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House of Commons Hansard

Huddersfield Royal Infirmary

02 February 2016
Volume 605

    [Mark Pritchard in the Chair]

  • I beg to move,

    That this House has considered A&E services at Huddersfield Royal Infirmary.

    It is a pleasure to serve under your chairmanship, Mr Pritchard. Labour’s ruinous private finance initiative deal; Tory top-down reorganisation; socialist independents’ sniping; Lib Dem opportunism; UKIP wanting to privatise the NHS; Socialist Workers using the issue to scrap Trident and bring down capitalism—that’s all the party politics done. Let us put that to one side. I hope that for the next 89 minutes, we can continue with our cross-party consensus to make a compelling case for keeping our full A&E services at Huddersfield Royal infirmary.

    I would like to thank my parliamentary colleagues for attending today, particularly the hon. Members for Huddersfield (Mr Sheerman) and for Dewsbury (Paula Sherriff), who applied for this debate along with me. I was fortunate enough to be successful, but we are all here together, along with the hon. Member for Batley and Spen (Jo Cox), with one strong local voice.

    The background to this issue is that the Greater Huddersfield and Calderdale clinical commissioning groups have unanimously voted to put their “Right Care, Right Time, Right Place” proposal to a public consultation, which could lead to Huddersfield losing its A&E service. We anticipate that the 12-week consultation could start next Monday, 8 February.

    The CCG’s preferred option is to close Huddersfield’s A&E and keep the provision at Calderdale Royal hospital in Halifax. The background to that proposal is the ruinous PFI deal negotiated in the 1990s and signed in 1998. The initial cost of Calderdale Royal hospital was £64.6 million, but it will end up costing the Calderdale and Huddersfield NHS Foundation Trust an incredible £773.2 million when the deal expires in 2058. That scandalous PFI deal is now influencing clinical and community health decisions, with an enormously detrimental effect. That dodgy deal is set to cost lives, and we are set to lose our A&E in Huddersfield while the PFI money makers stuff their pockets.

    Throughout the past 12 months, our local CCGs have been mooting a reorganisation and reconfiguration of emergency and acute care and high-risk planned care, with HRI being the preferred location. In fact, the CCG’s own modelling of option 5B stated that Huddersfield Royal infirmary should provide all acute and emergency care and clinically high-risk planned care, because it was “in line with” the clinical model of safer and higher quality services, 24-hour consultant-led care, undisturbed planned care and a more resilient workforce model. It was only when the PFI financial considerations were factored in that the appalling proposition of closing A&E at Huddersfield suddenly emerged.

    What has been the reaction to that plan? I was shocked at the proposal, and so was our community. I live in the village of Honley; I do not live anywhere else or have a second home—that is where I live. I have had to use HRI A&E a number of times, and I have always received excellent care. I put on the record my thanks to the wonderful staff there. In 1995, I fell seriously ill on my return from deployment in Turkey and northern Iraq while serving in the Royal Air Force and had to go to A&E. Eighteen months ago, I fractured my elbow in a fall while running the Honley 10 km race—being fit is not good for your health, by the way. My parents, who live just up the valley, have used our A&E. My mum had a bad fall on the ice a couple of years ago and had severe facial injuries, so getting to our local A&E in wintery conditions was crucial.

    I am so proud that our community has come together to fight to keep our A&E at HRI. Karl Deitch set up a Facebook group, which now has more than 46,000 members. From that, we have already seen a rally in St George’s Square in Huddersfield, where more than 1,000 local people came together. The group has formed a campaign committee, which is meeting again tonight to plan the way forward. I would like to say a huge thanks to Karl and the whole team of volunteers for their superb community campaign. We are right behind them.

    I have told my story of using HRI A&E. On Saturday, at the Huddersfield Town match, Sean Doyle, a constituent and friend of mine from Brockholes, spoke movingly on the pitch at half time about when he had a massive heart attack in Greenhead Park in Huddersfield. He owes his life to the emergency care he received at HRI, which was just up the road, where A&E staff used a new electronically powered chest compression system. Sean says he would not have survived if he had had to go to Halifax. I have received many emails from other constituents telling me how they owe their lives to the location and proximity of HRI A&E and how the golden hour saved them.

    The campaign to save our A&E is by far and away the biggest local issue I have dealt with while I have been the Member of Parliament for Colne Valley. There are posters everywhere. Volunteers are taking petitions from door to door. The hashtag #handsoffHRI is being projected on to public buildings, and we are all receiving hundreds of individual emails. It is so clear that this proposal is just plain wrong.

  • The proposed reorganisation, which would leave Huddersfield without an A&E, is being done under the rationale that there will be no change of provision in the other half of Kirklees district. However, the diminution of services at Dewsbury and District hospital, which sits within my constituency, is a significant change—not least for the A&E, which is a key service for local constituents in neighbouring Dewsbury and elsewhere. Does the hon. Gentleman agree that that is an embarrassing oversight, with the potential to leave the eleventh largest district in England without a fully functioning A&E? That is not in the public interest and not in our constituents’ interest.

  • Absolutely—the hon. Lady makes a great point; she must have read my speech, because I will make that exact point in about three pages’ time. She is spot on.

    Huddersfield Royal infirmary is in my constituency of Colne Valley, which includes the western side of Huddersfield, Colne Valley itself and Holme Valley, where I live. That means that if any of my 81,000 constituents or their children need to go to A&E in the back of an ambulance, they will have to pass HRI before undertaking the congested trek over to Halifax. In fact, most signatories to the parliamentary petition are from my constituency. I thank the 46,000-plus people who have signed the petition so far and the volunteers who are working tirelessly to get more folk signed up.

    May I also say a big thank you to our local Huddersfield Examiner newspaper? In an era of digital online media and falling newspaper sales, we are so lucky to have a quality six-day-a-week local paper that is backing this campaign 100%. I thank the editor, Roy Wright, and his energetic and committed team of local journalists. Their excellent in-depth analysis has included an interview with Mike Ramsden, chairman of Hull and East Yorkshire Hospitals NHS Trust, who is quoted as saying:

    “The reality is the CCG in Huddersfield exists to represent the health issues of the local population. If the proposals are now being delivered because of the financial pressure on a hospital in Halifax, then it’s my belief that it’s not a matter for Huddersfield CCG… it can’t be seen to be fair that a PFI deal in Halifax is taken on by people in Huddersfield.”

    That is the view of a top NHS boss.

    Let me address the issue of this proposal coming from the CCG. It is a panel of local doctors, and yes, I voted for CCGs to take over from primary care trusts, because I saw the faceless bureaucrats of the old PCT downgrade maternity care at HRI. Remember that, back in 2008? I believe that healthcare professionals will, at the end of the day—and they will need a lot of support and encouragement from us—make the right decisions for patients.

    We need to make sure that the voices of all our local doctors are heard, and not just those on the CCG. A doctor from a surgery in my constituency wrote to me to say that moving A&E services to the town with the smallest population is “crazy”. Unfortunately, she is not one of the doctors on the CCG panel, although perhaps we wish she was. Another local GP from Colne Valley—a high-profile one—says that care for patients in Kirklees and Calderdale should not be driven by the PFI. Strategy should be driven by care needs, not financial concerns.

