Hospital Services (West London)

Andy Slaughter Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is a pleasure to be here under your chairmanship, Mr Gray, and a pleasure to see so many colleagues from west London, of various parties, here for an important debate that concerns us all. It is a particular pleasure to see the hon. Member for Ealing Central and Acton (Angie Bray), relieved of the cares and constraints of office and therefore able to speak. I am slightly surprised that she chose to be pushed over House of Lords reform rather than this issue, the third and fourth runways at Heathrow airport or the cuts to Sure Start, pensions and other things that are going into the next manifesto, but we all find our path to salvation. I also welcome the hon. Member for Cities of London and Westminster (Mark Field), who already adorns the Back Benches. I hope that we can see others, including the hon. Member for Chelsea and Fulham (Greg Hands), joining the hon. Member for Ealing Central and Acton soon in order to fight the appalling changes to our health service.

Members of Parliament for the north-west London NHS area represent 2 million Londoners, and I know that all of them, whether they can be here or not, are very concerned by the proposals in the consultation document, “Shaping a healthier future”, published on 2 July. I will primarily deal with that document today. I intend to confine my comments, as the debate’s title suggests, to the effect on the major hospitals in north-west London of the proposed changes. Given the time constraints and the fact that hon. Members with more knowledge of hospitals in their own constituencies are here to speak, I will deal principally with the risks to Charing Cross and Hammersmith hospitals, but I will try to put those in the wider context of what can only be called a crisis in the NHS in north-west London. That is in the light of the further decision last week to put the future of Royal Brompton hospital at risk by the closure of children’s cardiac services there and the failure by Imperial College Healthcare NHS Trust to manage waiting lists and GP referrals.

The Minister will have seen the letter that I sent last week to the Secretary of State, asking for independent intervention to rescue the health service in west London before matters get more out of hand. I will expand on that and hope that the Minister can respond positively.

The other point that I will make in opening the debate is that the consultation should not be a Dutch auction. I do not think that any hon. Member will have come here to say, “Don’t close my hospital; close his or hers.” Every hon. Member and, indeed, every member of the public I have spoken to in the past few weeks wants to challenge not the detail or options that we are offered, such as they are, but the premise that such a major downgrading of the health service is sustainable, safe or sensible. If any hon. Member here felt a moment’s relief when they saw the schedule of closures—in particular, of accident and emergency departments—and realised that their local hospital was not on it, that relief was short-lived. The question immediately arose: how will the five remaining A and Es cope with the consequence of closing four busy departments and the consequent downgrading of other hospital services?

I am pleased to see here hon. Members representing, I think, all the north-west London hospitals, not only those under threat. Neither I nor my constituents are resistant to change in the NHS or unaware of the cost pressures that it faces. Indeed, it is the Government, not us, who need to be candid about both their failure to fund the NHS and the underlying financial motivation for these proposals.

The medical director for north-west London has been admirably frank. In approving the consultation two weeks ago, he stated that the local NHS would

“literally run out of money”

if the closures did not go ahead.

[Mary Macleod (Brentford and Isleworth) (Con)]

I congratulate the hon. Gentleman on securing the debate. Does he agree that whatever the shortfall in funding in London that he talks about, more funding has gone into the NHS from the current Government than ever before?

[Mr Slaughter]

Apart from the bit of fun that I had at the beginning of the debate, I am going to stay off party politics. I think the hon. Lady knows that the NHS was rescued under a Labour Government, and knows about the increase in funding then. She will also know from articles in the press this week and last that in fact, the promise made by the Prime Minister before the election to increase funding for the health service is not being kept. [Interruption.] I therefore think that that was a bad point to make. [Interruption.]

[Mr James Gray (in the Chair)]

Order.

[Mr Slaughter]

There has already been significant change in hospital services in north-west London. That has been for clinical and financial reasons. It has involved within Imperial the centralising of services, including renal, paediatric, oncology and vascular specialisms. More of that was anticipated. Other proposals for savings have been leaking out of Imperial for the past six months. Further moves away from hospital to community or GP services were expected—but nothing on the current scale.

This review is driven by the need to cut costs and is unrestrained because the chaotic reorganisation in the NHS, for which the Minister must answer, means that there is no accountability on the part of those who are making decisions. The Joint Committee of Primary Care Trusts, itself a body artificially created to make these cuts, is neither their author, nor will it survive to see their execution.

