South London Healthcare NHS Trust

Jeremy Hunt Excerpts

Thursday 31st January 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to make a statement on the future of South London Healthcare NHS Trust.

The NHS exists to provide patients with the highest levels of care and compassion, and it does so in a way that is more equitable than the system in any other country in the world—it provides comprehensive care, free at the point of need. But to be true to those values, different parts of the NHS need to be financially sustainable. Financial problems left unaddressed become clinical problems, not least because money used to fund deficits cannot be used for patient care. The South London Healthcare NHS Trust is the most financially challenged in the country, with a deficit of £65 million per annum.

It currently spends some £60 million a year, or 16% of its annual income, to service two private finance initiative contracts signed in 1998. For this and other reasons, repeated local attempts to resolve the financial crisis at the trust have failed. As a result, the trust is losing more than £1 million every week. In the three years since it was formed in 2009, it has generated a deficit of £153 million. That figure will rise to more than £200 million by the end of this financial year, a huge amount of money that has to be diverted away from front-line patient care.

After consulting with the trust, its commissioners and the London strategic health authority, my predecessor as Health Secretary, my right hon. Friend the Leader of the House, instituted the special administration process, which includes a period of intense local engagement. Matthew Kershaw, former chief executive of Salisbury NHS Foundation Trust, was appointed as the trust special administrator in July 2012. I would like to put on record my thanks to him and his team for his exceptionally detailed and thorough work.

Mr Kershaw had the extremely difficult task of finding a clinically and financially sustainable way forward for the South London Healthcare NHS Trust. Reluctantly, he concluded that only by looking beyond the boundaries of the trust to the wider health community could he put forward a viable solution. I support that analysis.

I received his recommendations on 7 January. Six of his seven recommendations were as follows: first, that over the next three years, all three hospitals within the trust, Queen Elizabeth hospital in Woolwich, Queen Mary’s in Sidcup and the Princess Royal in Bromley, should make the full £74.9 million of efficiencies he has identified; secondly, that Queen Mary’s in Sidcup be transferred to Oxleas NHS Foundation Trust and developed into a hub for the provision of health and social care in Bexley; thirdly, that all vacant or poorly utilised premises be vacated, and sold where possible; fourthly, that the Department of Health pay the additional annual funds to cover the excess costs of the PFI buildings at the Queen Elizabeth and Princess Royal hospitals; fifthly, that the South London Healthcare NHS Trust be dissolved, with each of its hospitals taken over by neighbouring NHS and foundation trusts; and sixthly, to aid implementation, that the Department of Health write off the accumulated debt of the trust so as not to set the new trusts up to fail, that the Department of Health provide additional funds to cover the implementation of his recommendations and that a programme board be appointed under an independent chair, reporting to Sir David Nicholson as chief executive of the NHS Commissioning Board, to ensure the changes are effectively delivered. I have accepted each of these recommendations in full.

As a consequence of what he found, Mr Kershaw also recommended that services be reconfigured beyond the confines of South London Healthcare NHS Trust across all of south-east London. This part of his recommendation included reducing the number of accident and emergency departments across the area from five to four, replacing the A and E department at University Hospital Lewisham with a non-admitting urgent care centre, reducing the number of obstetrician-led maternity units from five to four and downgrading the current obstetrician-led maternity unit at University Hospital Lewisham to a stand alone midwife-led birthing centre. Each obstetrician-led maternity units would also have a midwife-led birthing centre. The recommendation also included co-locating paediatric emergency and in-patient services with the four A and E units, with paediatric urgent care provided at Lewisham, Guy’s and Queen Mary’s hospitals. Finally, he recommended that University Hospital Lewisham should become a centre for non-complex elective procedures, such as hip and knee replacements, to serve the entire population of south-east London.

The public campaign surrounding services at Lewisham hospital has highlighted just how important it is to the local community. I respect and recognise the sense of unfairness that people feel because their hospital has been caught up in the financial problems of its neighbour. However, solving the financial crisis next door is also in the interests of the people of Lewisham because they too depend on the services that are currently part of the South London Healthcare NHS Trust. None the less, I understand their real concerns about how any changes could affect their access to vital health services. Those concerns are echoed by Lewisham clinical commissioning group and many clinicians at Lewisham hospital. I have had in-depth discussions with the hon. Members representing those affected who have reflected those concerns to me.