    As I said, we have excellent cross-party parliamentary co-operation on this campaign. Local folk have really appreciated that, and my colleagues and I are committed to continuing that unity. I do not know whether the Minister has ever visited Huddersfield—he is trying to remember—but we are a growing, vibrant university town. If this appalling proposal goes ahead, we would be the largest town in our country not to have an A&E within five miles.

    Huddersfield has a population of 146,000, and it is growing. We have more than 20,000 students, with thousands of international students, at our award-winning University of Huddersfield. Sadly, I have already had an email from a father whose son is now not going to apply to the university for fear of not having a local A&E. If Dewsbury loses its A&E, the whole Kirklees council area will be without one, as the hon. Member for Batley and Spen rightly said—442,500 residents who would be without an A&E in their council area. The hon. Member for Huddersfield and his team have calculated that that would potentially lead to an extra 157 deaths a year, and I am sure that he will elaborate on that later.

    In this debate, it would be very easy to go down the route of just being emotional, but as the Minister is seeing we are laying out hard facts about why the proposal is plainly wrong. We will all make these points and arguments to the CCG as well once the consultation starts. However, I would like to highlight two other main areas.

    Syngenta on Leeds Road is a top-tier COMAH—control of major accident hazards—safety site. It handles parquet, sodium cyanide and methyl chloride, and other operators on site handle toxic and carcinogenic chemicals. Its community safety plan states that

    “we handle chemical substances which are classified under the regulations as toxic, very toxic, oxidising and flammable.”

    Just imagine if there were an incident; the proximity of an A&E would be crucial. Has the CCG looked at that? In response to such an incident, response times and getting to an emergency treatment centre close by would be everything. The CCG has not mentioned Syngenta in its consultation document.

    I turn to travel times, which really are a key issue—remember the golden hour. It is all well and good talking about average travel times to an A&E, but emergency care is not about averages. My constituents have been sending me Garmin and TomTom reports—other satnavs are available—of their recent journeys from Huddersfield to Halifax. It can take up to 45 minutes and in some instances, even longer. It is an extremely congested journey. Bad weather, floods, damaged bridges, increasing housing developments in the Lindley area, and the Ainley Top roundabout see our local road system creaking at the seams. That is before we even start analysing peak travel times from, say, Hade Edge or Marsden in my constituency.

    My constituent Elaine writes that she has regular appointments on a Thursday morning at 9.15 am at Calderdale and has told me that the Elland bypass is regularly blocked twice a day, with her average journey time taking over an hour. It recently took a Huddersfield Examiner photographer 52 minutes in morning rush-hour traffic to get from the centre of Huddersfield to Calderdale Royal hospital. Hepworth in my constituency to Calderdale Royal is 13.7 miles. Most parts of my constituency and Kirklees will have to travel past Huddersfield Royal infirmary, or what is left of it, to get to CRH.

    HRI serves a number of outlying and rural communities. My team and I have been scouring the consultation document and there are some really interesting little facts in there. Page 215 of the consultation document acknowledges that

    “the population of Calderdale and Greater Huddersfield is aging slightly faster in the rural areas than in urban areas.”

    On page 239, we learn that A&E attendances are high among those aged between 65 to 80 and highest for those aged over 80—so, those most likely to need A&E will now have further to travel, and that will cost lives.

    Page 76 states that most journeys to A&E under the dual sites are less than 30 minutes—we may want to dispute that, by the way. However, the document goes on to admit—this is the official consultation document—that a single site could push travel times well over that, particularly at peak times. Let me repeat that: the consultation document states that travel times could be pushed well over 30 minutes, particularly at peak times.

    My constituents at the top of the valleys in Holme village or Marsden could face an hour to get to Halifax. That brings me to the point made by the hon. Member for Batley and Spen. Patients who live at the tops of the valleys are already being diverted to Oldham and Barnsley, so the predicted patient models just do not stack up. My mum and dad are regularly sent to Barnsley from Holmbridge for routine tests. Huddersfield needs to be at the heart of our region’s emergency care. This proposal just has not been thought through. The whole proposal needs to be scrapped, with Barnsley, Oldham, Wakefield, Bradford and Halifax all part of a proper plan for emergency healthcare for where we live.

  • I just want to reinforce that point for the Minister. It seems as though there is a lack of regional oversight about the implications of both this public consultation and what is happening at Dewsbury and District hospital. We have raised that issue directly with the Minister, and I raised it with the Mid Yorkshire Hospitals NHS Trust last Friday to ask who holds responsibility for the pan-Kirklees, pan-Yorkshire, strategy, to make sure that none of our constituents loses out from these individual public consultations and reconfigurations. It would be very helpful if the Minister focused on that oversight.

  • Thank you very much for that incredibly constructive comment.

    I have been talking about how we need a regional plan. I have been trying, as I come to the end of my speech, to dispel some myths. Some party political activists have been bleating on about budget cuts, but that is just a myth—it is plain wrong. This proposal, if it goes ahead, could actually end up costing £490 million, as it would see HRI knocked down and replaced with a much smaller hospital on an adjacent site. Surely that financial injection, if secured—and that is a big “if”—would make better sense if it was invested in A&E in both Halifax and Huddersfield.

    What happens next? I have specific questions for the Minister. The hon. Member for Huddersfield and I wrote to the Secretary of State last week. Will the Minister expedite an urgent meeting for me and the hon. Members for Huddersfield, for Dewsbury and for Batley and Spen, and others who are not here, with the Secretary of State to discuss the future of emergency healthcare in Huddersfield and Calderdale? In an ideal world, I would like the Minister to intervene to avert this appalling proposal and I hope he will explain the process. In the meantime, will he launch an investigation into the PFI deal, which many are calling one of the worst ever signed?

    When the Prime Minister visited Halifax last year, he said:

    “After the election we want to do what we’ve done with other hospitals, which is sort out the PFI mess and financial mess that they’re in.”

    Will the Minister explore the potential of uncoupling the Calderdale and Huddersfield NHS Foundation Trust so that the PFI deal can be tackled and removed from clinical decision making? For the record, we want Calderdale Royal hospital to keep its A&E. Calderdale’s population is increasing, as is that of Huddersfield and Kirklees.

    In conclusion, I think, we think, the campaigners think and all our community thinks that Huddersfield and Halifax require and deserve excellent A&E services. The decisions should be based on saving more lives, improving experiences and delivering better outcomes, not short-term financial implications. Patient safety must come first, which means keeping our A&E, so hands off our Huddersfield Royal infirmary!

  • It is indeed an honour to serve under your chairmanship, Mr Pritchard. Before I start my speech, I congratulate the hon. Member for Colne Valley (Jason McCartney) on securing this incredibly important debate and on his constructive and reasoned speech.

    Kirklees is an area with a population of over 430,000. My constituency has a population of 110,000. The majority of my constituents access emergency care at either Dewsbury and district hospital or Huddersfield Royal infirmary. Dewsbury district hospital is already subject to a planned downgrade, which hospital bosses propose to bring forward. It will take place this year. It will see the accident and emergency department downgraded to an urgent care centre with no provision for acute emergency care.

