Late Stage Hepatitis C

Virendra Sharma Excerpts

Tuesday 6th January 2015 Westminster Hall

[Stephen Pound]

One would almost think that my hon. Friend the Member for Easington (Grahame M. Morris) had had sight of my notes, because there will be, in a few moments, a section on that. The bullet point, my aide-mémoire, my prompt, is simply the two words “Good news”, because there is good news. One reason why we are having this debate is to tell people that there is a cure—a very successful rate of cure—but also to say that we need people to be able to access that and we need, above all, to have a plan.

Let me explain why I called for this debate. Many years ago, I had a private Member’s Bill on presumed consent for organ transplants. At that time, the then Secretary of State for Health, rather aggressively, said that it was not the business of the state to decide what happens to a person’s body after they have died. Lord Reid, as he now is, apologised to me afterwards for being quite aggressive, but one thing that it brought home to me was the difficulty of finding livers for transplant. Hepatitis C leads to cirrhosis of the liver in virtually every case, and in some cases that can then become acute liver failure, in which case one of the treatments would be a liver transplant. People think that is an easy solution when in fact it is not. As I discovered, livers for transplant are very difficult to get hold of—very hard to access.

Modern medical advances have opened up a completely new world. I will say more about that, and particularly the new therapies, in a moment, but there is still massive and widespread ignorance, and what I am asking the Minister for today is to have a plan for addressing that. I am reluctant, as is anybody, to give over-much credit to the Scottish Parliament, but on this occasion I have to say that the Scottish plan, the “Hepatitis C Action Plan for Scotland”, which is now six years old, does, if I may say so gently, represent a far more comprehensive and overarching strategy than we currently have in England.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

rose—

[Stephen Pound]

On the issue of strategy, I am honoured to be joined here today by my friend and constituency neighbour, my hon. Friend the Member for Ealing, Southall (Mr Sharma), to whom I will happily give way.

[Mr Sharma]

I congratulate my hon. Friend on securing this very important debate. Does he agree that there is a large south Asian community living in the UK who, due to many cultural and other barriers, are not getting treatment? I was organising roadshows in London with the Hepatitis C Trust to raise awareness and to offer free testing. Does he agree that if the NHS and the Government take initiatives to promote free testing, people will be able to get an early diagnosis and, we hope, secure treatment?

[Stephen Pound]

I am more than delighted to give credit to the Hepatitis C Trust, which has done exceptionally good work—I have been to a number of its meetings—but also to my hon. Friend and neighbour in Ealing. His document, “The Challenge of Hepatitis C for the South Asian Community”, will be formally launched next week. I believe that the Minister has a copy; if not, I will provide her with one almost immediately. At that launch, the issues that my hon. Friend mentioned will be widely discussed and information widely circulated. It is important to realise why there is such a high prevalence of hepatitis C in the south Asian community. Bizarrely, it is a consequence of improved health provision in that area. There are parts of the world where there is virtually no formal, structured health provision and there is no hepatitis C or, if there is, it is a minute amount, brought in externally. In south Asia, the health service is increasing its outreach: more and more people are accessing it and making use of it. However, the medical advances are not keeping pace with the advances in sterile treatment and sterile methods prevailing in the rest of the world. So, bizarrely, although there is considerable health provision in south Asia, it is not quite there yet in terms of providing a sterile environment and avoiding transmission, whereas other parts of the world have not even reached that level.

Oral Answers to Questions

Virendra Sharma Excerpts

Tuesday 25th February 2014 Commons Chamber

[Jane Ellison]

That is exactly why we want to reissue the guidance on this matter. I cannot add to what I have said. I say with complete clarity that the Government’s view is that sex-selection abortion—abortion on the grounds of gender alone—is illegal and we will report it to the police if we are given evidence of it.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

16. What assessment he has made of trends in the number of attendances at type 1 accident and emergency departments since 2009-10.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

We have debated the hon. Gentleman’s concerns about the A and E services in his area in the past. I want to reassure him that, despite the overall growth in attendances at A and E—we know that there is pressure on A and E—the changes that are recommended for his area have enormous clinical support across all the local CCGs and trusts.