As a result of those concerns, I asked the NHS medical director, Professor Sir Bruce Keogh, to review the recommendations and to consider three things: whether there was sufficient clinical input into the development of the recommendations; whether there is a strong case that the recommendations will lead to improved patient care in the local area; and whether they are underpinned by a clear clinical evidence base, as set out in the third of the four tests for reconfigurations.

On the matter of clinical input, a highly experienced clinical advisory group, led by local GP, Dr Jane Fryer, and including eight trust medical directors, six clinically qualified clinical commissioning group chairs, the London ambulance service medical director, the local director for trauma and three directors of nursing, supported the trust special administrator. Further scrutiny and challenge was provided by an external clinical panel, which included representatives from the Royal Colleges of Midwives and of Obstetricians and Gynaecologists. The panel was chaired by Professor Chris Welsh, the strategic health authority medical director for the midlands and the east of England. Both groups included respected national and local clinicians. They built on years of previous work in this area and held a series of clinical workshops in August and September last year. Sir Bruce was satisfied that there had indeed been sufficient clinical input.

On the issue of better care and clinical evidence, the recommendations provide for the adoption, for the first time in south-east London, of the 2012 pan-London standards for acute care, which are the standards that all six local CCGs have said that they want to commission for emergency and maternity care. They define the best available clinical practice and set the bar higher than that provided by most other acute providers in England.

Sir Bruce agreed that the adoption of these standards could not be achieved without a reduction in the number of sites delivering acute in-patient care. Such a reduction will enable the necessary concentration of resources and senior clinical staff. A similar approach has already led to significant improvements in stroke, major trauma and cardiovascular disease services throughout London, saving hundreds of lives.

For both emergency and maternity care, Sir Bruce found no evidence that patients would be put at risk through increased journey times. The whole population of south-east London will continue to be within 30 minutes of a blue light transfer to an A and E department, with the typical journey time being on average only one minute longer. Accessing consultant-led maternity services will involve an increase in journey times on average of two to three minutes by private or public transport. Sir Bruce therefore concluded that there should be no impact on the quality of care due to the small increase in travel time.

On the issue of maternity services, the expert clinical panel advising the TSA was not willing to support the increased risk to patients of having an obstetrician-led unit at Lewisham without intensive care services. As achieving the London-wide clinical standards will be possible only with the consolidation of the number of sites with these facilities, Sir Bruce supports the proposal for this unit to be replaced with a free-standing, midwife-led unit at Lewisham hospital. This will continue to deal with at least 10% of existing activity and potentially up to 60%, and £36 million of additional investment has been earmarked to ensure that there is sufficient capacity at other sites.

Turning to the emergency care proposals, Sir Bruce was concerned that the recommendation for a non-admitting urgent care centre at Lewisham may not lead, in all cases, to improved patient care. While those with serious injury or illness would be better served by a concentration of specialist A and E services, this would not be the case for those patients requiring short, relatively uncomplicated treatments, or a temporary period of supervision. To better serve those patients, who will often be frail and elderly, and would arrive by non-blue light ambulances, Sir Bruce recommends that Lewisham hospital should retain a smaller A and E service with 24/7 senior emergency medical cover. With these additional clinical safeguards and the impact that this is likely to have on patient and clinician behaviour, Sir Bruce estimates that the new service could continue to see up to three quarters of those currently attending Lewisham A and E.

Allowing Lewisham to retain its A and E would help to reduce the level of increased demand at hospitals with larger A and E services, while an additional £37 million of investment will further expand services at these hospitals for more serious conditions. Sir Bruce advised that patients with those more serious conditions should now be taken to King’s, QE, Bromley or St Thomas’s—not for financial reasons, but to increase their chances of survival.

On the issue of paediatric care, Sir Bruce recognised the high-quality paediatric services at Lewisham and that any replacement would have to offer even better clinical outcomes and patient experience. His opinion is that this is possible, but dependent on very clear protocols for primary ambulance conveyance, a walk-in paediatric urgent care service at Lewisham, and rapid transfer protocols for any sick children who would be better treated elsewhere. He is clear that this will require careful pathway planning and will need to be a key focus of implementation.