    Dewsbury district hospital’s A&E currently sees around 80,000 patients a year. The downgrade was referred to the Secretary of State for Health by the Kirklees and Wakefield joint health scrutiny committee because its members believe there remains sufficient doubt to provide the necessary assurance and confidence that the proposals are in the best interests of the local population. The planned downgrade hinged on the fact that many of the patients who currently access Dewsbury and district hospital would travel to Huddersfield for emergency care.

    The loss of full emergency services in Dewsbury was a bitter blow. We now hear that Calderdale and Greater Huddersfield clinical commissioning groups are planning their own hospital downgrade. The plan, as we have heard, is to close the A&E department at Huddersfield and to transfer all emergency services to Calderdale Royal hospital in Halifax. Those plans will see the whole of Kirklees without any accident and emergency provision. Over 430,000 people will have to travel outside the borough for vital emergency healthcare for themselves and their loved ones. How on earth can that be acceptable? Kirklees is a vast geographical area that spans many towns and rural and semi-rural areas. Many people rely solely on public transport as a means of travel and parts of the borough are in the bottom 10% of the country’s most deprived areas, which brings about huge health issues and inequalities.

    The hon. Member for Colne Valley alluded to Huddersfield being a university town with over 24,000 students, many of whom come from outside the area. Many of them are not registered with a local GP, so are more likely to attend A&E.

    A large part of my constituency nestles between Huddersfield and Dewsbury hospital. My constituents will be among those hit hardest by the closure. We have heard in recent days that the proposed changes could result in 157 more deaths a year. We know that the closure will not improve life chances or enhance health care provision, but is purely a cost-cutting exercise that could result in lives being put at risk.

    In 2007, prior to being elected Prime Minister, David Cameron said:

    “I can promise what I've called a bare-knuckle fight with the government over the future of district general hospitals.

    We believe in them, we want to save them and we want them enhanced, and we will fight the government all the way.”

    We welcome the Prime Minister’s possible intervention. If any Health Minister, the Secretary of State or the Prime Minister would like to visit our beautiful part of Yorkshire, I am sure that we would, on a cross-party basis, be delighted to show him the issues that the closure would cause.

    Hospital downgrades and closures are happening up and down the country. Two out of three NHS trusts are in deficit and the situation is only set to get worse. Headlines in our national newspapers scream of “NHS facing…worst financial crisis in a generation”, “NHS deficit soars to £1.6bn” and “Will 2016 push the NHS over the edge of chaos?” Searching “hospital closures” on the internet shows the full scale of the problem nationally.

    A pledge was made that the PFI deal in Calderdale would be sorted out, but that neither hospital would close. It is beyond absurd that the price to pay for keeping Halifax A&E open is the closure of the Huddersfield facility. Across the two hospital sites, there are 141,000 A&E visits a year. How can one hospital, which is already buckling under the pressure, cope with that many emergency patients in one year? In addition, there will be further pressure on Yorkshire Ambulance Service to transfer acutely ill patients away from Kirklees to hospitals on routes that are often congested and severely gridlocked. Current proposals would see the average ambulance transfer time increase from 16 to 21 minutes. I reiterate that that is an average, so many patients would be in an ambulance for much longer.

    I have received a number of emails, as I am sure have my hon. Friends, from understandably concerned constituents who have recounted extremely problematic journeys between the two sites, leading to real fear that there could be a catastrophe in a life and death situation. I recently undertook the journey between Huddersfield and Halifax after the recent rally in Huddersfield centre. I was caught in severe traffic and saw an ambulance held up. I would have hated it if a loved one or someone I knew had been in that ambulance being prevented from getting essential emergency care.

  • Another issue for cross-party consensus is the lack of a coherent, integrated transport assessment of all the reconfigurations across Kirklees, in Dewsbury and in Huddersfield. Many of our constituents are on low incomes and rely on public transport. With congested roads, moving people around is not easy. I am not reassured that either trust has looked fully at the transport implications of these reorganisations and what they will mean for our constituents.

  • I thank my hon. Friend for her contribution. She has almost read my mind. I have just come out of a meeting with the chief executive of the Yorkshire Ambulance Service NHS Trust and put that exact point to him. I was incredibly alarmed to hear him say that it is working on the modelling for how to transfer patients between hospital sites given the number of reconfigurations in the area. I emphasised that that should have been resolved before, and he acknowledged that perhaps it should have been. The work has not even been carried out, yet there are proposals on the table that hospitals should be downgraded.

    Yorkshire Ambulance Service has its own financial pressures and is struggling to meet its current performance targets. We have heard this afternoon that it is failing to meet performance targets for red 1 and red 2 ambulance patients. The question needs to be asked. Have they been consulted about these plans and can they deliver on the promises made by the clinical commissioning groups, despite the fact that we have received an acknowledgement this afternoon that the work is ongoing?

    Other factors that need to be seriously considered include the looming adult social care crisis, impending pharmacy cuts—which could mean that 25% of community pharmacies close—lack of GP provision and uncertainty regarding junior doctors. All these factors impact on our local hospitals, and we need to be confident that they are addressed and answered.

    Just yesterday evening we learnt that Calderdale Royal hospital and Huddersfield Royal infirmary were on black alert, which meant that they were unable to take any more patients because of a shortage of beds. The trust was said to have implemented the senior level gold command arrangements. Let us imagine the situation had that occurred when only one of the A&E services was functioning.

    In the less than two weeks since the plans were announced, we have seen a massive public outcry—bigger than anything that I have witnessed before. Like the hon. Member for Colne Valley, I thank, applaud and pay tribute to all the people involved in the campaign. We have seen the message “Hands off HRI” projected on to many public buildings and looking absolutely fantastic. Sweatshirts and T-shirts have been printed. There are car stickers. People have been going door to door with petitions. There has been a wonderful community response. There is a Facebook campaign with more than 45,000 members—I wish that my MP page got that level of support—and there is an online petition with more than 46,000 signatures. I am pleased to say that at a recent Kirklees Council meeting, councillors voted to work cross party to oppose the changes. All those voices need to be heard, and we must have as long a consultation period as possible to ensure that they are.

    Casually sitting back and watching this situation develop is simply not an option. Action must be taken, and it is our job, as elected representatives, to stand up and fight for our constituents. I for one will not be lying down on this issue and I welcome the cross-party pledge from all my MP colleagues—I know that they feel exactly the same way about this issue—that we will work together for a better funding deal and a solution to the chaos that we now find ourselves in.

  • It is a pleasure to follow the hon. Member for Colne Valley (Jason McCartney) and my hon. Friend the Member for Dewsbury (Paula Sherriff), who have eloquently made the case and saved me from spending an awful lot of time going into the detail. However, I must repeat some of the narrative. Mr Speaker often, I think, verges a little on ageism when he points out how long I have been in the House of Commons, but it does mean that I have a long memory and I know the narrative of what has happened in health provision in my part of the world. That is always difficult for Ministers.