[Mr Sharma]

I thank the Minister for her response. Will she explain why attendances at hospital A and E departments increased by 16,000 in the last three years of the Labour Government, but by 633,000 in the first three years of this Government?

[Jane Ellison]

As the hon. Gentleman knows, we have often debated in this House the many reasons for the increased pressure on A and E. However, the rate of growth in the first three years of this Government has been lower than the rate of growth in the last three years of the last Government. We are responding to the pressures. That is why the Secretary of State has addressed issues such as named GPs for older patients and the integration of social care. We acknowledge that there is pressure on A and E; it is the action that the Government are taking to respond to it that really counts.

Health Care (London)

Virendra Sharma Excerpts

Wednesday 8th January 2014 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

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

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

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

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

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

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

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

[Glenda Jackson]

rose—

Urgent and Emergency Care Review

Virendra Sharma Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

I find it a little difficult to take a lesson from the right hon. Gentleman, as his Government cut social care funding per head when they were in power and when the economy was in much better shape than it has been since the financial collapse that they caused. If he looks at what we announced this summer, he will know that the Chancellor announced an extra £2 billion of support for the NHS budget going into social care to deal with precisely the problems that he raised.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Last week, the Secretary of State assured—[Interruption.]

[Mr Speaker]

Order. I apologise to the hon. Gentleman, but there was a lot of noise. I am sure that the House will wish to hear his question—let him start again.

[Mr Sharma]

Last week the Secretary of State assured me that A and E at Ealing hospital is safe, but since then we have heard very confusing and contradictory statements in the local area. First, will the Secretary of State reassure us today that the A and E department at Ealing hospital is safe in the future? Secondly, will he meet me and my colleagues from the west London area—I have written to him—to discuss our concerns and so that we can express our feelings?

[Mr Hunt]

I am always happy to meet colleagues if they have concerns about what is happening in their constituency, but I absolutely stand by what I said. There will remain an A and E at Ealing. That was the decision that I made because I wanted to give clarity, but I also said that the shape and size of that A and E may change in accordance with the announcement that is being made tomorrow by Sir Bruce Keogh. I hope that will give the hon. Gentleman further clarity and further certainty to reassure his constituents.

Changes to Health Services in London

Virendra Sharma Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I cannot find the words to express how disappointed the residents in my constituency, and elsewhere in west London, will be on hearing the statement. We are not clear about what will happen to Ealing hospital. You are not clear in your statement, before the final decision is made, about the range of services that will be provided from Ealing and Charing Cross hospitals. What work will be done? Will you consider or ignore, like you totally ignored the thousands of people who marched in the rain outside Ealing hospital in west London two weeks ago—

[Mr Speaker]

Order. I am extremely grateful to the hon. Gentleman, but may I just say to him that I will not be doing any of the things that he suggested? I think his inquiry was directed at the Secretary of State, rather then me. I have no responsibility for health services in London or anywhere else.

[Mr Sharma]

I apologise if I have given that impression.

[Mr Speaker]

I am obliged to the hon. Gentleman.

[Mr Sharma]

Will the—

[Mr Speaker]

Order. The hon. Gentleman has had his say and we are grateful to him.

Oral Answers to Questions

Virendra Sharma Excerpts

Tuesday 11th June 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

That is a good point, but I have to say that I am not convinced that it is just a Labour-run council that might have chosen to invest their staff pensions in this way; I strongly suspect that all political parties are guilty of this. While this is, of course, a matter for local authorities, it is also the sort of great campaigning work that MPs can do with their local councillors. It is even more important that they do that, given that they now have this great responsibility for public health.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

T3. I welcome the leading role that the Department is taking in the formulation of a national strategy for TB. Its importance was reinforced by a recent all-party group report on resistant forms of the disease. One of the key points in the report was the importance of joint working in the development of the strategy, and that it should be public health-led. Does the Minister agree that NHS England also has a crucial role to play in the development of the strategy? Will she ensure that it works closely with Public Health England to develop it?

