Oral Answers to Questions

Robert Neill Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

My right hon. Friend the Secretary of State has visited twice in the past year, and the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne) is more than willing to meet my hon. Friend next week, with other colleagues.

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

16. What assessment he has made of the level of co-operation between clinical commissioning groups and local authorities.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

The Government want and expect strong relationships and joint working between the NHS and local authorities to make a success of STPs. They are meant to be a one-system solution.

[Robert Neill]

The London Borough of Bromley has had considerable success in joint working with its clinical commissioning group, through joint appointments, a multi-agency use of funding and a complete sign-up from the council, but we are concerned that reorganisation may detract from this operation at the local level. Will the Minister agree to meet me to discuss Bromley’s proposals to build on the success it has had so far?

[Steve Brine]

We are confident that we have some of the best STP leaders in place. I was looking last night at the figures for south-east London, and I saw that my hon. Friend’s local STP is highly rated, both on leadership and overall. I was thinking about him in the gym last night and I thought he might say what he did, so let me say that I am very happy to meet him and to broker a meeting between him and the NHS.

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[Mr Hunt]

What the CQC actually said this morning is that the majority of health and care systems across the NHS are providing good or outstanding quality; that the safety of care is going up; and that performance is improving. None the less, the hon. Gentleman is right that we are always concerned about winter. Let me tell him the new things that are happening this year to help prepare the NHS: £1 billion more going into the social care system in the most recent Budget; a £100 million capital programme for A&E departments; 2,400 beds being freed up; and an increasing number of clinicians at 111 call centres. A lot is happening, but, overall, let me remind him that our NHS is seeing 1,800 more people every single day within four hours—that is something to celebrate.

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

T7. The Minister will be aware that clinical commissioning groups and the London region are currently consulting on changes to governance and commissioning arrangements. Given the positive words already said about arrangements in Bromley, will my right hon. Friend confirm that no changes of any kind will undermine the accountability at a local level, or the ability to commission locally in Bromley?

[Mr Hunt]

I can confirm that because the legal accountability, whatever co-operation arrangements are made, will stay exactly the same.

Oral Answers to Questions

Robert Neill Excerpts

Tuesday 15th November 2016 Commons Chamber

[Nicola Blackwood]

The hon. Gentleman is absolutely right that diabetes is a major health risk in the UK. That is why we have rolled out the first ever NHS diabetes prevention programme this year on 27 sites, covering nearly half of England and referring nearly 10,000 people. Next year, the second wave of the programme will reach a further 25% of the English population. The aim is for the NDPP to be rolled out across the whole of England by 2020 to support 100,000 people at risk of diabetes each year.

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

T6. Proper integration of adult social care and health services requires co-operation on both sides. Does the Secretary of State agree that it is really not acceptable that in a borough such as Bromley, the CCG top-sliced only 3.5% of its funding to go into the better care fund—nowhere near enough to make a difference to hard-pressed local services?

[Mr Jeremy Hunt]

I thank my hon. Friend for bringing up that issue. Everyone recognises, on both sides of the House, that the health and social care sectors need to work together. That happens very well in some parts of the country, but not in others. I think all hon. Members have a job to make sure that people behave responsibly in their constituencies.

Cities and Local Government Devolution Bill [Lords]

Robert Neill Excerpts

Monday 7th December 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

Our national parks are precious national assets. Millions of people use and enjoy them every year. They are areas of protected countryside that everyone can visit, and where people live, work, and shape the landscape. We have 15 national parks: 10 in England, three in Wales and two in Scotland.

In his autumn statement, the Chancellor included devolution to national park authorities in England, allowing them to lend, invest, trade, and set up co-operatives with businesses. That is legally known as the general power of competence. However, we know what is driving this change: cuts made by this Government. Since 2010, national park authorities in England have suffered cuts of up to 40% in their Government funding. Indeed, Northumberland national park is already renting out its spare office space—vacated by staff who have lost their jobs—where an enterprise hub has been set up.

New clause 7 would amend the Environment Act 1995 to provide English national park authorities with general powers to do anything they consider appropriate in carrying out their functional purposes. The new general powers in proposed new section 65A are similar to those conferred on other authorities by chapter 1 of part 1 of the Localism Act 2011. The new clause only applies to English national park authorities.

