Healthier Together Programme (Greater Manchester)

Tuesday 22nd July 2014 Westminster Hall

[Mrs Linda Riordan in the Chair]

14:30

[Mrs Linda Riordan (in the Chair)]

Before the debate starts, I should say that I will allow gentlemen to remove their jackets.

[Graham Stringer (Blackley and Broughton) (Lab)]

Although it is the last day of term, it is still a pleasure to serve under your chairmanship, Mrs Riordan.

I am going to be critical of the Healthier Together programme, but one facility that it does have, of which I was unaware until about half an hour ago, is the gift of prophecy. It has just put out a press release in response to what I am about to say, which is particularly clever because I have not yet fully decided what to say. Although the programme has failed in many ways, it clearly has attributes that most of us do not have.

As it stands, the Healthier Together programme is both a shambles and a charade. I shall start by talking about the shambles. So far, more than £4 million has been spent on the process leading up to the consultation. Some of that money has gone on producing 200,000 leaflets for the consultation, which started two weeks ago. Unfortunately, as far as I am aware not a single one of those leaflets is yet in a public library—there were certainly none in the library near my office in north Manchester when I checked an hour or so ago, and I cannot believe that that library has been discriminated against. That is a failing of organisation.

That is not the only such failing. The website is complex and not easy to navigate. If someone can find the consultation document, they can download it, and they will find that at the end it says, “Please fill in the questionnaire opposite”. But there is no questionnaire opposite; it is elsewhere. If someone can continue to struggle through the website they can find it, but it is not where it is supposed to be.

I am not the only person who is critical of the consultation. The University Hospital of South Manchester wrote to me to say that the proposed changes are incomprehensible and full of NHS jargon. That is an improvement on the previous document that was produced, which was totally and completely incomprehensible. The more recent document varies between NHS jargon and “Janet and John” talk, which is almost as meaningless. There are phrases in speech bubbles saying:

“Knowing the council and the NHS will work together to look after mum.”

There is no reasoning or line of thought, just nice ideas about things that we would all hope the NHS would do. The University Hospital of South Manchester also criticised the fact that the consultation meetings—the proposed engagements, some of which may have already happened—all take place during the day. That means that the vast majority of people of working age cannot attend.

It is not only me and other members of the public who are greatly concerned about the proposals; as far as I can see, there is little clinical support for them. The chief executive of Wrightington, Wigan and Leigh NHS Foundation Trust, Andrew Foster, said that there is

“a lack of widespread support for the consultation process”,

and he went on to say stronger things as well. I have been sent information from a GP survey showing that almost 50% of GPs are concerned about the process and certainly do not support it in its current form. The University Hospital of South Manchester says that the process is “flawed and misleading”, and

“not an integrated care consultation…but rather a consultation on changes to a small number of acute providers”.

Healthwatch England has been very critical of the process, because until March this year all meetings took place in secret. It has been allowed to attend meetings since March, but, as I will explain later, many decisions had already been taken by that point. I would be interested to hear the Minister’s response to a more worrying point: according to Healthwatch England, the Healthier Together body—the combined committee of the commissioning groups—has no power to spend until the draft Legislative Reform (Clinical Commissioning Groups) Order 2014 is passed, and that has not yet been passed by either House. I would be interested to hear whether there will be a power to spend or to go ahead with the proposals, although I would be surprised if the proposals were not challenged.

There is not only the problem that legally, perhaps, the £4 million should not have been spent; the consultation document also refers time and again to hospitals co-operating with each other. However, the competition authorities ruled that the attempt by the Royal Bournemouth and Christchurch hospital and Poole hospital to work together was unlawful. If, after the consultation, it is decided that the proposals will go ahead—I hope that it is not—will they be lawful? Behind all that, £4 million may have been spent unlawfully, and could have been better spent on nurses, doctors and the health of people in Greater Manchester.

I turn to the charade aspect of the Healthier Together programme. It is a charade in many different ways. Who is conducting the consultation? The document contains statements from the chair of the Association of Greater Manchester Authorities, Lord Peter Smith, and from a number of doctors on the clinical commissioning groups, but if one looks deeper, one finds that a large multinational corporation called Mott MacDonald is involved but not declared. It has all sorts of consultancy interests in areas ranging from engineering to private and public health care. Why were we not told?

Part of the charade is that we are not told who is conducting the consultation, but the real charade is that a number of decisions have already been taken before the consultation has gone out to the public. The document itself does not show to the public the configuration of health services as they currently are in Greater Manchester; it presents a number of decisions that have already been taken without any form of consultation. I will return to that point later.

It is also unclear what the consultation is about. The University Hospital of South Manchester said that it thinks it is about the reorganisation of acute care in hospitals. I do not think that it is. It is not clear—it is muddled—but it could be about primary care, because there is talk of more GPs and more access to primary care services. There is no financial plan for that and it is not clear how it would happen, which is not a bad thing in itself, but it is mentioned in the consultation document without it being clear what anyone is expected to say about it, apart from their wanting better care for their relatives, mother, sons, daughters, wives or anyone else.

There is an absence of financial information in every part of the document, not just the primary care part. So is it about money? It is indicated and implied that there is not sufficient money. The background document makes it clear that, within two-and-a-half to three years, there will be a £1 billion, or 16%, black hole in Greater Manchester’s health budget of £6 billion. Is the consultation about that—it certainly is not clear—or is it a south Manchester thing? Is it about hospital reorganisation? If it is about hospital reorganisation, creating more specialist hospitals and downgrading some hospitals, why were we not consulted?

Fairfield hospital in Bury, Tameside hospital and North Manchester hospital have been downgraded to so-called community general hospitals, but that is not in the consultation. We are told that we are going to get almost immediate access to GPs, but there is no mention of what has been happening in the health service in Greater Manchester over the past few years. Fifty per cent. of the walk-in centres in Greater Manchester have been closed down, and they gave people immediate access to a GP. They have closed, but the Government are talking about improvements.

The Government are talking about improving care in the community, and specialist nurses would certainly help to keep people out of hospital and reduce costs in the long term, yet when I put in a freedom of information request to Tameside metropolitan borough council, half a Parkinson’s nurse was available for the whole of Tameside, which is shocking. One can go through the other specialist nursing services and find the same. Why have we not been told the proposals for those specialist nursing services, which are vital for keeping people out of A and E and out of long-term care within hospitals?

The proposals are a charade. In the original consultation, and when the Healthier Together people had a meeting with Greater Manchester MPs, we were told there was a guarantee that no hospitals or A and E departments would close. Why is that missing from the consultation document? Why is it not still a commitment? When the commitment was given, I did not believe it because I do not believe, when there is a looming financial crisis in the NHS in Greater Manchester and across the country, that any group of medics or health bureaucrats can guarantee that hospitals will stay open. A 16% gap is looming in the care and health service budget, and the gap might get bigger. That is equivalent to two or three hospitals in financial terms. We were given that guarantee yet, arrogantly, three hospitals have been downgraded without any consultation.

