Accident and Emergency Departments

Heidi Alexander Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has campaigned as hard as anyone in the House for more personalised and humane care for his constituents, and he is right. We need a radical rethink about the way that A and E departments work. My only hesitation in leaping to accept his suggestion of a White Paper is that that process takes a very long time. Professor Sir Bruce Keogh is in the middle of a review and I want him to be able to report back. I hope that we can get support across the House for what he says so that we can implement his solutions much sooner than that White Paper process would allow.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State may be holding on to some sort of misplaced belief that he did the right thing with regard to Lewisham. However, the High Court judgment in the summer ruled and found him to have acted unlawfully in taking the decision to slash services at Lewisham in order to solve financial problems elsewhere. Rather than wasting more taxpayers’ money in appealing against this judgment further, why will he not allow local health care professionals to determine the future shape of acute services in south-east London to meet the needs of the community and not just the needs of NHS accountants?

[Mr Hunt]

I know that the hon. Lady has campaigned assiduously and determinedly for her constituents. Even though we have different views, I hope she will understand that at every stage I have taken the decisions, often difficult decisions politically, that I think will best serve her constituents and the people of Lewisham. I accepted the advice of the medical director of the NHS that that decision on Lewisham would save a significant number of lives. That is why I took that decision. As to what we do going forward, I will continue to do what I think is the right thing for her constituents. If she does not agree with the decisions I make, I hope she will at least show greater respect for the motives behind them.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

The reasons that Robert Francis recommended statutory regulation of health care assistants were twofold. First, he wanted to ensure that people who had been involved in incidents of poor care could not pop up somewhere else in the system. Secondly, he wanted to ensure that everyone had proper training. We are going to solve both those problems, but I am not convinced that a big new national database of 300,000 people is the way to do it.

[Heidi Alexander (Lewisham East) (Lab)]

12. What recent progress his Department has made on negotiations with acute providers on the capital and revenue costs of implementing the recommendations of the special administrator of the South London Healthcare NHS Trust.

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

Decisions on funding for each individual hospital are being worked through as part of the implementation planning process, in collaboration with the Department, to ensure value for money for the taxpayer. Decisions need to ensure that capacity is available in the right place and that quality and safety are maintained.

[Heidi Alexander]

Is it true that King’s College hospital wants £109 million in capital funding alone to cover changes at the Denmark Hill site and at the Princess Royal hospital, given that in January the Secretary of State announced £73 million of additional investment for all the other hospitals in south-east London to deal with displaced patients from Lewisham? Will the Minister explain where the money is coming from? Will she also tell us whether all this will be centrally funded, or whether local commissioners will be asked to pick up the tab?

[Anna Soubry]

What I can say is that it will be centrally funded, but as to the other detail in the hon. Lady’s question, I will have to write to her with those answers. As ever, my door is open and I am more than happy to meet her to discuss it further.

Health Services (North-West)

Heidi Alexander Excerpts

Thursday 11th July 2013 Commons Chamber

[Mr Speaker]

Order. May I say to the hon. Member for Lewisham East (Heidi Alexander) that I am sure that she would not seek to use this statement as a back-door method of talking about health services in Lewisham? If she wishes to expatiate on health services in the north-west, we will hear from her.

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful, Mr Speaker.

The Health Secretary repeatedly said that changes will be made at Trafford only if the neighbouring hospitals that have to take additional patients are consistently meeting their waiting time targets for A and E. Will he define “consistently” and clarify exactly what he means by that? Will it apply to all A and E reconfigurations throughout the country?

[Mr Hunt]

We are absolutely clear that we will not proceed with A and E reconfigurations unless the outcome will be an improvement in clinical care. That applies across the country as well as in Trafford.

Accident and Emergency Waiting Times

Heidi Alexander Excerpts

Wednesday 5th June 2013 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to follow the Chairman of the Select Committee, the right hon. Member for Charnwood (Mr Dorrell).

The speech that we heard from the Health Secretary was pathetic. He spent 25 minutes making up excuses for not taking action but not telling us anything about what this Government plan to do.

When I stood for election three years ago, A and E services were not an issue on the doorsteps of Lewisham East but now, as a result of this Government’s determination to decimate services at Lewisham hospital, it is the most frequently cited concern. My constituents are at a loss to understand why, when there is such pressure upon A and E, this Government want to get rid of the full A and E service at their local hospital. This situation is not limited to Lewisham. It is happening all over the country.

[Dame Joan Ruddock]

My hon. Friend will know that on every occasion when she and I have had exchanges with the Secretary of State—it is a great pity that he has left the Chamber—he has justified the downgrade of Lewisham hospital on the basis that 100 lives across the south-east of London could be saved. We can find no evidence for that. Both my hon. Friend and I have written to Sir Bruce Keogh—I did so on 14 May—who the Secretary of State always says is the man who made this recommendation. The Secretary of State takes no responsibility.

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[Madam Deputy Speaker]

Now.

[Heidi Alexander]

I agree that the evidence on which that assertion was based is deeply spurious and a meeting with Sir Bruce Keogh, which I requested, would be very helpful to the three Lewisham Members.

The situation, as I said, is repeated all over the country. There are more people stuck on ambulances waiting to get into A and E, more people waiting longer for treatment when they get there, and this Government’s answer is to close the A and E, ask people to travel further, and tell them to go to a bigger hospital, where the queue will probably be longer. If this is not the politics of the lunatic asylum, I do not know what is.

My constituents in Lewisham have been told that their full A and E service has to close in order to bail out the hospitals down the road. The whole decision-making process has been opaque and, in my view, deceitful. It is now rightly being challenged in the courts by Lewisham council and the save Lewisham hospital campaign. But for now, my constituents still face the prospect of seriously downgraded services at their local hospital. Not only are my constituents being told that they will have to travel further in future to get to an A and E, but to add injury to insult, they are being told to go to departments where performance is generally below that at Lewisham. In 29 of the 35 weeks between the end of September last year and the end of May this year, people were seen more quickly at the A and E in Lewisham than they were at the hospitals within the South London Healthcare NHS Trust where they are now being told to go.