Proposed new section 65B limits the scope of the general power of competence in several respects. It does not allow English national parks to borrow money or charge a person for anything they do other than for a commercial purpose. That immediately raises concerns. The coalition Government’s attempt to privatise our forests was met with a public outcry. That plan was rightly defeated. This Government have attempted to open up our national parks to fracking, again causing a great deal of concern among the public, who value our precious national assets and have no wish to see them opened up to commercial ventures in that manner. We need strong assurances that the character of our national parks will be protected and that such important national institutions are maintained for the benefit of the public. We need a cast-iron assurance from the Government that fracking is not going to be allowed in our national parks.

We need more details on Government funding of national parks. We need more details on what the national parks are actually planning to do with the new powers. We cannot allow the commercialisation of our national parks by the back door. The future governance and accountability of our English national parks is an absolutely massive issue, which deserves proper debate. It does not belong here, in the Cities and Local Government Devolution Bill, inserted at the eleventh hour with no time for the weighty issues raised to have a proper discussion.

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

Given that national parks are local authorities for these purposes, will the hon. Lady reflect upon the complete and deeply misleading red herring that she raises? After all, the fracking matter has nothing to do with the role of local authorities of any kind—national parks or otherwise —in relation to a general power of competence. Should she not welcome the ability of national parks to enter into joint agreements, for example with their district and county councils, which is precisely what this provision is aimed at? She is actually setting up a complete Aunt Sally in this matter.

[Liz McInnes]

Red herrings, Aunt Sallies: I am merely expressing the unsuitability of the new clause in application to this Bill. It has been brought in at the eleventh hour with the minimum of notice. It raises huge issues. I do not think the general public would agree with the hon. Gentleman that the worry about fracking in our national parks is a red herring. I certainly got a lot of correspondence about it when the Government were talking about it a few weeks ago, and I think we need a proper debate.

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[Liz McInnes]

I will not take any more interventions. I have already given way to hon. Members.

The national park authorities are one part of the equation, and, as I have already said, we have not had time to consult them properly because this proposal was brought in at the eleventh hour. Surely any reasonable person would want—[Interruption.] Conservative Members had prior knowledge of it. I am sure that every reasonable person would agree that we need a proper debate on such an important issue. The national park authorities are not the only stakeholders involved. The public are the real stakeholders. Millions of people use and enjoy our national parks every year, and they should have their say. They would not thank us if we allowed this measure in through the back door.

Neither I nor any of my team are opposing the new clause for opposition’s sake; we are opposing it because we have serious concerns about the way in which it has been introduced. We will not agree to such a huge change in the governance and accountability of our national parks at only a few days’ notice and without a proper debate. If the Minister thinks that we are going to let this go through without a proper discussion, he is very much mistaken.

It is totally inappropriate that the new clause, which could bring about major and irreversible changes to our national parks, should be slipped into the Bill in this manner. The national park authorities are there to protect the environment for the good of the nation and its people. I call on the Secretary of State to withdraw the new clause. It does not belong in the Bill. If a discussion is needed about the future funding of our national park authorities, so be it, but let us have a proper debate. Let us give our stakeholders, the people, a chance to have their say, and let us not try to introduce damaging changes to our national parks by the back door.

[Robert Neill]

rose—

[Peter Heaton-Jones (North Devon) (Con)]

rose—

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[Robert Neill]

Thank you, Mr Speaker.

That was without any doubt the least-informed speech I have heard from a Front Bencher in the whole of my career in the House of Commons. I am sorry to say that to the hon. Member for Heywood and Middleton (Liz McInnes), but she has simply not read the new clause and understood what it is about. It extends the power of general competence that applies to local authorities, which her party supported as a welcome thing when I introduced it as a Minister, along with my colleagues, to local national parks authorities; it does not affect planning in any way whatever. I am horrified that an Opposition Front-Bench spokesman does not understand the difference between the role of a national parks authority qua local authority and its role as a planning authority, which is not changed in the slightest by any of this. The Opposition’s approach is therefore worrying.

[Steve Brine]

As the shadow Minister would not give way to me for a second time, I wish to put on the record the fact, which my hon. Friend will confirm, that we did have advance notice of the new clause. I met the South Downs national park authority on 13 November, when it made clear its support for the provision. It, like me, has had that much time to look at it. The Opposition may have been distracted by other matters, but that is a whole other matter—and, for the record, Aunt Sally was in “Worzel Gummidge”.

