Oral Answers to Questions
Linda Riordan Excerpts(9 years, 4 months ago)
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Norman Lamb
I am happy to make sure that we liaise properly with the devolved Administrations and it is important for officials on both sides to ensure that the language is as clear as possible across the United Kingdom.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
8. What the clinical reasons are for plans to close Calderdale Royal hospital A and E department.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
There are no plans for the closure of A and E at Calderdale Royal hospital.
Mrs Riordan
Calderdale and Huddersfield NHS Foundation Trust failed to give one clear recommendation for closing a 24-hour A and E service in Halifax in its business plan. Is that simply because there aren’t any?
Jane Ellison
The hon. Lady and I have debated this topic before on the Adjournment. This is a locally led process. Nothing has been ruled in or out, no decision has been made, and first and foremost comes the safety and efficacy of local health services. May I commend to the hon. Lady the approach of her constituency neighbour, my hon. Friend the Member for Calder Valley (Craig Whittaker), who at all times has championed the best outcomes for his constituents’ health, rather than seek to make politics out of this?
Health Services (Halifax)
Linda Riordan Excerpts(9 years, 5 months ago)
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Mrs Linda Riordan (Halifax) (Lab/Co-op)
I am delighted to have secured this debate on health services in Halifax, and I will focus particularly on the proposal to close the accident and emergency department, which is the most important issue that has faced Halifax since the banking crisis of 2008. The axe hanging over Calderdale Royal hospital has been handled in the most underhand way. People have been left in the dark over the future of the services they need and value the most. That is simply not acceptable.
I hope that today’s debate will shed some light on what is taking place. I also place on record the excellent health care staff that we have in Halifax, and the nurses, doctors, consultants, clinicians and everyone in the NHS wider health family who do a superb job in difficult circumstances. That is why, as Healthwatch Calderdale has found, although it is sometimes difficult for patients to get an appointment with their GP, the clinical treatment administered by GPs in the district is good and makes a positive contribution to residents’ health in the area. It is, however, the future of A and E that has caused most worry and concern in the town, and the Government, the clinical commissioning group, and the trust’s approach to the whole debate has been lacking in openness and transparency.
I will focus on three key areas in my speech: the funding of health services in Halifax; the so-called consultation and engagement process; and the future of A and E. Those factors tie the whole debate together and I hope that today, the Government can at least provide me and my constituents with some answers in those important areas.
Let me set out briefly the background to the case. Calderdale Royal hospital opened in 2000 thanks to investment from the then Labour Government. It was a new, modern hospital to serve communities across Halifax and Calderdale. There were concerns at the time that the new hospital might not have enough capacity—it did, although that is rather ironic when we consider the arguments and debates that are used to justify the closure of A and E in Halifax. Any problems back then have been overcome, and the hospital has proved a real success story.
The hospital serves communities across Calderdale, and right across to the Lancashire border to the west. It is estimated to have a catchment area of nearly 200,000 people—some as many as 30 miles away. We are talking not about a small, rural hospital, but a major health centre in the heart of an urban area. Why does that matter? It matters simply because it underlines the importance of the hospital services, including A and E, to thousands and thousands of my constituents. The hospital is at the heart of local health services and needs. That is a reason to invest in health services in Halifax, not to cut them; to keep wards open, not close them; to protect A and E, not put it on a life support machine, its future clouded in doubt, with Ministers and the clinical commissioning group playing for time to deal with the issue post the general election in 2015. Questions are dodged, not discussed. Information is wrapped in secrecy and the people of Halifax and Calderdale are, it would appear, treated with contempt on this issue. This is their hospital. These are their health services. They deserve some answers.
That is the brief history. Where are things at today? Well, frankly, it is all a bit of a mess. At its heart are the inherent contradictions in the Government’s approach to health policy across the country generally, and in Halifax specifically. Let us take a look at some of them. The Government say the funding of hospitals is not a problem. Why then is there a funding shortfall in Halifax of potentially £50 million? I noticed this week that Monitor is to investigate the trust to understand why its finances have deteriorated so much. This is an extraordinary amount of money by which to be in deficit.
We all know that the Government’s desire to cut A and Es like the one in Halifax is to save money. It has nothing to do with improving patient care.
Craig Whittaker (Calder Valley) (Con)
At a recent debate in the Calder Valley with my Labour opponent, I asked him eight times whether he had been out to see the doctors, nurses and decision makers about the strategic review. His answer was no, he had not been out to see them and he had not read the strategic review. He said, instead, that he was following the hon. Lady’s lead and the lead of the candidates in Halifax. Will the hon. Lady tell me how many times she has been out to see the decision makers and whether she has read the review?
Mrs Riordan
I thank the hon. Gentleman for that intervention. Talking about confusion—that is what the whole debate is about today—let me remind him of his article in the Halifax Courier last week, in which he said:
“There are no proposals to close our A and E”.
Then we have the Conservative candidate’s website for Halifax:
“On the frontline defending the A&E cut in Halifax”.
There is his answer.
I use the health service regularly: I am a patient and I visit my GP regularly. The Government say that funding for hospitals is not a problem but we all know they want to cut the A and E. I know the Minister will get up in a moment and tell me that Halifax has not suffered health cutbacks in the past four years. Well I can tell him that I use Halifax hospital regularly. Recently, there have been staffing cuts, ward closures and fewer and fewer beds available on the wards. Sadly, I fear that Halifax is suffering cuts, cuts and more cuts. If there is not a funding problem, why are these reductions taking place? Is it a lack of demand for services?
If there is a funding problem, why do the Government claim to have protected health spending? Both cannot be correct. I say today that what Health Ministers are being told in Whitehall offices and what is happening on the ground in places like Halifax are miles apart. Ministers urgently need a reality check if they think that closing Halifax’s A and E will not put lives at risk.
Mrs Riordan
No. I am sorry, but I must make progress now.
I would be grateful if the Minister explained to me the reality of the funding situation in Halifax. What has the clinical commissioning group been required to do? What front-line services will be a cut as a result of this financial black hole? My constituents want some answers today—they do not want fobbing off until next May. This issue is too important to be kicked into the post-general election long grass.
The issue has never gone away in the town, despite the best efforts of the powers that be. Now, more than ever, is the time to set out why the A and E is important and needed in Halifax and Calderdale. I am not here today to discuss Huddersfield hospital or play the two off against each other. For the record, I want both to stay open, serving their communities as they have done for many years. Both cater for diverse and distant communities. To outlying communities, the local A and E is, quite literally, their lifeline, their reassuring presence should tragedy strike. In that sense, I have to say that the issue of engagement, consultation and information over Halifax A and E has been handled pretty woefully.