In the first four months of this year, ambulances were placed on divert 25 times to Lewisham hospital. They were diverted away from the very hospitals where my constituents are now being told to go. It does not take a brain surgeon to work out why 25,000 people chose to march against these proposals in January. Under no circumstances should any changes at Lewisham hospital be made unless ambulance diverts have stopped and waiting time targets in neighbouring hospitals have been met. I do not want the changes to happen at all, but surely this is the least that the Government should commit to.

The Government seem intent on blaming everyone but themselves for the crisis in A and E. They seem oblivious to the fact that the things they are doing now, such as destabilising reorganisations and the devastating cuts to adult social care, are making the situation worse. They are shutting their eyes to the problem and ploughing on regardless with a programme of A and E closures. I accept that in some places reconfiguration of hospital services will be necessary, but this process must be driven by what is in the best interests of patients. That is not what is happening in Lewisham.

The Government want to blame everyone but themselves for the crisis in the NHS. The sooner we ditch the blame game and have a grown-up debate with thought-out solutions, the better our NHS will be for it.

A and E Waiting Times

Heidi Alexander Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate.

What struck me when listening to the contributions from all parties represented in Westminster Hall this morning is the consensus that exists about the fact that we need to hear from the Government their vision for accident and emergency services. I agree entirely with the comments of the hon. Member for Cheltenham (Martin Horwood) and my hon. Friend the Member for Stretford and Urmston (Kate Green) when they say that we need clarity about how that vision is developing.

There is a fundamental tension between the centralisation of specialisms in accident and emergency services, and the desire of local people to be treated close to home. In London, there are fantastic A and E facilities in some of our central London hospitals, such as Guys and St Thomas’s hospital over the river, and yet—as hon. Members know—we equally find that hospitals in some of the outer parts of London are, frankly, either being sold off or seeing their services hugely downgraded, such as the downgrading that we are experiencing at Lewisham hospital at the moment.

Before I make some specific remarks about the situation in south-east London and some of the things that I have learned and been thinking about since we have been dealing with the issue at Lewisham hospital, I will quickly pick up on one of the other remarks made by my hon. Friend the Member for Stretford and Urmston. She talked about the problems she had experienced in extracting clear and concise information from the Department of Health about waiting times in Manchester hospitals. I, too, have asked several questions recently, not about waiting times but about the provision of health services at hospitals in London. I have simply been told that the Department does not hold that sort of information and it has been recommended that I make freedom of information requests. That is all well and good, but the public want to be reassured that Ministers at the heart of Government understand what is happening in hospitals out there and that they have an appreciation of the wider picture so that they can develop their vision of hospital services, whether they are A and E services or maternity services, but I am not sure that we feel reassured when we get such parliamentary answers that that is the case.

I will make two specific points about Lewisham hospital. Hon. Members will know that, in January, the Secretary of State for Health announced that Lewisham hospital would have a smaller A and E department, and that it would lose its maternity services. That was as a result of the trust special administration process that took place in the South London Healthcare NHS Trust, which was in huge financial difficulties. The hospitals in Woolwich, Bromley and Sidcup had a very significant operating deficit, and as a result of that we were told that the hospital down the road in Lewisham would have its services decimated. The full A and E department at Lewisham hospital will close; all blue-light ambulances will go past Lewisham hospital to other hospitals; all medical emergencies will not be able to be treated at Lewisham hospital; and yet the Secretary of State still calls it a “smaller” A and E department.

We might think that, on the basis of taking capacity out of the system at Lewisham hospital and—I should say—having to invest £37 million in other hospitals to deal with the displacement of people from Lewisham’s A and E department, everything is operating smoothly and well in south-east London. That is not the case. One in 10 people is waiting longer than four hours at hospitals that used to be part of the South London Healthcare NHS Trust, and now in Lewisham, one in 10 people is waiting longer than four hours to be treated. That was not the case in Lewisham a year ago; in March 2012, 97% of people were being treated at Lewisham hospital within four hours. So there is huge pressure upon A and E departments in south-east London.

Yesterday, I asked Lewisham hospital for information about the number of times that ambulances had been diverted to it from other hospitals. Lewisham hospital told me that, since December 2012—in the last four months—there have been 25 separate occasions when ambulances have been diverted to Lewisham. On 10 of those occasions, ambulances were diverted from the Queen Elizabeth hospital in Woolwich, and on 11 other occasions ambulances were diverted from the Princess Royal university hospital in Bromley. Those are the very hospitals that are meant to be picking up the people who will no longer be able to go to Lewisham hospital when our full A and E department goes. I seek a guarantee from the Minister that no changes will be made at Lewisham hospital until these diverts from other hospitals have stopped, and that no changes will be made until we see that, at the other hospitals I have mentioned, they are dealing with patients within a four-hour window.

I should like to make two general points about some issues that have already been touched on. There is a fundamental problem with people’s understanding of where they should go for the best possible treatment. The Government have asked Sir Bruce Keogh to conduct a review of emergency care, which is much needed and timely. I would rather the Government waited for the outcome of that review before they took decisions about hospitals such as Lewisham.

At the moment, when people are ill, they have no idea where they should go. They are faced with a plethora of places. Should they go to their general practitioner, a walk-in centre, a minor injuries unit or an urgent care centre, or A and E? It is confusing for people. If there was better information about where people can get the most appropriate treatment, potentially people who do not need to be in A and E would not go there. I do not criticise people for going to A and E, because they know that they will get treatment there and will be dealt with—hopefully—quickly. We cannot expect them to understand all the intricacies of what is available elsewhere. That fundamental problem needs to be addressed.