    I noticed that this Minister, when asked whether he had visited Huddersfield, looked down at his papers rather intently. I do not blame him for that—there are parts of England that I have yet to visit—but Huddersfield is an absolute gem of a place. It nestles in the Pennines. I once had an American student who said, “I’ve found out the difference between Lancashire and Yorkshire—you’ve got the Pyrenees between you.” I said, “A lot of people in Yorkshire wish it was the Pyrenees; actually, it’s the Pennines.” That is a slightly humorous remark, but the fact is that it is a very hilly area; conditions can be very difficult. We see the special signs up in bad weather. Can we go over the tops? Often the conditions are such that we cannot. Very close to us, it is very hilly, with very difficult road networks. There is not much flat land. We were looking for industrial investment. You and I, Mr Pritchard, care very much about the manufacturing sector, and when people are trying to attract new businesses, they are all the time looking for flat land. We do not have any flat land; that is the truth. It is very difficult to find a flat space in our part of the world. It is difficult terrain.

    What is nice about this debate is that from both sides of the Chamber we are making it clear that we do not want to beggar our neighbour. We want good health provision throughout our area. Good health provision is what motivates all of us. We want the highest-quality health provision. However, we do want accountable delivery of health provision. Many of us feel that the old system had its imperfections and the new system has its imperfections. Both the hon. Member for Colne Valley and my hon. Friend the Member for Dewsbury talked about the PFI. I have a long knowledge of PFIs. When I was chairing the Select Committee on Education, PFIs were used, as you know, Mr Pritchard, for much school building. I learnt over many years of controversy over PFIs that one cannot dislike PFIs on principle, but one can be against bad PFIs and in favour of good PFIs. I think that that is the truth of the matter.

    There is a lot of evidence that some of the health PFIs were entered into with a rather amateur group of people representing the health trusts. That is the only explanation if we are to be kind to those people who made the arrangements. They were dealing with some pretty clever people—leading consultancies and people who really knew their stuff from the City of London. A senior professor said to me that some of the people sitting on the other side of the table were not as sharp as they could have been. They may have been local accountants and solicitors or the local management team, and perhaps they did not see quite how much the PFI was going to cost them over the number of years for which it was to run. That is the context.

    A particularly worrying PFI was agreed for the Calderdale hospital in Halifax. There were two trusts in those days: the Halifax trust and the Huddersfield trust. The Huddersfield trust was always very well managed and had plenty of reserves, but when Halifax and Calderdale ran into trouble, we were pushed by the then Department to merge with the trust that was limping rather. People may remember this. We did merge, because we did believe in a good health service for all the people in our part of Kirklees and in Calderdale. That is the history; now we have to bring ourselves up to date.

    There is a new dilemma, and I do not want to make it party political, but the urgent question on national health service finances yesterday did point to the fact that up and down the country a number of trusts are in serious financial trouble. Until comparatively recently, our health trust was in pretty good shape. Only comparatively recently did we suddenly have some real financial challenges. The Minister will be very familiar with this dilemma. On the one hand, we are being asked to make savings, efficiencies—4% every year—in order to maintain a good record with all the organisations that look at our health provision. On the one hand, there is that pressure for greater efficiency and saving money, but at the same time on our patch we have this PFI that is a great drain. On the other hand, we have what is a pretty old hospital in modern terms. I was once with Harold Wilson in the hospital when I was a very young MP. He had come up, and we were waiting for the top brass to come down and guide us. He said, “Barry, I don’t think I’ve ever been here before,” and behind him was a great marble stone that said, “Opened by Harold Wilson in 1965”.

    The hospital is a classic early 1960s building. Some of us love some of the 1960s buildings. There are some that we cherish, such as the Barbican. Many people hate the hospital; I quite like it. There is a kind of brutalism that one likes. However, a lot of 1960s building was a little bit below par. We have on the one hand a hospital PFI that is very expensive and on the other a local hospital that is getting old. It has been invested in over the years. A great deal of investment has gone in, but I am told that a conservative estimate is that at least £200 million would be needed really to get it back on track. That is a great pressure on local health provision.

    All of us across the parties in our area—local councillors have also been very active in the campaign—understand that we want the best possible healthcare for all the people on our patch. I know that the Minister is not so familiar with our part of the world. Not only is it hilly but it has a very mixed population. A lot of wealthy people live on our patch. There are a lot of middle-class people and a lot of people who are more challenged in terms of their income. It is a very mixed area, and that is the beauty of it. It is not boring; it is in every sense a vibrant area. I recently challenged the Secretary of State for Business, Innovation and Skills to come to Huddersfield and have a decent suit made of fine Huddersfield worsted; we still make the finest worsted in the world. Indeed, Mr Speaker is now also coming to Huddersfield to have a fine worsted suit made. I see you looking interested, Mr Pritchard—the invitation could be extended.

    The fact is that, were there not so much contest between the smaller towns, the area might have had the name “Greater Huddersfield”. It is a city—one of the biggest urban conglomerations in the country—but people, especially outsiders, do not realise that because we have broken it up into different names. Kirklees is vast, which means that there are great healthcare challenges. Put that together with our difficult geography and an interesting history, and we face real challenges. We want the Minister to be open-minded and to enter into a discussion to find a way to get the very best result for the people of our area.

    I shall be quite blunt about my resistance to CCGs. I wanted to be independent in assessing PFIs, and I said that there had been good PFIs and poor PFIs. There are also good CCGs and not so good CCGs, and I am not impressed by the quality and leadership of my local CCG. Although I have some resistance to CCGs, the general model is not a difficult one. I chair the all-party parliamentary group on management, so I am keen on good management in the health service and outside. Sometimes I see doctors managing CCGs; management is not part of any medical course I know of. We would not expect it to be. We train doctors to be good clinicians and good GPs, not to be managers. Some CCGs have real difficulties because they lack quality management.

    There has been a failure of management in our local CCG when it comes to a proper, rational assessment of where we are now and how we can get the best possible healthcare in our area, taking into account all the difficult pieces of information that I have mentioned, including an ageing hospital that needs investment, a newish hospital that was built under a PFI, and difficult communications. I ask the Minister to look very carefully at what has been going on in our locality and to get the whole situation appraised carefully, independently and objectively.

  • I understand that this is an issue for the A&E in Huddersfield, but the hon. Gentleman mentioned getting other advice. In Northern Ireland, the Minister has set up a new panel to look at the whole health service and how best to take it forward in an area of financial restraint. Does he agree—I suspect that he does—that it is time to share those ideas across the whole United Kingdom of Great Britain and Northern Ireland? Thereby, we can all learn together.

  • I very much welcome that information, which relates to the point made by my hon. Friend the Member for Batley and Spen (Jo Cox). She said that there was no clear, strategic plan for the broader area of West Yorkshire. West Yorkshire is very close to Barnsley on one boundary. On another, it goes a long way right up the valley to where a very large number of people live in places such as Todmorden, where a bridge was recently affected by floods. Those places are in strong Manchester commuting territory. The area is vast and complex, and I cannot remember a proper evaluation across the piece, rather than an assessment that just carved out one bit of territory and looked into that very carefully.

    I do not want to go through how many people are enraged, but they include—I read in the Huddersfield Examiner—Sir Patrick Stewart. Until recently, he was the chancellor of Huddersfield University, which was university of the year last year. He sends, from Hollywood, his solidarity with the people of Huddersfield on the issue of keeping the A&E department open.