Mrs Riordan
No.
There has been buck passing, misinformation and a lack of honesty and clarity. Neither the CCG, the trust nor the Government have stood up and accepted responsibility for what has taken place. Just because things have gone a bit quiet does not mean that this is not the biggest issue in town.
It is difficult to know where to start. First, there is the closure by stealth that seems to be taking place. I have here articles from the Halifax Courier about people being driven regularly across to Huddersfield for treatment. I could talk about the staff cuts or the stealth cuts that could easily render the A and E a glorified walk-in centre. It is just not good enough, and people across Halifax are right to be angry and dismayed, especially when they read contradictory stories such as those I have read out. If the plan is to close the A and E, why do the decision makers not say so? Let us stop this nonsense that an A and E will stay in some form or another. That is rubbish.
Mrs Riordan
No.
If the existing 24-hour access with full A and E services is axed, it will not be an A and E. It is as simple as that. It is time to stop the spin and give us some substance.
Mrs Riordan
No.
The Government and the CCG know that they cannot do this. They know that there will be a public backlash; they have read the newspapers, seen the rallies, heard the debates and studied the letters. There is not one person in my constituency saying this is a good idea, or, if there is, I have yet to come across them. This is closure by stealth, by secrecy and by drawing out the whole sorry process over months. I and thousands of other people are not going to walk on by and let this happen.
The facts speak for themselves. This a hospital that only opened in 2000. It is an A and E unit that treats thousands of people every year and a hospital that serves people within a 30-mile-plus radius. We are already reading about a winter crisis in A and E—there was a major one last weekend—and what is the Government’s answer? To close them down. We cannot deal with one crisis by causing another. The way to deal with the A and E issue is to invest in the service, reassure people about its future and not put lives at risk.
I say not to the Minister but to the people making these decisions: do not take people for fools. If they strip away A and E services, stop 24-hour care, create an appointment system and move services to Huddersfield, we will not have an A and E service; we will have a glorified walk-in centre or an extended GP service. Will the Minister outline the case for closing Calderdale A and E? I have not heard one decent argument so far, so I would be grateful if he put the Government’s position on the record.
Mrs Riordan
No.
So what do I propose now? There is now a window of opportunity. The “Hands off our A and E” campaign has worked so far: we have delayed the closure, put the issue at the front of the debate and kept the issue at the top of the agenda. However, there is a lot more to do. The issue might have gone quiet, but it has not gone away. The so-called engagement process over the summer months was pathetic. A few afternoon meetings to hear people’s opinions is not good enough. I expect better, and more importantly, my constituents expect better.
Three things need to happen. First, there needs to be proper engagement. What are the plans? What is the impact likely to be? So far, we have had none of these, which has left people in the dark. Secondly, there needs to be proper consultation. Not one-way but proper two-way consultation that actually listens to people and takes notice of their views, and this needs to be done properly, not in the half-baked way we have seen so far. Thirdly, there needs to be a full reassessment of the hospital services offered in Halifax. It is beginning to get treated as a branch hospital, not one at the heart of health services. I have said that I use that hospital regularly, which I do. I have had a few appointments recently, and I have been referred to Calderdale Royal, but when I get the appointment through the post, it is always at Huddersfield hospital. That is what patients are experiencing across Halifax.
People need to be told straight what is taking place. The lack of information over the last few weeks and months has been almost as bad as the decision to axe the A and E in the first place. Let us not pretend that an A and E will exist in some form or another post-2015. There either is an A and E or there is not. The time has come for the Government to come clean on their plans; they should set them out, so we can have a proper consultation and a proper debate. This time, however, the people of Halifax need listening to.
The time has come to say “enough is enough”. The facts are clear that without an A and E in Halifax lives will be put at risk. These unnecessary cuts to front-line services will be a body blow to all ages and all sections of the local community. That is why people have been taking to the streets to protest at these proposals. That is why across the whole spectrum of community opinion, there has been a united voice of, “Save our A and E”.
I hope that the Minister can shed some light today on what exactly is going on. The people of my constituency, who need and deserve the best possible health services in Halifax expect nothing less. It is time to come clean and spell things out. In the run-up to the general election, people expect to know what is going to happen to their local A and E unit. I say today, loud and clear, that the fight to save the A & E goes on, and deserves to be a successful one.
George Freeman
My hon. Friend has made an excellent point. I think it important to be guided by what the local professionals—clinicians and NHS staff—are saying. I have spoken to them this week, and I can indeed confirm that there are no plans to close the A and E at present. A clinically led consultation is taking place, quite properly, and before the local NHS leadership recommends any decisions, they will be the subject of public consultation with local people.
Mrs Riordan
I can tell the hon. Member for Calder Valley (Craig Whittaker) that I have read the strategic review. Let me also make it clear that when the consultation began, the acute trust recommended the closure of the Halifax A and E.
George Freeman
As I have said, the local NHS leadership is looking at all the issues on behalf of the patients whom they are there to serve. My point is merely that playing party politics is not helpful. We need to be guided by the local clinical experts. It is important for the NHS to engage widely on the future provision of health services, and it has done that over the last three years. Thousands of local people have given their views on what matters most to them, and that feedback is shaping thinking locally.
Local clinical commissioning groups are focusing on the phased delivery of improvements in community services ahead of any changes in hospital services. Our health system is evolving to adapt to the new landscape of modern medicine, and I think it is in the interests of our patients to encourage that, provided that it is led by clinical decision making. Local commissioners recognise the need for change in hospital services, and I suspect that, as a user, the hon. Lady would recognise that as well. The local NHS believes that the way in which services are currently organised in Halifax does not deliver the safest, most effective and most efficient support to meet patients’ needs. Patients rightly expect that when they see the initials “NHS”, they can expect the very best service that is available, and when they do not receive that service, it is incumbent on the system to adapt so that they do.
The trust is affected by shortages in middle-grade doctors and the high use of locums in A and E, which has an impact on the safety of patient care, and difficulties are involved in providing senior consultant cover overnight and seven days a week. Those are classic problems, which often affect smaller hospitals. We need to ensure that we are delivering the very best care to our patients.
There is often a need for inter-hospital transfers owing to the lack of co-location of first-class services on both sites. The co-location of emergency and acute medical and surgical expertise can result in significant improvements in survival and recovery outcomes, most notably for stroke and cardiac patients. Those who are most seriously ill, with life-threatening conditions, have a much greater chance of survival if they are treated by an experienced medical team that is available 24/7.