The Government are making the situation worse in Lewisham, when they say that Lewisham will retain a smaller A and E. On the day that the Secretary of State made that announcement, I said to myself, “What is a smaller A and E? What will happen there?” I am not the only one who is concerned about this. On 21 February, the president of the College of Emergency Medicine, Mike Clancy, tweeted:

“We have raised questions about the lack of clarity”—

with regard to Lewisham hospital—

“and that what’s proposed doesn’t meet our definition of an”

emergency department. Even the CEM is saying that the Government are making this more confusing for people. The way that the whole process has been dealt with has been quite deceitful and potentially dangerous. Telling people that there is a smaller A and E when it will be nothing more than an urgent care centre has potentially serious implications.

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

I am sure that the hon. Lady is not suggesting the Secretary of State was in any way deceitful.

[Heidi Alexander]

I said that the whole process was deceitful and potentially dangerous. A legal challenge about Lewisham is under way. We have to await the outcome of that to see what the future holds for Lewisham. I stand by my remarks. The process was not really open from the outset.

My final point has already been mentioned. We need to work out exactly how we stop people going into A and E who do not need to be there. Yesterday, I was at my grandmother’s funeral. For a number of years, she had been very poorly and was a frequent attendee at her local hospital. Several times when she turned up there, she did not really need to be there. She was a poorly, lonely old lady. If we are to address the number of people who present at A and E when they do not need to be there, we must find proper ways of caring for people well and with dignity, especially towards the end of their lives, in the community. The problem at the moment is that we are trying to reduce the availability of A and Es in local areas when we do not have alternative care in place to stop people having to rely on A and E as the last resort.

I am grateful for the opportunity to speak in this debate. Again, I congratulate my right hon. Friend the Member for Cynon Valley on securing the debate. The availability of high-quality local health services matters to everyone. It will be interesting to hear what the Minister says about how she is going to address those important issues.

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[Grahame M. Morris]

I did not vote for the NHS reorganisation; I spent 40 sittings in Committee trying to resist what is now the Health and Social Care Act 2012 and the damaging changes it introduces. That includes those that are about to be implemented under section 75, on the introduction of competition, which will fragment the service and add to costs and complexities. I do not, therefore, accept the hon. Gentleman’s criticism, but I will press on because I want shortly to raise a couple of issues specifically about County Durham.

Part of our responsibility is to hold Ministers and, indeed, the Prime Minister to account. On waiting times—this was one of his five guarantees—he said:

“We will not lose control of waiting times—we will ensure they are kept low.”

Other Members have quoted the King’s Fund and patient surveys, and the figures clearly show that 32 foundation trust hospitals, out of 88 acute trusts in England with an A and E unit, missed the target in the last three months of 2012. I am not sure whether Kettering was one of them, but those figures should be cause for concern for everybody, including Ministers and the Prime Minister. That is double the number of trusts that missed the target in the same period last year, and four times the number that missed it in the previous quarter.

It is therefore clear that A and E waiting times are spiralling out of control. There have been various surveys, including one conducted by the Care Quality Commission, which found that one in three people spent more than four hours waiting for treatment. It also noted a large rise in the number of patients waiting for 30 minutes or more before seeing a doctor or a nurse.

In my area, The Northern Echo is campaigning on this issue, highlighting the alarming rise in the number of patients in the north-east waiting more than four hours for treatment. That number has almost trebled in the past 12 months. The paper has disaggregated figures from the Department of Health and found that more than 1,000 patients have waited longer than the target time, including 536 in County Durham and Darlington. Compared with 12 months ago, the number of patients waiting more than four hours has increased by 200% in County Durham and Darlington. South Tees and York have also seen increases in excess of 200%, compared with the previous year. However, at the Newcastle foundation trusts, the percentage increase is a staggering 630%. Alarm bells should be ringing for Ministers, because those figures are quite dreadful.

I was concerned by the Secretary of State’s responses at Question Time. One disturbing characteristic of this Government is that they are not taking responsibility or coming forward with proposals to address these issues. Specifically, in response to a question from my hon. Friend the Member for Manchester Central (Lucy Powell), the Health Secretary said:

“We are looking at the root causes of the fact that admissions to A and E are going up so fast”

—I think he quoted a figure of an additional million. The factors he blamed were that

“there is such poor primary care provision…changes to the GP contract led to a big decline in the availability of out-of-hour services…and…health and social care services are so badly joined up.”

He added:

“That is how we are going to tackle this issue”.—[Official Report, 16 April 2013; Vol. 561, c. 168.]

That really is not good enough. Indeed, Dr Laurence Buckman, who is chair of the British Medical Association’s General Practitioners Committee, has been quite dismissive and scathing about the Health Secretary’s decision to blame the increase in A and E numbers on the changes to GP contracts. He said it was “impressively superficial”—[Interruption.] Well, that is what the man said, Minister. He said that the decision was not based on any evidence. He went on to say:

“Most GPs were not providing personal access out of hours anyway; it was provided through a variety of out-of-hours routes and that has been the case for the past 30 years, so it would be nonsense to suggest that because GPs haven’t been personally responsible since 2004, therefore casualty is full of people. That is just such fatuous nonsense. I question the wisdom of the people briefing the Secretary of State.”

I tend to agree with him.

There is no magic bullet. With a complex organisation such as the NHS, we need a broad-spectrum antibiotic; we need to apply a number of measures. The fragmentation of the service is certainly contributing to the problem. There is also the issue of people not having access to their GP within 48 hours. Like many Members, I have, unfortunately, had experience of close family members and constituents being left with little alternative but to go to A and E, when the GP could have addressed the issue, had they been available in a reasonable period. This issue therefore requires a team effort.