I would like to say a little about the history of hospital services in my part of west London, the scale of the changes proposed and the flawed process under which they are being made. I would then like to summarise the emerging public and professional views on the proposals, before finally asking the Minister for his response. Given that many in the NHS see the north-west London proposals as a prototype for what will happen elsewhere, it is not satisfactory for him to disown interest. He must either justify or be prepared to criticise the loss of front-line hospital services.

Each of the hospitals now under threat has a long and distinguished history. I am afraid I am old enough to remember when Charing Cross was Fulham hospital and when Chelsea and Westminster was St Stephen’s. Hospitals have stood on the Hammersmith campus since 1905 and at Charing Cross since 1884. Originally, these were workhouse infirmaries, fever hospitals or military hospitals. They have evolved into the world-class treatment centres that they are today. I do not want to take up a great deal of time with the history, but while preparing for the debate, I did come across this interesting paragraph on the opening of Hammersmith hospital:

“Immediately on opening, there was an outcry about the cost of the…building…£261,000…and its lavishness. The vestibule was paved with mosaic and was surrounded with a dado of the most expensive encaustic tiles. The dining hall was ‘of baronial splendour’. The press dubbed it the ‘Paupers’ Paradise’ and the ‘Palace on the Scrubs’.”

I did not know the Daily Express was going in 1905, but clearly it was. I am not sure that that was a completely accurate representation of the hospital, because its annual report for 1957 illustrated a granite block—part of the last consignment to the workhouse for breaking up by the inmates of the casual ward. I do not want to give the Minister any ideas about reintroducing rock breaking for out-patients, but that does show that we have come a long way over that time.

The Minister may say that I am being nostalgic in looking at the history of Hammersmith’s hospitals or that it is evidence that change in the health service is nothing new, but that misses the point. These hospitals have grown up on their current sites and changed in response to local need. These are some of the most densely populated parts of the UK. There is intensive residential development in the area: tens of thousands of new homes are planned for the next decade. This is a population with complex health needs and high turnover. This is an area with major transport infrastructure—air, road and rail—and with risks ranging from major trauma accidents to tropical and infectious diseases.

The accident and emergency departments under threat are always busy. They are trusted by my constituents. They have evolved to work side by side with GP practices, walk-in clinics and urgent care centres. However, they work, because the level of clinical expertise available can be adapted to cases ranging from the relatively minor to the very serious. I understand the debate about having fewer major trauma centres—the trade-off between travelling further and losing critical treatment time against the quality of care on arrival. I do not think that that argument is settled, not least because of the unpredictable and congested road system in west London, but also because of the conflicting opinions as to how crucial minutes can be in reaching specialist care in different trauma cases. What is unarguable is that the vast majority of patients currently attending A and E will potentially receive a worse service. They will not be sure whether their condition merits a longer trip to a hospital that still has A and E services, or whether seeing a GP at an urgent care centre will suffice. There will certainly be confusion and delay, and overall standards in quality of care will fall.

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

I apologise for missing the first couple of minutes of my hon. Friend’s remarks. Does he accept that, notwithstanding the proposed closure programme, there is already growing concern about the length of waiting times in A and E? Many of my constituents will be worried that their wait at Northwick Park hospital A and E unit will increase as a result of this closure programme.

[Mr Slaughter]

My hon. Friend missed the point that I made at the beginning: this affects all MPs and all communities in north-west London, not only those expecting the closure of services. The closures go against the thrust of the changes in the health service over the past five to 10 years, which have seen the huge pressure on A and Es relieved by the addition of urgent care centres, not the replacement of A and Es by them.

[The Minister of State, Department of Health (Mr Simon Burns)]

rose—

[Ms Karen Buck (Westminster North) (Lab)]

rose—

[Mr Slaughter]

I give way to my hon. Friend and will give way to the Minister in a moment.

[Ms Buck]

I am grateful to my hon. Friend. He was with me when we met representatives of north-west London recently and were advised that the number of A and E attendances is rising by about 10% a year. Does he agree that, even for those of us who agree that in an ideal world, we would reduce unnecessary A and E admissions through the provision of quality care in the community, it is wrong to propose the closure of A and E units before we have a demonstrable improvement in the community facilities that would allow for that reduction in unnecessary A and E admissions?