It is right for the local NHS to address those challenges to ensure that it can continue to deliver safe, sustainable, high-quality services. Heaven forbid that the hon. Lady should fall ill and require any of those services, but I am sure that, were that to happen, she would want to receive the very best care, and that if that were available in Huddersfield, she would want to be treated in the best possible place. To that end, Calderdale and Huddersfield NHS Foundation Trust has considered a number of options for the future delivery of services, one of which involves one hospital delivering planned care and the other delivering unplanned care. At this stage, no proposals have been ruled in or out. Preferences have been expressed in regard to how services can best be delivered, but no decisions have been made, and I can confirm that there are no formal proposals for changes in hospital services.
In August, the local CCGs decided to delay public consultation on hospital services. While they are signed up to the need for change, they have chosen first to focus on the delivery of improvements in community services in order to build confidence in the changes and demonstrate to local people the benefits they are confident they will deliver. That seems to me entirely appropriate. The CCGs are following a process of change. They understand the need to take people with them, and to build confidence in the changes that they propose. It is incumbent on all Members to encourage and support our NHS leadership locally in building that public confidence in the services.
Change can be difficult to explain to patients, particularly the most vulnerable and elderly patients whose focus is, rightly, on the immediate availability of care. Patients’ reasonable anxieties are often exacerbated by speculation in the media about potential changes and their possible local impact. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.
I know that local people care deeply about the future of their local health services and will want to be involved in decisions about the future of their local hospitals. This is, and should be, a locally led process. Local people should continue to make their views known to those developing proposals for the future of local services, as they have done throughout the engagement process. I also want to encourage them to listen to the reasoning behind any proposals from local NHS clinicians and management for any service changes. I encourage the hon. Lady to work with the local NHS as it further develops its proposals. I know that the CCGs have met hon. Members and are happy to continue to do so.
When talking about potential changes to hospital services, it is important to remember that it is the services, the people and the co-ordination—not the bricks and mortar—that really matter in getting people the right care at the right time. The flexibility and co-ordination of services are just as important as how they are geographically configured. In supporting our local NHS we often end up supporting the current institution—the building in its present location and configuration—but we need to allow the service to evolve and allow our local clinicians and NHS leadership to develop the best possible provision for the people it is designed to serve.
The NHS is one of the great institutions in the world; it is one of this country’s great legacies. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. Freezing a service in aspic out of love for it will not allow the NHS to develop and maintain its leadership in the provision of 21st century health care. These decisions are made only when representatives of the local NHS, working in collaboration with local people and local authorities, are convinced that what they are proposing is absolutely in the best interests of their patients.
I make no apology for the fact that it is this Government who have taken these decisions out of the hands of the politicians and the mandarins in Whitehall and put them into the hands of local clinicians and local NHS managers who have the interests of local patients at heart and who are driving those decisions in their interests. It is important that the NHS in Calderdale and Huddersfield develops solutions that will allow it to provide high quality, safe, effective and sustainable services to local people for generations to come.
Transient Ischaemic Attacks
Linda Riordan Excerpts(9 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I intervene only to apologise most profusely for not being here at the start of the debate. We checked with the Doorkeeper following the Division and were advised that a quarter of an hour would be added and that this debate would start at quarter to 5. I would never be so discourteous to the hon. Member for Warrington North (Helen Jones). I really am extremely sorry, but that was the advice that we received. We were only next door.
Mrs Linda Riordan (in the Chair)
Order. The sitting was suspended at 4.15 pm, but Members were back shortly after the vote. The rules are that we start again as soon as the Minister, the Member who proposed the debate and the Chair are back. As long as three Members are here, we can resume, which we did, and the debate finished at 4.38 pm. Helen Jones began her debate then.
Helen Jones
I of course accept the Minister’s apology. I am sure that she would not be deliberately discourteous to any Member of the House.
Part of the reason why action is not being taken is that public awareness of TIAs is low. A 2012 poll for the Stroke Association found that few people understood the symptoms. In a recent survey of people who had experienced TIAs, the association found that 44% had no knowledge of TIAs prior to having had one and, astoundingly, 61% did not know that it was a warning sign of a possible future stroke. Those were people who had already had TIAs, so it is unsurprising that a third of people take no action following a TIA. Others do not realise that it is a medical emergency and wait for appointments. Astonishingly, the Stroke Association found that a quarter of the people surveyed did not take any action even though they had had TIA symptoms more than once. People may not know where to go for help, and some think that nothing can be done.
When people do seek help, however, it is fair to say that the service that they receive is variable. The all-party group on stroke heard from two former patients, one of whom had been treated quickly and efficiently, but the other had had the opposite experience. The Stroke Association found that while many people have a great deal of praise for how they were treated and for the care provided by health care staff—it is important to put that on the record—16% felt that they were not taken seriously and 25% said that their symptoms had been misdiagnosed. One person at the all-party group meeting had actually heard a paramedic say those classic words, “It’s just a funny turn.” Another person told the Stroke Association:
“Our GP has told us not to bother to attend GP surgery or A and E as it is not worth it for TIAs.”
Another said:
“I had numerous TIAs that were misdiagnosed as migraine.”
Such comments are worrying, particularly given that parts of the NHS deal with the matter well and show great examples of good practice. The south-western ambulance service, for example, has pioneered direct referral of suspected TIA patients to a TIA clinic. It has invested in training its staff and all ambulances carry details of TIAs, of the referral pathway and, importantly, information for patients. I have also heard a great deal about what has been done at Southend university hospital, which went from having a Monday to Friday TIA clinic to having an online rapid referral system, using new technology, that helps GPs and health care staff to assess patients and to transmit information directly to the clinic or even to the consultant’s mobile. It trained more clinical staff to do ultrasounds and changed the protocol for MRI scans, so that patients can be accommodated in between the normal list. As a result, its service operates seven days a week and sees all high-risk patients within 24 hours and others within a week, as recommended. That service saves lives and enables tests to be done and treatment to be begun on the same day. If that can be done in Southend, it can be done elsewhere. The first problem is actually getting patients to realise that they need treatment.
Healthier Together Programme (Greater Manchester)
Linda Riordan Excerpts(9 years, 9 months ago)
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Mrs Linda Riordan (in the Chair)
Before the debate starts, I should say that I will allow gentlemen to remove their jackets.
Graham Stringer (Blackley and Broughton) (Lab)
Although it is the last day of term, it is still a pleasure to serve under your chairmanship, Mrs Riordan.