With these caveats, Sir Bruce was content to assert that there is a strong case that the recommendations are likely to lead to improved care for the residents of south-east London and that they are underpinned by clear clinical evidence. He believes that overall these proposals, as amended, could save up to 100 lives every year through higher clinical standards.

Yesterday, 30 January, as no viable alternative plan had been put forward, and in light of Sir Bruce’s opinion, I decided to accept the recommendations of the trust special administrator, subject to the amendments suggested by Sir Bruce. It is important to be clear that my acceptance of these recommendations is conditional on Monitor approving the proposals relating to foundation trusts, and on my Department negotiating an appropriate level of transitional funding with organisations such as King’s Partners.

Owing to the size of the task, there is a significant level of risk associated with achieving the identified savings. I recognise that the additional clinical safeguards that I have put in place will marginally increase these financial risks, but on balance I have made the judgment that this is worth it if it means that local patients are reassured that they will gain from an additional better service, rather than losing their A and E.

I believe the amended proposals meet the four tests required for local reconfigurations and I am therefore content for the process now to proceed to implementation. I expect the South London Healthcare NHS Trust to be dissolved by no later than 1 October 2013. The implementation of these proposals will be challenging and complex. It needs to be planned for carefully and will not happen overnight. I call on all organisations, hospitals and commissioners to offer their full support during the coming years to achieve the ambition of these proposals for the benefit of the people of south-east London, and I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

Just when we thought this Government’s mismanagement of the national health service could not get any worse, it just has. Let us be clear about what the Secretary of State has announced today. He has at last accepted recommendations that were agreed by the previous Government but then delayed by his predecessor’s moratorium, thereby deepening the financial problems of South London Healthcare NHS Trust. And he has rejected an outrageous proposal that Lewisham hospital should lose its accident and emergency department—a proposal that never should have been made in the first place, but which has cost more than £5 million of precious NHS cash on accountants in the process, enough to give some of the 5,000 nurses who were sacked their jobs back.

But the Secretary of State has accepted the principle that a successful local hospital can have its services downgraded to pay for the failures of another trust. That takes the NHS into new territory. The Secretary of State has just crossed a line and set dangerous precedents—namely, that in his new market-driven NHS, finance takes precedence and any hospital, no matter how successful, is vulnerable to changes through backdoor reconfiguration, that success can be punished and failure rewarded, and that a community can see its A and E and maternity services downgraded without proper consultation and without clinical justification.

There will be no cheers for the statement in Lewisham and it will send a chill wind through any community worried about its hospital services. There is now utter confusion about the Government’s policy on hospital reconfiguration. In three years, they have gone from moratorium to pandemonium. Across the country, half-baked cost-driven proposals to close A and Es and maternity units are being foisted on local communities without evidence of how that can be done safely and without putting lives at risk, yet at the same time, A and Es everywhere are under severe pressure. Thousands more patients are waiting for more than four hours to be seen and there are queues of ambulances lined up outside.

In that context, it is simply not tenable to downgrade any A and E department without first establishing a clear clinical case for how it can be done without compromising patient safety, but that is what the Government are doing here. They have set up a financially driven process and thrown together a clinical justification that is not independent but drawn up in his own Department, leaving the Secretary of State’s so-called four tests in tatters. Let me remind him that the fourth test is that any proposal for change must have “demonstrable support from commissioners”. Let me quote to him the chair of the Lewisham clinical commissioning group, Dr Helen Tattersfield, who has said:

“If the TSA proceeds as currently planned it is my belief that not only will this result in a reduction of quality and provision of health services for Lewisham residents with huge risks to health outcomes but also the effective end of clinical commissioning in Lewisham.”

It is clearly the case that the proposals that the Secretary of State has announced today will lead, in Dr Tattersfield’s words, to a reduction of quality and provision in Lewisham. These changes are opposed by the doctors he promised to put in charge of the NHS, and therefore clearly fail the fourth test that he has set out.