[Mr Slaughter]

Indeed, and I will come on to that when I talk about the process and history of the closure of services.

[Mr Burns]

I rise in response to the comments of the hon. Member for Harrow West (Mr Thomas) on A and E waiting times. Would he like to tell us what the percentage standard is for A and Es and what was achieved in his trust?

[Mr Slaughter]

I am here to question the Minister, and I hope that in response he will not adopt the complacent tone that he has just shown.

[Mr Burns]

rose—

[Mr Thomas]

rose—

[Mr Slaughter]

I will not give way to the Minister again yet. I want to make some progress. We shall see what happens in a few moments, but after I give way to my hon. Friend, I really must move on.

[Mr Thomas]

I am grateful to my hon. Friend for giving way. I do not know whether the Minister’s intervention was prompted by the recent answers he gave to my parliamentary questions. He will be aware of the approximately 180,000 people who waited more than four hours from arrival in A and E to departure. Will my hon. Friend ask the Minister for an assurance in his final remarks that the figure is not likely to rise for the 2011-12 period?

[Mr Slaughter]

I am happy to trade statistics with the Minister, but the debate is not about incremental performance, but the fundamental change to services.

[Mr Burns]

I just want to inform the hon. Member for Harrow West (Mr Thomas), because he clearly does not know, that the percentage standard for A and E waits is 95% and in his trust in the past quarter it is 97.5%, which is 2.5 percentage points above the standard.

[Mr Slaughter]

I am glad that the Minister is praising the standards of health care in Hammersmith. Saving the recent problems over referrals, we are all very proud of the standard of clinical care that people receive in our world-class hospitals under a world-class trust. The subject of the debate, which I hope that the Minister will address, is the fundamental changes being wrought on that and other trusts in north-west London, which will damage the standard of medical care and the health of my constituents. He has entirely missed the point.

The headline news from the consultation launched last week is the proposed closure of both A and E departments in my constituency, along with two of those closest by: Central Middlesex and Ealing. Clearly, that is a disaster for everyone living in the area, perhaps particularly for those in Shepherds Bush, White City and Old Oak, which include some of the poorest areas in London, with low car ownership, poor health outcomes and low life expectancy. The consequences for the two hospitals however are very different. Although neither will provide emergency care for my constituents, Hammersmith will remain a specialist hospital, but Charing Cross will be reduced to little more than an urgent care centre on an otherwise vacated site. Of the 500 beds, all but 30 will be closed or moved elsewhere. One of the largest and busiest hospitals in London will effectively become a clinic.

I want to move on to talk a little about the process of the review. I want to spend time on that, because it is the reason why there is so much disquiet and so much need for external intervention. Proposals for the closure of hospitals in Hammersmith have a chequered history. In my constituency office, I have a photograph of the former Health Minister, Ann Keen, standing on a chair with a megaphone outside Charing Cross hospital, when she was head of nursing there in the early 1990s and there was a massive community campaign against the then Conservative Government’s attempt to close the hospital. That campaign was successful, as I am sure this one will be. Over and between the past two elections there were, what I can only call scurrilous rumours that Charing Cross hospital would close either wholly or in part. That substantially muddied the waters, and was done, I think, purely for electoral advantage, in that there was no substance to those rumours at the time.

The rumours resurfaced last autumn in an article on the front page of The Independent, which speculated that either St Mary’s or Charing Cross or both would close. Following that, I, my hon. Friend the Member for Westminster North (Ms Buck) and, I am sure, others, sought assurances from Imperial College trust that that was not the case, and we were given those assurances. We are now told in the documentation, which I have brought with me today and was approved by the Joint Committee of Primary Care Trusts two weeks ago, that, over the past two years, when we were being assured that there would not be closures of the type now mooted, a very close consultation was going on and we all knew about it.

To take one page from the documents, it tells me that I received five pieces of correspondence from the trust in relation to the closures, and that at a meeting in March, which I did not attend, I was represented by my hon. Friend the Member for Westminster North. She is in the room and may contradict me: I did not know about that meeting and I certainly did not authorise her to represent me at that meeting.

