no emergency surgery, no blue-light A and E, no stroke unit and no intensive treatment on those sites. I am afraid that the Secretary of State’s intervention so far has been genuinely unhelpful and done for political reasons. We have invented a second-tier A and E, as it is called. A second-tier A and E is an urgent care centre. The only differences that clinicians could identify for me were that at a second-tier A and E there would be GP cover and X-ray services, and for elderly and vulnerable people there might be some beds for recuperation after minor treatment. Otherwise, it is an urgent care centre or a minor injuries unit.

Let us not play political games. I am not saying that we can keep politics out of the NHS—of course we cannot—but this is dangerous because it will mislead people. If people think that there is an A and E at Charing Cross or at Ealing when there is not, they will go there when they should have gone elsewhere. We will continue to campaign to save emergency services. It is not feasible for the Imperial family to go from three major emergency departments to one. All three are currently under pressure and overcrowded. The decision has to be taken by Ministers, so I implore the Minister to go back to the Secretary of State and ask that he meet us.

The level of politics is not acceptable. Politics comes into these matters all the time. Before the last election, when there was no threat to the hospitals, the Conservatives kept saying that there was—I have their election literature here. We now have taxpayers’ money being spent on campaigns saying that hospitals are staying open when, in fact, departments in them are not. Let us at least tell our constituents the truth. There may be unpalatable decisions to be taken, but as far as Charing Cross is concerned, the health service is clear that it will be a local hospital. It will not be an emergency hospital. That is not acceptable in any way to my constituents. It is not feasible to run a health service in west London on that basis.

I have made my points to the Minister clearly, and I look forward to her response. I also look forward to the meeting with the Secretary of State where I can put my points in more detail and more forcefully.

I am grateful for the opportunity to speak in this debate. We have already heard that the NHS in London is most definitely straining under the weight of demand for services. The problem is related to the constrained financial environment, but fundamentally it is about the increasing needs of our population. The population of London has grown by 12% in the past decade and is likely to grow by another million in the coming decade. That is why the plans to downgrade and close desperately needed and often very successful emergency and maternity departments in London are met with such incredulity and anger.

I would like to make a few points to the Minister today. First, I ask her to consider the overall shape of maternity services in London. Much of the debate focuses on big arguments about the reconfiguration of emergency departments, but maternity services are often a victim of those reorganisations, because as soon as an intensive care unit is taken away from a hospital, it is unable to provide full maternity services. Does the Minister really want to ask women in the capital to travel even greater distances to give birth to their children, when they want to be close to home and family? Will she look at some of the sacred cows that have built up in the wisdom on maternity services?

I know there is an aspiration to provide 168 hours of consultant cover every week in maternity departments, but I understand that that currently happens at only one trust in the whole country. I ask the Minister whether it is achievable, affordable, or necessarily in the best interests of women to continue to aspire to reach that standard in all our hospitals in London.

Another point I want to make to the Minister—it has already been made—is on the crucial importance of the public being involved and having a genuine say when hospital services are being reconfigured. In Lewisham, we saw the exact opposite of that, with the unsustainable providers regime. The Government are trying to augment that process and apply it more widely, which has very serious implications for trust in politics and in our health service.

I am very conscious of time and that two other Members wish to speak. I ask the Minister to look very hard at the existing evidence on centralising all hospital services in London. I know there is a lot of evidence for creating centres of excellence for stroke, trauma, and vascular disease in big hospitals. However, I wonder whether the same evidence exists for other acute medical emergencies and whether there is evidence, for example, for centralising mental health services or maternity services.

I have one final point—I will sit down very shortly. There are currently plans at many hospitals in London to flog off hospital sites. That land should not be used to create playgrounds for the rich and the international jet set. Public land is a very precious asset in London, and if we are going to use it for anything, could we please explore the possibility of using it for housing for elderly people, providing communities of care? Provision of suitable accommodation is one of the crucial things we need to get right if we are to tackle some of the underlying problems in the NHS.

Thank you, Mrs Main. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) on securing this very important debate. I share the concerns expressed by my colleagues earlier, including those about the Secretary of State cancelling the meeting that I and the leader of Ealing council requested. We were looking forward to expressing the views of the residents of our constituencies.