Furthermore, is the Secretary of State confident that what he has announced today is legal? We warned him that he was going beyond the powers in the Health Act 2009. He said that he would commission fresh legal advice. Will he publish it today so that there can be a proper debate on the legal position? He mentioned PFI, but is it not the case that the schemes he mentioned were initiated and negotiated under the Major Government? He said that he had consulted South London Healthcare NHS Trust, but is it not a fact that it found out about this process from the media?

This decision will damage fragile trust in the way that the NHS manages changes to hospitals. The Government need to get back to first principles. Will the Secretary of State confirm, learning from this debacle, that in future no proposal to downgrade or close A and E and maternity services will ever get out of the starting blocks if it does not have a proper clinical case to support it?

Will the Secretary of State today issue an apology to the people of Lewisham? How on earth are they expected to have confidence in the figures he has announced from a clinical review thrown together—cobbled together —in his Department in a matter of days? He has caused huge distress to them but he has also failed to listen to them. Thousands of people have put their lives on hold to fundraise, to lobby, to campaign: 52,000 names on a petition; 25,000 people on a march. This community have rallied together to defend their local hospital, led by the fantastic efforts of the local MPs, but more than that, they have fought valiantly for every community worried about this Government’s cavalier approach to our country’s most valued institution. This community have stood up to an out-of-touch Government who think they can treat some of more deprived parts of our country with utter disdain. This community have achieved something today, but I am certain that they will continue the fight—and let me say that they will have our support. Will the Secretary of State confirm that what he has just announced takes away their right of appeal to the Independent Reconfiguration Panel? If that is the case, are they not justified in continuing the fight to stop this Government riding roughshod over the people of Lewisham and south London?

What we have seen here today is the first glimpse of the new market-driven NHS that the Government have created, where the moneymen and not the medics are calling the shots. We have seen another chapter in the unfolding omnishambles that is this Government—this one, sadly, could be entitled the Lewishambles. We have seen a scandalous waste of money on a solution that will not be acceptable to people in Lewisham—and it is not acceptable to people anywhere. The Secretary of State is asking this House to accept the unacceptable. We will not do that for Lewisham and we will not do it for anywhere else.

[Mr Hunt]

I am afraid that the shadow Health Secretary clearly wrote his response before he read my statement. Listening to him this morning, he has never sounded further away from being part of the Government-in-waiting that he aspires to be.

Let me say this to the right hon. Gentleman: the apology over what is happening in South London Healthcare NHS Trust needs to come from Labour Members, because they were the people who failed to resolve this problem over very many years. It was their party that set up two PFI deals, signed in 1998, which have been incredibly dangerous. It was their party that created a financial situation that means that £1 million every week is being bled from front-line patient care in order to fund a deficit, and that 100 lives every year are not being saved that could be saved in Lewisham and the whole of south-east London.

What I did not hear from the right hon. Gentleman was any contrition about the fact that this incredibly difficult problem was something that his Government and, indeed, he as Health Secretary totally failed to resolve. Let me remind him that the legislation that I followed actually came from the Labour party, which passed it when it was in government. He asked me to confirm that the people of Lewisham have no right of appeal to the IRP against this decision, but who was it who stripped them of that right to appeal? It was him when his Government passed the legislation. Nothing that he has said has contained a single alternative proposal to deal with this problem. If he was being responsible as shadow Health Secretary, he would have come up with just one proposal, but he did not come up with a single one or tell the House about any of his ideas.

The right hon. Gentleman talked about the pressure on A and E, but we will take no lessons from him. We met our A and E targets last year, whereas in Wales, where the Labour party is cutting the NHS budget by 8%, the A and E targets have not been met since 2009.

I am afraid that what we have heard—I hope that other contributors will strike a different tone—is a very disappointing response from the Labour party. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), who is not on the Opposition Front Bench today—perhaps this will explain why—has said that Labour would not do what she called the “easy politics” of opposing every single reconfiguration, but what we have heard this morning is easy politics from a party that closed at least 12 A and Es and at least nine maternity units while it was in office. The right hon. Gentleman needs to recognise that the responsible thing for a Health Secretary to do is that which will save the most lives, and that is what I have announced this morning.