I am going to be critical of the Healthier Together programme, but one facility that it does have, of which I was unaware until about half an hour ago, is the gift of prophecy. It has just put out a press release in response to what I am about to say, which is particularly clever because I have not yet fully decided what to say. Although the programme has failed in many ways, it clearly has attributes that most of us do not have.
As it stands, the Healthier Together programme is both a shambles and a charade. I shall start by talking about the shambles. So far, more than £4 million has been spent on the process leading up to the consultation. Some of that money has gone on producing 200,000 leaflets for the consultation, which started two weeks ago. Unfortunately, as far as I am aware not a single one of those leaflets is yet in a public library—there were certainly none in the library near my office in north Manchester when I checked an hour or so ago, and I cannot believe that that library has been discriminated against. That is a failing of organisation.
That is not the only such failing. The website is complex and not easy to navigate. If someone can find the consultation document, they can download it, and they will find that at the end it says, “Please fill in the questionnaire opposite”. But there is no questionnaire opposite; it is elsewhere. If someone can continue to struggle through the website they can find it, but it is not where it is supposed to be.
I am not the only person who is critical of the consultation. The University Hospital of South Manchester wrote to me to say that the proposed changes are incomprehensible and full of NHS jargon. That is an improvement on the previous document that was produced, which was totally and completely incomprehensible. The more recent document varies between NHS jargon and “Janet and John” talk, which is almost as meaningless. There are phrases in speech bubbles saying:
“Knowing the council and the NHS will work together to look after mum.”
There is no reasoning or line of thought, just nice ideas about things that we would all hope the NHS would do. The University Hospital of South Manchester also criticised the fact that the consultation meetings—the proposed engagements, some of which may have already happened—all take place during the day. That means that the vast majority of people of working age cannot attend.
It is not only me and other members of the public who are greatly concerned about the proposals; as far as I can see, there is little clinical support for them. The chief executive of Wrightington, Wigan and Leigh NHS Foundation Trust, Andrew Foster, said that there is
“a lack of widespread support for the consultation process”,
and he went on to say stronger things as well. I have been sent information from a GP survey showing that almost 50% of GPs are concerned about the process and certainly do not support it in its current form. The University Hospital of South Manchester says that the process is “flawed and misleading”, and
“not an integrated care consultation…but rather a consultation on changes to a small number of acute providers”.
Healthwatch England has been very critical of the process, because until March this year all meetings took place in secret. It has been allowed to attend meetings since March, but, as I will explain later, many decisions had already been taken by that point. I would be interested to hear the Minister’s response to a more worrying point: according to Healthwatch England, the Healthier Together body—the combined committee of the commissioning groups—has no power to spend until the draft Legislative Reform (Clinical Commissioning Groups) Order 2014 is passed, and that has not yet been passed by either House. I would be interested to hear whether there will be a power to spend or to go ahead with the proposals, although I would be surprised if the proposals were not challenged.
There is not only the problem that legally, perhaps, the £4 million should not have been spent; the consultation document also refers time and again to hospitals co-operating with each other. However, the competition authorities ruled that the attempt by the Royal Bournemouth and Christchurch hospital and Poole hospital to work together was unlawful. If, after the consultation, it is decided that the proposals will go ahead—I hope that it is not—will they be lawful? Behind all that, £4 million may have been spent unlawfully, and could have been better spent on nurses, doctors and the health of people in Greater Manchester.
I turn to the charade aspect of the Healthier Together programme. It is a charade in many different ways. Who is conducting the consultation? The document contains statements from the chair of the Association of Greater Manchester Authorities, Lord Peter Smith, and from a number of doctors on the clinical commissioning groups, but if one looks deeper, one finds that a large multinational corporation called Mott MacDonald is involved but not declared. It has all sorts of consultancy interests in areas ranging from engineering to private and public health care. Why were we not told?
Part of the charade is that we are not told who is conducting the consultation, but the real charade is that a number of decisions have already been taken before the consultation has gone out to the public. The document itself does not show to the public the configuration of health services as they currently are in Greater Manchester; it presents a number of decisions that have already been taken without any form of consultation. I will return to that point later.
It is also unclear what the consultation is about. The University Hospital of South Manchester said that it thinks it is about the reorganisation of acute care in hospitals. I do not think that it is. It is not clear—it is muddled—but it could be about primary care, because there is talk of more GPs and more access to primary care services. There is no financial plan for that and it is not clear how it would happen, which is not a bad thing in itself, but it is mentioned in the consultation document without it being clear what anyone is expected to say about it, apart from their wanting better care for their relatives, mother, sons, daughters, wives or anyone else.
There is an absence of financial information in every part of the document, not just the primary care part. So is it about money? It is indicated and implied that there is not sufficient money. The background document makes it clear that, within two-and-a-half to three years, there will be a £1 billion, or 16%, black hole in Greater Manchester’s health budget of £6 billion. Is the consultation about that—it certainly is not clear—or is it a south Manchester thing? Is it about hospital reorganisation? If it is about hospital reorganisation, creating more specialist hospitals and downgrading some hospitals, why were we not consulted?
Fairfield hospital in Bury, Tameside hospital and North Manchester hospital have been downgraded to so-called community general hospitals, but that is not in the consultation. We are told that we are going to get almost immediate access to GPs, but there is no mention of what has been happening in the health service in Greater Manchester over the past few years. Fifty per cent. of the walk-in centres in Greater Manchester have been closed down, and they gave people immediate access to a GP. They have closed, but the Government are talking about improvements.
The Government are talking about improving care in the community, and specialist nurses would certainly help to keep people out of hospital and reduce costs in the long term, yet when I put in a freedom of information request to Tameside metropolitan borough council, half a Parkinson’s nurse was available for the whole of Tameside, which is shocking. One can go through the other specialist nursing services and find the same. Why have we not been told the proposals for those specialist nursing services, which are vital for keeping people out of A and E and out of long-term care within hospitals?
The proposals are a charade. In the original consultation, and when the Healthier Together people had a meeting with Greater Manchester MPs, we were told there was a guarantee that no hospitals or A and E departments would close. Why is that missing from the consultation document? Why is it not still a commitment? When the commitment was given, I did not believe it because I do not believe, when there is a looming financial crisis in the NHS in Greater Manchester and across the country, that any group of medics or health bureaucrats can guarantee that hospitals will stay open. A 16% gap is looming in the care and health service budget, and the gap might get bigger. That is equivalent to two or three hospitals in financial terms. We were given that guarantee yet, arrogantly, three hospitals have been downgraded without any consultation.