[Anna Soubry]

The short answer is yes. I pay tribute to the hon. Gentleman for the work of his APPG. We had a good meeting in December and I am looking forward to our follow-up meeting tomorrow when we will discuss this matter further.

A and E Departments

Virendra Sharma Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I do, and my hon. Friend is right to point out that the last Labour Government closed or downgraded 12 A and E departments. The Opposition have criticised us in the press—indeed, the shadow Minister, the hon. Member for Copeland (Mr Reed), who is sitting on the Front Bench, has criticised me for not getting on and closing more A and E departments, which is what he seems to want to happen. Every time there has been a controversial reconfiguration, Labour has opposed it all the way. I think we could expect a bit more consistency from a shadow Secretary of State who was once a Health Secretary.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

About eight weeks ago, the Secretary of State made a commitment to refer the decision to close four out of nine A and E departments in north-west London. Can he tell the House why he has not kept his word?

[Mr Hunt]

It is a very important, complex and difficult decision, so I thought it was right to get independent advice from the Independent Reconfiguration Panel, and that is what I have done.

Health Inequalities

Virendra Sharma Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is my great honour, Dr McCrea, to serve under your chairmanship.

It is crucial that everyone in this country, regardless of income or location, should have access to the same level of health care; social background should not be a determinant of health. Currently, people who live in the poorest neighbourhoods will die on average seven years earlier than those in the richest neighbourhoods, and the average difference in disability-free life expectancy is 17 years between the richest and the poorest. We should be concerned about health inequalities existing on that basis, because it shows not only that we are not all in this together but that people throughout the country are unnecessarily and unfairly suffering because of their social background.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate the hon. Gentleman on securing the debate and on the work that he has done on the subject over the years. He was talking about life expectancy; in Medway, which covers three parliamentary constituencies, the difference in life expectancy between the most deprived 10% and the least deprived 10% is 9.6 years. He talked about all being in this together, but that 9.6 years did not arise in the past three years; that difference in life expectancy was present for many years under previous Governments as well.

[Mr Sharma]

I thank the hon. Gentleman for his important intervention, but we are not present as part of the blame culture. We are not debating what happened 10 years ago; we are talking about learning from the past and about how best to improve services. I am sure that the Minister will answer such questions, but I assure Members that I am not here to defend or not to defend, but to raise the issue, and to talk about what is happening in today’s terms and about why, what and how to improve.

The previous Labour Government committed themselves to reducing health inequalities. They made progress in meeting targets on infant mortality and headline indicators for life expectancy as a result of early intervention programmes and initiatives such as Sure Start. Reducing health inequalities is not only fair but makes economic sense.

[Stephen Barclay (North East Cambridgeshire) (Con)]

I am staggered by the hon. Gentleman’s statement about the previous Government making progress. The gap in life expectancy between deprived and wealthy areas widened under Labour, and there were more GPs per head of population in wealthy, healthy areas and fewer in poor, unhealthy areas. Can he explain why?

[Mr Sharma]

We are trying to avoid getting into the blame culture or blaming the previous Government. I am sure that that gap of 9.6 years or whatever was an improvement on previous years.

[Stephen Barclay]

Will the hon. Gentleman—

--- Later in debate ---

[Mr Sharma]

It is unnecessary to debate that. My point concerns what is happening today; I am not rude, arrogant or avoiding the issue, but the debate is about what is happening in the system, and the purpose is to find out what steps the Minister can assure us are being taken to improve the situation.