A similar guarantee was given when maternity provision was taken out of Hope hospital during a review five or six years ago. It was guaranteed that a midwife-led maternity service would continue in Hope hospital, but there is currently a consultation on removing that service. Those of us who have been discussing, debating and arguing with the health service for some time about the provision of services are sceptical about all guarantees.

There is also an ongoing trauma review in relation to Wythenshawe hospital, yet Wythenshawe hospital is being downgraded. It is an extraordinary decision to say, “We will have this discussion, but we have already taken some decisions. We want to know what should happen to these hospitals but, although two other major service reviews are ongoing, we will completely ignore them and not mention them at all in the consultation document.”

I am sure my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will want to mention Wythenshawe hospital, so I will not steal his speech. I am an ex-chair of Manchester airport, and downgrading Wythenshawe hospital from its grade 1 status is appalling because it has the nearest A and E unit to Manchester airport. If there was an unfortunate air crash, people would want to go to the nearest hospital. The downgrading of Wythenshawe hospital is another extraordinary decision.

We have been here before with such consultations. At the moment, the Healthier Together people are saying that there is 98% support on Twitter for the proposals. They are in a feedback loop in which they are twittering to themselves, and we know what the Prime Minister thinks two twitters make. We were in exactly that position on the congestion charge. When the people running the scheme ran opinion polls and consultations, they all showed huge support for the congestion charge—anyone who talked to anybody in Greater Manchester would have found that support unbelievable—and of course when it came to putting crosses in boxes in the referendum, 80% were against the congestion charge. That is exactly the position we are in at the moment. There is an unreality about the people who are doing this, and they are trying to fiddle things. This is a scandalous fiddle.

At the end of the debate, I do not want to be accused of pretending that there are no real problems—there are. I have mentioned the financial problems, and there are also the differences between Greater Manchester hospitals. Given the survival rates for similar operations, people are clearly better off in some hospitals at certain times of the week. People are clearly better off in other parts of the country than in some Greater Manchester hospitals. That needs to be put right, but the consultation will not do that. We need to consider why there are problems—it is not just about recruitment, although recruitment is part of the problem—and try to solve those problems, rather than wishing them away with yet another reorganisation of the health service.

I could give more examples, but time is limited. The current booking system in Greater Manchester must waste many millions of pounds a year. The NHS authorities regularly criticise patients who do not turn up for appointments, but they do not criticise themselves when they fail to organise appointments properly. From the past 12 months I can give five examples from my close family, and from my constituency casework, of where the booking system has been appalling. I know of people who have been sent to closed service centres in hospitals and people who have been told that the plaster on their arm would be examined to see whether it has set when, in fact, the plaster should have been taken off. I could go on about the booking system’s failings. Addressing those failings would save millions.

Cleanliness is not a cost issue directly, but it is a health issue, and there is a massive difference in cleanliness levels both within hospitals and between hospitals, which could be addressed. There could be improvements in other areas. There are big decisions to be made on hospital configuration, finances, how much money should be put into primary care and the structure of the health service. Those questions will not be addressed by the current process. There are genuine differences between the Labour and Conservative parties on how those issues will be resolved, and those differences will be resolved at the general election.

The process is trying to do two things. First, it is trying to usurp the political process at the general election, when those big decisions will be taken. Secondly, it is asking for a blank cheque. If the Government put out such a rubbish consultation document that people do not know whether it is about primary care, secondary care or hospital reorganisation, and if Healthier Together is already saying that it has 98% support, what do they want to do? They are asking for a blank cheque to do whatever they want, and it should not be given to them.

I will finish with another quote from University Hospital of South Manchester, which I completely agree with, although I would add other things to it:

“Wait until the trauma review is finished and do the consultation properly.”

In other words, withdraw this consultation, do it properly, wait until the review of maternity and trauma services is in, wait for the general election and then we can have a serious, proper and grown-up discussion about how we can make health services in Greater Manchester better.

14:50

[Kate Green (Stretford and Urmston) (Lab)]

It is a great pleasure to speak in this debate, and I am grateful to my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for introducing it.

I am here to express the concerns of my constituents in relation to what my hon. Friend has rightly described as a consultation that people are either completely unaware of, or, if they are aware of it, unsure what they are being consulted about, what the next steps might be, where decisions will be taken and by whom. As he said, everyone understands the pressures that we face within the NHS in Greater Manchester and across the country.

[Andrew Bingham (High Peak) (Con)]

I know that the consultation is about Greater Manchester, but may I just put it on the record that the impact of this consultation will go far beyond Greater Manchester? My constituency is split between relying on Stepping Hill hospital and Tameside hospital, so this consultation affects us as well. I just wanted to put that on the record, so that people are aware of it.

[Kate Green]

The hon. Gentleman is absolutely right, and I am pleased to see that the hon. Member for Macclesfield (David Rutley) is also present this afternoon. The ripple effect of the consultation, on hospitals in neighbouring areas and indeed—as I will go on to talk about—on the wider north-west and northern region of the country is quite significant in one reading of what is going on.

It is true that the pressures of rising demand on the NHS are well recognised, as are the cost constraints on social care provision. However, my constituents in Trafford were told all that three or four years ago, and we went through our change programme. We feel that we have been here before and, for us, this is groundhog day and a bit worse than that. We underwent the consultation “A New Health Deal for Trafford”, which took place in 2012 and culminated in the downgrading of Trafford general hospital. Looking at how the current consultation has been launched, I am concerned that a number of lessons that were learned from that Trafford process are being totally ignored.

I say clearly that I am not against sensible reconfiguration of acute services. I am very much in favour of concentrating expertise and specialisms in a small number of expert sites. I am entirely in favour of as much provision as possible being pushed into the community to front-line, preventive, community-based care, and of keeping people at home to receive that care for as long as possible.

However, if this is a consultation about the provision of integrated community-based care, it is not possible to go down the road of consulting about that provision and withdrawing services in acute settings before we are clear what the landscape and the reality of that community provision is. Nor is it possible to go down the route of suggesting that some acute services might be rationalised or closed when existing acute services are under so much pressure already. In particular—I know that my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will talk about this issue too—one consequence of the downgrade of Trafford general hospital’s accident and emergency provision is that during the past nine months the waiting times and queues at Wythenshawe hospital have been significant, with little sign yet that they will be reduced.

In addition, I point out that we have some real uncertainty. My hon. Friend the Member for Blackley and Broughton mentioned the uncertainty that exists around trauma services, maternity services and so on, but we also have uncertainties in Trafford in relation to some of the primary provision that will be in place. We know that the NHS local team and the clinical commissioning group envisage a two-hub model of primary care and community-based care for our borough. The provision in the south is largely established, but in the north—including in my constituency, where we have some of the worst health outcomes in the borough—we are still completely unsure what sort of hub will be put in place, as the NHS local team and NHS England are quite unable to tell us what the funding for that kind of hub model will be.

I know that the Secretary of State for Health is aware of that particular situation and I am grateful to him and his office for what they are doing to try to unscramble it, but from the point of view of my constituents the idea that they will be consulted on a major reconfiguration, either of primary care or of acute services, does not inspire their confidence, because currently they simply see deficiencies in those services and particularly because they believe that their voice counts for little when it comes to the decision that will ultimately be taken.