Although I do not rule out some of the documents having been sent to me, they are junk e-mails—I do not use the term offensively; it is accurate. They are electronic newsletters that go straight into the very efficient House of Commons spam system. If we retrieve the e-mails and look at them, we can read things like, “There will be major improvements at Hammersmith and Charing Cross hospitals in the near future.” Even the document sent on the Thursday before the decision was taken, which was hidden in another newsletter from the chief executive of the trust, did not spell out the proposals.

When we walked into the decision-making meeting at Central hall Westminster two weeks ago, we were handed a bundle of 18 volumes of documentation to look at, which I believe had been available online for two days before that—very generous. We were expected to understand and respond then. That is not consultation. We are now told that a thorough process has been gone through, in which opinion formers have been consulted, and therefore we can proceed to the public consultation. We are presented with a fait accompli. The medical director of NHS North West London, Dr Spencer, when asked whether it was worth people lobbying and petitioning as part of the consultation process, said:

“No. People are currently wedded to mediocre services. If we don’t do this then people need to realise that our hospitals will go bankrupt. We have already seen this in south London.”

That does not sound to me like open and reasonable consultation. What is taking place is a pretence of consultation.

The options are no options at all. There is a preferred option, which I am sure will be adopted, and two others. All of them involve closing the A and E department at Hammersmith hospital, and two involve closing the A and E department at Charing Cross hospital. We will get the usual farrago of road shows, boards and helpful-looking people standing around with clipboards asking for our views. I am told that there is a five-page document that will be delivered, doubtless summarising the much larger consultation document, to all households in the area. However, if someone actually wants to take part in the consultation, they either have to go online—a lot of my constituents do not have access to the internet—or request a questionnaire.

NHS North West London could not provide me with a copy of the questionnaire or indeed a copy of the consultation document for the meeting that I had last Friday. I managed to print one off the internet and Sir Humphrey would have a field day with it. Buried at question 15, it says:

“How far do you support or oppose our recommendation that we should use our high quality hospital buildings with spare space as elective hospitals?”

At question 17, it says, and this is the closest that the questionnaire comes to asking a clear question in all its 50 pages:

“How far do you support or oppose the recommendation that there should be five major hospitals in North West London?”

At the meeting where it was decided that there would be consultation, I specifically asked, “Will there be questions that people will understand? Will there be questions such as, ‘Do you agree that Hammersmith hospital’s A and E should close?’, or, ‘Do you agree that the hyper-acute centre should move?’, or ‘Do you agree that the A and E at Charing Cross should close?’” There are no questions of that kind. As far as I can see, there is no question that relates to Charing Cross hospital’s A and E department at all. The only question that relates to Hammersmith hospital says:

“All the options above include the recommendation that Hammersmith Hospital should be a specialist hospital. There would continue to be a maternity unit at Hammersmith. How far do you support or oppose the recommendation that Hammersmith Hospital should be a specialist hospital with a maternity unit?”

My constituents are supposed to take from that the fact that they are losing their A and E service. As I have said already, they are living in some of the most deprived communities in the country and many of them have English as a second language. So I do not accept that this consultation is a valid process.

I want to finish before 10 am, because I know that a number of Members wish to speak. However, I will just make two or three other points. First, there is professional opinion to consider. It is increasingly clear that this proposal does not have the support of the local GPs. At a meeting of Ealing GPs a week or so ago to which my colleagues—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—may wish to refer if they speak, there was universal opposition to the proposal from the 50 or so local GPs who were present. The only local GPs who did not oppose the process were those who are involved in it, and they abstained. I have written to Hammersmith GPs and they have expressed only questions, queries and doubts about the process in response to my inquiries.

[Stephen Pound (Ealing North) (Lab)]

Will my hon. Friend give way briefly on a point of information?

[Mr Slaughter]

Yes.

[Stephen Pound]

At that particular meeting of GPs, the voting figures, which I am sure hon. Members will want to know about, were 47 against and three for.

[Mr Slaughter]

I am grateful to my hon. Friend for that information. I had thought that the vote was 47 against, with three abstentions, but I always stand to be corrected by him.

The bodies that have supposedly devised these proposals are indeed the commissioning groups. As far as I can see, the only people supporting these proposals on a clinical level among the GP community are those who are heavily involved and who perhaps have a vested interest in relation to those commissioning groups, which of course will not take control until April next year.