    On 11 March this year, we celebrate the centenary of the birth of Harold Wilson—a great man and a great Prime Minister—who was born in Huddersfield. When I used to drive him around Huddersfield, we would pass the old further education college, which was the old, old Huddersfield hospital, and he always said, “My appendix is in there.” The area has a great history. Please, in this special year, let us listen to the voices of the people of Huddersfield and Halifax, and get this right. At the moment, the suggestion of closing A&E in Huddersfield is not right, nor is the suggestion that Halifax is the only alternative. Personally, I think that there is a scheme by which we could keep both A&E departments open. My request to the Minister is: get that rigorous, independent, thoughtful appraisal of what the hell is going on, and get it right.

  • It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Colne Valley (Jason McCartney) on securing this extremely important debate, and on the eloquent and powerful way in which he set out the issues in his opening speech. We heard quite a remarkable volley of NHS-related slogans at the start. I aim to keep a copy of that Hansard extract in my pocket for future use at rallies and so on, such was the power and breadth of his comments. He deserves praise for the non-partisan way in which he presented the issues, and his passion for the local hospital, which he and his family have clearly used on a number of occasions, shone through. He spoke with great personal knowledge about the geography of the area and how it does not lend itself to the proposals, and he pointed out, quite rightly, a need for a wider, sub-regional focus on services.

    I pay tribute to the contribution of my hon. Friend the Member for Dewsbury (Paula Sherriff), who spoke with typical passion and sincerity, and brought with her a wealth of experience from the health sector. She rightly questioned whether Halifax will be able to cope with the extra A&E visits, and we all ought to take note of her revelation that the ambulance service has not yet worked out the implications for its service.

    My hon. Friend the Member for Huddersfield (Mr Sheerman) spoke with typical authority about how his constituents will be affected. His recounting of the history of healthcare in his area was highly informative. He rightly pointed out that the financial pressures that this trust faces are not unique and he was characteristically forthright about what he considered to be the failings of the local CCG.

    I congratulate my hon. Friend the Member for Batley and Spen (Jo Cox) on her intervention. She spoke eloquently and clearly about how significant the issue is when she pointed out that an entire Kirklees Council area will be without its own A&E unit. She also astutely pointed out that the issue has ramifications far beyond the immediate CCG area.

    All hon. Members who have contributed to the debate have clearly set out their constituents’ concerns about the proposals, which will fundamentally change how NHS services are delivered in Huddersfield, Calderdale and the surrounding areas. The question of how services are configured in the area has been the subject of discussion for some time, but found a new impetus on 15 January when Calderdale CCG and Greater Huddersfield CCG released the pre-consultation business case on a reconfiguration of hospital services across Calderdale and Kirklees. As we know, the proposal is to treat emergency cases at Calderdale Royal hospital in Halifax, while a newly built Huddersfield Royal infirmary will tackle planned cases. That will involve the closure of the A&E department at Huddersfield, which has understandably caused a great deal of anxiety locally and has been much of the focus of today’s debate.

    It is not just hon. Members who have expressed concern. Stellar characters such as Patrick Stewart have joined in, and there has been a considerable reaction in the community. On 25 January, a paramedic was quoted in the Huddersfield Examiner expressing concerns that the proposals had the potential to create delays of up to an hour in taking a 999 patient to casualty. As we heard, a local statistician has warned that there could be an additional 157 deaths a year if the changes go ahead. It is hugely important that the CCG responds to those claims as part of the consultation process, as patient safety must be the primary consideration when any changes to health services are proposed.

    It is clear from the pre-consultation business case that the changes are significant. As the risk assessment states,

    “the most likely areas for negative impact is to those groups who are high users of accident and emergency services, such as younger, older people, and some ethnic groups.”

    As the hon. Member for Colne Valley mentioned, the risk assessment also states:

    “We understand that the population of Calderdale and Greater Huddersfield is ageing slightly faster in the rural areas than in urban areas. This means that new service models could place older residents at a slight disadvantage if the services they need to access are located further away than the services they are currently using.”

    We know before we start that older people are more likely to be particularly affected by the proposal to close Huddersfield A&E, as they are more likely to live in rural areas that are further away from Calderdale Royal and, of course, they are far more likely to use emergency services. It is therefore vital that there is the widest possible consultation on these proposals and that the consultation is meaningful. I note from the business case that seven separate engagement exercises have so far been undertaken. However, not one of them has asked this simple question: “Do you want the A&E at Huddersfield Royal infirmary to close?” It is vital that residents are now given the opportunity to engage with those core issues through accessible methods.

    Residents of Calderdale and Huddersfield may well be a little disappointed that we are even discussing this issue today. As my hon. Friend the Member for Dewsbury said earlier, residents will remember that in 2007, when in opposition, the Prime Minister visited, posed for photographs and spoke about having a bare-knuckle fight with the then Government to safeguard A&E services at Huddersfield Royal and many other hospitals. The Prime Minister’s attention has been elsewhere recently, so perhaps he needs to be reminded of those comments now. The Minister will know that when the Prime Minister visited Halifax last year, he promised to

    “sort out the PFI mess and financial mess that they’re in.”

    My hon. Friend the Member for Halifax (Holly Lynch) had hoped to be here today, but she has whipping responsibilities on the Energy Bill. She has been persistent in trying to hold the Prime Minister to account for that promise. I trust that the Minister will be able to set out what is being done to sort it out.

    I am sure the Minister will also be gracious enough to acknowledge, as the hon. Member for Colne Valley did, that although the PFI deal was signed when Tony Blair was Prime Minister, much of the work and negotiating was done when John Major was in charge. I am sure the Minister will also agree that the residents of Huddersfield would be right to say that arguing about who is responsible takes us no nearer to finding a solution.

    It would also be fair to say that the financial problems faced by the trusts are not solely down to the PFI deal, nor are they alone in facing such challenges. Despite the warm words on funding, a number of challenged trusts are now being asked to consider headcount reductions additional to the current plan. The truth is that the Government have lost control of NHS finances. By slashing social care budgets, they have created a crisis in the sector that is adding pressure to every part of the NHS. By completely mismanaging staff issues, they have created a crisis in recruitment and retention, leading to a surge in spending on agency staff. The report makes it clear that workforce issues are a factor in driving the need for reconfiguration. In 2010-11, the spend on agency staff at Huddersfield and Calderdale was £7.2 million; according to page 29 of the business case, this year the figure is forecast to be £21.2 million, an increase of 194% in just five years.

    That issue is not unique to Huddersfield and Calderdale; it is a deeply worrying trend that we see replicated across the country. One of the key reasons for that increase, which again is set out in the business case, is recruitment, retention and vacancy challenges. An example of that is the Government’s decision, after taking office, to slash the number of nurse training places, which led to far fewer nurses qualifying than in previous years. The upshot of that, as the Royal College of Nursing and the Labour party warned at the time, is that trusts across the country are simply unable to fill all their vacancies and are left to rely on expensive agency staff. I ask the Minister, as I have asked him before, whether he will now accept that cutting the number of nurse training places was the wrong thing to do and is a fundamental cause of the increase in spending on agency staff.

    The business case also refers to sickness rates being a worrying 5.3% in the clinical directorate, with by far the main causes being anxiety, stress and depression. Sickness rates are high and retention rates are low because the NHS workforce are, frankly, demoralised. I look forward to hearing what the Minister intends to do to improve the position, as many of the challenges facing this trust pervade throughout the NHS.