Not only is there pressure in the system, but the NHS seems to make some really perverse decisions as it goes along, because of its rather hand-to-mouth approach to planning this kind of reconfiguration and strategic change. When the decision was taken to downgrade the A and E services at Trafford general hospital, the hon. Member for Altrincham and Sale West (Mr Brady) and the late Paul Goggins, my good friend and former colleague, managed between them to secure around £11 million of new investment in Wythenshawe hospital to provide for the extra capacity that it would need. We are now unclear, of course, about what will happen with that £11 million of investment; it would be good if the Minister could put it on the record today that it will continue. Given that the hospital cannot envisage even its short to medium-term future, that is a worrying situation.

We saw something similar in Trafford, when investment of around £300 million in the intensive care unit was pretty well written off two years later when the new health deal for Trafford was implemented and the ICU was closed down. That may have been the right decision, but it was certainly a waste of money if investment was being poured into a hospital just two or three years before the whole status of that hospital was changed.

[Lisa Nandy (Wigan) (Lab)]

I am grateful to my hon. Friend for giving way, and I apologise for being late for the start of this debate, Mrs Riordan.

Does my hon. Friend agree that part of the problem with the process is that it does not take into account the particular needs, circumstances and history of our individual communities? For example, in Wigan we have invested in a number of our specialist services. However, we are a big borough, we have our own particular health challenges and we have real transport issues as well, which are different from those affecting other areas of Greater Manchester. Quite simply, a centrally driven top-down process that lacks any kind of democracy whatever, as far as I can make out, is not capable of delivering the sort of services that we need in our areas.

[Kate Green]

I absolutely agree with my hon. Friend, and the issue about democracy that she raises is one that we are all particularly concerned about.

[David Rutley (Macclesfield) (Con)]

I would just like to put it on record that my hon. Friend the Member for Altrincham and Sale West (Mr Brady), who cannot be here because of a commitment, shares concerns about the process and the way in which things are moving forward, which I think he has also expressed to the hon. Member for Wythenshawe and Sale East (Mike Kane). I just want to put it on the record that other Members are also expressing their concerns.

[Kate Green]

I am grateful to the hon. Gentleman for that contribution.

I am sure that my hon. Friend the Member for Wythenshawe and Sale East will talk particularly about the situation at Wythenshawe hospital, which is in his constituency, and our particular concern for the status of that hospital as a fixed-site specialist centre of excellence for a number of specialisms that matter not only to the population of south Manchester, or even to the population of Greater Manchester, but to the whole population of the north-west region. Some of those specialisms matter to the whole population of the north of England, and parts of Scotland too. It is deeply concerning to us that the Healthier Together consultation appears not only to be unaware of the difficulty of protecting those specialisms in the proposed process of remodelling hospital configurations, but to be completely unaware of the interdependency of specialisms and general acute and medical provision. If one element is removed from a cocktail of clinical support that is available to support high-level specialisms, those specialisms are completely undermined and eventually will probably be unable to survive.

I have a particular example of that process that I will draw to the Minister’s attention; it arises from my visit last week to Wythenshawe hospital and its highly regarded cystic fibrosis unit. The doctors and clinical staff there told me that the unit benefited from being part of a much broader, fixed-site specialist team, and indeed survived on that basis. It draws on a range of other specialisms around the hospital, including interventional radiology, transplantation, urology, nutritional support teams, gastroenterology, diabetes, endocrinology, ear, nose and throat services, obstetrics, extracorporeal membrane oxygenation and so on. Picking out some specialisms and moving them cannot be done in isolation, but Healthier Together does not seem to be aware of that at all.

Finally, as my hon. Friend the Member for Blackley and Broughton said, there are concerns about process—about how the public are being engaged in this debate. He said that we have a consultation taking place over the summer holidays, exactly as happened with the new health deal for Trafford, although we told them not to do that again, and during the working day. I understand that few people attended the public meeting in Trafford; I am not surprised, because it was difficult to know that it was even taking place. I would not be able to tell when it happened, because I was not notified directly, let alone my constituents.

[Andrew Bingham]

I thank the hon. Lady for giving way again; she is being generous. I tend to agree. There is a consultation meeting in the High Peak as we speak, although it is a Tuesday afternoon. I, for one, should have liked to be there. I just wonder: next week during the recess would have been a lot easier for me.

[Kate Green]

I agree.

Meanwhile, Healthwatch Trafford says that there is concern about whether the committee-in-common model in Manchester is sufficiently transparent, regarding its ability to engage with and represent the concerns of local people and to oversee, in the wider public interest, what is being proposed.

I am utterly unconvinced that local people are aware of or understand the steps that are being put forward now that could result in major changes to health care provision in our area.

[Julie Hilling (Bolton West) (Lab)]

Before my hon. Friend moves away from the consultation, does she agree that the questions asked in the consultation document are ridiculous? For example:

“Do you…disagree that children and young people should be cared for closer to home where appropriate?”

Nobody would ever disagree with such questions.

[Kate Green]

That is absolutely right. Again, that is exactly what we saw in the consultation on the new health deal for Trafford. We raised concerns about that at the time, but the NHS has learned nothing about how proper engagement and debate with the public can be managed and take place.

There is real concern that a lot of groundwork has gone into producing this consultation but that much of it has happened behind closed doors. If the significant changes that are being advocated, or significant changes in other forms, are needed— the document says that they are, which may well be the case—it is imperative that the public be brought on board through a process of careful, systematic, dedicated engagement. It is not good enough to land a document out there without that work being put in and without any clarity about how decision makers will be informed by the views and opinions of the public at large and of elected Members who represent them.

15:02

[Mr David Nuttall (Bury North) (Con)]

It is a great pleasure to serve under your chairmanship, Mrs Riordan.

Some may find it surprising, given our political differences, that I agree with much of what has been said by the hon. Members for Blackley and Broughton (Graham Stringer) and for Stretford and Urmston (Kate Green). Like them, I entirely accept that things cannot always remain as they always have been in our NHS. There have to be changes in any large organisation, from time to time.

Of course, I am speaking purely from the perspective of my constituents in Bury North, including the townships of Bury Ramsbottom and Tottington. They are only too aware of the repercussions of health service reorganisation, having recently lost the children’s services at Bury Fairfield hospital. Pledges were made before the last general election. The process of the “Making it Better” scheme was stopped. Local GPs had an opportunity to say, “We will keep the services”. I do not know about 98% of people on Twitter agreeing with this. I always used to say it was about 99% of people in Bury, when I asked them. I could hardly find anybody who thought it was a good idea to close maternity in Fairfield. Notwithstanding that, and notwithstanding the clear steer of the Secretary of State about wanting to keep those services open, local health officials, backed by local doctors—the GPs—said, “No, we’re too far down the line. We’ve got to stick with the ‘Making it Better’ scheme and with what has been agreed.” Those services at Fairfield have now been lost.

