asked Her Majesty’s Government:

What is the estimated revenue and capital cost of the London polyclinic project; what is the expected number of hospital bed closures across London; and what are the estimated savings from it.

My Lords, the costs of service changes in London depend on the specific models pursued and the existing infrastructure in each community. The introduction of polyclinics is not about closing hospital beds but about preparing the infrastructure to cope with future demand for health services. There is an international evidence base for developing integrated services based around the needs of patients and providing access to a range of community-based services with convenient opening hours.

My Lords, that is all very well, but I asked what the estimated capital and revenue costs were. As I understand it, the answer is that the Government have absolutely no idea at all. Secondly, of the 31 PCTs in London that signed up, rubber-stamping the idea, how many undertook independent clinical and managerial assessments before they agreed, as the noble Lord stated in his previous paper that they were required to do? Why does the Minister ignore the 1.2 million people who have signed petitions against this idea and the majority of doctors who are against it? Would not the money be better spent on getting rid of the superbugs that have killed 8,000 people and on a number of other areas, not least the waiting lists, as well as the 50 per cent of young mothers who are turfed out 24 hours after having their child?

My Lords, I shall try to answer at least one question. The first question was on cost. As I highlighted, a polyclinic is not a building. In the London report, which I led with 100 clinicians in London, I described a number of different models of polyclinics, one of which is a network, or federated, model. It is not a building; I say that for the record. The costs will have been carefully estimated by London’s SHAs. I shall be more than happy to send the proposals to the noble Lord. As far as the petitions are concerned—I should declare to the House that I am a member of the BMA—I met the chair of the patients’ forum this morning. Patients signed these forms based on their understanding at the time of their visits to their GP practices that the practices were about to close. This is not about closure. We have invested £250 million in building additional primary and community services. We have done so because patients expect extended opening hours and opening hours over the weekend. This is to drive patient choice. As a patient and a clinician, I believe in both.

My Lords, given the obvious benefits of polyclinics in London to patients, doctors and nurses, can my noble friend suggest why the BMA is so opposed to the idea?

My Lords, as I said, I am astonished and alarmed as a doctor and a clinician that some patients have been misled into signing petitions to save their local surgeries. I am sure that noble Lords will agree that the trusting relationship between any clinician and patient is sacrosanct; it is one of the key values that underpin our professions. Misleading patients and breaking their trust by causing them unnecessary concern and worry breaks that professional vow that we all take.

My Lords, I am polyclinic enthusiast. However, will the Minister please tell us the difference between a large health centre, a community hospital and a polyclinic? Will he confirm that if a primary care trust in London, in consultation with local people, decides to expand the services of an existing community hospital, for example, it will still get the money that it would have got for a polyclinic?

My Lords, we should ignore what we call these things. At the end of the day, this is an investment in the primary and community setting to meet the healthcare provision demands facing the nation over the next 10 years. We are all getting older and we all want to enjoy a better quality of life as we do. We all know that the biggest challenge is long-term conditions. As the noble Baroness said, we are trying to shift diagnostics and care closer to the patient’s home. On funding, whatever the clinics are called, there is a major shift. As we have demonstrated with our investment of £250 million in these new GP-led health centres, our future investment must be in primary and community settings.

My Lords, what will be the position of accident and emergency services? No matter how good the polyclinics are—and they may be good if you live right near one—accident and emergency services are important to people in London at all hours of the day and night. Can the Minister assure us that there will be no diminution of those services?

My Lords, I could not agree more. Because of the baseline historical growth in A&E attendance over the past three or four years, this is one of the biggest growth areas that we envisage in London: we calculate a 66 per cent growth in attendance by 2016. The system as it stands will be unable to cope with that. The health centres to which we are referring will cope with the significant number of patients that are currently attending A&E. In my hospital, you could claim that 60 per cent of them could be dealt with in a primary and community setting.

My Lords, can the Minister assure us that these groups of GPs—call them “polyclinics” or whatever—will be actively involved in teaching undergraduates and postgraduates and in research, evaluating healthcare delivery and contributing to innovation in new NHS treatment? We know that the involvement of people in teaching and research drives up the quality of care.

My Lords, I am grateful to the noble Baroness for highlighting the importance of the role of primary and community services in the education and training of our future practitioners and research. I will have a lot to say about this in the primary and community strategy, which will be published as part of my next-stage review in a few weeks’ time.

My Lords, as someone who has been required to go to a local or neighbouring hospital at least six times this year for blood tests and X-rays because those facilities are not available from my local GP, I welcome the opportunity of immediate access to such facilities. Will the NHS do some calculations on the likely cost—in time, travel and probably stress—of patients going to hospitals for X-rays and blood tests when these could done nearer to their homes?

My Lords, I am grateful to the noble Lord for highlighting the importance of future planning in the NHS being designed around patients’ needs rather than professional ones.

My Lords, will the Minister confirm that 50 per cent of PCTs have tendered for polyclinics and that over 600 general practices have been listed as being in competition with these polyclinics?

My Lords, the Joint Committee of Primary Care Trusts, leading the Healthcare for London programme, met in public last Thursday, 12 June. It made 19 final recommendations, including one to implement the polyclinic service model. On competition, I am not aware of the figure that the noble Lord cites. As I said, capacity expansion creates the choice for patients to register with these new health centres if they wish. However, they do not have to change registration; they can just walk into these health centres to get access to treatment.