  • It is a great pleasure to serve under your chairmanship, Mr Pritchard. I, too, thank my hon. Friend the Member for Colne Valley (Jason McCartney) for the clear-sighted way in which he set out his case. This clearly is a cross-party effort, for which I respect him all the more. Everyone sitting in this room has come here with earnest intent on behalf of their constituents, and I take their representations very seriously indeed. I appreciate the comments of those who have spoken in this debate, including the hon. Members for Batley and Spen (Jo Cox), for Huddersfield (Mr Sheerman) and for Dewsbury (Paula Sherriff). I also thank the shadow Minister. There was an intervention from the hon. Member for Strangford (Jim Shannon), who has left.

    This is one of what I imagine will be a series of debates on reconfigurations, because throughout the NHS’s history—I am sure the hon. Member for Huddersfield will know this better than me—reconfigurations and the configuration of health services has been a feature of how the NHS works. In beginning to respond to the debate, it would be helpful if I set out where the Secretary of State and I stand in relation to reconfigurations. That will explain what I am able to do and, perhaps more helpfully, what I am not able to do, because that has changed in the past few years.

    I recognise that the clinical commissioning group has presented a very detailed plan—the plan is very detailed, whatever one’s arguments about its merits, or otherwise—but it has, rather classically, chosen a title, “Right Care, Right Time, Right Place,” that is so generic in its quality and so indirect in its aspiration that the CCG should first look to change the title to say what it actually proposes to do. Such generic consultation titles and bureaucratic-speak are a feature across the NHS, and it does not help anyone to get to the nub of the matter.

    Were the reconfiguration to procced, it would be for the CCG to make the decision about how it wished to buy services on behalf of the people it serves. That is a key reform of the Health and Social Care Act 2012 but, even before then, previous Secretaries of State—Labour ones—recognised that it is wrong for Whitehall to make determinations on matters of reconfiguration because it is often influenced by politics when it should be the clinical voice that is heard first and foremost.

    The hon. Gentleman mentioned the former Prime Minister Harold Wilson a number of times. Harold Wilson was a well-known exponent of valuing expert opinion, and we should do that in the NHS above all, because we are dealing with people’s lives. That is why I ask people speaking in this debate more broadly to listen carefully to what clinicians are saying on both sides of the argument and to weigh up their opinions before coming to a settled point of view.

  • I absolutely agree with the Minister. It is the clinicians who are talking to us. The clinicians in hospitals do not want this reconfiguration and do not agree with it; it is general practitioners jumped up into management in the CCG who are putting this before us. The clinicians to whom my colleagues and I have talked are almost uniformly against the reconfiguration. He is absolutely right. If we listen to the clinicians, we will have A&E in both hospitals.

  • I will come on to that process. It is a little unfair to characterise the clinical commissioning group in that way. Primary care is the frontline of all patient care in this country. GPs see and deal with the majority of patients in the health service, and they guide the patient pathway. Therefore they should have responsibility for ensuring that services are fit and proper for patients. It is GPs who make the decision on how that happens. If local people disagree with that decision, as the hon. Members for Dewsbury and for Batley and Spen are experiencing in their own areas, a referral can be made to the Independent Reconfiguration Panel via the local authority’s overview and scrutiny panel. The Secretary of State will then take the recommendations of the independent panel.

    So far, out of a number of Secretaries of State, none has chosen to go against the panel’s recommendations, although there is always a first time. However, the panel exists, and I do not think that anyone disputes its independence. That is the process. All that I can do here is set out the broader clinical arguments on which I know the CCG will draw, and with which I expect all Members will agree, to talk about private finance initiatives and answer the specific questions raised by speakers in this debate.

    For the record, I will explain what the CCG claims are its reasons for the reconfiguration. It is important for people watching this debate to know the CCG’s side of the story also. The CCG believes that the NHS services in Halifax and Huddersfield, as currently organised, do not deliver the safest and most effective and efficient support to meet patients’ needs. It believes that the trust is affected by shortages of middle-grade doctors and a high use of locums in its accident and emergency department; I will turn in a minute to the remarks on that matter by the hon. Member for Huddersfield. Sickness absence levels are high, and clinical rotas are described as “fragile”. There are difficulties providing senior consultant cover overnight and seven days a week, which is a wider issue in which hon. Members will know the Government have an interest.

    Both hospital sites operate an emergency department and a critical care unit. The care provided by both those services is, in the CCGs’ view, neither compliant with some of the standards for children and young people in emergency care settings nor fully compliant with guidance on critical care workforce standards. Neither site satisfies the Royal College recommended minimum of 10 consultants per emergency department and 14 hours a day of consultant cover.

    Inter-hospital transfers are often necessary due to the lack of co-location of services on both sites. Those factors have a direct bearing on the safety of patient care. The co-location of emergency and acute medical and surgical expertise can result in significant improvements in survival and recovery outcomes, most notably for stroke and cardiac patients. The most seriously ill with life-threatening conditions have a much greater chance of survival if they are treated by an experienced medical team available 24/7. That last comment is not just the opinion of the CCG; it is the recommendation of Professor Bruce Keogh, the medical director of NHS England. I think that we all agree on the principles from which he speaks.

    The CCG believes, first and foremost, that the proposals are designed to save lives. It is not an issue of cost. However, there is an issue of cost involved in deciding where the co-located services should go. We must be open about that; the CCG has made a value for money determination suggesting that the better site is in Halifax, at Calderdale Royal hospital, and not at Huddersfield.

  • On a value for money basis, because of the ability to release the Huddersfield site to build the new hospital and the more modern facilities available in Calderdale. That is the CCG’s determination, and it is important in these discussions that everyone examines whether they believe that the CCG has made the right determination.

    Turning quickly to an issue of numbers, I want to make a general point about the number of people being supported by A and E services across the country. The current chief executive of NHS Improvement, Jim Mackey, ran a successful large hospital system in Northumberland where a reconfiguration is providing some of the finest patient outcomes not just in the United Kingdom but in western Europe. It was brave and controversial at the time. What he has proved, and what has subsequently been proved in Manchester and in London stroke services, is that where services are reconfigured sensibly, outcomes improve. I know that that is the driving ambition of clinicians in Mid Yorkshire, and indeed in Huddersfield and Halifax. Whether they are arriving at the correct way of delivering those improved outcomes should be the exercise of the consultation, so it is an appropriate way to start the debate, but it is important to inform the discussion with all the current facts.

    According to Public Health England, the Calderdale and Huddersfield NHS Foundation Trust serves a population of 402,000 across two hospital sites. That means that each hospital serves what is, in the scale of the NHS, a small population group. To give some local comparisons, Leeds Teaching Hospitals Trust serves a population of 752,000, and Mid Yorkshire Hospitals NHS Trust is also a bit larger at 553,000. Within the scale of local health economies, Calderdale and Huddersfield serves a relatively small population, across two sites. The CCG’s judgment, and I suspect clinical opinion across the NHS, is that something must be done to improve clinical outcomes by concentrating consultant and clinical offer. I am not making any judgment about where that should happen, merely about the principle being established by senior clinicians.