I am also concerned about what the RCN is saying about the reduction in the number of community and district-based nurses, and I hope the Minister will refer to that. Information provided through freedom of information requests shows that the number of nurses in communities who are part of the rapid emergency assessment and co-ordination teams and the rapid response teams that help to keep elderly people, in particular, out of hospital, has been dramatically reduced.

[Heidi Alexander]

Does my hon. Friend agree not only that there are fewer community nurses, but that those who still remain have much enhanced work loads, which means the time spent with each individual patient is reduced? That, too, causes problems with the quality of care provided in the community.

[Grahame M. Morris]

That is certainly a factor, and I thank my hon. Friend for raising that issue. Part of the solution is a more visionary approach and a care model that integrates NHS services with social care in a seamless service. We need to end the fragmentation and to have full co-operation. We do not want people—particularly elderly patients—to be discharged from hospital, only for their cases not to be followed up by social care or primary health care services. That is a key challenge facing the Government. I will leave it at that.

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[Anna Soubry]

I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.

[Heidi Alexander]

Will the Minister give a commitment today that no changes will be made to Lewisham’s A and E until there are no ambulances being diverted to Lewisham hospital, and waiting time targets are met in the neighbouring hospitals?

[Anna Soubry]

I took that intervention in good faith, hoping that I might be able to assist. The hon. Lady is more than experienced and knows that I cannot give her any such assurance. She, too, talked about the provision of data in her speech. All I know is that 75% of the people who would ordinarily have gone to A and E in Lewisham will continue to go there, but she makes important points, all of which will be put in the right place.

I conclude by addressing the cause. Well, we do not know. There are various factors, but, as has been said, there is no easy answer and no silver bullet. We know that a seasonal downturn in performance in not unusual, but the dip in performance this year is deeper and longer than in previous years. One million more people—perhaps this is not understood by some hon. Members—are using A and E departments every year, and it is important that we understand why that is. We know that there are nearly 4 million more A and E attendances compared with 2004, when the previous Government carried out what I and others believe was a disastrous renegotiation of the GP contract, which has had a clear knock-on effect on access to out-of-hours services.

Immigrants (NHS Treatment)

Heidi Alexander Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is right. We have one of the most generous systems of health provision for overseas visitors of any country in the world. Most other European countries are less generous because they operate a social insurance system, which makes it much easier to collect the money that they are owed by the people who are not entitled to free care. We have to change the system here. The key thing that is wrong with it is free access to primary care, because that is the gateway into the NHS. Although primary care itself is not the most expensive part of the NHS, because of its gateway role, unless we control it, we will not get the overall system under control.

[Heidi Alexander (Lewisham East) (Lab)]

If the child of an asylum seeker who is yet to have their asylum application determined requires NHS primary care, will they still be eligible for free treatment?

[Mr Hunt]

Yes, they will.

Oral Answers to Questions

Heidi Alexander Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Speaker]

I am disappointed, but never mind. We will hear from the hon. Gentleman ere long on another matter, I feel sure.

[Heidi Alexander (Lewisham East) (Lab)]

Demand for A and E services at Guy’s and St Thomas’ and at King’s will go through the roof if Lewisham’s full A and E closes. The Secretary of State may claim that he is keeping a smaller A and E at Lewisham, but that is nothing more than dangerous spin. No blue-light ambulances will call at Lewisham under his plans, and even the College of Emergency Medicine says that they do not meet its definition of an emergency department. How on earth can the Secretary of State be so confident that other hospitals in south-east London will be able to cope once he has taken the axe to Lewisham?

[Mr Hunt]

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

Accident and Emergency Departments

Heidi Alexander Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Thomas]

Yes, and Kingston, too. Both Chase Farm and Queen Mary’s A and E have either closed already or are earmarked for closure this autumn.

My hon. Friend the Member for Ilford South (Mike Gapes) referred to the planned closure of A and E services at King George hospital in Redbridge, and Epsom and St Helier hospital in Sutton, which has also been mentioned, is also set for closure.

We have all heard about the scandal of the events in Lewisham, where doctors do not support the closure of the A and E department, but it is still going to close. I thought the whole point of the recent NHS Act was to give doctors control over service delivery. That has clearly gone out of the window now.

[Heidi Alexander (Lewisham East) (Lab)]

My hon. Friend mentioned the hospitals the Prime Minister visited before the election whose A and Es he promised to retain. Of course, in 2007 he also said that he would get into a bare-knuckle fight over the future of Lewisham hospital. Does my hon. Friend agree that the Government’s A and E policy seems somewhat hypocritical?

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[Gavin Barwell (Croydon Central) (Con)]

For the second time this week I have reason to thank you, Mr Speaker. Six minutes seems like an eternity compared with four. A number of colleagues kindly commented positively about my speech on Tuesday, but this one is going to be much less popular, particularly with the hon. Member for Mitcham and Morden (Siobhain McDonagh), and I apologise to her at the outset for that. I am going to strike a slightly different tone from that of many of the people who have spoken in the debate.

The hon. Lady mentioned the “Better Services, Better Value” review, which has been commissioned for health services across south-west London. In the final clinical report’s introduction, the clinicians involved in the review found that

“health services in south west London are not sustainable in their current configuration. In the opinion of the clinicians leading the review, no change is not an option.”

A number of points made in the review are specifically relevant to A and E departments and I wish to draw the House’s attention to them.

The review looked at the number of full-time equivalent emergency medicine consultants in each of the four A and E departments in the area and compared that with the recommended minimum number to achieve cover for 16 hours a day, seven days a week. Croydon Health Services NHS Trust should have 16 whole-time equivalent consultants, but it has 4.9. The figures for St Helier show that it should have 12 but actually has 4.5. Kingston Hospital NHS Trust should have 16 but it has 10. St George’s should have at least 16 but it has 21. So that provides clear evidence that the departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended minimum level of consultant cover.

The review says specifically:

“In London, data shows that the probability of dying as a result of many emergency conditions is significantly higher if the admission is at the weekend, compared to a weekday.”