Residents in Bury could be forgiven for being somewhat sceptical about the nature of consultation. I share that. I took part in the after-the-event analysis that was done by some professional surveyors. I said to them, “Look, if you’re going to do a genuine consultation, you’ve got to be clear about what the options are. It’s got to be a genuine consultation and the public have not got to be left thinking that, actually, it is a foregone conclusion and the decisions have already been made.”

A proposal is before the people of Greater Manchester now. Out of all the hospitals in the area, only at Wigan, Bolton, South Manchester and Stockport is there some element of choice. With all the others, it is the same: it is a done deal. So I understand why many of my constituents will say, “Well, there’s not much point in us taking part in all this. Nobody listened to us last time; nobody will listen to us this time.”

[Lisa Nandy]

I agree with almost everything the hon. Gentleman has said. Is not the tragedy of this process that, as he and my hon. Friend the Member for Blackley and Broughton (Graham Stringer) said, most of us could get behind some principles underlying the proposal, including greater care in the community locally when people need it, greater specialism and supporting people to get care outside hospital? There is consensus on all those things, but the way the process has been handled, as has been compellingly outlined, has left people feeling that there is simply no point getting involved.

[Mr Nuttall]

The hon. Lady makes a good point. The vast majority of the public would, in an ideal world, like every service to be provided at their local hospital, so that they could have everything just by travelling a couple of miles. In a perfect world, they would have every conceivable treatment available at their nearest hospital. However, they have long since accepted, and we all know, that that is not possible. The clearest example of that in Manchester is, of course, cancer care and Christie’s. People accept that if, sadly, they are diagnosed with cancer, they will have to travel to a specialist cancer care hospital, where they will get better treatment.

It gets a bit more difficult when moving further down the specialism chain. Certainly, we were at the front line in that regard, as were Rochdale and other areas in Greater Manchester, when maternity services were being considered, because people felt that such services ought to be available everywhere. Of course, there are drivers behind this, if truth be known—if truth could be expounded by the health chiefs—in that, whether we like it or not, it comes back to the working time directive, for example, which has had an effect on the configuration of doctors’ working hours.

Medical negligence claims against the health service have also had an impact in this regard. I can understand that, coming from a legal background. People are better protected if they are in an environment where greater numbers of people are working together to watch each other’s backs. That is another driver of these reconfigurations, as some people like to call them.

To get back to the points I was making before that intervention, one of the problems with this consultation, which the hon. Member for Blackley and Broughton mentioned, is that the website and the documents are littered with unintelligible gobbledegook half the time. I am not being patronising, because I do not understand half of it myself, to be perfectly honest. Most people will look at that website and think, “Frankly, it goes over my head.” That will be their general view. I accept that the website and the documents sway wildly the other way as well and have apple pie and motherhood statements that absolutely everyone will agree with, such as “Do I want mum to get that good treatment if she goes into hospital?” No one will say no to that, will they? It is a complete waste of time and effort, and I cannot believe that highly qualified individuals have put together this mishmash of a website and consultation. It is not clearly thought through.

I have no idea of where this will end in terms of the hospitals where there is an option, but I know that my constituents in Bury want access to an accident and emergency department at their local hospital. Going back to what I said about the specialism ladder, by definition, one expects things such as accident and emergency to be available at the nearest general hospital. That is what my constituents will be looking for. If these services are salami-sliced away from Bury, my constituents will be concerned that they will be left with a hospital in name only—one that does not provide them with the services that they have come to expect.

I echo what has been said about Healthwatch England. Bury Healthwatch has e-mailed me and wants me to put on record its concerns about its involvement in this process. I appreciate that it is a new body, but clearly there are problems with the introduction of the legislative order for clinical commissioning groups, the Legislative Reform (Clinical Commissioning Groups) Order 2014. Healthwatch England has written to the Secretary of State about that. I understand that the order will come into force on 1 October. I can only assume that, to meet that deadline, those problems will be dealt with in our September sitting.

To be perfectly honest, demand for health care services will always outstrip supply, under any Government. It does not matter whether it is a Labour Government or a Conservative Government; people’s desire to be healthy and their need to feel that they and their loved ones are receiving the best possible treatment will always result in demand being greater than the ability of the public purse to meet that demand. That is of course largely driven by the fact that so many people think that our NHS is free. Of course it is not free. We all know that it is not free.

In the current year, the NHS is spending something like £119 billion. It is a huge consumer of public funds, and rightly so. It is right that the Government have protected the health care budget. Notwithstanding that, there are pressures, because the population is getting older and new treatments are being discovered and becoming available all the time. I am grateful for the opportunity to put on record my constituents’ concerns, and I am conscious of the fact that others want to put similar concerns on the record.

15:14

[Mike Kane (Wythenshawe and Sale East) (Lab)]

It is a pleasure to serve under your chairmanship today, Mrs Riordan. It is also a pleasure to follow the hon. Member for Bury North (Mr Nuttall), who speaks with passion about his constituents, and the authoritative contributions from my hon. Friends the Members for Stretford and Urmston (Kate Green) and for Blackley and Broughton (Graham Stringer), whom I congratulate on securing a timely debate.

We have world-class health services in Greater Manchester. My constituency is home to University Hospital of South Manchester, which delivers services amounting to £450 million, employs 6,500 people and has 530 volunteers, who give up their free time to help patients and visitors. The hospital has several fields of specialist expertise, including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, cancer and breast care services. Indeed, the trust is home to Europe’s first purpose-built breast cancer prevention centre, which I visited just a few weeks ago to see the unveiling of the new plaque dedicated to my predecessor, Paul Goggins, who worked so hard for the services at Wythenshawe. The hospital not only serves the people of south Manchester, but helps patients from across the north-west and beyond.

[David Rutley]

The hon. Gentleman speaks with passion and great knowledge about his local hospital. I was fortunate enough to be able to witness how good the services are at Wythenshawe, because I was whisked away when I spent a day with the North West ambulance service. I went in to see heart surgery taking place there, and it is first class. We must recognise that the care pathways that link Wythenshawe—or Stepping Hill, for that matter—to outlying hospitals outside the Greater Manchester area, such as Macclesfield, are vital. Does he agree with my hon. Friend the Member for High Peak (Andrew Bingham) that it is critical that the ripple-out effects of the consultation are taken into account?

[Mike Kane]

I cannot agree more. Wythenshawe hospital lies at the south of the conurbation and at the south of the area of the Healthier Together consultation. Being at the south of the conurbation and south of the River Mersey, it has traditionally looked to provide services to people in Cheshire as a whole, including the hon. Gentleman’s constituency.

[David Rutley]

I am sorry to take the hon. Gentleman’s time again, but I thank him for giving way. It is odd that there are at least two options—options 4.1 and 4.2—where there would be no hospital in the south, with neither Wythenshawe nor Stepping Hill. Does he agree that that would be a strange outcome that could endanger patient health?

[Mike Kane]

I agree. It would be odd not only for my constituency, but for constituencies to the south in the Cheshire belt and the Cheshire plain that those hospitals serve.