[Stephen Barclay]

It is worth putting it on the record that the cross-party Public Accounts Committee, chaired by a Labour Member, the right hon. Member for Barking (Margaret Hodge), looked at how in 1997 the Government were to put health inequalities at their heart and at setting targets in 2004, but those targets were not met. It is remiss of the hon. Gentleman to come to the Chamber today and to talk about the previous Government making progress when the gap in life expectancy increased, the GPs were in the wrong place and a cross-party Committee chaired by a Labour Member is saying that they failed to meet their targets.

[Mr Sharma]

I thank the hon. Gentleman for correction on that and I am sure that there are many other areas we could cover, but given the time available I want to complete my way of looking at the subject. He will have the opportunity, through the Minister, to talk about those questions.

Reducing health inequalities is not only fair but makes economic sense, as I said. Reducing such inequalities will diminish productivity losses from illness and cut welfare costs. My constituency is a diverse area with a high rate of deprivation and with about 19,100 children living in poverty. The impact on the health service is noticeable. The mortality rate is a lot higher than average, especially in the most deprived wards of the constituency. Diseases such as diabetes, coronary heart disease and tuberculosis are much more prevalent than in the rest of the country, and they are unfortunately directly related to the social inequalities in the area.

The coalition Government have shown a lack of commitment to reducing health inequalities, whether through their health policies or their socio-economic policies which will increase inequality between the richest and poorest. Through the Health and Social Care Act 2012, the Government have increased competition and opened up NHS services to tender from the private sector; if the section 75 regulations are pushed through the House of Lords tomorrow, patients with complex conditions that are perceived as less profitable will not be as readily treated by private providers. On top of that, the increase in private patients in hospitals after the lifting of the private bed cap will mean that access to beds for those who cannot afford private services will be restricted, increasing waiting times. In my own constituency, Ealing hospital will be downgraded and the A and E closed. Some of the poorest and most vulnerable people will therefore see the services that deal with their specific needs closed, and they will have to travel great distances, which they cannot afford to do, to get treatment.

Recent reviews and evidence have proved the link between health inequalities and wider social determinants such as income, employment, welfare and housing. The Government’s record gives us poor hope of progress in reducing those inequalities: fuel and food prices have gone up; increases in wages are less than those in the consumer or retail prices index, leaving people out of pocket every month; child poverty is increasing; homelessness is set to rise after the recent welfare cuts; and, as announced last week, unemployment is rising again. Those affected will only be more vulnerable to health difficulties, increasing the inequality between the richest and poorest in our society.

The Government need to commit themselves to reducing health inequalities to ensure that social background does not determine lifespan and quality of life. The previous Labour Government took some first steps towards reducing the health gap between the richest and poorest, but that progress is likely to be thwarted by the Government’s unfair policies. Can the Minister provide some reassurance from the Government that they are committed to reducing unfair and harmful health inequalities during their term?

--- Later in debate ---

[Anna Soubry]

I can say that absolutely. The hon. Member for Ealing, Southall asked whether the Government are committed to reducing health inequalities and making the sort of progress that we did not see in 13 years of the previous Government. I assure him that it is not just a question of blind intention, but an absolute fact that we have already done it.

[Interruption.] I am making a noise because I am removing the script of my speech. I am not good at following a script from my officials. They are extremely helpful, and it sometimes causes them concern that I go off script and speak off the cuff.

I am familiar with the Health and Social Care Act 2012. What the hon. Gentleman either does not know—this is not a criticism—or may have forgotten is that, for the first time ever, there is a statutory duty, not just on the Secretary of State, but throughout the NHS, to improve health inequalities. It is not a question of targets, which have not always delivered the right outcomes, and Mid-Staffordshire NHS Foundation Trust is a good example, as was identified in the Francis report. That duty is statutory so the Secretary of State and all those involved in the NHS must deliver, and the Secretary of State must give an annual account of how his work in leading the Department of Health and being the steward of the NHS in England has delivered a reduction in the sort of health inequalities that we all understand. That is there in law, but in 13 years in government, the hon. Gentleman’s party failed to do that.