That is because of that low level of consultant cover. It continues:

“Each year, there are around 25,000 deaths following emergency admission to London’s hospitals. If the weekend mortality rate in London was the same as the weekday rate there would be a minimum of 500 fewer deaths a year.”

[Heidi Alexander (Lewisham East) (Lab)]

How does the hon. Gentleman know that those different mortality rates that he cites are down to less consultant cover at weekends and are not, for example, the result of a sicker population entering A and E at weekends?

[Gavin Barwell]

The honest answer to the hon. Lady’s question is that I do not know. I am simply relying on the report, which is suggesting that that analysis points to 500 as the number of deaths that are purely due to the timing of the week. We could argue about the figure, but I hope that she would agree on the point of principle that having fewer consultants on at the weekend must impose some level of risk.

The report also says:

“The Royal College of Surgeons state that a critical population mass is required in order to provide an efficient and effective emergency service. This is supported by literature that suggests that surgeons who perform a high volume of procedures tend to have better outcomes. The preferred catchment population size for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency surgical cases would be 450,000-500,000.”

We have a problem. We have a large number of hospitals in London with accident and emergency departments and they do not have the recommended level of full-time equivalent consultant cover to provide the best medical outcomes. Every single Member of this House will defend their local hospital, as that is where their constituents go for treatment. If I was in the same position as the hon. Member for Mitcham and Morden, I would be doing exactly the same.

South London Healthcare NHS Trust

Heidi Alexander Excerpts

Thursday 31st January 2013 Commons Chamber

[Mr Hunt]

There is not a closure. Let us talk about maternity deaths. London has a higher rate of maternity deaths than most other parts of the country, and that is something that any responsible Health Secretary should try to tackle. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives agree that the way to reduce the number of maternal deaths, in which London does not score well, is to centralise the facilities that deal with the more complex births in fewer sites, where surgeons can get more experience and deliver better clinical outcomes. That is what this proposal is doing. It will lead to fewer maternal deaths in Lewisham and south-east London. It will also mean that, for the first time, south-east London will do something that it does not do at the moment, which is to meet the London-wide clinical quality standards. That must be the most important thing for the people of south-east London.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State’s announcement today might appear to offer something of a lifeline to Lewisham’s A and E, but it is far from the emergency and maternity services that my constituents and the people of south-east London deserve. I remain concerned about maternity services in south-east London. Between April 2011 and November 2012, maternity services were suspended 37 times in south-east London. There are 4,000 babies a year born at Lewisham. Can the Secretary of State give me an assurance that the money spent on increasing capacity for maternity services at other hospitals will be spent in the hospitals where Lewisham mums will actually go?

[Mr Hunt]

The hon. Lady is absolutely right that any change such as this has to be done extremely carefully, and we are investing an extra £36 million to expand the capacity of neighbouring consultant-led maternity services to make sure that they can cope with the extra demand, but may I urge the hon. Lady to understand the clinical rationale behind what is happening? London has halved its stroke mortality rate, because it reduced the number of hospitals treating people with strokes from 32 to eight. As a result, her constituents in Lewisham now go for their stroke treatment to the Princess Royal and King’s. That has led to fewer deaths in Lewisham and many other places. We need to do the same for high-risk pregnancies, and the Royal College of Obstetricians and Gynaecologists has established that women with high-risk pregnancies would prefer to travel a little further if that means they will get better clinical outcomes, which is what this is all about.

Hospital Services (South London)

Heidi Alexander Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful for the opportunity to hold this debate today, Dr McCrea, and I am very pleased that other hon. Members are here in Westminster Hall to take part in it.

In the two and a half years that I have been the MP for Lewisham East, I have not known an issue to cause as much anger and concern as the proposals that are currently on the table to close the A and E department and the maternity department at Lewisham hospital. I know from my colleagues, my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham West and Penge (Jim Dowd), that in the 20 or so years that they have served the people of Lewisham, they too have not witnessed such outrage and disbelief over an issue.

Lewisham is not the only place in south London where emergency and maternity services are under threat. There has been a long-running dispute about the future of St Helier hospital, and of course changes at any hospital will always impact on neighbouring areas. Patients displaced by the closure of one unit have to go elsewhere. Children who are hurt and elderly people who have had a bad fall do not disappear into thin air; they still need treatment. Mums-to-be still need somewhere to give birth. It is not possible to close and A and E department that sees 115,000 people a year and axe a maternity department in which more than 4,000 babies are born each year and not to expect other hospitals to feel the impact.

This issue affects not only Lewisham but people across south London. The real problem is that there is no free capacity in the other hospitals close by to deal with the demand for hospital services that will be displaced.

[Gareth Johnson (Dartford) (Con)]

I am grateful to the hon. Lady for giving way, and I congratulate her on securing this debate. She is making a very good point about the adverse effect that closing Lewisham hospital will have on neighbouring areas as well, especially, of course, with Queen Mary’s hospital also shutting both its A and E department and its maternity services.

Does the hon. Lady accept that the closure of Lewisham hospital will also have an impact on my constituency, including at Darent Valley hospital, with people seeking out A and E treatment or maternity services? In a hospital such as Darent Valley that already has its own capacity issues, there will be serious repercussions from closing Lewisham hospital—not only for the area that the hon. Lady represents but far beyond.

[Heidi Alexander]

I very much agree with the hon. Gentleman, and I think that there will be a ripple effect across the whole of south-east London and beyond if the A and E department and maternity services at Lewisham hospital close.

--- Later in debate ---

[Dr William McCrea (in the Chair)]

The right hon. and learned Member for Camberwell and Peckham (Ms Harman) will know that interventions must be short. Certainly, however, the point she makes is well made.

[Heidi Alexander]

My right hon. and learned friend encapsulates the issues in relation to King’s College hospital perfectly.