Wythenshawe hospital is very much looking to the future and its long-term sustainability. It is developing the Manchester MediPark in partnership with Manchester city council and private sector developers. MediPark will exploit the huge strengths of Greater Manchester and the north-west in health and life science services. Research and development forms a key part of the new Manchester airport city enterprise zone, which I had the opportunity of updating Members on only last week during my Adjournment debate on regional airports.

UHSM is recognised as a centre of excellence for research and development, and is a founding member of Manchester Academic Health Science Centre. The partners of the science centre share the common goal of providing patients and clinicians with rapid access to the latest discoveries and improving the quality and effectiveness of patient care. It is clear that the hospital is going from strength to strength, but I fear that the planned Greater Manchester Healthier Together proposals, to which my hon. Friend the Member for Blackley and Broughton referred, could fundamentally destabilise the trust and lead to a loss of its major emergency service, many of its specialised services, its trauma service and even its teaching status.

The additional reorganisation is set against the backdrop of the Government’s £3 billion reorganisation of the NHS, which has siphoned off money from the front line to pay for back-office restructuring. In the first three years of this Government, attendances at A and E have increased by 633,000, yet Trafford general, to which my hon. Friend the Member for Stretford and Urmston referred and which serves many of my constituents, has seen a downgrading of its A and E department. It has got harder to get a GP appointment since the Government scrapped the previous Government’s guarantee of an appointment within 48 hours, and cut funding for extended opening hours. That is a key cause of Wythenshawe’s A and E problems.

[Julie Hilling]

Does my hon. Friend agree that the major vision that seems to be emerging is simply one of pitching hospital against hospital—fighting about whether to have a hospital in Wigan or Bolton, or four or five specialist hospitals, when, as has been said, we all want a good local service? Should not the concentration be first and foremost on getting primary care services correctly in place? That should be sorted out, and afterwards we can look at what hospital care we need.

[Mike Kane]

I agree; the most important thing is to get primary care in place first. Starting a consultation nine months from a general election that will pit MP against MP is not a good idea.

A quarter of walk-in centres, including Wythenshawe, have closed, and NHS Direct has been dismantled. On top of all that, the new Healthier Together proposals mean there is potential for a downgrade at Wythenshawe hospital. That would, as has been pointed out, be a broken promise for people in Wythenshawe and south-west Manchester, who following the downgrading of the A and E at Trafford general were assured that University Hospital of South Manchester would not be affected.

The aim of Healthier Together, to give patients across the region the same excellent standard of service wherever they live, is the right one. The challenge is huge. Manchester has the highest premature death rate of any local authority in the country. There can be no doubt that health care services in Greater Manchester need to change. Almost £2 billion has been taken out of the budget for adult social care. We need to do things differently to meet the challenges of the time and better integrating local authority services with the NHS will be a key part of that change. However, the current process is flawed and is moving too fast. The proposals fail to recognise that Wythenshawe is already a major specialist site that provides many vital services to the people of Greater Manchester.

The public are not being provided with enough detail to enable them fully to understand the implications of the proposed changes. The consultation meetings have been criticised—as they have today—for being jargon-ridden and held at inaccessible times. No financial models have been provided in the information for the public and UHSM believes that the current proposals could destabilise the finances of the trust.

Wythenshawe is a level 1 major trauma centre, and is currently the only site capable of developing a single level 1 trauma site for adults for the whole of Greater Manchester. As my hon. Friend the Member for Blackley and Broughton pointed out, it covers Manchester airport, and if an accident were to happen such a nearby centre would be vital. The current proposals could leave the southern sector of Greater Manchester and north Cheshire with no specialist major emergency hospital. The proposal does not reflect the view of providers and local commissioners in the southern sector that Wythenshawe should remain and be developed further as the sole specialist site in the southern sector.

The failure of the proposals to acknowledge Wythenshawe as one of the fixed sites threatens the future clinical, operational and financial sustainability of the trust. For changes at such a level to have the desired impact on services across Greater Manchester, all the partners must be firmly on board. I urge Healthier Together to look again and ensure that the baby is not being thrown out with the bath water, because of a rushed consultation and flawed proposals.

15:23

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I thank my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for securing the debate. It is particularly useful that we can express our views before the summer recess. I do not want to speak for too long. I will echo my colleagues’ sentiments about the quality of the consultation process, but I want to give a view from the eastern part of the conurbation, Tameside, and make a couple of additional observations.

A lot is going on with the NHS and health care in Greater Manchester at the moment, so the timing is not very conducive to running such a consultation. The changes to Trafford A and E have already been mentioned. Passenger transport has been privatised from the NHS ambulance service to Arriva. Most of the walk-in centres that I am aware of have gone. I do not know about the situation in other constituencies, but in mine GP access is a huge issue—people regularly wait a fortnight for access to a GP in Stalybridge. Of course, in Tameside there are particular challenges because of the Keogh review in Tameside hospital. All the Tameside MPs warmly welcome that. It has been a positive process enabling a light to be shone on many of the things that we have been discussing for several years. However, when all the factors I have mentioned are added together, it is a difficult time to carry out a consultation on any part of the NHS and particularly on hospitals, because the public are most sensitive about them in many ways.

I understand the need for specialisation. I echo the remarks of my hon. Friend the Member for Stretford and Urmston (Kate Green). Even if we had substantially greater resources, it would be difficult to recruit the people we would need to meet the standards now required for hospitals in the conurbation. With the financial modelling that has been done in Tameside, we are perhaps a little more advanced in our forward projection work than some other boroughs, and I think that we are in a perfect storm. We have had to spend a lot of money at the hospital to try to meet the higher standards that people should expect by correcting some of the processes that the Keogh review highlighted as wrong. On top of that, the council was always one of the leanest in the country, let alone in Greater Manchester, so it suffered the worst from the severe reductions made by the coalition in northern local authorities. Our clinical commissioning group is in a relatively good position, but clearly it is not to anyone’s benefit simply to use that financial picture to prop up other parts of the system that are not working so well.

History will be hard on the coalition for prioritising such a big ideological reorganisation at a time when the figures show that the situation I have described is the challenge that incoming Health Ministers should have concentrated on. The promise that no A and E departments in our hospitals will close is welcome news, but I wonder whether the scale of the rhetoric around Healthier Together justifies or validates that promise. Either we shall not produce the results that have been promised, or that promise on the long-term future of hospitals and A and Es may not be honoured in the way we expect.

[Graham Stringer]

My hon. Friend is right to say that that commitment was given when we met the Healthier Together people and in some background documents. Does he agree that it is worrying that it is not in the consultation document, whatever credibility we give to the commitment itself?

[Jonathan Reynolds]

I do agree. That is a matter of extreme concern to me. My understanding is that we have been given a cast-iron pledge that there will be no hospital or A and E closures as part of Healthier Together. The problem with all hospital reconfigurations anywhere—it happened with the maternity services consultation—is that they always appear to people to be about cuts. It is hard to get across the argument that they are about improving services. There is some mixed messaging about the primary outcome of such a process.