[Robert Neill (Bromley and Chislehurst) (Con)]

My hon. Friends the Members for Old Bexley and Sidcup (James Brokenshire) and for Bexleyheath and Crayford (Mr Evennett) are on duty on a Public Bill Committee, but they wish to associate their views with my question. We thank the Health Secretary and congratulate him on taking a tough but necessary decision to deal with a mess that was not of his making and that was inherited from the Labour party. Does he accept that, thanks to the intervention of Sir Bruce Keogh’s review, more care has been taken, with both an evidence base and a consultation, than under the previous Government with regard to the reduction of A and E services at Queen Mary’s, Sidcup? Will he also help me by explaining the likely time frame for the conclusion of discussions with King’s Partners on transitional funding, which is particularly important for those of us whose constituents are predominantly served by the Princess Royal university hospital in Farnborough?

[Mr Hunt]

I thank my hon. Friend for his constructive involvement in all the discussions we have been having to resolve this difficult issue, particularly with respect to his own constituents. He is absolutely right, because in the end the things that matter most are the clinical considerations. I thought it was extremely important to take advice from the NHS medical director, Sir Bruce Keogh, and I have taken that advice. He is absolutely clear that this will save lives, which is my biggest responsibility.

My hon. Friend is also right to say that the success of these proposals depends on negotiations with King’s Partners about the potential merger that it is involved in, and we want to conclude those as quickly as possible. They are a very important part of this issue. It is our ambition to proceed as quickly as possible for the sake of the people of south London, who need certainty about the future provision of their health services, but we have some difficult negotiations to conclude in order to make that happen.

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

The only reason the proposals to close the A and E at Lewisham and downgrade the maternity services have not gone ahead in full is, of course, because of the enormous protests of over 50,000 local people and the almost total opposition of all consultants and GPs, including the GP commissioning group. Today’s proposals are an absolute sham and a shambles and utterly unacceptable to all of us who represent people in Lewisham.

Does the Health Secretary agree that, instead of allowing this rushed TSA process, which is completely unsuitable for the reconfiguration that he now proposes, he should allow the GP commissioning group to do the job for which he set it up, namely to lead a consultation process, properly, in order to understand the clinical needs of local people, whether the merger between Lewisham and Woolwich hospitals should go ahead, and to meet the real clinical needs of the local people? Will he also acknowledge that no due diligence was done in respect of the proposals, and that Lewisham hospital will need the strongest guarantees that it will not be led into a new, unsustainable trust by his proposals?

[Mr Hunt]

May I say to the right hon. Lady that a “sham and a shambles” are what I inherited and what I am dealing with, not what I am bequeathing through my announcement this morning. With respect to the GP-led clinical commissioning group in Lewisham, of course I understand its opposition to the proposals put forward by the trust special administrator, but it supports the principle that complex procedures should be done from fewer sites. That is an important point. Inevitably, when we are reducing the number of sites for complex medical procedures, the people in the areas where those procedures will no longer happen will often be opposed to the changes. That is what has happened here, but the group supports the principles behind what the trust special administrator has said.

The right hon. Lady’s concern that we are setting up a new trust that will not be sustainable is precisely why I am taking this extremely difficult decision today. Lewisham hospital has proposed that it and Queen Elizabeth hospital in Woolwich should be allowed to work out their own way of dealing with the deficit, but that was precisely the problem that happened when the South London Healthcare Trust was set up. Trusts with deficits were put together in a marriage that, in the end, failed to address those difficult decisions. My responsibility to her constituents is to address those issues and to give them certainty about the provision of their health services. Already, her constituents who have a stroke or a heart attack do not go to Lewisham hospital. They go to Tommy’s or Guy’s or other places where those specialist services can be delivered, and they get better treatment. We are expanding that principle through what I am announcing today, and it will save around 100 lives a year. That is something that she should welcome.

[Bob Stewart (Beckenham) (Con)]

I find it rather strange that a successful hospital is being slashed when others are being saved. I am particularly concerned about some of the figures on which these decisions have been made, and I really require my right hon. Friend to justify the financial figures that support this case. I am personally very worried about where babies will be born in Lewisham, and about the loss of the full A and E services there. I am not very happy about this, and I clearly do not support the closure.