A similar guarantee was given when maternity provision was taken out of Hope hospital during a review five or six years ago. It was guaranteed that a midwife-led maternity service would continue in Hope hospital, but there is currently a consultation on removing that service. Those of us who have been discussing, debating and arguing with the health service for some time about the provision of services are sceptical about all guarantees.
There is also an ongoing trauma review in relation to Wythenshawe hospital, yet Wythenshawe hospital is being downgraded. It is an extraordinary decision to say, “We will have this discussion, but we have already taken some decisions. We want to know what should happen to these hospitals but, although two other major service reviews are ongoing, we will completely ignore them and not mention them at all in the consultation document.”
I am sure my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will want to mention Wythenshawe hospital, so I will not steal his speech. I am an ex-chair of Manchester airport, and downgrading Wythenshawe hospital from its grade 1 status is appalling because it has the nearest A and E unit to Manchester airport. If there was an unfortunate air crash, people would want to go to the nearest hospital. The downgrading of Wythenshawe hospital is another extraordinary decision.
We have been here before with such consultations. At the moment, the Healthier Together people are saying that there is 98% support on Twitter for the proposals. They are in a feedback loop in which they are twittering to themselves, and we know what the Prime Minister thinks two twitters make. We were in exactly that position on the congestion charge. When the people running the scheme ran opinion polls and consultations, they all showed huge support for the congestion charge—anyone who talked to anybody in Greater Manchester would have found that support unbelievable—and of course when it came to putting crosses in boxes in the referendum, 80% were against the congestion charge. That is exactly the position we are in at the moment. There is an unreality about the people who are doing this, and they are trying to fiddle things. This is a scandalous fiddle.
At the end of the debate, I do not want to be accused of pretending that there are no real problems—there are. I have mentioned the financial problems, and there are also the differences between Greater Manchester hospitals. Given the survival rates for similar operations, people are clearly better off in some hospitals at certain times of the week. People are clearly better off in other parts of the country than in some Greater Manchester hospitals. That needs to be put right, but the consultation will not do that. We need to consider why there are problems—it is not just about recruitment, although recruitment is part of the problem—and try to solve those problems, rather than wishing them away with yet another reorganisation of the health service.
I could give more examples, but time is limited. The current booking system in Greater Manchester must waste many millions of pounds a year. The NHS authorities regularly criticise patients who do not turn up for appointments, but they do not criticise themselves when they fail to organise appointments properly. From the past 12 months I can give five examples from my close family, and from my constituency casework, of where the booking system has been appalling. I know of people who have been sent to closed service centres in hospitals and people who have been told that the plaster on their arm would be examined to see whether it has set when, in fact, the plaster should have been taken off. I could go on about the booking system’s failings. Addressing those failings would save millions.
Cleanliness is not a cost issue directly, but it is a health issue, and there is a massive difference in cleanliness levels both within hospitals and between hospitals, which could be addressed. There could be improvements in other areas. There are big decisions to be made on hospital configuration, finances, how much money should be put into primary care and the structure of the health service. Those questions will not be addressed by the current process. There are genuine differences between the Labour and Conservative parties on how those issues will be resolved, and those differences will be resolved at the general election.
The process is trying to do two things. First, it is trying to usurp the political process at the general election, when those big decisions will be taken. Secondly, it is asking for a blank cheque. If the Government put out such a rubbish consultation document that people do not know whether it is about primary care, secondary care or hospital reorganisation, and if Healthier Together is already saying that it has 98% support, what do they want to do? They are asking for a blank cheque to do whatever they want, and it should not be given to them.
I will finish with another quote from University Hospital of South Manchester, which I completely agree with, although I would add other things to it:
“Wait until the trauma review is finished and do the consultation properly.”
In other words, withdraw this consultation, do it properly, wait until the review of maternity and trauma services is in, wait for the general election and then we can have a serious, proper and grown-up discussion about how we can make health services in Greater Manchester better.
Oral Answers to Questions
Linda Riordan Excerpts(9 years, 11 months ago)
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Mr Hunt
I would be delighted to meet my hon. Friend, and she is right to say that the long-term solution to pressures in A and E is to find alternatives in out-of-hospital care that are easy for people to find. That means improving GP access and any other alternatives, and I am sure we can find a good solution in Norwich.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
There is not one person in my constituency who does not want to see the accident and emergency unit stay open. If this is made clear in any consultation, will the Secretary of State commit today to scrapping the callous closure proposals?
Mr Hunt
As the hon. Lady knows, local service changes are the responsibility of the local NHS, but when they get referred to me, through local authorities, I will never take a decision that is against the interests of patients, including her constituents. Were such a proposal to come to me, I would indeed listen to any representations that she makes.
Oral Answers to Questions
Linda Riordan Excerpts(10 years, 1 month ago)
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Jane Ellison
I congratulate my right hon. Friend’s local CCG. Increasingly, I am seeing, right across the country, imaginative and innovative ways in which people, local clinicians, public health professionals and people in wider health services are looking at how we keep people who do not need to go to A and E out of A and E. Some of them are doing remarkable work. We will be celebrating that this week by recognising some of those unsung heroes who are doing that great public health work in our communities.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
Calderdale Royal hospital’s A and E is well run and very busy at times. Why does the Minister think that the proposed closure of it will improve the health care of my constituents?
Jane Ellison
I responded to a debate on that issue a few months ago. As the hon. Lady knows, there are no plans for what she suggests, but the local trust has begun a process, in which she and other local politicians are engaged. At the heart of that process is care for local people, looking at what is clinically best for them and what the best outcomes are for them in the long term. That will have regard to Sir Bruce Keogh’s review of urgent care. What we want are the best outcomes for people, and I am sure that that is what she wants too.
Calderdale Royal Hospital
Linda Riordan Excerpts(10 years, 5 months ago)
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Mrs Linda Riordan (Halifax) (Lab/Co-op)
I am delighted to have secured this Adjournment debate on such an important issue for my constituents and for the Halifax and Calderdale area. This goes to the very heart—the very essence—of what people should be able to expect from their national health service, what services they should get from their local hospital, and how they should have confidence that well-run, popular and accessible services like Calderdale Royal hospital accident and emergency department will not be cut back or closed. However, for some time now Calderdale Royal hospital’s accident and emergency department has been under threat. It is an issue that has been simmering away in my constituency and recently the rumours have turned to reality as the Government and local health bosses, much to the anger of local people, have refused to guarantee that Calderdale’s A and E department is safe.