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[Robert Neill]

My hon. Friend is absolutely right. The troubling thing is this: applications for fracking, licensing matters and all that regime are not governed by a power of general competence in the slightest. The new clause has no effect on fracking of any kind whatever, and I regret to have to say to the hon. Lady that to suggest otherwise is either wilful ignorance or a serious piece of misleading the public.

The new clause gives local authorities that are national parks the same powers to deal with things as their district councils and county councils have. The point has also been well made that it enables them to enter into devolution deals, which again I believe the Opposition supported. So far, they are against a power of general competence, which they supported when we brought it in, they are against devolution deals in national parks, which they have supported, and they have set up an Aunt Sally that has nothing to do with the case.

I appreciate that the Opposition Front Benchers have been shuffled so many times that they probably do not have time to read an Order Paper nowadays, but the most cursory reading of the amendment might have given them some idea that their approach is totally off the case, it is against the views expressed by the Select Committee rightly and properly and it is against devolution. I am sorry to say that we heard a bizarre speech from the Opposition and they are taking a bizarre approach. If they divide the House on this, they are simply—

[Richard Graham (Gloucester) (Con)]

Is my hon. Friend aware that quite a campaign has been whipped up across the country about the possibility of fracking springing up in national parks as part of some dastardly plot by the Conservative Government to introduce fracking wherever they can find a national park? Does he think that perhaps the response from the Opposition is influenced in some way by that campaign?

[Robert Neill]

I have always taken the view in politics that the further left you go, the greater the conspiracy theories get; I suspect that may have happened, perhaps with one or two honourable exceptions, to the Opposition Front-Bench team. But that has nothing whatever to do with what we are about. It has nothing to do with their ludicrous scare campaign. A simple amendment, whose principle was not objected to when the Localism Bill was brought through, is suddenly being seized upon for the most bizarre bit of political grandstanding by a bankrupt Opposition. The best thing they can do is find something to agree upon. Their approach would prevent a national park authority from entering into a joint venture with its district and county councils, although that is a perfectly sensible and reasonable thing to do. Anyone who speaks to people who have represented areas in national parks will know that one of their concerns was the inability to join up the service delivery between the national parks authority, the district council and the county council. That sort of thing was a regular issue upon the desk of any Minister.

The new clause enables that to be done through a simple, legal structure. It has nothing whatever to do with applications for planning permission for fracking and with the licensing regime for fracking. It is a sad and sorry day when an important and useful technical amendment is hijacked by one of the more bizarre bits of political boulevardiering that I have ever seen in my time in the Commons.

Princess Royal University Hospital

Robert Neill Excerpts

Wednesday 25th March 2015 Westminster Hall

[Jim Dowd]

I was talking about the fabled meeting in July 2012—two and a half years ago. When the Secretary of State and the trust special administrator said that the answers to the problems of the then South London Healthcare NHS Trust did not lie within its own boundaries, I knew that what they had in mind was effectively the evisceration of Lewisham hospital. For reasons that have eluded me for decades and more—I used to be on the health authority of Lambeth, Southwark and Lewisham, and the district health authority for Lewisham and north Southwark—various elements of NHS London have always had Lewisham hospital in their sights. There was once a plan for there to be only four accident and emergency and general hospitals in south-east London: St Thomas’, King’s, PRUH and Queen Elizabeth; there was no room for Lewisham. I do not know why the various NHS powers think Lewisham is such an encumbrance. The service it provides to its residents and the pressure it relieves from the other hospitals around south-east London are proof positive of its value.

The morning of 5 March dawned—I was quite delighted about that, because it was my birthday. At 9.25 am, I received an e-mail from Monitor, explaining that,

“Monitor is opening an investigation at King’s College Hospital NHS Foundation Trust to find a lasting solution to long-standing problems at the Princess Royal University Hospital…The regulator is concerned that some patients are waiting too long for A&E treatment”—

nothing unusual there. Not one of the hospitals in south-east London—not St Thomas’, over the river, not PRUH, not Queen Elizabeth, not Lewisham, not King’s—is currently meeting the 95% targets for seeing attendances at A and E, so that is not surprising. The e-mail went on to say,

“and routine operations…the trust is predicting a deficit of more than £40m this financial year. This deterioration in its operational and financial performance follows the unexpected costs of making urgent improvements to the quality of care at the PRUH.”

