The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his long service and the great work he did as a Department of Health Minister and for securing this debate. He has made a number of very good and important points—although I do not agree with everything he said—and I assure him that my officials will read his speech, and if I fail to respond to any of his points now, we will write to him. He has asked a number of questions, and I may not be able to answer all of them—and strongly suspect I will not be able to give the sort of answers he would like.
My right hon. Friend is standing up for his constituents’ health services, which is absolutely right. It is right that Members come to the House and speak up on behalf of their constituents. On hospitals and health care services, at the end of the day we all want the same thing: the very best services for our constituents. Everyone is entitled to the very best health services.
As my right hon. Friend will know, it is not my role to defend or to rubbish the “Better Services, Better Value” process. He has made some very good points, but I have no doubt that it was set up for the very best of reasons. There are no proposals at this stage, but there is a huge consultation stage. I am told the underlying reason for setting up the BSBV was to ensure that everyone in south-west London and Surrey Downs has the very best health services seven days a week, 24 hours a day.
A number of hon. Members who represent the area covered by the review have rightly made representations. Some, like my right hon. Friend, have spoken in this House. He has also been to see me, as have others, including my right hon. Friend the Deputy Leader of the House, and the Under-Secretary of State for Transport, my hon. Friend the Member for Wimbledon (Stephen Hammond), is coming to see me next week. My hon. Friend the Member for Croydon Central (Gavin Barwell) and the hon. Member for Mitcham and Morden (Siobhain McDonagh) spoke in the most recent debate on the future of A and E services, which was held only a few weeks ago. I shall refer to some of those speeches.
The area affected by the reconfiguration covers south-west London and the Surrey Downs. South-west London has a population of 1.4 million, the Surrey Downs have a population of 280,000 and between them they enjoy a health service that is funded to the tune of £2.8 billion a year. As my right hon. Friend the Member for Sutton and Cheam has made clear, although much of this is about saving money and meeting the Nicholson challenge —a scheme introduced under the previous Government and supported at the time by both Opposition parties, and one that continues because we recognise that those savings must be carried through—this is not about cuts. If anybody makes that case, as I have said before, they do no service to anybody or to the debate. This is not about brutal cuts but about trying to deliver the best service for people throughout the whole area seven days a week, 24 hours a day.
My right hon. Friend the Prime Minister, when he presented the Francis report to this place and answered various questions on it, gave an answer that we should all remember. I have used it before, but let me repeat it now. He said:
“Let me refer again…to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront”—
which is something on which we all agree—
“we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included”—
and it includes me, too—
“reach for the button that says ‘Oppose the local change”’.—[Official Report, 6 February 2013; Vol. 558, c. 288.]
I agree with those words. We are all beholden, whatever part we play in reconfiguring and reorganising health services, to ensure that we do not have an immediate knee-jerk reaction to oppose change. I am not saying that my right hon. Friend the Member for Sutton and Cheam has done that, but others have. Change is the right vehicle and the right driver to ensure that the people of this country get the best services.
To explain how difficult it is to make a reconfiguration, let me refer to the speech made by the hon. Member for Mitcham and Morden in the recent debate on A and E services. She said:
“My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.”—[Official Report, 7 February 2013; Vol. 558, c. 515.]
That is another hon. Member who would join my right hon. Friend in opposing any changes, cuts, closures and so on at St Helier.
The Minister is responding fully to the points I have made so far, but let me demonstrate the distinction between my point and that made by the hon. Member for Mitcham and Morden (Siobhain McDonagh). She has conflated the BSBV programme, which is a reconfiguration, with the Nicholson challenge. The Nicholson challenge is being taken forward separately in south London and BSBV does not deliver on it.
I am grateful to my right hon. Friend because I was going to agree with him that the hon. Lady’s analysis was not correct. The point that I am trying to make is that she seeks to defend her hospital, as my right hon. Friend does. She does not want changes that in any way undermine her hospital, and she makes that case with some passion. It is interesting that my hon. Friend the Member for Croydon Central, who also took part in that debate, made a speech that completely contradicted what the hon. Lady had said.
Motion lapsed (Standing Order No. 9(3)).
Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)
That is a peculiar, old-fashioned procedure, but none the less valuable and enjoyable, Mr Deputy Speaker.
My hon. Friend the Member for Croydon Central argued in the same debate in favour of the BSBV review on the basis that, according to one of the many reports that form part of the review, Croydon Health Services NHS Trust—in other words, his hospital—should have 16 whole-time equivalent consultants, but it has 4.9; St Helier should have 12 but has 4.5; Kingston hospital NHS trust should have 16 but has 10; and St George’s should have at least 16 but has 21. That suggests that departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended level of consultant cover. He went on, as we might imagine because he, too, wants the very best for his hospital and his constituents, to make the case that BSBV would deliver exactly what he wants for his constituency.
The hon. Member for Croydon Central (Gavin Barwell) made some important points in that debate, but he did not go on to make the key point that when we look at the figures for BSBV, we see that the cost of delivering the improvement that he and I both want is between £4 million and £7 million, yet under BSBV £350 million would be spent to do that.
All I can say is, a good point well made, and move on towards my concluding remarks.
My right hon. Friend has asked me a number of questions. If I do not reply in full, I assure him that I will in a letter. I am told that a “do minimum” option should exist. I know that he knows this, because he was a Minister in the Department of Health, but I want to remind everyone that, for this scheme or any reconfiguration scheme to go forward to full public consultation, it has to pass four tests that were clearly laid down by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) when he was Secretary of State for Health. The four tests are support from GP commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice.
In conclusion, I shall deal with my right hon. Friend’s three final questions. I am told that a “do minimum” option should exist. In relation to whether CCGs are free to withdraw from the process, I think it is important that I read out what I am told; I do not want ever to be accused of not saying things I have been advised on. I am told that local CCGs are already a key to BSBV. However, and perhaps more important, after 1 April CCGs will be in the driving seat and by definition BSBV would be unable to continue without their support. That would seem extremely obvious.
That is very helpful. Given that CCGs will be in the driving seat from 1 April, does that mean they can hit the ejector button and get BSBV out?
I do not know the answer to that, and of course I would not put it in those terms, but I shall make further inquiries and certainly write to my right hon. Friend so that he has a proper and full answer to that very important question, which I have no doubt many other right hon. and hon. Members would like to ask in relation to other reconfigurations, notably in the south of England.
My right hon. Friend’s other question, in effect, was: would someone at the Department of Health look at BSBV? As he knows, from 1 April the NHS Commissioning Board will have responsibility for determining whether the four tests have been met, prior to a public consultation on BSBV. The Secretary of State only becomes involved quite some way down the line. I will not—I nearly said I was going to bore you, Mr Deputy Speaker; I would not dream of doing such a thing. However, the intervention of the Secretary of State can only occur much later down the line, when the matter has been referred to him by the overview and scrutiny committee of any local authority, by way of an independent reconfiguration panel, and so on.
As I said, my right hon. Friend has raised some important points. If they have not been addressed by me, they will be by way of a letter. I congratulate him again on having secured the debate.