I shall briefly set out some of the background to this issue. In 2001 Halifax’s general and royal infirmaries merged with Northowram hospital to become Calderdale Royal. Over the last decade it has served the area extremely well. It has excellent, dedicated and well-qualified staff who provide a first-class health service to people across the district. It serves many diverse communities in Halifax and Calderdale, and its reach extends to the Lancashire border and to communities bordering Bradford. Therefore, a wide geographical area needs, and relies on, Calderdale Royal, and in particular its A and E department.
In recent months, as speculation has risen that the axe could fall on the town’s A and E, so has the sense of public outrage that such a short-sighted, unnecessary and unwanted decision is even under consideration, let alone that there is the possibility of it being implemented. United against that are hospital users, health campaigners, trade unions and Calderdale council. I have yet to find anyone who would be in favour of such a decision.
I know the Minister will say that nothing has yet been proposed, but nothing has been denied either. Indeed, I have asked in this House whether Calderdale’s A and E is safe and no one has confirmed that it is.
Craig Whittaker (Calder Valley) (Con)
I dare say that the hon. Lady, coming from the Calderdale area, has, like myself, had briefings both from the chief executive officer of the NHS trust and the chairman of the Calderdale clinical commissioning group, and I must say that at no time have either of those two people mentioned to me that Calderdale Royal is under threat of closure. I just wonder whether she could elaborate on where this information has come from.
Mrs Riordan
I have met the Calderdale and Huddersfield NHS Trust CEO and doctors and other clinicians. They say—and they gave out a document for me to read—that changes are afoot. That is coming from inside the hospital and the council, and from the general public. So, again, I ask the Minister to rule out the possible closure or even any cuts.
All I have been told is that a strategic document is available on the future of local services. Frankly, my constituents do not need to read jargon-filled paragraphs about clinical decisions. They know when something is right or wrong, and they know that what matters in Halifax is the continuation of our good local health service, with an accident and emergency department free at the point of need. They do not want that service to be in Huddersfield, Dewsbury or Bradford. They want it where it is, in Halifax, serving the communities that I represent and those of Calderdale.
I have read and heard a lot in recent weeks about how A and E departments need reforming. I have heard that too many of the people using them could be seen elsewhere. I am afraid that that is a weak argument. The whole point of the service is to deal with accidents as well as emergencies. People cannot be told to use alternative services if their walk-in centres are closing, or if their doctor’s surgery has closed for the night or, when it is open, they cannot get an urgent appointment.
Craig Whittaker
The hon. Lady will know that we recently had a campaign to keep the walk-in centre in Todmorden open. The reality is, however, that the walk-in centres in Halifax and Todmorden are both under-utilised. Would it not be far better if those carrying out the review came up with a proposal for a low-level accident and emergency-type service in Halifax and in Todmorden? Surely that would be better than the current arrangements.
Mrs Riordan
I am not sure whether the hon. Gentleman is suggesting that the A and E should be closed down and replaced by a low-level service in Halifax and Calderdale—
Mrs Riordan
We need the full A and E. Walk-in centres were designed to take the pressure off A and E departments and if they are used correctly, in conjunction with educating people on how they should be used, that is exactly what they will do.
My constituents certainly do not want to make a 25-minute journey across town to access health services that they rightly want to see in their own community. Let me be clear: the Government could and should have an important role to play in this decision. The buck should not be passed solely to local clinicians so that the Government can wash their hands of the matter. I was hoping that the hon. Member for Calder Valley (Craig Whittaker) would make it clear that he intended to put pressure on his Government to protect local health services.
Craig Whittaker
I am in total agreement with the hon. Lady: I would not accept the closure of A and E at Calderdale Royal. I am very much hoping that, following the review that is due in January, we will see an enhanced service not only in Calder Valley but in Halifax and the whole of Calderdale. I am looking forward to seeing those proposals.
Mrs Riordan
I am very much hoping that the Minister is going to tell us that Calderdale Royal hospital’s accident and emergency department is guaranteed to stay open.
The Government set the policies, and they must also take responsibility for any decisions that will affect the A and E in Calderdale. Also, there should be no hiding behind a public consultation. The question is quite simple: do the Government support the retention of the accident and emergency department in Calderdale? If they do, there is no need for any consultation. If they do not, they should come clean and set out their position. This lack of clarity is causing a lot of worry, anguish and anger in my constituency and across Calderdale.
Last week I organised a round-table meeting with interested parties at a local level to discuss a way forward. The town is united in the need to ensure that Calderdale’s A and E stays put. Let us imagine what would happen if the department were cut back or closed. I presume that the services would transfer to Huddersfield. For many of my constituents that would mean at best a 20-minute journey, but probably journeys of 25, 30, 35 or even 40 minutes along busy roads, past a motorway interchange, and into Huddersfield. At the risk of using emotive language, such a move really could be a matter of life and death. Do health bosses think that people would stop using the other A and Es if they closed the one in Calderdale? I do not think they would. I also want to place on the record that this is not about Halifax versus Huddersfield; it is not about pitting one A and E against the other. This is about ensuring that people across west Yorkshire have access to good quality health care that is rooted in their local communities.
Let us just examine for a moment why this position might have come about. Since 2010, the Government have been systematically dismantling alternatives to A and E: a quarter of walk-in centres have been closed since the election; NHS Direct has been scrapped; the guarantee of a GP appointment within 48 hours has been scrapped; and fewer and fewer GP practices are open at evenings and weekends. People in Halifax and Calderdale will have fewer alternatives, not more, if the A and E closes. If patients are waiting more than four hours for treatment, is the answer to close A and Es? I do not think it is. This crisis is not due to a lack of education or people going to A and E with minor problems; it is more to do with cuts to social care budgets, meaning that more older people are ending up in hospital because there is no one else to take care of them.
If the Government’s answer to an A and E crisis is to close A and E departments, we really are in trouble in Halifax. Cutting back on services does not solve the problem; it just transfers it elsewhere. I am determined to fight for better services at Calderdale Royal, not to see them cut. I want to see our A and E department saved, not sacrificed. I want to see the excellent staff supported, not under-resourced, and to ensure we have the best possible NHS serving Halifax and its wider communities.
The reaction of the public in my constituency has been an overwhelming “Hands off our A and E department.” We need it to stay open, to continue the excellent service it provides and to ensure it serves the people of Halifax today and for years to come. Anything else would be a tragic mistake of short-term thinking, and a failure to provide my constituents with a local hospital and a national health service fit for the 21st century.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate the hon. Member for Halifax (Mrs Riordan) on securing this debate and my hon. Friend the Member for Calder Valley (Craig Whittaker) on staying on to attend and intervening in the telling way he did. There is obviously a keen interest in all these local health matters among Members on both sides of the House. I am aware that all parties are interested in these matters; I have received representations from other Members, and not just the hon. Lady who has raised this matter in the House previously during Health questions.