Multiple A and E departments in the capital have been under threat of closure or set for closure, from Lewisham, where a hard-fought campaign has saved the hospital from closure, to south-west London, Ilford, and the four A and Es in west London, two of which have been marked for closure and two of which are still effectively closed—they are being called A and Es when they are not. One of them is in my constituency in Ealing hospital. In a city of more than 8 million inhabitants, where the population growth is twice the national average, those closures and downgrades will have a huge impact on the lives and safety of local residents, leaving many residents miles from their local A and E.

Accident and emergency services are already under tremendous pressure and will be subject to increased strain with local closures. We know that the number of blue-light ambulance diverts increased drastically in London, by almost a quarter, proving that A and Es in London are over capacity. One of the hospitals that has regularly turned away ambulances is Northwick Park. With the closure of A and Es at Central Middlesex and Hammersmith hospitals, and with Ealing and Charing Cross hospitals seemingly unable to receive blue-light ambulances in north-west London, Northwick Park will be under even more strain as patients are sent there for emergency treatment.

Northwick Park is already overburdened and is one of the worst-performing A and Es in the country. It will simply not be able to cope with the four other local A and Es closing and will be unable to accept blue-light ambulances. Journey times for patients will be longer and they face the risk of travelling elsewhere if the ambulance is turned away. That will be the difference between life and death for emergency patients—an unacceptable situation.

Back at the end of October, the Secretary of State confirmed the closure of A and Es at Central Middlesex and Hammersmith hospitals, and announced that A and Es would remain at Charing Cross hospital and Ealing hospital, in my constituency, the shape and size of which would be subject to a review. His statement, which was supposed to remove uncertainty about the future of our local hospitals, only further increased confusion.

It has, however, been made clear, through the Keogh review and Dr Mark Spencer’s subsequent comments, that the review would in fact reduce the size of Ealing’s A and E, and that Ealing would be unable to receive blue-light ambulances. The Secretary of State, who pledged to keep the A and E services, has in fact downgraded Ealing hospital, while keeping the A and E in name only. The Secretary of State promised an A and E for Ealing, but delivered only more disappointment to local residents. There are many other concerns, not least of which is the fact that many of my constituents in Southall are the poorest and most vulnerable members of society, with specific health needs that are met by nearby Ealing hospital. They will have to travel considerable distances, putting their lives at risk.

With the population of west London growing, those decisions seem, at best, unsafe and, at worst, dangerous. The concerns that we have in my constituency and in west London will obviously be replicated across London with the threat of more closures in the midst of an A and E crisis. There needs to be more of a concerted effort from the Secretary of State and the Department of Health to help Londoners receive the best health care, rather than making this existing crisis worse.

Thank you very much, Mrs Main. I had intended to talk for slightly longer than two minutes, but the central thing I wish to say is about mental health. Other contributors to this very important debate have touched on that, but it seems to me that for us, as a nation, it is essentially a Cinderella service, and certainly has been all the time that I have been in the House.

The hon. Member for Cities of London and Westminster (Mark Field) referred to the pressures on central London. That is not only to do with the churn of people moving into London and moving out, but, as he rightly said, it is most markedly about people who are dependent, or over-dependent, on drugs and alcohol, and people with mental health issues. A peripatetic patient cohort—I hate that word, but I cannot think of anything else at the moment—is virtually not being regarded, let alone something on which the multifarious bodies and boards that are now responsible for delivering health care in London are working together.

I hope the Minister will take that away and put it at the top of her list, because the enormous damage that is done to individuals when they are allowed to go over the cliff of their crisis is reflected in the damage inflicted on their families and their wider community. I am firmly of the opinion that the right provision, as we have had in my own constituency, is a house that is open 24/7, 365 days a year. People who felt that they were going to go over the edge of their mental health crisis could walk in through the door. There were people there all the time to care for them. Yes, such facilities are expensive to set up, but I am firmly of the opinion that the money we save by having them could be put towards the sharp end of delivering a high-quality health service to people who are not suffering from mental health problems.

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) on securing this very important debate about health care in London. I hope that hon. Members will forgive this Mancunian for gatecrashing the debate to respond for the Opposition.