[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.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

I appreciate the thoughtful way in which the Secretary of State has tried to deal with a problem that is absolutely not of his making, and I appreciate the fact that he has changed key recommendations and that there will be a continuing A and E service at Lewisham, dealing with up to 75% of the work. However, like other colleagues, I do not therefore understand why there cannot be continuing maternity care there as well, because the key point is that there should be intensive care provision on the site and maternity care services should be provided. I also say to him honestly that I have not heard of any evidence that the key fourth test—support from GP commissioners—has been passed, and I ask him to give me an assurance that no plans will go ahead until and unless the GP commissioning body in Lewisham agrees.

[Mr Hunt]

Let me take those two points in reverse order. First, on GP commissioners, all six local commissioning groups support the principles upon which these proposals were developed. To meet the London-wide clinical quality standards, which are not being met in south-east London at present, it is necessary to centralise the provision of more complex services in the same way that we have already successfully done for heart attacks and strokes. That principle applies as much to complex births and complex pregnancies as it does to strokes and heart attacks, and it will now apply for the people of Lewisham to conditions including pneumonia, meningitis and if someone breaks a hip. People will get better clinical care as a result of these changes. That is the most difficult project in all the work of the trust special administrator. The project has been to try to resolve an unsustainable financial situation while improving clinical care for the people of south-east London, and I think that, in the end, we have got a set of proposals that does that.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

The Secretary of State will be aware of the dismay with which this statement will be heard across south London. Whatever eloquent argument he advances, the people of south London will take from what he said that the maternity and A and E services at Lewisham have been downgraded.

I have had the opportunity to look briefly at the wording of his statement, and I am alarmed by the degree of risk that Sir Bruce Keogh identifies, particularly in relation to the relocation of the paediatric service. The clinical outcomes to which he refers are dependent on extremely difficult interconnections among ambulance services, receiving staff and inpatient beds, and rely on them all working effectively. He rightly recognises the knock-on effect for other hospitals, and my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Streatham (Mr Umunna) and I, together with all south London MPs, also recognise those knock-on effects. Given that King’s college hospital has seen a fourfold increase in cancelled operations since 2009-10, we are therefore very concerned about the consequences for the care of the constituents whom we represent. We are also concerned that the responsibility for the PRU, which King’s is prepared to welcome, will be properly and adequately financed.

[Mr Hunt]

The right hon. Lady talks about the risks that Sir Bruce alludes to in his analysis of the trust special administrator’s proposals. Those risks are precisely why I have not accepted the proposals in their entirety and have put in place a series of additional safeguards.

Not resolving this issue, which is effectively what the Labour party is calling for because it has put forward no alternative proposals, would carry a high degree of risk. It would mean that south London would not meet the London-wide clinical quality standards. It would mean that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit. That would be bad for her constituents and those in neighbouring constituencies.

We must look at the south-east London health care economy as a whole, but the objective must be to improve the services that people receive. That is a difficult balance to get right, but I think that we have the right balance in the proposals that I have outlined this morning.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the very difficult decisions that he has announced to the House reflect the application in south London of something that is needed across the health service—a willingness to address difficult issues, but led always by clinical evidence on how to deliver the best possible outcomes for the patients who rely on the service?

[Mr Hunt]

I entirely agree with my right hon. Friend. It would be totally irresponsible for me as Health Secretary to fail to take a decision that could save as many lives as I believe this decision will save. If we are to save more lives in A and E and reduce the number of maternity deaths in London, it involves taking difficult decisions. The disappointment for me is that the Labour party has chosen to jump on an Opposition bandwagon, rather than putting forward its own solution to deal with the clinical issues in south-east London. Unfortunately, the Opposition are playing to the gallery. That is not what a Government-in-waiting should be doing.

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

I start by congratulating the Secretary of State on admitting in his statement something that has been denied from the outset: that this is a reconfiguration. Indeed, it is a back-door reconfiguration.