[Mr Sharma]

I am not disputing the matter and, as I said at the beginning of my speech, I do not want a blame culture or to say what happened during those 13 years, but I ask the Minister to join me in my constituency on Saturday when thousands of people will march from Southall to Ealing. At the last march in September, there were more than 20,000 people, and we expect more this time. She will then know whether people believe that services have improved or got worse.

[Anna Soubry]

I am grateful to the hon. Gentleman but, with great respect, he does not understand that reducing health inequalities is not simply about saving an A and E department. I hope that, when the hon. Gentleman is marching on Saturday, he will remonstrate with anyone who has a banner saying “Fight the NHS cuts”. Whenever anyone looks at reconfiguration, they do so on the basis of how to make the service better.

Accountability and Transparency in the NHS

Virendra Sharma Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you, Mr. Speaker, for allowing me to speak in this important debate. I congratulate all those who made it possible.

In the light of the tragedies at Mid Staffordshire and Winterbourne View, it is clear that some of the mechanisms for ensuring accountability and transparency in the NHS must be reviewed. Safeguards need to be put in place to make our NHS more accountable. That means listening to the concerns of patients, heeding the advice of NHS staff, and ensuring that whistleblowers are correctly protected.

Patients have always been, and always should be, at the centre of the NHS. It is true, of course, that the discoveries made at Mid Staffordshire do not represent the typical experiences of NHS patients, and that nurses and doctors deliver great care for patients every day, but it should not be possible for the failings of Mid Staffordshire to be replicated. If such failures are to be prevented in future, patients’ voices must be heard, and patients must receive clear assistance and information about their treatment.

Figures from the national cancer patient experience survey show that only 64% of patients felt they were able to discuss their concerns and fears with staff in the hospital, and that just over 50% were given information about the financial support to which they were entitled. While the survey goes a long way towards ensuring that there is more transparency, some of those figures are worrying. A large proportion of cancer patients still feel that they are not given sufficient information, or that they are unable to relay their concerns to those who are caring for them.

We welcome the creation of bodies designed to establish greater accountability to patients and the public by giving them a stronger voice in the Health and Social Care Act 2012. However, many councils across the country are still unsure whether they will have a running local HealthWatch in coming months, or have not even signed contracts with organisations to run it. These bodies are crucial in providing accountability for NHS patients; without them, the public does not have a voice.

One of the main reasons for the failings at Mid Staffs is the existence of a culture of covering up mistakes. Those who tried to speak out were bullied, hassled and silenced. It is crucial that NHS staff are allowed to voice their opinions without fear of unjust repercussions.

The previous Labour Government made huge inroads in helping NHS staff raise their concerns and in protecting their rights. These have, however, not been sufficient. I also have to commend the Secretary of State’s timely decision to ban gagging clauses in severance agreements. However, should not the Government be making it easier for NHS staff to voice their concerns while they are still in employment? We have seen many examples of consultants, doctors, nurses and other staff who spoke out about the failings of Mid Staffs and who were persecuted and struck off for doing so, and about NHS staff who felt unsupported and bullied by their supervisors to hide their concerns.

I must mention the case of Dr Narinder Kapur, one of Britain’s leading neuropsychologists and now campaigner for fairer treatment for whistleblowers. Out of his moral and ethical responsibility as a doctor, Dr Kapur alerted the NHS of certain failures he observed within his department, such as under-qualified, unsupervised staff treating patients and putting them at risk. His dismissal by the Cambridge University Hospitals NHS Foundation Trust was ruled unfair, but he still was not reinstated. This man, who was one of the best neuropsychologists in the country and was trying to help his patients and make his hospital a better place, was left penniless and lost his home.

The Government need to do more to ensure that NHS staff who blow the whistle on unethical practices do not receive the same treatment as Dr Kapur, and are protected from such persecution. Hard-working consultants, doctors, nurses and other staff who want to make the NHS a better place should not fear for their jobs and should not be bullied by their supervisors. Patients should be assured that they have recourse for complaints and that their voices will be heard. What will the Government do to protect patients and change this culture of covering up and bullying, to ensure that we do not have another Mid Staffs and to make the NHS more transparent?