The future of health services and especially accident and emergency services across London is an important issue of genuine concern to a great many of the constituents of hon. Members present. It is definitely an issue of real significance right across our capital city. I pay tribute to all the hon. Members who today have made contributions, long and brief, on a wide variety of matters.

Let me take this opportunity to pay tribute to the staff working in the national health service for their commitment in providing a first-class service to patients in what has been a very trying period for the NHS. As we know, there have been important changes in the provision of hospital care in London. We have had “Health for North East London”, “Shaping a healthier future”, the Barnet, Enfield and Haringey clinical strategy, the trust special administrator’s review of South London Healthcare NHS Trust and the NHS in south-east London and “Better Services, Better Value” in south London, to name a few of the reconfigurations that have taken place in the capital.

My hon. Friend the Member for Westminster North is right to point to extreme financial pressures on hospital services. North-west London hospital services must accommodate a £125 million reduction in service between 2011 and 2015. The people who use hospitals in London are rightly concerned about the changes to the services on which they rely. We have heard about the proposals that will lead to the loss of accident and emergency departments at Charing Cross, Ealing, Hammersmith and Central Middlesex hospitals.

However, it is not only my hon. Friends who are concerned about the future of A and E departments in London; local authorities are, too. Local authorities such as Ealing have voiced their concerns about the downgrading of their A and E services. As we have heard from my hon. Friend the Member for Hammersmith (Mr Slaughter), A and E facilities that both the Prime Minister and the Secretary of State had promised to save across north-west London and elsewhere in the capital will be closing. I hope very much that the meeting between the Secretary of State and the hon. Members who represent Ealing and Hammersmith can be reconvened as requested.

Of course, all this is in direct contradiction to what the Prime Minister said during the general election, when he promised to halt the closures of hospitals, accident and emergency departments and maternity units. Why does the Minister think that there is such widespread concern about the lack of leadership in the health service in London at a time when the NHS is dealing with unnecessary upheaval?

Frankly, it was a disastrous decision on the part of the Government to spend billions of pounds on an unnecessary top-down reorganisation, which has led to a loss of financial grip in the NHS. Now, more than 6,000 nursing posts have been lost, waiting lists are getting longer and we are seeing the return of patients on trolleys in corridors. Indeed, we are now seeing A and Es not just in London but across the country facing a winter crisis after an unprecedented summer A and E crisis. At the same time, local authorities are having a huge cut to their social care budgets. More and more elderly people are therefore ending up in A and E, because there is no one at home to care for them, adding even more pressure to a pressured system.

Labour Members warned Ministers repeatedly during the passage of the Bill that became the Health and Social Care Act 2012 that the legislation would lead to the break-up of the NHS. The public rightly expect to have easy access to health services, and Ministers have a heavy responsibility to show leadership and to act to prevent people’s lives being put at risk. Ministers must also tell the House today what action they propose to take to ensure that London’s growing population will continue to have good access to hospital and other health service provision in their local areas. Those points were made eloquently by a number of hon. Members, but I have to mention my hon. Friend the Member for West Ham (Lyn Brown) in relation to Newham.

Of course, Labour Members do not oppose all the changes to local health services. Surely, it is right that hospitals and services evolve and change. However, it must be change based on good clinical reasons and not just financial necessity.

Does my hon. Friend agree that the issue in London is not just provision for its size of population, but the extreme diversity and complexity of the population? It is a very mobile population. There are large numbers of refugees and asylum seekers, and London has the largest lesbian, gay, bisexual and transgender community in the country. That is what people have to pay attention to if they are reconfiguring services.

My hon. Friend is right. London is a global city. It has people coming in from all over the world, not just from elsewhere in the United Kingdom. It is a diverse city. It is an exciting, vibrant city—I am probably over-egging it for a Mancunian, but it is a great place. Those complexities are what makes London fantastic, but they are also what makes delivering health services a real challenge.

To make the change work, there must be clarity and partnership. Everyone must understand what is being proposed and how the decisions are to be taken. That brings me on to the issue of Lewisham and clause 118 of the Care Bill. We saw in Lewisham the power of an effective campaign in the face of unpopular change to health services and what that can achieve.