The reconfiguration of health services is an important issue for all of us and our constituents, and the future of A and E departments is particularly topical at present. I understand that people have anxieties about change and, in particular, about change in the NHS, because it is such a greatly loved and respected institution, but I hope I am in keeping with the spirit of this debate when I say that it is vital that we do not play on those anxieties, especially for purely political purposes. It is important that these difficult but necessary debates take place in an atmosphere of calm consideration.
Jane Ellison
I ask the hon. Lady to let me develop my points, because I have not even begun to respond to her speech. I shall give way, if time allows, a little later.
Before I address the particulars of this debate, may I touch on the Government’s policy on changes to services in general? I realise that the hon. Lady may say that this is what I was going to say, but it is important to understand the principles behind reconfiguration policy. This Government are clear that the design of front-line health services, including A and E, is a matter for the local NHS. That is for good reason, because those local leaders, working closely with local democratic representatives, local government and the public they serve, can come to better conclusions about the services for their area than a Minister sitting in Whitehall trying to decide policy for the whole country, which is a very old-fashioned model of how to do these things.
The NHS has a responsibility to ensure that people have access to the best and safest health care possible. That means planning ahead and looking at sustainability as well as safety in NHS health care provision. No party can escape the challenge of providing sustainable services, and I do not think that challenge is any different for the Labour Front-Bench team from how it is for the Government. The Labour party made these points often when it was in government.
Reconfiguration is about modernising delivery of care and ensuring that we have the facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. I listened carefully to the hon. Lady’s arguments about her own local area, but if we look at an area in London, as I represent a London seat, we will see that exactly the same arguments were made against centralising stroke care, which was centralised in eight hyper-acute stroke units. They are now providing 24/7 acute stroke care. Stroke mortality is now 20% lower in London than the rest of UK, and survivors are experiencing a better quality of life.
I gave that example to illustrate the fact that we must be wary of some of the arguments against reconfiguration. I am quite clear that in London something that was opposed for some of the reasons the hon. Lady has touched on in her speech is now saving lives for my constituents and others. I want to ensure that that point is at least underlined.
We must allow the local NHS continually to challenge the status quo. I do not accept the hon. Lady’s argument, which, as I understand it, is that nothing should ever change. How, in a modern and ever-changing world, can she advance the argument that nothing should ever change and that it would be wrong of her clinicians even to look at the case for change?
Mrs Riordan
I am sure that the Minister listened to my speech. I did say at the beginning, just to give her some brief history, that in 2001, under a Labour Government, we finally got that brand-new hospital for which we had waited nearly 20 years. It had been promised by a Tory Government. We went from three hospitals to one. She is quite right: things do change, and I was part of that change in 2001.
Jane Ellison
I thank the hon. Lady for her intervention, and I am glad that we have established some consensus on that point She is probably aware that I know her area quite well, having lived there for quite a few years before I moved to London.
All service changes should be led by clinicians, and be based on a clear, robust clinical case for change that delivers better outcomes for all our constituents. We have put patients, carers and local communities at the heart of the NHS, by shifting decision making as close as possible to individual patients, devolving power to professionals and providers, who also have patient care, safety and sustainable service at the core of their public service commitment, and liberating them from top-down control.
The principles are enshrined in the four reconfiguration tests. I am sure the hon. Lady knows them well, but for the record they are support from GP commissioners; strengthened public and patient engagements; clarity on the clinical evidence base; and support for patient choice. Those are the tests against which any reconfiguration needs to be judged.
A and E is obviously very topical at the moment. The NHS is seeing increasing pressure on A and E services, but is generally coping well. I am sure that that is the case with the hon. Lady’s local hospital as well. We are meeting our four-hour A and E standard at the moment. It is the 32nd consecutive week the standard has been met. We are determined to do everything we can for the NHS to continue providing high-quality care. She will know of some of the extra moneys that we have allocated—I think it is £2.3 million for Calderdale and Huddersfield—for winter pressures. That does not allow us to escape the fact that there are longer-term challenges, and these have been acknowledged across the House. One million more patients have gone to A and E in the past three years, and there are the pressures of an ageing population. We, across the House, have to address those long-term challenges, and the Government are trying to focus on some of the underlying causes, whether by having named GPs for the over-75s or changes to GP contracts; or, in public health, helping people to manage long-term conditions and to live well for longer; or the £3.8 billion allocated to help to integrate health and social care, because we recognise how vital that process is. All those measures are about addressing the underlying drivers of pressure on A and E and pressure on our health service and looking at how we can make it sustainable in the longer term.
We have recently had an excellent review from Sir Bruce Keogh that looked at urgent and emergency care. It also looked at demands on services and how the NHS should respond. We asked for that review because of the determination not to sidestep the problem of growing pressure on A and E but to deal long term with a problem that has been building for decades. Too many sticking plasters have been applied in the past to get through a year or two. That is why we need to clarify to the public how we are planning to shape those services for the longer term and where they will be delivered.
Most of the current reconfiguration projects are in line with the Keogh report’s principles as an overall direction of travel. We have been clear about that for some time. All local health economies that are undergoing reconfiguration have to pay close heed to the direction of travel set out in the Keogh report, the essence of which was that this is about services, people and co-ordination. It is not just about the bricks and mortar; it is about getting the right care to people at the right time, and flexibility and the co-ordination of services are just as important as how they are geographically configured, and that was the message from the Keogh review.
Let me turn to the hon. Lady’s local area. She said that people want good quality health care rooted in the local area. That is exactly what is at the heart of the review that is being undertaken. As I have outlined, the configuration of local health services is a matter for the local NHS, for the very good reasons I have given. It cannot be dictated from Whitehall. Locally, I understand that the review is considering health and social care services with the point about ensuring that patients continue to receive high-quality and sustainable services at its heart. The work includes considering how best emergency care services and other acute services can be delivered, and in an intervention my hon. Friend the Member for Calder Valley touched on some of the ways that can be done differently and in a more imaginative and responsive way.
No decisions have been made at the moment, and of course any plans for major service change that emerge from the review would be subject to formal public consultation. Public consultation has to be real and robust. Commissioners know that, and at all stages of the process I would expect Members to be involved, as well as local government. At this stage, the commissioners have not brought forward plans for consultation, but they will need to be assured that any proposals they make for reconfiguration and change will meet the strengthened tests I mentioned earlier.