    Turning to the issue of deaths, it is the judgment of Professor Bruce Keogh, who is coming to the end of his urgent and emergency care review, that intensive procedures are best done by people who are well practiced and do many a year. The best way to do so is to ensure that they are concentrated in centres of excellence. The understanding of the rest of the world is that we prevent deaths by doing so. The hon. Member for Huddersfield contends that we could cause 157 deaths by joining the services.

  • Yes. I caution the hon. Gentleman about using such figures. Whereas the CCG has been careful not to use a precise figure for how many lives will be saved, merely citing international evidence about improved outcomes, that figure, which has been provided to him, makes the serious error of conflating and confusing emergency admissions with emergency attendances; they are two completely different things. Using those two figures has allowed the person who made that figure to come up with 157. The figure itself is erroneous, and it is important that it is not repeated until there is a proper statistical base that can be shared with local people, because it will clearly frighten people. It is important that that figure, if it is true at all, has a proper statistical base before it is used.

    Likewise, figures have been quoted about PFI. I actually have a dogmatic view on PFI, which is that it is a less than elegant way of borrowing money. Classically, the Government will borrow money at around 4%, and the private sector at 6% or 7%. One can get PFI deals that work; there are some. They work when one can incentivise efficiency over a long period, but it is very difficult to measure, and the jury is still out on even the best deals. There are circumstances in which they do work, but they do not work in every circumstance.

    None the less, it is important that we present local people with the figures. My hon. Friend the Member for Colne Valley has mentioned in the House the figure of £773 million over the course of the contract; I believe that that figure is just the sum of all the unitary payments made year by year. If we strip out inflation, as we must in order to come to a real figure, we arrive at a sum that is about two thirds of that: £527 million. If we then subtract from that £527 million the costs of providing maintenance, cleaning, porterage and the other functions that form part of the PFI deal, we come to a figure about half that, or about £263 million or £264 million. It is difficult to divide it up precisely, because it is a unitary payment. That is the financing charge.

    If we compare that financing charge with what it would have been for public debt if the money had been borrowed, as it would have been at the time in order to build the hospital, we are talking about a difference of about £90 million to £100 million. Again, when presenting these figures to the public, it is very important that we are consistent about it. This figure is not £773 million and in that sense it does not matter who signed it, and I will be the first person to stand here for hours defending Sir John Major. It is much closer to £100 million over and above what would have been paid for had it been public debt.

    Again, I think that puts it in context and may explain why this figure is not the defining figure, because when £100 million is divided up by the course of the contract it comes out at a much smaller figure than might be supposed. It is not the determining factor in what the CCG is trying to do, and I am convinced of the CCG’s arguments in that respect.

    However, the CCG is very open about the value for money that it says there is in using the Halifax site as opposed to the Calderdale site, and Members should discuss that with the CCG. They might have a very interesting discussion with it about how it will dispose of the capital one way or another.

    I will just run through the CCG’s proposals quickly in response to the problems it has identified in the local area, and then I will just turn quickly to some of the additional comments that have been made by Members.

    The trust identifies that in the area the summary hospital-level mortality indicator—the SHMI mortality figure—was 108.9 in March 2015 against an expected benchmark of 100, so it is significantly over the expected figure. The trust did not achieve a reduction in its mortality rate during 2014 and 2015; it was not able to narrow the gap in the mortality rate to 100. In large part, it puts that down to the operating problems it has on the two sites.

    Therefore, the trust’s answer to that problem is to provide exactly the kind of specialised concentrated care that Members from all parties have identified—albeit they think it is in the wrong place—as part of a joined-up community care plan, which it is developing in co-ordination with the wider local area.

    The hon. Members for Dewsbury and for Batley and Spen came to speak to me in great detail, and very interestingly, about the proposals for their area. I take very seriously the remarks that the hon. Member for Batley and Spen made about looking at the wider area of mid-Yorkshire in co-ordination with this work.

    I do not know whether I have been to Huddersfield and I told the hon. Member for Huddersfield why. I spent the first year of my life in Wakefield, as I explained to the hon. Members for Dewsbury and for Batley and Spen the other day, and so maybe my mother took me to Huddersfield. I would like to return in the near future and experience it properly as an adult, and I shall. Nevertheless, it is clear that the area we are discussing is a very complicated one to deal with. It is a hilly area, something which—being a boy from East Anglia—I do not understand very well, and it has a lot of towns of considerable population that are divided by difficult terrain, and travelling between those towns can be less simple than travelling in other parts of the country. So I take on board the points that the hon. Gentleman made.

    I will certainly take back the suggestion by the hon. Member for Batley and Spen that this issue we are debating today should be looked at in the wider context, and I undertake to ask Jim Mackey to see whether there is a co-ordination between these two plans and whether he can encourage the CCGs to adopt a more joined-up approach to what they are doing. Maybe they are already joined up—I am not prejudging the conversations that have happened—but it is important that the CCGs answer these questions.

  • On the figures, we listened intently on the lesson on PFI. But these figures have been in the public domain from many sources since the announcement and the PFI has been looked at. People find these sums difficult to understand. It is our job to ensure that we make the toughest case we can. Yes, we have used those figures, and they are still pretty appalling. Regarding the figure of 157, we got it from an impeccable source; we will go back and check it, but I think it is good.

  • I would submit both figures. There is a difference between £773 million and £100 million, although one is larger than the other. I am not justifying the original deal, but it is important that we put it in context.

    My hon. Friend the Member for Colne Valley asked me whether I would arrange a meeting with the Secretary of State; of course, I will be happy to do so. However, can we wait for some of these issues to have been thrashed out with the CCG, so that we have a proper evidence base that we all agree on? That is part of the point of a consultation. Then we will have an even better informed meeting than if we had one tomorrow. So let us have a proper public debate locally and allow the CCG to respond to some of the accusations that have been made here and elsewhere.

    My hon. Friend also asked about investigations into the PFI deals. Each PFI deal is different; some are legally very difficult to unpick while some are easier. We have unpicked quite a few during the past few years and I know that the team are looking at all the PFI deals on a revolving basis. Therefore, I can make a commitment that the Department of Health will continue to look at PFI deals—each and every one of them—to see whether we can get more value from them. However, I have to be clear with my hon. Friend that this deal, which was one of the earliest to be made, has been very carefully worded.

  • This gets to the nub of the matter. May I just confirm that the Minister’s team will specifically look at the Calderdale PFI, because it was a bit generic there as well? There are discrepancies over the figures, which are slightly different. Incidentally, my colleagues and I would be absolutely delighted if this process were not being influenced by the PFI; if the issue is down to clinical reasoning and other matters, Huddersfield will keep its A&E unit.

  • I can guarantee that Lord Prior is looking at every single PFI in the country on a revolving basis, because we are trying to ensure that we can squeeze maximum—

  • This one is part of “every single PFI in the country”, so I assure my hon. Friend that it will be looked at.

  • Perhaps it would be helpful to the Minister if—

  • May I just respond to my hon. Friend’s original point?

    We must remember that the PFI deal is borne by the entire trust, so it is not as if it fixes precisely on one site or another; it does not influence the decision of where to go. It could be possible to run a cold site on the PFI hospital and fill the hospital that way. It does not have to be filled with the particular function that the CCG wishes to put there. The CCG just believes that the buildings there are better, more suited and more modern—the hon. Member for Huddersfield would agree with that assessment—for the particular purposes it wants to put there.