I pay tribute to the Lewisham MPs and to the campaigners, who fought tirelessly for their local hospital. The proposal to close their A and E department was rightly met by a strong local campaign, which included protest marches and a successful legal challenge to the closure. Indeed, the Court of Appeal ruled that the Health Secretary did not have the power to implement the cuts at Lewisham hospital. If only he had listened to my hon. Friends in Lewisham—they had been arguing that beforehand.

Clause 118 should give very real concern to all hon. Members in the debate, because in future it will give carte blanche to the Secretary of State and the Department of Health to reconfigure services right across the country as they sought to in Lewisham, disfranchising the communities that have spoken out very loudly across London against some of the changes. Labour Members are rightly concerned about that measure and we will be opposing it during the next stages of proceedings on the Care Bill.

In conclusion, I pay tribute to my hon. Friend the Member for Westminster North and to all my right hon. and hon. Friends who have taken part in the debate. Hospital services are very important to the capital. We must make sure that there is proper strategic planning across London, not the piecemeal approach to reconfigurations of services that we have seen, so that the complexities in health needs—including mental health, which my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson) mentioned—are taken on board fully for the betterment of people living in London.

What an amazing debate! I congratulate the hon. Member for Westminster North (Ms Buck) on securing it; a lot of issues have been covered. Many London colleagues have contributed, made interventions or simply been present to listen to it. As a London MP, I am particularly conscious of the unique challenges facing health care in London, and many of the issues raised apply as much to my constituents as they do to those of colleagues across the House. As hon. Members have said, London is an amazing city with world-leading expertise and services, but it has unique challenges. Whichever party was in government, it would have to respond to those challenges.

I will do my best to respond to some of the points that have been made, but there were such a range of points, and some of them were so specific, that I may need to write to colleagues after the debate. I hope that hon. Members understand that. I will ensure that I follow up those points personally or ask NHS London to do so. Forgive me for having to make that health warning.

I start by echoing the praise from the hon. Member for Westminster North for our NHS staff in London. They work under many interesting and unique pressures, and they respond, for the most part, magnificently. We all realise that no service is above criticism, but our starting point is that we have some amazing people working very hard under difficult circumstances. I am particularly glad that the hon. Lady and her family experienced good care at a crucial time.

The hon. Lady is right to caution that debates about health need to acknowledge, but not to exaggerate, risk. We always teeter on the brink of exaggerating points for political effect, and it is really important that we keep some sense of perspective. Several hon. Members have referred repeatedly to an A and E crisis. I want to put on the record that for the week ending 29 December 2013 last year, the figures for A and E waiting times in London demonstrate that 96% of patients were seen in under four hours in all A and E types, against a standard of 95%. For the third quarter of last year, 95.3% of patients were seen in under four hours in all A and E types.

I am not saying that we do not have problems and challenges, but let us be clear that in many places, the NHS is responding well to those challenges and meeting targets. Work force statistics show that the number of community health service doctors increased by 8.5% from 2010 to 2013. Let us make sure that we keep a sense of perspective on where we are.

Some of the comments during the debate referred to reconfigurations across London. We are quite clear that reconfiguration of front-line health services is a matter for the local NHS, precisely for the reasons that some hon. Members have given. We are trying to make sure that they are led by clinical decisions. That was acknowledged in the opening speech, as was the need for change. The hon. Member for Westminster North made that point.

Forgive me, but I really will not have a chance to respond to any of the points made if I give way. I will catch up with the hon. Lady afterwards if there are points that she specifically wants to discuss.

All the reconfigurations must focus on delivering modern health care, better patient outcomes and services as close to home as possible, but, most importantly, they must focus on saving lives and improving quality of life. Those service changes are best led by clinicians, with all of us getting involved and engaging with the process, as we must do. That is what we all want for our constituents, and there are different ways to achieve that.

Change is inevitable, as most, but not all, hon. Members have acknowledged. We have debated questions such as the changes to stroke services in London, which many campaigners predicted would have dire and dreadful outcomes. In fact, the opposite has been true, and London clinicians believe that hundreds of our constituents’ lives have been saved by the concentration of excellence in certain centres. We must be realistic about the fact that reconfiguration can bring great health benefits, as long as it meets the important tests set out by the Secretary of State, and is clinically led.