The fact of the matter is that millions of pounds will have to be spent at neighbouring hospitals to enable them to do the job that doctors and nurses at Lewisham hospital are already doing very well. Roughly £200 million has to be spent on making those changes happen, and that is not to mention the £12 million that has just been spent on Lewisham hospital’s A and E department.

In my view, this process is sheer madness. I do not think that there is any guarantee that money will be spent in the right places. If the predictions about where people will go after the closure of the A and E department and maternity department at Lewisham hospital are not right, we will end up spending money on the wrong hospitals. That could result in complete chaos. I cannot see the sense in the proposal, and neither can thousands upon thousands of people in south-east London.

The proposed closure of Lewisham’s A and E department and maternity department would also mean that two thirds of the building and land at Lewisham hospital would be sold off. These plans were hidden in an appendix to the initial proposals document, which was first published at the end of October last year.

I cannot overstate the opposition to these plans. More than 40,000 people have signed a petition against the closures; not one Lewisham GP is in favour of the changes; and the chair of the local commissioning group is also opposed to them. Put simply, these changes are unwanted.

[Bob Stewart (Beckenham) (Con)]

I thank the hon. Lady for giving way, and I will make a short intervention, Dr McCrea, so that I do not get a finger-wagging from you. Frankly, GPs should be in support of these changes; support from GPs is one of the conditions that is a requirement for such changes. If they are not in support of these changes in Lewisham, that is a big problem.

[Heidi Alexander]

The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.

[Jim Dowd (Lewisham West and Penge) (Lab)]

I am most grateful to my hon. Friend for giving way, and I join others in congratulating her on securing this extremely timely debate. She said a few moments ago that she did not understand where this plan had come from. Has she considered that it is merely a rehash of the scheme that NHS London tried to get past the “Picture of Health” review four or five years ago but failed miserably, both in the review itself and in the subsequent re-examination by Professor Sir George Alberti, and that in its death throes—NHS London only has a few months before it is extinguished by this Government—it is trying to get through the scheme to reduce hospitals in south London from five to four, and for no other reason than that it thinks that that reduction should happen?

[Heidi Alexander]

My hon. Friend has a long history of working and campaigning on health issues in south-east London, and I agree with his analysis that the scheme that he refers to may have been one of the places from which these proposals for Lewisham hospital emerged. I said earlier that these changes are unwanted. In addition, I want to say today that they are also unfair, unsafe and unjustified. I will now take a few minutes to tell Members why that is the case.

Why are these proposals unfair? The closure of Lewisham’s A and E department and its maternity department has been recommended to the Secretary of State for Health by the special administrator to the South London Healthcare NHS Trust. In July last year, the special administrator was appointed to the trust, which is made up of the three hospitals to the east and south of Lewisham—Woolwich, Sidcup and Farnborough hospitals. The administrator’s job was to find a way to balance the trust’s books. It was the first time that a special administrator had ever been appointed in the NHS, and the first time that the unsustainable providers regime—that is, the process for sorting out failing hospital trusts—has been used anywhere in the country.

The trust had, and still has, serious financial problems. I should be clear: Lewisham is not part of the trust; nor does it share the trust’s financial problems. Lewisham hospital is a solvent and successful hospital. Its management has worked hard during the past five to 10 years to improve standards of care and to make the hospital more efficient. Yet, because Lewisham hospital is next to the South London Healthcare NHS Trust, because it has only a modest private finance initiative, so there are not as many constraints on the site as on the two big PFI hospitals at Woolwich and Farnborough, and possibly because of its location in relation to surrounding hospitals, the special administrator decided to recommend the closure of its A and E and maternity departments.

As I said, the draft proposals were published at the end of October. There ensued six weeks of the worst public consultation that I have ever seen. There was no direct mailing to the people affected, and there were opaque and complicated questions in the consultation document. There was not even a direct question about the closure of Lewisham A and E. To add insult to injury, there was no question at all about the sale of the land at the hospital.

Not only are my constituents up in arms about the so-called consultation, but they are rightly asking how Lewisham got dragged into this. Why does it have to pay such a heavy price for financial failures elsewhere? How can it be right that a process set up to sort out financial problems in a failing trust has led to services being cut at a separate, well-performing, financially stable hospital? I cannot answer those questions; nor can I explain why such a significant reconfiguration of emergency and maternity services is being proposed.

The statutory guidance to trust special administrators and the written statement that the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), made to the House when he enacted the special administration regime last summer clearly state that the process should not be used as a back-door approach to service reconfiguration. I laughed out loud when I read those words in the statutory guidance, because that is exactly what is happening in south London. If closing A and E and maternity departments is not a service reconfiguration, I honestly do not know what is.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I congratulate my hon. Friend on securing a debate on the hospital, which my constituents share with hers. When I brought the current Secretary of State for Health to the House to answer an urgent question, he seemed to imply that, in fact, reconfiguration is a major consideration. He said that giving details at that stage

“would prejudice my duty to consider the recommendations with care and reach a decision…I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister…with respect to any major reconfigurations”.—[Official Report, 8 January 2013; Vol. 556, c. 169.]

The Secretary of State clearly does believe that reconfiguration is a major consideration. The next day, I asked the Prime Minister about the four tests, and he said:

“I specifically promised…there should be no closures or reorganisations unless they had support from the GP commissioners, unless there was proper public and patient engagement and unless there was an evidence base.”—[Official Report, 9 January 2013; Vol. 556, c. 313-14.]

My hon. Friend will agree that none of those tests is met in the trust special administrator’s proposals.

[Heidi Alexander]

I do agree, and it would be incredibly helpful if the Minister confirmed when she responds to the debate that the four tests would apply to any changes made as a result of the TSA’s recommendations.