Accident and Emergency Departments

Virendra Sharma Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I beg to move,

That this House has considered the matter of the closure of accident and emergency departments.

On behalf of all my Back-Bench colleagues who wanted time to be allocated for this important debate, may I put on record my thanks to you, Mr Deputy Speaker, and to the Backbench Business Committee for today’s scheduled parliamentary time? The closure of accident and emergency departments is a national issue and one that has profound impacts on the current and future provision of health care across the country. Concerns about the A and E closures and accompanying hospital reconfigurations have been voiced by members of all political parties including Back Benchers and Front Benchers on both sides of the House, so it is crucial that we have this debate.

Weighty decisions are being made about A and E closures across the country by NHS bureaucrats, under the guise of localism and clinically led decision making, without the democratic accountability that is vital for decisions of such importance. In order to bring these decisions to the Secretary of State for Health, local council scrutiny panels have to refer such decisions to the independent reconfiguration panel, which then reports its findings to the Secretary of State. Why are primary care trusts in their dying days making such critical decisions and not clinical commissioning groups? It is vital to have democratic accountability for these decisions and, although it is not sufficient, this debate will shine some much-needed light on these huge decisions that will have profound impacts on all our constituents. I am pleased that the Government have belatedly announced a national review of A and E services, but I am horrified that the review is planning to report by March this year. This is being done in an obscene rush, and it cannot be the considered review that we need.

There are proposed and actual A and E closures in my constituency and in those of other hon. Members. It is clear that this is an NHS-wide change that will affect every constituency in the land. The NHS needs to change and be fit for purpose in the 21st century, and I am not saying that there must be no change. Clearly, we have to provide health care in changed ways, but I am concerned about the pace of change, the impacts on the poorest and the financial drivers of the changes. The financial drivers are clear. The Nicholson challenge means that the NHS is seeking to cut spending by £20 billion by 2014-15.

[Margaret Hodge (Barking) (Lab)]

Does my hon. Friend agree that the care of patients must be at the heart of any changes in the NHS, and not finance? In my part of London, there is a proposal to close the A and E at King George hospital, but it would be madness to do so at a time when Queen’s hospital in Romford has far too many A and E patients and when a Care Quality Commission report has just condemned the quality of care for people who visit that A and E unit.

[Mr Sharma]

I thank my right hon. Friend for putting that case so strongly. I do not think anyone—inside or outside the House—would fail to agree with that suggestion.

In North West London NHS, the proposal translates into a £1 billion cut to budgets over the same time scale. The medical director of North West London NHS said that it would

“literally run out of money”

unless the closures proceeded. The scale of change driven by this financial pressure is unacceptable. It is targeting the poorest and most vulnerable, and it is unfair on the hospitals that have been financially solvent. That last point was graphically illustrated last week at Lewisham hospital, whose A and E was unjustly proposed for closure because of a neighbouring trust’s financial insolvency. That brought tens of thousands of incensed protesters on to the streets.

Sadly, this is happening in Ealing, too, whose hospital is faced with losing its A and E department, yet it is financially viable and has been for many years. It is being sacrificed on account of financial problems in other neighbouring hospital trusts. This threat of closure in Ealing exists even after the Prime Minister assured me, in a response to my question, that there was no such threat.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Although this is a debate about the closure of A and E departments across the country, does my hon. Friend accept that it seems particularly unfair that London, with nine accident and emergency departments apparently set for closure, is being hit so hard in losing vital NHS services?

[Mr Sharma]

I agree with my hon. Friend, and I shall definitely cover that point later in my speech.

