My Lords, the reconfiguration of front-line health services is a matter for the local NHS. Any decisions regarding changes to services are taken locally and are subject to the four tests for service change. On 19 February, the NHS North West London Joint Committee of Primary Care Trusts decided to proceed with a “Shaping a Healthier Future” service reconfiguration programme in north-west London.
My Lords, will the Minister confirm that A&E waiting times are increasing in the areas covered by the four hospitals even before the closures have taken place? There is enormous local concern about a plan to, as it were, reduce services in a series of hospitals more savagely than anything else in the history of the NHS. In particular, the plan includes the proposed demolition of Charing Cross Hospital and its replacement by a handful of beds. Is it not the case that the Minister or the Secretary of State has the final decision and that it is quite possible for the Secretary of State to say, “No, I do not accept this. Think again.”?
My Lords, we believe very firmly as a general principle that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements through the health and well-being boards. To answer the noble Lord’s question, it is entirely possible for a reconfiguration decision to be referred upwards to the Secretary of State by the overview and scrutiny committee of a local authority, and in that event it is customary practice for the Secretary of State to receive independent advice from the independent reconfiguration panel. However, we have not reached that stage yet. We have agreement locally as to what these arrangements should look like and I think that we should wait to see how the plans develop.
My Lords, is my noble friend aware that the Whittington Hospital, which serves a densely populated area of Islington and of Haringey, where there is no other hospital, suddenly announced in January without any proper consultation its major plans for reconfiguration, including changes to buildings and services? Those plans include the downgrading of the A&E department of the hospital, where I have spent many an unhappy hour with my children and other family members but receiving an excellent service, to an emergency care service. Does he think that it is appropriate to do this without proper consultation and explaining the plans to local people?
My Lords, I cannot comment specifically on that particular set of proposals. However, I can say that we made it very clear nearly three years ago that reconfiguration proposals, wherever they arise, should be underpinned, as should the arising decisions, by four reconfiguration tests. Local plans must demonstrate support from GP commissioners; a strengthening in public and patient engagement, which is the issue raised primarily by my noble friend; clarity on the clinical evidence base for whatever is proposed; and support for patient choice. We expect that where proposals of this kind arise, those four tests need to be met.
My Lords, again I declare my interest in health. On that, I am puzzled because of what has happened in the case of Lewisham A&E where the clinical commissioning group itself is clearly absolutely opposed to the downgrading of that A&E service. Why has the Secretary of State determined to go ahead with those changes?
Five out of the six clinical commissioning groups involved in that area were supportive of the changes. It is true that Lewisham CCG was not. However, the four tests were looked at and it was clearly determined by the trust’s special administrator that those tests had been met.
My Lords, will the Minister recognise that parking needs of both visitors and patients need to be fully taken into account when making this sort of decision? I declare an interest as being an only-too-frequent visitor to Charing Cross A&E over the last year. It would have been impossible to get to Chelsea and Westminster hospital where the parking is appalling, both for myself and for my visitors.
I agree with the noble Baroness that this is most certainly a factor. In the case of north-west London, an independent equalities impact assessment was undertaken to check how the proposed options would affect all strata of local population under the Equality Act in particular. The assessment found that the impact on travel times by car, and indeed by blue light ambulance, would be minimal under all three of the options that were being looked at. The point that I am making is that in any context, it is important to factor in the effect on travel for all patients likely to be affected.
My Lords, I am shocked that the use of the word “reconfiguration” by the Government has brought into the English language an alternative to “cuts”. Will the Minister not accept that what is being proposed in the four hospitals in the north-west London region are savage cuts which will damage services for local people? That is the bottom line.
My Lords, I think that often when plans are explained to patients, they realise that the word “downgrading” is inappropriate. For example, in north-west London, there has been a lot of unnecessary worry about urgent care centres as substitutes for A&E units. The majority of people who attend A&E can very well be treated in an urgent care centre on the same site, and patients who dial 999 will be taken by ambulance straight to the appropriate hospital. Therefore, I think there is, in some senses, a false debate going on here.