    It is for the CCG to justify that; I cannot speak with any authority about this, because I do not know. However, I really do not think that the PFI has a bearing, because no matter where the services are put, the PFI deal will still exist. All I am saying is that I want to be realistic about our ability to unpick every single PFI in the country, because in many cases they have been very carefully worded and agreed in a lawyerly fashion—

  • Order. I remind colleagues and the Minister, first, that the Minister should face inwards, so that we can get a good shot of him on camera. This debate is being televised—just a gentle reminder. Secondly, those Members who want to make comments should stand up to do so, so that the Hansard writers can identify who they are. Thank you very much indeed.

  • Thank you, Mr Pritchard. I hope this is a useful intervention. We have written to the Public Accounts Committee to ask it to have a look at this particular PFI, on the basis that it would be a very good one to try to unpick. That might be helpful to the Minister and us.

  • I am sure that the Chairman of the PAC will listen carefully to the hon. Gentleman, who is her esteemed colleague. I know that the PAC has looked at the PFI issues many times before, but I would be glad if it were willing to look at them again.

    The hon. Member for Dewsbury raised the issue of traffic, as did other hon. Members. Again, it is for the CCG to ensure that it justifies the traffic times that it is putting in the consultation document. I have sympathy with Members who say that these consultation documents are often impenetrable. I cannot speak for this one, because I have not read it in its entirety, but such documents must be written well—especially the parts that will be put to local people—so that they are understandable to people who do not speak NHS-speak. It is not a question of people’s intelligence; it is about ensuring that the document is written in normal English in a way that people can understand. As to whether the document could ask, “Would you like your A&E to move?”, as long as people are informed about the facts of the case and understand that such a move could improve their children’s outcomes, and there is a reasonable case for it, I see no reason why that question should not be put.

    The hon. Member for Huddersfield and the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), both raised the issue of wider deficits across the NHS. We addressed that point in the urgent question yesterday; there is financial pressure in the NHS and there are reasons why that should be the case, which I will not go into now. The issue is not cuts, because the amount of money going into the NHS is increasing. The NHS faces a raft of challenges, as it has since its foundation, and our job is to ensure that the money is used as efficiently as possible, which is why we have brought in the controls on consultancy spend, locums and agency workers.

    What is true is that under the previous Labour Government and the coalition Government, the number of doctors in training went up. I genuinely do not blame the previous Labour Administration for the current shortages, but we have inherited the numbers from decisions made in the 2000s about the length of doctor training, and before that date about consultant grades. The fact is that, in some parts of the country, it is difficult to recruit—sometimes because the clinical base under which consultants, especially A&E consultants, are asked to operate is not safe. Again, I cannot speak, publicly, about the situation in either of the two hospitals under debate, but that is the case elsewhere, while in some metropolitan centres it is easy to recruit vast numbers of doctors. How do we create hospital bases to which we can recruit clinicians who want to work in a safe place, and carry out good procedures—and numerous ones, to keep the rates up? That is one of the challenges for all healthcare systems across the world, and one that we are determined to meet here in England.

    Finally, the shadow Minister spoke about the overall control of finances in the NHS. It is important not to link the overall financial performance of the NHS with this consultation, which, as the CCG makes clear, is centrally about clinical outcomes. I know that the shadow Minister cares very much about ensuring good clinical outcomes, as do all hon. Members; to do that, it is important that local people get a full grasp of the facts. Although we might have a broader argument about NHS finances, it is important to focus on the core facts of the situation. This is about clinical outcomes, the difficulty of providing the outcomes on two sites where they are best provided on a single co-located site, and the value-for-money arguments about what that site should be.

    If we can have a strong, well-informed and nuanced debate, and take into consideration the surrounding area—a point well made today—local people can come to a good decision that is supported across the patch, which will mean better health services for those living in Huddersfield and Halifax and the surrounding areas, an improvement in clinical outcomes, and better life chances, especially for those who are born with the least.

  • I used to have good discussions with the Minister’s father. One thing I know about him is that he, like me, was really interested in good management. The Minister has not come back to us about the quality of management, which is something that CCGs in many places do not seem to have. Good managers in the health service seem to be undervalued. I made what I think was a good point about medical training not containing any management element. I am sorry to remind the Minister of his father’s excellent commitment to good management, but I am sure that he shares that view.

  • I share the view of the hon. Gentleman. Good management is, of course, vital in the NHS, which is why I am never particularly keen to beat up NHS managers—a predilection of politicians on both sides. But it is true that we have not considered carefully enough the quality of management in CCGs; I agree with the hon. Gentleman about that. That is precisely why we are bringing in a CCG scorecard, just as we have done with the Care Quality Commission rankings for hospitals—that is a well-led domain—that describes precisely how well a hospital is managed.

    We want to do similar work for CCGs, which will enable the hon. Gentleman to say, “Empirically, my CCG is poorly—or well—managed compared with neighbouring ones”. That will be useful for our holding them to account. I agree with the hon. Gentleman, and I hope that I will be able to deliver, in the next year, precisely what he wants.

  • I thank the Minister for his thorough and detailed response, which we will obviously pick through. I thank him also for his specific commitments. We will have a cross-party meeting with the Secretary of State for Health once the consultation is up and running, which is imminent, as we want to get the best value from it. The Minister’s team is considering the PFI deals, including the one at Calderdale. I assure him that he will be seeing a lot more of not just me but my parliamentary colleagues here in the coming months, as the consultation gets under way.

    I also thank my parliamentary colleagues for their contributions. I work with the hon. Member for Huddersfield (Mr Sheerman) on so many issues. We co-chair the all-party Yorkshire and North Lincolnshire group. Many people who watch debates in Parliament do not realise that we work cross-party on important issues for our local areas. Such working is not uncommon, and it will continue.

    The hon. Member for Dewsbury (Paula Sherriff) gives an extra perspective, and her passion really came across loud and clear today. I thank the shadow Health Minister for his kind comments and support, and the hon. Member for Batley and Spen (Jo Cox), who was here earlier. The hon. Member for Barnsley Central (Dan Jarvis) was here, too, for much of the debate, although he could not stay because of other pressing commitments; his presence shows how our region is closely considering the issue. Also, of course, there was the hon. Member for Strangford (Jim Shannon), from Northern Ireland, who talked about similar issues in his part of the world.

    The consultation is about to start and this is where the battle begins—with me and my parliamentary colleagues, the community campaign, the volunteers and the 46,000 people who are now in the Facebook group. We have firm, clinical evidence and logical, safe, patient-led reasoning to persuade the GPs on the clinical commissioning group to keep our A&E at Huddersfield Royal infirmary. We will fight all the way. We have worked together so far and will continue to. We will say once again, “Hands off our HRI, we’re going to save our A&E at Huddersfield!”

  • I thank colleagues for their co-operation today. My intervention earlier was due in part to some of the microphones not working today, which is unusual. We will have an inquiry into that. But do not worry; Hansard is here and everything was captured on television also.

    Question put and agreed to.

    Resolved,

    That this House has considered A&E services at Huddersfield Royal Infirmary.