I do not think that my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock), my hon. Friend the Member for Lewisham East (Heidi Alexander) and I can adequately represent the outrage and anger of the people of Lewisham at the sheer unfairness of this proposal. The Secretary of State is wrong to say that Matthew Kershaw concluded that his review needed to go wider than South London Healthcare NHS Trust; he started from that premise and said so openly at the meeting in July at the office of the Secretary of State’s predecessor.

Is the Secretary of State aware that even the maternity proposal will mean that a double rota is necessary at King’s College hospital and Queen Elizabeth hospital Woolwich, because it will increase the expected annual number of births at both units to more than 8,000? That will lead to worse services and less choice for patients. The fact that it does not have the support of local commissioners does not seem to register with the Secretary of State.

Will the Secretary of State say whether it was really necessary to spend £5.5 million of taxpayers’ money to demonstrate that his four tests are meaningless and that the guarantees and undertakings of this Tory-Liberal Government are worthless?

[Mr Hunt]

First, let me say to the hon. Gentleman that this is a reconfiguration. However, the normal processes for reconfigurations have been suspended because of legislation that was passed by the Government who were in power until 2010 and whom he supported.

The trust special administrator, Matthew Kershaw, looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but nobody was able to come forward with a proposal that would solve the problem within the geographical confines of the trust. Indeed, nobody—not the Labour party, nor any of the people who oppose these changes—has come forward with a proposal that would not impact on neighbouring health care economies.

The hon. Gentleman spoke about choice. Choice is not just about the number of hospitals that one could go to, but about the number of good hospitals that one could go to. Nowhere in south London currently meets the London-wide clinical quality standards. As a result of my decision today, the whole of south-east London will meet those standards and it will have some of the highest quality care in London for people who use A and E and maternity services.

On the cost of the process, £5.5 million is the cost of failure—the total failure of the last Government to address this issue when they could have done, rather than bequeath the highest deficit anywhere in the NHS.

[Nick de Bois (Enfield North) (Con)]

The Secretary of State recognises that Lewisham is the victim of an unfair decision as a result of failed PFI and failed finance, which were not of his making. He will recognise the striking similarities with Chase Farm hospital, which has also been downgraded because of the appalling PFI arrangements at neighbouring hospitals. He knows that I utterly oppose that decision. Given the present concerns, particularly with regard to implementation, will he meet me and a cross-party delegation to look closely at these matters?

[Mr Hunt]

I recognise how hard my hon. Friend has campaigned on behalf of his constituents and how deeply they feel about these issues. He knows that the decision has been made. We want to get the safe implementation of that decision absolutely right and I would be more than happy to meet him to discuss how we can best ensure that that happens.

[Clive Efford (Eltham) (Lab)]

The Secretary of State inherited a mess that was created by his Conservative predecessor, who abandoned the “A picture of health” process. That led to the betrayal of my constituents in respect of what they expected to come out of that process, particularly at Queen Mary’s hospital Sidcup. When he opposed “A picture of health”, the former Secretary of State said that he would decide on that closure based on what local clinicians said. In this process, it is clear that local clinicians are opposed to the closure of the A and E. Will the Secretary of State therefore say what value he places on the views of the local commissioners, who are completely opposed to what he proposes?

[Mr Hunt]

Of the six local clinical commissioning groups, five support these proposals. One group is against the proposals, but it accepts the principles behind them, including the idea that to deliver higher quality care, we must perform complex surgery at fewer sites. That will mean that more of the hon. Gentleman’s constituents have better care outcomes. I remind him that if his Government had resolved this problem when they were in office before 2010, none of us would be having this discussion today.

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

The Secretary of State has accepted all Matthew Kershaw’s recommendations. He will know that the trust special administrator recommended a substantial investment package to support the changes that he recommended, including £161 million of capital funding and £55 million of transitional funding over three years. In his statement, the Secretary of State referred to just £36 million of capital spending for maternity and £37 million for A and E. That is £73 million lower than Mr Kershaw’s recommendation. There was no reference in the statement to the transitional funding of £55 million. Will the Secretary of State confirm whether Mr Kershaw’s funding recommendations have been accepted?

[Mr Hunt]

We accept that very detailed analysis was used by Matthew Kershaw to come up with those numbers. We will look at them very carefully. However, we need to have sensitive negotiations with the new partners who will be part of making this solution happen before the final numbers are agreed on.