Well, Princess Royal was taken over by King’s College hospital as a consequence of the trust special administrator’s recommendations, and that is the problem it has run into.

When the trust special administrator was appointed, the Secretary of State said in a statement to the House:

“The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS.”—[Official Report, 29 October 2012; Vol. 552, c. 3WS.]

The difference between the £1 million a week then and the predicted £40 million a year at PRUH alone now clearly demonstrates that the trust’s special administration process did not address the right problems. Clearly, the problem was predominantly at Princess Royal.

Queen Elizabeth is now part of a very successful partnership with University hospital Lewisham, and it is doing quite well. It is not without difficulties, but that is the case for any organisations that come together under difficult circumstances. However, it is making progress in clinical and financial affairs, and is well on the way to building a solid and reliable NHS entity in our part of south-east London. That demonstrates that the entire TSA process was substantially illegal, because as we know, the High Court—and subsequently the Court of Appeal—found the trust special administrator’s recommendation with regard to Lewisham hospital, and the current Secretary of State’s stubborn refusal to accept anything other than those proposals, to be illegal. The Secretary of State did not have the powers he assumed he had and could not reorganise in the way that was suggested. He even had the hubris to try and test it at the Court of Appeal, which found similarly that that was the case. Thankfully, sense prevailed at that stage and he left it there, deciding not to waste any more taxpayers’ money by going to the Supreme Court.

However, the Government introduced an amendment to the Bill that became the Care Act 2014, giving them the power that they thought they originally had to do whatever they liked by appointing a trust special administrator. This is where we come to the key worry about the future of Princess Royal and King’s. It is not just about the services that are provided there, which are critically important to all the constituents of Members here today, but about the fear that Monitor, using the powers that the Government put into that Act, will try to engineer another back-door reorganisation involving Lewisham hospital. As I say, that was originally declared illegal, but Lewisham could be dragged into it by other means, so the Government can achieve what they originally meant to achieve and were stopped from so doing.

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

I understand the hon. Gentleman’s point. Do I gather that his principal concern is the impact on Lewisham, and not the fact that Monitor is looking at accepted issues at the Princess Royal and King’s? From his point of view, it is the Lewisham dimension, rather than what it is necessary to do at the Princess Royal. Am I right in that?

[Jim Dowd]

I broadly agree with the hon. Gentleman’s point. Clearly, financial management is an important part of running the NHS. Everybody knows that, whether it is in our part of south-east London or more broadly.

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

I say now to colleagues who understandably are concerned about local health services and have rightly raised concerns on behalf of their constituents that if I cannot cover some of their questions in the next 12 minutes, I will undertake to write to them in the remaining days of this Parliament, or to ask someone else to write to them, so that we can try to give them some reassurance.

I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and the hon. Member for Lewisham East (Heidi Alexander) on raising her concerns. Taking my cue from what was said previously, I start by paying tribute to all those working in London’s NHS—in those hon. Members’ constituencies, in mine and right across London—for their dedication and commitment to providing first-class services to those in their care at a time when we know that the system is, in places, under pressure.

As we have heard, after consulting with the trust, its commissioners and the London strategic health authority, the then Secretary of State instituted the special administration process at South London Healthcare NHS Trust in July 2012. He was guided in making that very difficult decision on the basis of the clinical interests of local patients, with advice from the NHS medical director, Sir Bruce Keogh. The decision was also based on the fact that there was no clear option for restoring the trust’s finances while maintaining the quality of services to patients. It was clear at the time that doing nothing was not an option. Not resolving the issues at the trust would have carried a high degree of risk. It would have meant that the trust would not meet the London-wide clinical quality standards and that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit.

The trust special administrator 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 no one was able to come forward with a proposal that would solve the problem within the existing footprint of the trust. Indeed, there were no proposals that would not have involved neighbouring health care economies.

The long-standing clinical, operational and financial problems at South London Healthcare NHS Trust led the trust special administrator to recommend that Princess Royal university hospital be acquired by King’s College Hospital NHS Foundation Trust. The associated hospital sites in Bromley—Beckenham Beacon and Orpington hospital—were part of that transaction. I must say for the record that the transaction agreement was signed by all parties and no information was withheld from any organisation.