As in Lewisham, the people of Ealing took to the streets in huge numbers last autumn in protest at the proposals from North West London NHS whereby if the preferred option A is chosen on 19 February, it would mean the closure of four A and E departments in west London: in Ealing, Central Middlesex, Charing Cross and Hammersmith hospitals. The campaign to save our hospitals has been broad and deep, bringing together MPs and councillors of all political parties, and organisations and individuals from all segments of society.

[Martin Horwood (Cheltenham) (LD)]

I am concerned about the future of the emergency department at Cheltenham general hospital. It is not exactly in the same situation as London, but it lies in reasonably close proximity to the Gloucestershire Royal hospital down the road in Gloucester. The consultants and trust management in Gloucestershire tell me that their problem is not financial but the number of consultant posts and more junior medical posts that they can fill, and that there is a national shortage in emergency medicine. Is that a factor in the hon. Gentleman’s constituency, too?

[Mr Sharma]

I disagree with that. The evidence shows that all these decisions are finance-led. It is not to do with the clinicians’ or consultants’ proposals. That may apply in the hon. Gentleman’s constituency, but I can assure him that it is not true of west London.

My hon. Friend the Member for Ealing North (Stephen Pound) will join us later and the hon. Member for Ealing Central and Acton (Angie Bray) will speak later, too. I thank them for their support for our campaign. I would also like to acknowledge the tremendous efforts of my hon. Friend the Member for Hammersmith (Mr Slaughter), who would be in his place here were it not for his Front-Bench duties in the Justice and Security Public Bill Committee. Back in June, when North West London NHS announced its plan to close four of our A and Es, my hon. Friend organised a public meeting, which gave rise to the Hammersmith “Save our Hospitals” campaign. He has been at the forefront of the community campaign in his own constituency and has been instrumental in organising MPs of all parties to come together for this debate. He asked me to mention particularly the threat to Charing Cross hospital, which will lose not merely its A and E but 500 in-patient beds, turning a world-class hospital into a local urgent care centre.

My hon. Friend would have reminded us that this is the second time he has defended Charing Cross from closure. He stands now with his constituents, as he did in the last century during the dark days of John Major’s Government, holding a candle for Charing Cross at its Sunday evening vigils. That light did not go out, and I am sure it will not be allowed to go out now.

Let me now raise some of my specific concerns—as well as welcoming you to the Chair, Mr Deputy Speaker. I have very grave concerns about the way in which the consultation was carried out in north-west London. It was carried out over the Olympic summer months, with an impenetrable document of 80-plus pages and a response document with leading questions that set community against community, doctor against doctor, and hospital against hospital. There were also significant parts of the consultation period when no translated materials were available for many of my constituents who speak various community languages. That was totally unsatisfactory.

Notwithstanding those difficulties, some people in Ealing were able to complete the consultation and overwhelmingly rejected the preferred option that means the closure of Ealing’s A and E, maternity, paediatric and other acute services, and the closure of Central Middlesex, Hammersmith and Charing Cross A and Es. Moreover, a majority of respondents across the whole of north-west London rejected the fundamental premise of the proposed changes—that acute services should be concentrated on fewer sites. I fear that such an inconvenient consultation response will be ignored and ridden roughshod over.

Equally, I fear that the clinical opinion of Ealing’s GPs and hospital consultants who opposed the preferred option will be ignored, despite this being one of the Government’s four tests for such reconfigurations. The clinical concerns are real and should not be brushed over. Let me address some of the key concerns.

First, the scale of change being proposed in north-west London and the associated risks of such large-scale changes is causing great concern. Taking out in one go four of nine A and Es that serve a population of 2 million—set to grow continually over the next 20 years —is a high-risk strategy. Concerns over A and E capacity are growing, as hospitals up and down the country say that their A and Es are full and that they are putting patients on divert to other hospitals. This has happened recently at Northwick Park hospital—one of the hospitals that Ealing patients are meant to be treated at if the four A and Es close. If these proposals go through, yes, there are plans for some increased investment at both Northwick Park and Hillingdon A and Es, but there are well over 40,000 patients a year using Ealing hospital’s A and E alone, in addition to those currently attending Central Middlesex, Charing Cross and Hammersmith—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I think the hon. Member was told that he had a 10-minute limit imposed on him, as applied in the previous debate. Sadly, however, his time is up. If he wants to make a concluding remark, however, I think the House would allow him to do so.