The thing that really sticks in my throat about the proposals to shut Lewisham’s A and E and maternity departments is that they are fundamentally driven by money. If we start by saying that a process is being set up to sort out the financial woes of part of the NHS, how can people ever have any confidence that the clinical input and so-called clinical evidence that come later have not just been moulded to suit the accountants’ bottom line, which was there from the off?

I appreciate that there are financial pressures in the NHS, and I accept that it cannot be preserved in aspic for ever. For example, I support the recent changes to the way in which emergency care in London is provided for major trauma, heart attacks and stroke. However, where is the evidence that the changes on the table will result in more lives being saved and better health care overall?

That brings me to my second main point: the changes are not only unwanted and unfair but unsafe. It is proposed to replace the A and E at Lewisham with an urgent care centre. Initially, the special administrator told us that the centre would see 77% of the people who currently go to the A and E. In his final report, that was revised down to 50%. Based on an analysis of their case load, doctors at Lewisham suggest that the figure would be closer to 30%, so who is right? GPs in Lewisham, including the chair of the clinical commissioning group, suggest that the number of people who would go to an urgent care centre at Lewisham has been overestimated. They suggest that they would be inclined to send people to hospitals where they knew specialist opinion was available.

If I was a mum and my five-year-old woke up in the middle of the night in dreadful pain, where would I go? Would I go to a place that I was not sure had the appropriate staff and equipment to deal with my son or daughter, or would I go to an all-singing, all-dancing unit in central London or at King’s? I am not a mum, but I know where I would go. If people do not use the urgent care centre, the extra demands placed on neighbouring A and Es will exceed the numbers forecast in the plans before the Health Secretary. Ultimately, there may not be enough capacity elsewhere for people to be seen and to be seen quickly.

I should add to that the heroic assumptions in the proposals about reducing the need for acute care in the first place. I am all for tackling the reasons why so many people turn up at hospitals, but I know how hard it is to change people’s behaviour and to organise adequate community-based care to reduce the need for acute admissions.

[Dame Joan Ruddock]

One hallmark of the work at Lewisham hospital is that extremely important steps have been taken to integrate with community care. That is relevant for the elderly, who may have to be admitted for a short time before going back into the community, and for the young people with mental health problems, who need there to be integration between those who see them when they have an episode and those who receive them back into the community. All that will be lost if the proposals go ahead.

[Heidi Alexander]

My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.

I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.

When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.

Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.

I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.

More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.

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

Does the hon. Lady agree that the Government do not want anything at all at this stage, and that the Secretary of State has not made, and will not make, a decision until 1 February?

[Heidi Alexander]

I acknowledge that a decision has yet to be taken, and I take this opportunity to press the Minister to confirm that the decision will be taken on 1 February. If it will be taken before then, it would be useful to know. We are here to present the case for refusing the recommendation.

[Mr Nick Raynsford (Greenwich and Woolwich) (Lab)]

My hon. Friend has been making a powerful case. I want to pick up on the Minister’s interjection to the effect that no decision has yet been made and to reinforce my hon. Friend’s point that if changes as fundamental as those proposed in the trust special administrator’s report are introduced but are not safe and do not have clinicians’ true support, we run the risk of repeating the very mistakes of the last reconfiguration, which created South London Healthcare NHS Trust, and which proved not to be as financially sound as was expected when it was proposed. That is a real risk, and I hope that the Minister will pay attention to it.

[Heidi Alexander]

My right hon. Friend has consistently made that point in the House, and I totally agree.

It is a fact that maternity services in south London are under enormous pressure. In the 20 months between April 2011 and November 2012 providers of maternity services across south-east London suspended services on 37 occasions. Women in labour were therefore turned away from hospitals and told that they would have to go elsewhere. Of those 37 suspensions, 26 were necessary because of lack of beds. King’s College hospital also tried to suspend services on a further six occasions, but was unable to do so as no other unit had capacity to accept the women it was trying to transfer.

[Bob Stewart]

As the father of six children, I can tell the House from experience that nothing is more upsetting for a lady who is about to give birth than being shipped around when she tries to get into hospital. That is deeply upsetting to someone at such a fraught time in their life.

[Heidi Alexander]

The hon. Gentleman makes his point incredibly well.

Just a few weeks ago, both King’s and Woolwich were sending women to Lewisham to give birth. Women should be able to give birth at their local hospital and should not have to go to one hospital for the antenatal appointments only to have to go somewhere else to give birth. With high numbers of teenage pregnancies and a higher than average proportion of older mums in places such as Lewisham that is doubly important. The proposal for a midwife-led birthing unit at Lewisham is not a genuine option for any woman who wants to give birth safe in the knowledge that she would have back-up obstetric support if it were needed. I am told that that would not be an option for first-time mums. If I were to have a baby in two years’ time, I would not be able to go to Lewisham. The report tries to convince me that I would have greater choice, but that is just a joke.

One of my main concerns about the proposals for maternity services relates to where, and to what extent, capacity will be enhanced at other hospitals to deal with the mums who would otherwise have gone to Lewisham. The proposals before the Secretary of State assume a relatively even redistribution of women from Lewisham to King’s, the Queen Elizabeth hospital Woolwich and the Princess Royal university hospital in Farnborough. However, historically, when Lewisham women have not given birth at Lewisham, their main hospitals of choice have clearly been King’s and St Thomas’s. If more women go to those hospitals, projected births there could exceed 8,000 a year. Those would be really big maternity departments, potentially requiring a double rota of staff and consultants to deal with them. The cost of a double rota in maternity units at King’s and St Thomas’s is not accounted for in the plans before the Secretary of State.

[Jim Dowd]

On that very point, does my hon. Friend accept that the trust special administrator has deliberately manipulated the figures, in both the draft and final reports, to mask the fact that the proposal would push King’s at least and probably Queen Elizabeth hospital, Woolwich as well over the 8,000 births a year mark?