My principal problem with specialisation is the one that arises with specialisation in any field. Greater Manchester’s geography makes it hard to get from one borough to another. Public transport and the railway system are not configured to operate in that way. I should love the opposite to be true—if we had the resources and local autonomy to make public transport work differently. That will come one day, I think, but it is not true at the minute. I did not by any measure expect to become an MP in the 2010 general election, and my daughter was booked in to be born at St. Mary’s, because I worked in the centre of the city and it was easier to have appointments there than to get back to Tameside for them. Frankly, we were concerned about the possibility of labour starting in Tameside at the wrong time, because of the journey to get to St Mary’s and what that might mean. I think that that would be the same for many people, whatever the health issue: the journey is not easy in a car, but by public transport it is almost untenable. That would be people’s primary concern when they thought about the outcome of such a consultation

[Lisa Nandy]

I am grateful to my hon. Friend for raising that matter, because I do not think that the Healthier Together team has given it enough thought. My constituency has not only chronic transport problems, including traffic and the fact that some areas of the borough are densely populated and quite far from the existing hospital, but also large, tightly knit families who often do not have a huge number of resources. When a loved one is suddenly taken ill, the whole family wants to visit, which is particularly problematic and something that the team has not thought about. Does my hon. Friend agree?

[Jonathan Reynolds]

That is absolutely true. If someone lives near the station in Stockport, it is sometimes quicker to get to London than to another part of Greater Manchester.

I am pleased that the hon. Member for High Peak (Andrew Bingham) was here, because something that is forgotten across the conurbation is that the health economy and structures are not coterminous with the political structures of Greater Manchester. Glossop is part of Tameside’s health economy and getting from Glossop to Ashton-under-Lyne is not an easy journey, but trying to get to a different part of Greater Manchester in an ambulance or with a need to access a particular service would be extremely worrying.

[Julie Hilling]

It must be recognised that people living within Greater Manchester will also travel to hospitals outside. Some of my constituents might travel to Chorley for treatment, for example, because it is much closer than Bolton or Wigan. My hon. Friend is absolutely right that there is no wall around Greater Manchester in terms of people travelling in or out.

[Jonathan Reynolds]

That is absolutely true and has been mentioned by several colleagues today. My specific point about Glossop is that it shares an NHS trust hospital and clinical commissioning group with Tameside and that must be considered in a manner that people do not fully appreciate at the moment.

Looking at the financial picture for the NHS in Tameside and Glossop, we see many challenges to meet in future. I cannot see the utility in a big hospital reorganisation such as this unless there is much wider reform of out-of-hospital care, because we will still face the problem of too many medically healthy people being in hospital because they have nowhere else to go. Such reform would require much stronger integration of social services, public health, the CCG and the hospital, but the Government’s entire direction of travel is towards a more fractured and competitive system. I understand the motivation, but I cannot see how it tallies with something such as the Healthier Together programme.

The Minister has several points to address in his speech, but I hope that he can respond to that one in particular, because I am unsure about why we are going through this process if it will not deliver the improvements in health care that should be the ultimate goal of any kind of reorganisation.

15:32

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to conduct a debate under your chairmanship for the first time, Mrs Riordan. I congratulate hon. Members on both sides of the House on the spirit with which they have conducted themselves today and on their genuinely well informed and impassioned contributions. I also congratulate my hon. Friend the Member for Blackley and Broughton (Graham Stringer) on securing the debate.

Members of all parties will appreciate the concerns expressed in the House over many months on behalf of communities that are worried about changes to their local NHS services. Consultations and how they are conducted are vital to ensuring that people have the necessary information to participate effectively in the consultation process, but that does not always happen. The Healthier Together review of health and care services across Greater Manchester is intended to deliver improvements to primary and community-based care to reduce the need for people to go into hospital, and that principle has received broad endorsement from colleagues today. The intentions of the review for primary care are admirable, including that by

“the end of 2015, everyone living in Greater Manchester who needs medical help, will have same-day access to primary care services…seven days a week; by the end of 2015, people with long-term…conditions…will be cared for in the community…supported by a care plan which they own; community-based care will focus on joining up care with social care and hospitals, including sharing electronic records which residents will also have access to; and by the end of 2016, residents will be able to see how well GP practices perform against local and national measurements.”

The plan also aims to improve joined-up care and hospital care. Although the aims are good, it is essential that the review also provides reassurance and clarity. From what I have heard today, it is clear that that is missing by some measure and has not been achieved—at least not yet.

As is too often the case, the review started with what services will be taken away from hospitals. Instead, it should have begun with what services people will in future be able to receive in their own homes or in a local community setting. Rather than identify the services that will be taken from the general hospital and put into a specialist hospital, the review should have identified the services that will be repatriated from the specialist hospital to the general hospital.

We all recognise that how and where services are delivered does need to change, but it is a quid pro quo process and the specialist hospitals also need to put some services back into a general hospital setting. When the proposals from a review appear to be a power grab by the big players in the local health economy, it is no wonder that people fear for the future of their services. If services are taken away, “How viable will we be?” becomes a worrying question. We need specialist hospitals, as shown by the case of Fabrice Muamba, who was taken not to the nearest hospital but to the specialist hospital that would save his life, but we also need general hospitals serving their local communities.

The Healthier Together review has the chance to shape services across Greater Manchester, moving out into the home and community setting, at the same time as securing the future for the general hospital. However, several colleagues have raised genuine concerns about the process. If a review of health services is to command support and achieve success, it must be open and transparent and provide all the necessary information to the public. Members have expressed grave doubts about whether that truly is the case with the Healthier Together review. The future viability of all hospitals needs to be secured, the continuation of A and E services has to be ensured and the issue of travel times across a conurbation such as Greater Manchester has to be taken into account in precise detail.

Although the aims and objectives of the Healthier Together review are commendable and, if introduced properly, would deliver improved health and care services across Greater Manchester, as we have heard in detail today, many worries have not been addressed and significant concerns remain. It is now for the Healthier Together review team to provide the answers and reassurance that are needed for the review to be successful. I look forward to hearing from the Minister.

15:29

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate. The opportunity to debate important issues at the start of a process is welcome. I also thank my hon. Friend the Member for Bury North (Mr Nuttall) and the hon. Members for Wythenshawe and Sale East (Mike Kane), for Stalybridge and Hyde (Jonathan Reynolds), for Stretford and Urmston (Kate Green) and the shadow Minister—[Interruption.] I thank my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) for ensuring that I also thank the hon. Member for Wigan (Lisa Nandy) for her important interventions.

The impression that I got from all hon. Members is that there is a recognition that things need to change and of the importance of developing an integrated system of out-of-hospital support and strong primary care. Some hon. Members also recognised the importance of specialisms in specific cases, but concerns centred on the nature of the consultation. The shadow Minister was extremely fair in describing the process’s objective as a good one and the hon. Member for Wythenshawe and Sale East said that the aim is right, so there is something of real value to achieve here if it is possible. I completely understand, however, why hon. Members feel the need to speak up for and express concerns on behalf of their communities.