At the heart of all this is the need to serve local people better. I understand from some of the early engagement work, in which thousands of local people were involved, that the message was that people want quality and access. Those are the two key messages that came through and that are the forefront of people’s minds. They want quality services and they want access to them at the right time. The trust has, I believe, identified a need to co-locate acute services to maximise the potential of its work force, to ensure that services are safe and to deliver the best outcomes for patients for a long time.
The trust is taking on board a range of views as part of the review. I know that the hon. Lady has met local NHS leaders, as have my hon. Friend and other interested local parties. That will include external independent clinical opinion on how best to deliver emergency care, such as that given by the Keogh review. I stress again that the process is locally driven, and I encourage interested hon. Members to continue to engage with the process and to work with the local NHS as it develops those plans. The NHS is one of the world’s greatest institutions, so ensuring that it is sustainable and serves the best interests of patients sometimes means taking tough decisions, including on the provision of urgent and emergency care. Those decisions are taken for a reason: good-quality care and access to it are at the heart of this.
As the hon. Lady has acknowledged, sometimes things change over time. The pressures change, as do the way we respond to them and what we know about how we respond to them. For example, we know that more than 30% of people who go to A and E—in some places, it is more in the order of 50%—do not even need to be there. That is not sustainable in the long term and we need to address it, but those decisions are best made when the NHS is working in collaboration with local people, with local democratic representatives and with local authorities and considering what is best for the people of their area.
May I take this opportunity before I close to place on record my thanks to the hard-working NHS staff of Calderdale for the service they give to the people of that area and to the hon. Lady’s constituents? I hope very much that they have a good Christmas in the sense that they have as few people as possible in A and E who do not need to be in A and E over Christmas, because I know it is a difficult and challenging time for NHS staff, but we are all grateful for what they do for all of us.
Question put and agreed to.
Oral Answers to Questions
Linda Riordan Excerpts(10 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
When it comes to transparency about care, there should be an absolute level playing field between private providers and NHS providers. To answer the hon. Gentleman’s question on regulators, what this Government are going to do, Mr Speaker, is ensure that the Care Quality Commission has statutory independence so that no Government can ever try to interfere with the processes of reporting poor care.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
11. Whether he plans to close all or part of Calderdale Royal hospital’s accident and emergency ward.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I am advised by the NHS that there are no plans for the closure or downgrading of the accident and emergency department at Calderdale Royal hospital. Obviously, as the hon. Lady knows, the reconfiguration of local health services is a matter for the local NHS commissioners. As I understand it, they and the local authorities are currently reviewing health and social care services, including emergency care, across the wider Huddersfield and Calderdale area.
Mrs Riordan
I thank the Minister for her reply, but we need stronger reassurances in Halifax that the accident and emergency unit at Calderdale Royal is safe, particularly given the threatened closures of walk-in centres. Will she give that commitment now?
Jane Ellison
As I have said, those are matters for the local NHS commissioners. As I understand it, they have begun a review. The hon. Lady will want to be deeply engaged with it on behalf of her constituents. Everything that might be proposed will be subject to a full public consultation.
Oral Answers to Questions
Linda Riordan Excerpts(11 years ago)
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Dr Poulter
My right hon. Friend the Secretary of State has visited Wythenshawe hospital and can pay testament to the high-quality care available there. All the points that the right hon. Gentleman has raised will, of course, be taken into account when a decision is made.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
16. What steps the Government plans to take to improve public awareness of the signs and symptoms of early rheumatoid arthritis.
The Minister of State, Department of Health (Norman Lamb)
We have made earlier diagnosis a clear objective in our mandate to the NHS. It is for NHS England and local commissioners to undertake appropriate awareness campaigns on arthritis. We very much welcome the appointment of Professor Peter Kay as the first national clinical director of musculoskeletal disease to advise on specific initiatives.
Mrs Riordan
I thank the Minister for his reply. May I ask him for another meeting to discuss this very important matter and take forward further action on it?
Norman Lamb
The meetings are stacking up, but I would love to meet the hon. Lady. She should just get in touch with my office and we will get it arranged.
Health Inequalities (North-East)
Linda Riordan Excerpts(12 years, 3 months ago)
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Mrs Linda Riordan (in the Chair)
Order. At least six Back Benchers wish to speak. I mean to call the first Front-Bench speaker at 10.40 am. That leaves about 45 minutes, so I ask hon. Members to bear that in mind.
Grahame M. Morris
I am grateful to my hon. Friend for that intervention, and I agree with him. I was shocked to attend a meeting in my constituency last Friday about the contingency plans that are being put in place for emergency feeding centres after 2013. Those centres are the soup kitchens that we have not seen since the 1930s or the miners’ strike in 1984.
My final point is that the Labour Government produced the first ever targets to reduce health inequalities in the population, and the poorest were healthier when we left Government than they had been when we took office in 1997. My plea to the Minister is this: raise the standards and be a champion for public health and not an apologist.
Mrs Linda Riordan (in the Chair)
Order. I remind Members that I will call the Front-Bench spokespersons from 10.40 am onwards.
Anne Milton
I have only six minutes, and I have numerous questions to answer. The north-east has made commendable efforts to tackle its problems, acknowledging some of the things that happened under the last Government. At the core of Better Health, Fairer Health is a drive to tackle inequalities through multi-agency partnerships.
The north-east has its own tobacco control office, the first of its kind in the UK; Fresh began life in 2005. I am sure that the local authorities will recognise the work that has been done. It will be down to them to decide how the money is spent in local areas to improve their stubborn smoking rates. In the north-east, Fresh has managed to reduce the number of smokers by 137,000, and local NHS stop smoking services continue to provide support to the highest number of people in England. We in Government have introduced a tobacco control plan, and I assure the hon. Member for Newcastle upon Tyne Central that we will be consulting on plain packaging and continuing progress, as detailed in the plan, which I am sure she has seen.
However, the major part of poor health in the area will be remedied only by widespread changes in behaviour. It is this Government’s policy to encourage people to change how they live—[Interruption.] Hon. Members might gain slightly more from this debate if they listened to the answers rather than shouting at me from across the Chamber. We cannot frog-march people out of the off-licence, compel them to stop smoking or force them to practise safe sex. Our challenge is to make the case that freedom without responsibility is not sustainable, so for the first time, allowing for the progress of the Health and Social Care Bill through the House, the Secretary of State will have a specific responsibility to tackle health inequalities, whatever their cause, and will be backed up by similar duties— [Interruption.]
Mrs Linda Riordan (in the Chair)
Order. Will Members let the Minister be heard in this debate?