[Teresa Pearce (Erith and Thamesmead) (Lab)]

When modelling future need, what account did the administrator or the Secretary of State take of the fact that there will be increased health needs due to the increases in child poverty and homelessness in my constituency, as is predicted by every expert on these matters? The efficiency proposals rely to a large extent on keeping vulnerable elderly people out of hospital and caring for them in the community. Given the local authority budget cuts and the fact that some private companies that deliver those services in Bexley in my area are slashing the wages and conditions of staff, how does the Secretary of State think those services will be improved? Will he urgently review the services for elderly people to ensure that they stack up with the proposals that he has outlined today? This morning, the Secretary of State has said a number of times that these plans will save lives. I sincerely hope that he is right. If time shows that he is not right, will he resign?

[Mr Hunt]

In such matters, what a Minister does is take very seriously the medical advice they are given—I am sure the hon. Lady’s party was exactly the same when it was in power. Medical advice suggests that the way forward I am deciding on and announcing this morning will save 100 lives, and I am taking the decision on that basis. The hon. Lady would do no differently in my shoes.

For child poverty, changes in demography are taken into account in the modelling used, but the overriding priority has been to improve clinical services. That will make the biggest difference to the most socially disadvantaged people, including the frail elderly who—I agree with the hon. Lady—are often the least well served by our current NHS structures and the silos between what is done by local authorities and the NHS. I and my ministerial colleagues in government are currently doing a lot of work to break down those barriers and offer a more integrated service to the frail elderly, so as to avoid some of the problems mentioned by the hon. Lady.

[Kate Hoey (Vauxhall) (Lab)]

Surely the Secretary of State understands—even if Sir Bruce Keogh does not seem to do so—the huge effect that downgrading the maternity unit at Lewisham will have on King’s college and St Thomas’ hospitals. They are full to the seams and will not be able to cater easily for increased numbers of women. What exactly is the Secretary of State offering hospitals such as mine in terms of finance? Will he lay out clearly that this kind of merger of King’s college hospital, Guy’s and St Thomas’ and the mental health trust is not the way forward when it has been brought in from the top by those same experts who get it wrong so often, and when local people have had absolutely no involvement? In view of the disruption taking place, will he say that it is absolute nonsense for millions of pounds to be spent on consultants and business plans to bring together a huge organisation that will not be in the interests of local people?

[Mr Hunt]

On the merger, may I gently point out that I want to follow the hon. Lady’s advice if she is against people deciding things from the top down. It is for local trusts to negotiate such things, and they must do so on the basis of what is in the clinical interest of the population they serve. I will not be a Secretary of State who steps in and stops those things happening, unless they amount to a reconfiguration, in which case procedures are in place that require proper democratic support for any changes.

On the changes to maternity provision in Lewisham, we have allocated £36 million to expanding the capacity at those other hospitals that will take on more complex and high-risk births as a result of the proposals, and we will work closely with those trusts to ensure that that capacity is in place. I agree with the hon. Lady that it is extremely important for such work to be done in a meticulous way so that we get the better clinical outcomes we want as a result of what I am announcing today.

[Mr Kevin Barron (Rother Valley) (Lab)]

I sat on the Health and Social Care Bill Committee. The principle in that Bill, which became an Act last year, was that clinicians will be in charge. The lead clinical commissioner has said that this downgrading would pose a huge risk to health outcomes in Lewisham. How does that square with the provisions of that Act passed in this House last year?

[Mr Hunt]

Clinicians and commissioners have been closely involved in these proposals which, as the right hon. Gentleman will know from reading my statement, affect the broader south-east London area covering six clinical commissioning groups. Five of those groups support the proposals. One does not, but it supports the principles behind them, which is that more complex procedures must be carried out on fewer sites. We have had the benefit of the clinical input of senior people such as Sir Bruce Keogh, and many of the royal colleges have been involved in the external clinical advisory group, which had significant input on the proposals. One question I asked Sir Bruce was whether there had been sufficient clinical input, and his conclusion was that yes, there had been.

[Jim Dowd]

All paid for.