[Lisa Nandy]

rose—

[Norman Lamb]

I will give way in a moment, but I was about to comment on the intervention of the hon. Lady, whom I rudely left out of my list earlier, in which she mentioned the lack of democratic legitimacy. The reforms have strengthened legitimacy. Until the reforms, there was no local democratic accountability for the NHS, but every area now has a health and wellbeing board. Interestingly, Lord Peter Smith, who I think is from the hon. Lady’s own community, said:

“We accept the case for change made in this consultation document…Remember it is not buildings that deliver good health care, it is the dedicated NHS staff who make it possible.”

To pick up on the point made by the hon. Member for Stalybridge and Hyde, Lord Smith, a local Labour leader, also talked about the move being towards greater integration:

“We are clear that this improvement in integration and in GP services needs to be up and running before the changes to the hospital services are introduced”—

clear support there for the objective.

[Lisa Nandy]

The Minister is right. Like the leader of my council, I accept the case for greater integration. I wanted to make one point, because the Minister seems to be suggesting that the concerns centre only on the consultation. I have a real concern, which I am not sure has been expressed clearly so far, about how the consultation sets up hospitals as either specialist or local.

My hospital specialises already, and it is rightly fighting to retain that because good outcomes are delivered. That does not mean that my hospital can, or should, do everything. Indeed, many of my constituents travel, for example, to the Christie for cancer care, as the hon. Member for Bury North (Mr Nuttall) said. There is, however, a real issue about some hospitals being specialist and some being local, but with nothing in between.

[Norman Lamb]

I take that concern on board, and the hon. Lady should respond to the consultation. It is really important for hon. Members to do that.

Incidentally, I should say something on behalf of my hon. Friend the Member for Cheadle (Mark Hunter), because he is a Whip and so is unable to speak in the debate, although he has attended it all. He has expressed particular concerns about the potential implications for the University Hospital of South Manchester and Stepping Hill, and about options 4.1 and 4.2. It is important that I place that on the record.

[Julie Hilling]

Will the Minister give way?

[Norman Lamb]

Will the hon. Lady let me make another point that is on the tip of my tongue? I will then be happy to give way.

The hon. Member for Stalybridge and Hyde expressed the concern that, in his assertion, we are moving away from integrated care. Precisely the opposite is the case. Indeed, the hon. Member for Copeland (Jonathan Reynolds), the shadow Minister, expressed clearly some of the fantastic potential gains that could be achieved in the Greater Manchester area if the objectives were achieved. When I announced the pioneer programme to demonstrate the exemplars of integrated care, Greater Manchester was one of the applicants to get on to the shortlist and was close to securing pioneer status, so my every impression is that exciting work is going on in Manchester to change local health and care services in a way that all of us could probably sign up to.

[Julie Hilling]

rose—

[Kate Green]

rose—

[Norman Lamb]

I give way first to the hon. Member for Bolton West.

[Julie Hilling]

I thank the Minister for giving way. The bit that I do not understand is that local authorities, leaders such as Lord Smith and others, have been saying, “Yes, we need to sort out the integrated care”, but the consultation has been putting front and centre the need to change the status of hospitals. What everyone in the conurbation is saying is, “Let’s look at the integrated care and then see what comes out of that”, rather than putting changing hospitals up front, which is what exercises the whole community.

[Norman Lamb]

I note the hon. Lady’s point, but I come back to Lord Smith’s statement:

“We accept the case for change made in this consultation document”.

It cannot be clearer than that.

[Jonathan Reynolds]

Will the Minister give way?

[Norman Lamb]

Let me finish the point. I am acutely aware that it is critical to develop those out-of-hospital services to which the hon. Member for Wigan referred. That is the whole essence of integrated care, of which Manchester is seeking to be an exemplar. I applaud Manchester for doing that, because that is a big shift towards the greater focus on preventing ill health, rather than on repairing the damage once it is done.

[Jonathan Reynolds]

rose—

[Norman Lamb]

I am conscious that I need to make progress in my response to the debate, but I will give way to the hon. Gentleman.

[Jonathan Reynolds]

I am extremely grateful to the Minister for addressing my point directly. It is pleasing to see that he is well briefed. He is right about some of the exciting conversations about integration going on in Greater Manchester. I anticipate that he knows something about the proposals. If they develop into specific plans, is it his desire and belief that the Government would not seek to apply the competition law to which the NHS is now subject and allow them to proceed?

[Norman Lamb]

I have made the case very clearly that the whole purpose of the pioneer programme is to use the pioneers—although we are not simply focused on them—to identify the barriers to integration and to remove them. That is the whole point. There are concerns about all sorts of things that could block integrated care, such as information sharing across different providers and competition.

I should stress, incidentally, that in the section 75 regulations is a specific recognition that integrated care is an ambition that should be achieved, so commissioning can be for the whole integrated care pathway. There should be no problem in securing our ambition. Where barriers are found, they need to be addressed and removed.

I am conscious that the hon. Member for Stretford and Urmston asked to intervene—

[Kate Green]

indicated dissent.

[Norman Lamb]

The hon. Lady has moved on, so let me make some progress.

It is important to recognise that we are discussing proposals that originated with local clinicians. Dr Chris Brookes, who is not a politician or a bureaucrat, who too often get condemned, but an accident and emergency consultant and a medical director of Healthier Together, says—

[Lisa Nandy]

Will the Minister give way?

[Norman Lamb]

May I make this point? I am sure that the hon. Lady will be interested to hear it. Dr Brookes said:

“Currently, there are too many variations in the quality of treatment, whether its emergency surgery or getting to see a GP when you need to. Not one of our hospitals in Greater Manchester meet all the national quality and safety standards.”

I am sure that all hon. Members present are concerned about that. He goes on to say something which, if we think about it, is shocking:

“At present your chance of being operated on by a consultant surgeon in an emergency at the weekend is much less than midweek. Your chance of recovering well from surgery carried out by a consultant is greatly improved.

But it’s not just about hospitals. It’s about access to a GP, and better community-based services—more services provided locally or at home and joining up the care provided by local authorities.”

That is a clinician making the case for integration.

Before I turn to the Healthier Together changes, it is probably best to make a few points about service changes in the NHS generally and Government policy towards them. The Government are clear that the design of health services, including front-line services and A and E, is a matter for the local NHS and, critically, the health and wellbeing boards, which have democratic accountability. Our reforms put doctors in charge of the care that people receive and how it is delivered to best serve their populations.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible, which means that it must plan ahead and look at how best to secure safe and sustainable NHS health care provision—not only to meet today’s needs, but to plan ahead for next 10 or 20 years.

[Kate Green]

In Trafford, my understanding is that neither the local authority nor the CCG supports the proposals before us. Will the Minister explain the role of the health and wellbeing boards in the final decision on the plans?

[Norman Lamb]

I understand that the health and wellbeing boards are keeping a watching brief throughout. They will have a decisive voice at the end of the consultation process in declaring whether they support the outcome. They bring together the local authority and the NHS, so they are pretty central to the whole process—and rightly so. The local NHS is constantly seeking to modernise delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives.