It is absolutely true that, unlike some other hospital trusts, Imperial College Healthcare NHS Trust is at best acceding to this process and at worst actively supporting it. It is very clear why it is adopting that approach and why it would see the closure of two of its own A and E departments. The Imperial trust is in deep and dire financial trouble. It has a deficit of more than £100 million and the ability to close down significant services and, perhaps more importantly, to free up one of the most lucrative pieces of real estate in London—in other words, most of the Charing Cross hospital site—presumably for commercial disposal will, it believes, allow it to see its way out of its financial difficulties. Therefore, I am afraid that its opinion is coloured by that judgment.

Let me move on to discuss public opinion briefly. At 48 hours’ notice, I called a public meeting by e-mail and 250 people turned up. I also put a petition online and within a day 750 people had signed it. We have set up a consultative committee under the banner, “Save Hammersmith and Fulham hospitals”, which involves 40 concerned local residents. They have no particular political affiliation; they simply care about their local health services.

All that is but the germ of what I am sure will be the largest campaign of public opposition across west London that we have seen. There will be no safe parliamentary seats in west London if the Government pursue this course of action; there will be no limit on the opposition to the proposals, and there will be marches, petitions and protests until they are withdrawn.

I am hopeful that there will be a debate—at least a partial one—next Tuesday on the Floor of the House about children’s cardiac services, and therefore I will not spend as much time today discussing that issue as I had planned to. All I will say now is that the same body that has been involved in the proposals about my area—the Joint Committee of Primary Care Trusts—has taken the extraordinary step of recommending the closure of the children’s cardiac unit at the Royal Brompton hospital, despite knowing that there were no risks attendant on keeping it open. On the contrary, it is a world-class unit with world-class doctors and surgeons. Moreover, the JCPCT also took that step in the knowledge that a range of other world-class services at the Royal Brompton hospital—the respiratory service, the cystic fibrosis service and the neuromuscular services—are also at risk. The Royal Brompton hospital is not in my constituency, but it is used by my constituents and indeed I substantially used it myself when I was severely asthmatic in younger life. It is unthinkable that it should be put at risk by this decision to recommend the closure of services and I am glad to see that there is opposition to the review by the JCPCT from around the country.

Let me also mention the concerns that we in Hammersmith have about the Imperial trust and its use of data. I will quote from an article in last week’s Fulham and Hammersmith Chronicle, a local newspaper:

“An investigation has been launched to determine whether data recording blunders by Imperial College NHS Healthcare Trust could have cost lives. The panicked trust…realised there had been major errors in the way it handled recording files for patients referred for cancer tests earlier this year. People suspected of having cancer are required to be tested within two weeks of being referred by their GP. But Imperial found its records of this treatment path was flawed, with many incomplete, giving no indication of whether the patient was tested or not, and others duplicated.”

Furthermore, as was widely reported in the press last week, there were 25 deaths in that period in the local area that are still under investigation.

The issue of the Imperial trust’s record keeping and referrals was first raised by me in February. I know that there has been some limited improvement in clearing the backlog of cases, but it is simply not acceptable that a trust serving such a large proportion of west London’s population can continue to keep data in this condition.

That brings me to my final point, which is what I am seeking from the Minister. The Secretary of State for Health wrote to me last week and said that the consultation process

“is a matter for the local NHS.”

However, he acknowledged that

“there is an independent scrutiny and review process…which is overseen by local Health Overview and Scrutiny Committees (OSCs). OSCs have the power to refer proposals…which I am then able to pass…to the Independent Reconfiguration Panel for advice.”

I have no doubt that will happen at some stage, because there is such overwhelming opposition to these proposals from local authorities as well as from MPs and their constituents across west London. However, given the farce of this purported consultation and the way that this matter has been handled so far by NHS North West London, it would be better for the Government to act now and call off this consultation, review the proposals and engage genuinely with MPs, clinicians and local authorities in reaching a sensible set of conclusions and proposals. We are not luddites; we do not oppose change in the health service for the sake of it. But our NHS and our local hospitals are very special places. People who have used those hospitals—sometimes over generations—have a unique relationship with them. I am sure that is true. I know that the Minister is familiar with the area and has past associations with it, so he will know what I am talking about. I know that he will also be aware of my constituents’ special and particular problems in terms of complex health needs.