[Heidi Alexander]

I do not know whether the trust special administrator has deliberately manipulated figures, but the way that the figures have been presented looks quite suspicious.

The plans are completely unjustified. There has been much talk in recent weeks of the need for things to do what it says on the tin. The metaphorical tin with respect to the recommendations of the trust special administrator presumably says it will resolve the financial problems of the South London Healthcare NHS Trust and put the health economy in south-east London on a stable footing. I do not think the proposals before us do that. It will be necessary to spend £195 million on a one-off basis to make changes at hospitals in south London, to deal with the displaced demand for A and E and maternity care that will result from the closure of services at Lewisham. It is not clear to me where that money is coming from: which Department of Health budget is it to come from? Has the Treasury approved that non-recurrent expenditure? If it has not approved the required capital outlay, the plans fall apart. Perhaps the Minister can deal with that point.

The changes to the Lewisham site would involve demolition of the recently refurbished A and E, so that the land could be sold. Long after the A and E was knocked down, the hospital would still be paying £400,000 a year in loan repayments for the £12 million it borrowed to make the improvements. That is a bit like someone taking out a loan to do up their kitchen and knocking down that part of the house while still paying money back to the bank.

Another big question relates to the continuing year in, year out costs of the changes. The possibility of a double maternity shift at King’s and St Thomas’s, which I have mentioned, is just one example, and would surely add hugely to the bill. How much would it cost to implement a community-based care strategy to reduce the need for hospital services? Where is the money coming from?

If the proposed changes to A and E and maternity care in south-east London cannot be justified financially, do not result in better health outcomes and are unfair and unwanted, why on earth are we here to debate them today? The Government have consistently said that changes will not be made unless four specific tests are met, as my right hon. Friend the Member for Lewisham, Deptford and the hon. Member for Beckenham (Bob Stewart) have mentioned. In the present case, the tests are not met. The chair of the local commissioning group is opposed to the changes, as are virtually all Lewisham GPs. The process should result in strengthened patient and public involvement, but the current process has resulted in strengthened disillusionment among the public, and little else. Proposals should be based on a sound clinical evidence base—but the evidence base in the present case is virtually non-existent. It is also stated that the Government will not make changes to such major services unless doing so will strengthen and improve patient choice; the special administrator’s own report recognises that the proposals will result in a weakening of patient choice.

As I said earlier, the proposals are unwanted, unfair, unsafe and unjustified. Last week the NHS Commissioning Board announced a review of emergency care, to be led by the NHS medical director, Sir Bruce Keogh. I welcome that review, but what is the point of it if the Government are just going to push ahead with their proposals in south London? The chaotic handling of the process in Lewisham cannot be right. It rides roughshod over the wishes of the community and local clinicians. For the life of me, I cannot see how it is in the best interests of my constituents or the people of south London. I urge the Minister to reject these rushed and ill-conceived plans and to do as her party’s manifesto says:

“stop the forced closure of A and E and maternity wards, so that people have better access to local services”.

I am not asking for better access; I am just asking for the access that currently exists for people in Lewisham to be maintained.

--- Later in debate ---

[Anna Soubry]

Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by 1 February. As a result of that, bizarre as it may seem to those who do not know the House, I am in some sort of peculiar purdah where I am not allowed to give any opinion of my own. It might be that that is a good idea, I know not, but those are the rules and I stick by them. I am not in a place, as the hon. Member for Denton and Reddish (Andrew Gwynne) well knows, to be able to say whether or not the four tests have been satisfied or, as I have said, to give my opinion. Sometimes, it is extremely difficult for an MP such as myself not to give an opinion.

[Heidi Alexander]

rose—

[Dame Joan Ruddock]

rose—

--- Later in debate ---

[Anna Soubry]

That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.

Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.

The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.

[Heidi Alexander]

No one disputes the existence of financial problems, but the closure of A and E and maternity departments affects people’s lives and health. Will the Minister confirm that, were the Secretary of State minded to agree to the proposals put before him, the four tests set by her own Government will be applied?

[Anna Soubry]

I am happy to remind us all of those four tests and principles; they remain as firm as ever. First, any reconfiguration should have the support of GP commissioners. Secondly, there should be full public and patient engagement and proper consultation. Thirdly, there should be a clear clinical evidence base. Fourthly, any reconfiguration should be in support of patient choice.

The hon. Lady comes to the House to represent her constituents and to put forward their views, which she undoubtedly shares, and their anger and concern about their hospital. In her speech, she understandably uses the words outrage and disbelief to say that those four tests, in all or in part, have not been made. She speaks with passion and with detail about the lack of support from GP commissioners and consultants at Lewisham and beyond. She says that this is a hospital that has had many successes and a long-standing investment. She makes the point that, given all the arguments that have been advanced by her and other hon. Members, the decision clearly has no merit.

Let me mention here the interventions by the right hon. and learned Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Dartford (Gareth Johnson), the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who speaks in accord with others in support of the hospital, and the right hon. Member for Greenwich and Woolwich (Mr Raynsford). There were speeches by the hon. Members for Lewisham West and Penge and for Eltham (Clive Efford) and by my hon. Friend the Member for Beckenham (Bob Stewart).

This is a very serious subject and I do not want to be flippant. The views of all are certainly taken on board. In due course, the Secretary of State will announce his decision. Therefore, as I said at the outset, I cannot be of great assistance in addressing the various comments that have been made, because I am not allowed to give my opinion. I should, however, mention the contribution of my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes)—I think that I missed him off my list. He gave a thoughtful and frank speech in which he talked about his concerns about the legislation that brought about the appointment of the administrator. He has looked at an alternative and he advanced that.

Finally, the hon. Member for Eltham calls for a review of A and E, but he should do so with great caution. There might be merit in that, but when one embarks on such a review, we have to make it clear that, in those circumstances, some tough decisions might be made, and everyone involved in that would have to sign up to it on that basis.