The health service has to respond to growing demand. Much of the debate has focused on the long-term challenges to the health service in London and across the country. The Government are trying to respond to those huge long-term pressures. We are looking at GP opening hours and at access. That could not be a bigger issue in London, which has a highly diverse and highly mobile population in a 24-hour city. People need to be able to access health care at a time that suits their work patterns and lifestyle, and we are pushing for changes to contracts in that area. There will be named GPs for over-75s. We are looking at the integration of social care and public health. We know that there are big challenges around that, but a big project is under way to try to tackle it.

Ring-fenced public health budgets will empower local authorities to do the very thing that many hon. Members have drawn our attention to, which is to look at the needs of local communities and respond to them at the most local level. We do not want to take a “Whitehall knows best” approach; we want to tell local authorities, “We have ring-fenced your local public health budget so that you can look at the needs of your local population and work with health and wellbeing boards and clinical commissioning groups to devise services that help people to live longer and healthier lives without the need to resort to acute services.”

There has not been much recognition of the need for the changes made to public health budgets, but of all the measures raised in the debate, those changes have some of the most exciting potential to tackle the challenges that we face.

I have touched on health and wellbeing boards. The challenge around Newham GPs would be ideal for discussion at a health and wellbeing board, where all the key people are present. It is a big challenge, and one of the first questions I asked as a Health Minister is why we struggled so badly to get GPs in our most deprived areas. There are varying answers to that, but it is a problem across the country.

The health and wellbeing board is exactly the right forum for discussion because the right people are around the table. Tackling health inequality is now built into statute through the Health and Social Care Act 2012, which must be given due attention in all parts of the health service. The Darzi-led London Health Commission will be interesting. I spoke to Lord Darzi about it just before Christmas to improve my understanding of its objectives. As a Minister with responsibility for public health and as a London MP, I will be looking closely at the commission’s outcomes and I will be keen to work with people on that. It is a big opportunity.

To touch on the point raised by my hon. Friend the Member for Cities of London and Westminster (Mark Field), the formula does not currently reflect non-resident population or the homeless, but that is something that the Advisory Committee on Resource Allocation and NHS England continue to consider. I will ensure that I draw my hon. Friend’s concerns to their attention and that those are fed into the ongoing process of looking at formulas.

For the first time, the formulas for CCG patients and public health allocations take into account health inequalities, and they look at GP populations rather than census-based populations. The formulas are also designed to be more locally sensitive. As the hon. Member for Westminster North and I know particularly well, in a city such as London areas that appear to be quite affluent can contain pockets of tremendous deprivation. The new formula allows for that by enabling consideration of sub-areas and the real health inequalities that they suffer. I hope that hon. Members feel some reassurance about that. We keep the matter under close watch.

Several detailed concerns were raised by the hon. Member for Lewisham East (Heidi Alexander) about Lewisham, the south London reconfiguration, maternity services and accommodation. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne) referred to clause 118. I will ensure that I draw his concerns to the attention of the Minister who is leading on that Bill. No doubt that point will be responded to when the Bill is brought before the House. The Court of Appeal overturned the decision to make service change in Lewisham, and we respect that. The Secretary of State has put that on the record.

Several points were raised about the north-west London reconfiguration. That was debated in this Chamber on 15 October, after which a letter was sent by the local NHS to the hon. Member for Westminster North. If other hon. Members have not seen that letter and would find it helpful to, I am happy to put it in the Library. I note the ongoing concerns expressed by the hon. Member for Hammersmith (Mr Slaughter) about the reconfiguration, and I will relay to the Secretary of State the detailed points that he has made and his desire for a meeting.

Other hon. Members have made comments about the same reconfiguration. For all the criticism of the plans and the analysis, I note that the shadow Minister did not commit his party to changing any of the reconfigurations or to changing NHS funding levels. If I may say so, his speech was long on analysis and short on commitment.

I conclude by saying that the issues raised today are important to all of us as London MPs. There are some big long-term challenges and the Government are trying to respond to them in the best interests of all our constituents.

Before we commence the debate on Scotch whisky excise duty, I should say that we are expecting a vote—hence my glances at the Annunciator screen. Should that happen, I will call for the sitting to be suspended until the vote has taken place.