At the time, South London Healthcare NHS Trust was the most financially challenged in the country, with a deficit of £65 million per annum. Repeated local attempts to resolve the financial crisis at the trust had failed. Millions of pounds were spent on paying for debt rather than improving patient care for the local community in south-east London. The trust special administrator was clear that long-standing problems at South London Healthcare NHS Trust must not be allowed to compromise patient care in the future. That is why, after careful consideration, the Secretary of State accepted his recommendations, including that the PRUH be transferred to King’s.

The new expanded trust is one of London’s largest and busiest teaching hospitals and plays a key role in the education and training of the next generation of medical, nursing and dental students. King’s has acknowledged that it has been facing a number of pressures that have had a bearing on its performance. The challenge of integrating and transforming the performance of the PRUH, combined with a significant increase in emergency in-patient activity, has, as the hon. Member for Lewisham West and Penge described, adversely affected the trust’s operational and financial performance. A key aim of the trust’s five-year strategy is to restore its traditional high levels of performance, in particular by returning to achieving its emergency department and referral to treatment waiting time targets.

Monitor has concerns that some patients are waiting too long for A and E treatment and routine operations and that the trust is predicting a deficit of more than £40 million in this financial year. The regulator is undertaking its investigation to find a lasting solution to long-standing problems at the PRUH. Monitor is concerned that the trust’s operational and financial performance issues post the acquisition of the PRUH have not improved in line with expectations. In particular, some long-standing financial and operational performance issues at the hospital have continued post acquisition.

[Robert Neill]

May I say this on behalf of my hon. Friend the Member for Orpington (Joseph Johnson), the Minister of State, Cabinet Office, who cannot be at the debate? He and I would want to put on the record the fact that there have been areas of improvement at the Princess Royal and at Orpington, particularly in terms of patient experience scores, which have picked up considerably. On the point that my hon. Friend the Minister just mentioned, we are especially concerned at the prospect that has been raised that the full financial picture may not become available to King’s until after the acquisition. It is very clear—I hope that the Minister can assure us on this—that the Monitor investigation is intended once and for all to get to the bottom of, the root of, the financial difficulties that this trust suffers. May I also say that I welcome the appointment of the noble Lord Kerslake as chairman of the King’s trust? He will bring considerable credibility and rigour to that process.

[Jane Ellison]

I thank my hon. Friend for that intervention. I will say more about Monitor’s role, but it is very much in line with what he said and I hope to give him the assurance that he seeks.

Monitor has been working with King’s, local clinical commissioning groups, the NHS Trust Development Authority and NHS England since the acquisition and has worked more closely with the trust recently to get a better picture of the challenges that it faces. However, Monitor has decided to take the new, formal action because King’s has not been able to tackle its challenges on its own. Monitor considers that continuing to work with the trust through more intensive and formal engagement will help to drive the necessary changes.

I want at this point to highlight the fact that, following a formal investigation into a suspected licence breach at a foundation trust, Monitor does not have the power to direct non-foundation trusts, nor does it have the power to direct neighbouring foundation trusts unless they themselves are in breach of their licence. The range of actions available to the regulator range from informal action—for example, requesting further information—to formal enforcement action, including the imposition of additional licence conditions.

Where appropriate, Monitor seeks to encourage the whole health economy to work together to reach a locally owned, consensual solution, which is very much in line with the NHS “Five Year Forward View”. Monitor has said that it recognises that King’s has been working hard, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has said, to improve the quality of care provided at the PRUH. However, through its close work with the trust, Monitor has discovered that achieving the necessary financial and operational turnaround at the PRUH will be a greater challenge than was initially anticipated. Therefore, the regulator has decided to open a formal investigation as part of the regulatory process, which will enable it to use its legal powers to underpin the changes that the trust needs to make. The investigation will help Monitor to decide what resources and support King’s needs to enable it to deal with its financial problems and reduce waiting times for patients. Monitor will announce in due course the outcome of the investigation and whether it will take any further action. There is no statutory time scale for the investigation, because it depends on the scale of the issues encountered. I am sure that all hon. Members would want those issues to be looked at thoroughly.

South London Healthcare NHS Trust

Robert Neill Excerpts

Thursday 31st January 2013 Commons Chamber

[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.