The hon. Member for Stalybridge and Hyde focused on specialisation, and expressed scepticism about the case for it. Let me give him a case. It is from during the Labour Government and should be applauded—the lessons from it should be learned here. Stroke care in London, centralised into eight hyper-acute stroke units, now provides 24/7 acute stroke care to patients, regardless of where they live across the city.

Transport links are not that great across much of London—[Interruption.] Hon. Members should listen to Members from London complaining about transport links. Stroke mortality is now 20% lower in London than in the rest of the UK and survivors with lower levels of long-term disability are experiencing better quality of life. Hundreds of lives have been saved as a result of the specialisation undertaken predominantly under the previous Government.

[Jonathan Reynolds]

I was very fair in my speech and said that I absolutely accept the case for specialisation. I actually made the most positive case of any made by an Opposition Member today as to why that might be important for my borough, so the Minister has perhaps misunderstood that. But I have to say that comparing the transport situation in Greater London with that of Greater Manchester or any other northern city will, I am afraid, have our constituents in uproar: it is simply not the same picture by any means.

[Norman Lamb]

I acknowledge that, just as in London, there are real bottlenecks in Manchester. I have a son who was at university in Manchester—and found it to be a very fine city—so I understand the transport challenges there completely. The point remains that specialisations can save lives. We all have to recognise that.

All service changes should be led by clinicians and be based on a clear, robust clinical case for change that delivers better outcomes for patients.

[Julie Hilling]

Will the Minister give way?

[Norman Lamb]

I really cannot. I have been pretty generous in giving way many times, so I will make a bit more progress.

It is therefore for NHS commissioners and providers to work together with local authorities, patients and the public in bringing forward proposals that will improve the quality and sustainability of local health care services. Government policy has been to emphasise local autonomy and flexibility in how NHS organisations plan and deliver service changes, subject to meeting legal requirements, staying within the spirit of Department of Health guidance and ensuring schemes can demonstrate robust evidence against four tests. Those are that there is support from GP commissioners; there is a focus on improving patient outcomes; that schemes consider patient choice; and that they are based on sound clinical evidence.

I recognise that change is often difficult to achieve because the consequences of not getting it right could be so profound—hon. Members have been absolutely right to raise their concerns. It is therefore right that the NHS does not rush into change without fully understanding all the potential consequences, sometimes including unintended consequences. Change can be difficult to explain to patients who have had quite reasonable anxieties exacerbated by speculation—in many cases, in the media—about whether this or that service might close. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.

For example, my hon. Friend the Member for Macclesfield (David Rutley) referred to the possibility of hospitals closing, but I am not aware of any proposal to close hospitals. When we communicate to patients and the public, it is important that we are clear on what this issue is and is not about, so as not to raise anxieties. From my perspective, we have to be careful to avoid ramping up anxieties inappropriately by playing on fears. We see that too often; unfortunately, it stifles genuine debate and discussion about what health services will need to change in order to do better in future. But I applaud all hon. Members for speaking in this debate very reasonably and about legitimate concerns.

The right hon. Member for Leigh (Andy Burnham) has agreed that the NHS needs to have the freedom to change the way services are provided. He said:

“If local hospitals are to grow into integrated providers of whole-person care, then it will make sense to continue to separate general care from specialist care”—

the point made by the hon. Member for Wigan a moment ago—

“and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

Perhaps the hon. Lady will take the point better from her party’s health spokesperson than from a Minister, but the right hon. Member for Leigh was making the case for the specialisation of services.

[Lisa Nandy]

I thank the Minister for being so generous in giving way. He seems to be setting up straw men that he then batters down. As far as I can work out, there is no disagreement from me or any Member on either the Government or Opposition Benches about the need for specialisation, integrated health care and locally delivered services. That is not what we are talking about. We are talking about a process that lacks democracy, that has been top down and centrally driven and that the public have lost confidence in.

[Norman Lamb]

To be fair, when I indicated earlier that the issue is about process, the hon. Lady came back at me—as is her right—to say that it is not just about process but about the model of separating specialisms from general hospitals. I therefore quoted what the shadow Secretary of State for Health had said in that regard.

I turn to the specific case raised by the hon. Member for Blackley and Broughton in this debate. Healthier Together was launched by the NHS in Manchester in February 2012 and is part of the Greater Manchester programme for health and social care reform, which seeks to improve outcomes for all Greater Manchester residents. The scheme is substantial, involving 12 CCGs and 12 hospital sites across Greater Manchester. As the consultation sets out, the case for change aims to improve access to integrated care and primary care, community-based care and in-hospital care services, including urgent and emergency care, acute medicine, general surgery and children’s and women’s services.

The House should appreciate that although those are the services being looked at, there are interdependencies with the core in-hospital services, including anaesthetics, critical care, neonatal services and clinical support such as diagnostic services. Changes in one area might have consequential effects elsewhere, as hon. Members have pointed out, and those effects have to be fully understood.

I should also repeat that the proposed changes are not a top-down restructuring. They are led by local clinicians who know the needs of their patients better than anyone. They believe that the clinical case for change—

[Graham Stringer]

Will the Minister give way?

[Norman Lamb]

I am conscious that I have only three minutes left. I have tried to be generous.

Local clinicians estimate that across Greater Manchester around 1,500 lives could be saved over five years as a result of implementing the proposed changes; that is not my assessment, but that of local clinicians. That would be an impressive improvement in health care, touching and affecting the lives of thousands of ordinary people—not only the individuals concerned, but their families and friends. It is because of the area’s current performance: if all trusts in Greater Manchester achieved the lowest mortality rates in the country, the CCGs believe that the number of deaths in Manchester could reduce by some 300 per year, equating to saving 1,500 lives over five years. That is an objective that we should all sign up to.

I am sure hon. Members will agree that it is not an unrealistic aim for hospitals in Greater Manchester to want to be the very best in the country. I am also sure all hon. Members want the very best for their constituents. Greater Manchester has some of the best hospitals in the country. However, not all patients experience the best care all of the time. In particular, the consultation sets out evidence that suggests that for the sickest patients who need emergency general surgery, the risk of dying at some Greater Manchester hospitals might be twice that at the best hospitals. That is simply not acceptable.

There is a shortage of the most experienced doctors in services such as A and E and general surgery, leaving some hospitals without enough staff. Only a third of Greater Manchester hospitals can ensure a consultant surgeon operates on the sickest patients every time; similarly, only a third can ensure a consultant is present in A and E 16 hours a day, seven days a week.

Healthier Together aims to ensure that all patients receive reliable and effective care every time. The programme is endorsed by the independent National Clinical Advisory Team, which offered strong support for the programme’s ambition, vision and scope, as well as its impressive public and clinician engagement. The NCAT felt that the programme’s approach was an exemplar of how the NHS should try to improve safety, value and sustainability.

I have not had time to say everything that I wanted to. I am conscious that hon. Members raised specific issues that I should respond to and am happy to write to all Members who have taken part in the debate. I hope my remarks have been of some help.