[Mr Deputy Speaker]

We will give the hon. Member two minutes to conclude.

[Mr Sharma]

Thank you very much, Mr Deputy Speaker.

Let me finally say to the Minister that there should be a moratorium on all A and E closures until a proper, considered and full review of A and E services has been carried out, as opposed to the current rushed review. I hope that the Minister will listen.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am extremely grateful to you, Mr Sharma, for your understanding.

From now on, Back-Bench speeches will be limited to eight minutes.

--- Later in debate ---

[Stephen Lloyd]

The key difference is that the coalition Government ring-fenced it whereas the Opposition were considering a 20% cut—that is quite substantial.

Four reconfiguration tests were designed to build confidence among patients and communities as well as within the NHS. The right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) has already listed them, so I do not need to repeat them. In Eastbourne, my local hospital is run by East Sussex Healthcare NHS Trust, which also manages the Conquest hospital in Hastings. Last year, it consulted on the provision of orthopaedics, general surgery and stroke care in East Sussex. In my view and that of the cross-party Save the DGH campaign group, led by our remarkable and hard-working chair Liz Walke, it was clear from early on that the trust’s aim was to remove core services from my local hospital, the Eastbourne district general hospital, irrespective of the consultation.

This was not the first time the trust had tried to remove core services from Eastbourne. Only five years earlier it had tried, unsuccessfully, to downgrade our maternity services. At the time the trust claimed that that would provide safer and more sustainable services for the people of East Sussex. However, after much local opposition the independent reconfiguration panel found against the trust’s proposals, so when my local hospital trust again consulted on health services in East Sussex, my constituents and I were very worried. I was uneasy, as so many local clinicians started to share with me confidentially their deep concerns about the trust’s proposals.

I reassured constituents that we were in a stronger position than last time because the coalition Government had shown their commitment to the NHS by ring-fencing the NHS budget at a time of deep financial constraint. In addition, the Prime Minister and the then Health Secretary, the current Leader of the House, had continually stated that the NHS would be led by the public and clinicians, and to ensure this they had introduced the four reconfiguration tests that were mentioned earlier.

Imagine my horror when, just before Christmas, my NHS hospital trust had its proposals confirmed by the East Sussex health and overview scrutiny committee and was given the go-ahead for its plan to remove emergency orthopaedics and emergency and highest-risk elective general surgery from Eastbourne district general hospital and site them only at the Conquest hospital in Hastings, as much as 24 miles from some of my constituents.

The consultants advisory committee, the body which represents consultants at Eastbourne DGH, conducted a confidential survey of its members’ views on the trust proposals. More than 90% of DGH consultants responded to the survey, with 97% of those respondents opposed to the proposals. I remind colleagues in the House of the four tests. A confidential GP survey was also conducted and 42 GPs in the town also opposed the trust’s plans. In addition, 36,766 local people signed a petition against the proposals.

[Mr Sharma]

Is this not the story of every trust, including Ealing and other west London hospitals, where the local consultants and GPs have totally opposed such proposals but the threat of closure still exists?

[Stephen Lloyd]

I thank the hon. Gentleman for that intervention, and I agree. My point is that the four tests look good on paper but my anxiety, which I am putting to the Minister, is that they may not be so good in practice.

--- Later in debate ---

[Anna Soubry]

I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

[Mr Virendra Sharma]

rose—

[Anna Soubry]

I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.

As part of the review’s work, it needs to consider public understanding of the best place to go for care.

Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.

I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.

My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.

I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.

I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.

[Mr Virendra Sharma]

How disappointed I am that the Minister failed—utterly failed—to address the issue—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sadly, time has defeated us.