I ask the Government in what I hope is an open-handed spirit to look now at what is happening, not only in the Imperial trust but in NHS North West London, because this situation cannot be allowed to continue.

--- Later in debate ---

[Angie Bray]

I agree. It is always important to bear in mind the impact on families who want to visit, because that is all part of the healing process. That is an important consideration.

The consultation is not made easy when the options to choose from are buried in such a heavy document. I have concerns about how that will affect the consultation process. The consultation document is itself a barrier to participation, as it is so huge and bulky as to be virtually impenetrable.

It would be helpful if NHS North West London were to encourage the GPs that it says support its proposals to actually speak out in support of them. The public are much more inclined to listen to their doctors than their politicians—we all know that, unfortunately—and I have urged those behind “Shaping a healthier future” on numerous occasions to do exactly that. So far, however, there has been a deafening silence. If the case for change is so strong, why are we not hearing more local GPs coming out publicly in support of the recommended options?

It is, of course, important to acknowledge that the NHS is set to undergo a series of improvements. The health reforms will fully kick in in April next year, crucially putting GPs in charge of decision making. It therefore seems extraordinary that, after the lengthy process of getting legislation through Parliament, we are now seeing a last-minute, top-down reorganisation of local health care pushed through by NHS North West London, instead of waiting for the GPs to take charge.

The “Shaping a healthier future” programme is a bureaucratically-led initiative by NHS North West London. As such, I urge my neighbouring MPs to accept that this is not about Government cuts. In fact, the Government are putting extra funding into the NHS in real terms year on year, and the Conservatives were the only party to pledge to do so in their 2010 election manifesto.

[Mr Slaughter]

I entirely respect the position that the hon. Lady is speaking from today, and I accept that the NHS locally is behaving very badly. However, does she not agree that the Government must take some responsibility and that, as local MPs, we all ought to be talking to the Government as well?

[Angie Bray]

I spend quite a lot of time talking to Ministers, who have been very generous with their time on this and other issues. Finance is at the root of the problem, but I suspect that the Government have decided to make the NHS a major spending priority; rather more so than some other Departments. We have to accept that there was a problem with funding relating to NHS London for a long time before the Government took power—a point that I was going to come on to in a moment.

As I said, we were the only party to make a pledge on extra funding in its 2010 election manifesto. Furthermore, any efficiency savings do not go back to the Treasury, but are instead ring-fenced for reinvestment in the health service. The latest figures from the Department of Health show that by 2014-15, there will have been funding growth of £12.5 billion across London. The problem is that NHS North West London has been struggling in the face of a huge £5 billion or £6 billion deficit in the past five years or so.

Clearly, we cannot stand against every proposal for change. All institutions occasionally need refreshing and reforming. The key to “Shaping a healthier future” is to work with local communities to establish clinical need that works for those who use the hospitals. This clunky consultation does not do the trick. Nevertheless, I urge people to persevere and wade through the massive document. My message to the Minister is that for my constituents to have all four of their nearest A and Es downgraded is absolutely disproportionate. I hope that, should the consultation go the way that I suspect is intended, the decision will be then called in and a fairer way forward will be found.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Hammersmith (Mr Slaughter) on securing this debate, the importance of which is indicated by the significant number of Government and Opposition Members who have either taken part or listened. I also congratulate my hon. Friends the Members for Ealing Central and Acton (Angie Bray) and for Cities of London and Westminster (Mark Field) and the hon. Members for Ealing, Southall (Mr Sharma), for Hayes and Harlington (John McDonnell) and for Ealing North (Stephen Pound) on their contributions.

Before I get to the nub of the debate, it is important to pay tribute to all those who work in the NHS in north-west London, including in the constituency of the hon. Member for Hammersmith, for the selfless dedication and determination that they put in day in, day out—whether doctors, nurses, consultants, porters or ancillary workers—to ensure that the people of north-west London get the quality of care that they deserve.

I am aware of the controversy and high emotions that surround any service reconfiguration, or proposed reconfiguration, and I respect the way that hon. Members, including my hon. Friends, rightly draw the attention of the House to their concerns about aspects of the proposed reconfiguration. I should like to give a general message to all hon. Members: I urge them to engage fully in the consultations, to the best of their abilities, and make their case and argument, which can be part of the information gathering and ideas that will be considered when the consultation process ends in early October.

The reconfiguration of services is a matter for the local NHS. I hope that the hon. Member for Hammersmith agrees that that should not be dictated or micro-managed by Ministers in Whitehall. Reconfigurations are affecting local services and should be determined by the local NHS in full consultation with stakeholders within the local NHS in north-west London and the local community.

[Mr Slaughter]

Given that the medical director of the NHS, who the Minister says has to make the decision, has said that the NHS is doing this because it would be out of money otherwise and given that he has said that it would not take any notice of the consultation, does not the Minister see a role for the Government?

[Mr Burns]

First, the hon. Gentleman has unintentionally only given the Chamber half the quote. Secondly, the medical director will engage in the consultation responsibly and fully. It is—hon. Members asked about this—a full, proper and valid consultation, which is why I urge all hon. Members to take part.

My right hon. Friend the Secretary of State for Health wrote to the hon. Member for Hammersmith on 3 July—he mentioned this in his speech—on the process and the localism of the decision making, following the conclusion of the consultation, and to set out the process for service change that my right hon. Friend strengthened in 2010. For the record and for other hon. Members, I remind the hon. Gentleman of the position. The NHS in London, as elsewhere, has constantly to evaluate how services can best be tailored to meet the needs of local people and to improve the standards of patient care. The proposals in north-west London seek to do that, and the local NHS has now embarked on a full consultation with patients, the public and the local NHS. It is important to remember that no decisions have been taken.

On Monday 2 July, NHS North West London launched the full public consultation. It will last more than 14 weeks —two weeks longer than the normal period—to take into account that it spans the traditional holiday month of August. Patients, staff and the public will have the opportunity to review the clinicians’ suggestions, look at the evidence provided and have their say.

The hon. Gentleman knows that the NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to evolve, the NHS also needs to evolve. Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

As I said, the Government are clear that the reconfiguration of front-line health services is a matter for the local NHS, which knows the needs of local people and how to deliver services far better than Ministers in Whitehall. That is why we are putting patients, carers and local communities at the heart of the NHS, shifting decision making as close as possible to patients, devolving power to clinicians and removing top-down influence.

In 2010, my right hon. Friend the Secretary of State set out four tests that all proposed reconfigurations had to pass. I trust that that will help to answer the point made by the hon. Member for Ealing, Southall about the decision-making process. Reconfiguration and the consultation process that accompanies it must have support from general practitioner commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. Without all those elements, reconfigurations cannot proceed.

The health needs of north-west London are changing as its health services are increasing. The local NHS does not believe that the way that it has organised its hospitals and primary care in the past will meet the future needs of north-west London. I understand that north-west London has 8% more internal hospital space per head of population than the English average, even after excluding the specialist hospitals. Indeed, when combined with the number of beds available, hospitals in north-west London have approximately 50% more space per bed than the rest of the country. However, much of that extra space is not suitable for clinical care and costs those hospitals more money to run and maintain every day.

Under the preferred option proposed for changes to hospital services, the NHS in north-west London will invest £112 million in capital that will add capacity for expanded services, develop local hospital sites in the community and address maintenance issues. For example, I am sure that hon. Members, particularly in the Westminster and Fulham side of the area, will be acutely aware that only two weeks ago the Earl’s Court health and wellbeing centre re-opened after having £2.7 million capital invested in it to serve the local community.

Emergency services have been mentioned a lot. The quality of care and the time taken for hospitals to see and treat patients varies. A recent study showed that patients admitted at weekends and evenings in London hospitals, when fewer senior doctors are available, stand a higher chance of dying than if they were admitted during the week. Clinicians in north-west London have agreed clinical standards for emergency surgery and A and E that include providing expert consultant cover 24 hours a day, seven days a week. Therefore, patients admitted in an emergency at the weekend will have the same standard of care as those admitted on weekdays. We would like that approach to spread throughout the country. Rationalising emergency care in five north-west London acute sites will enable the NHS in north-west London to meet these standards, address service variability and save an additional 130 lives per annum, on the basis of the number of lives expected to be saved across London.

Clinicians argue that, to provide safe and effective care, they need experience of the most acute cases regularly, which means centralising services on fewer sites. A good example of that is stroke care provided in London, in respect of which significant improvements in outcomes and the quality and safety of patient care have been made. I hope that hon. Members agree that that is the right way forward.