---

Accident and Emergency Services

I am a great supporter of local government and served as a local authority councillor for eight years, so I understand clearly the important role that a local authority can play in a community. However, I am saying to the Minister that effective scrutiny and the effective ability to look at what is often quite complicated work would demand a rethink about the resources that we put into local government scrutiny. If we look back over the years during which there have been scrutiny panels in local government, we find that there is a concern about the capacity of local government to scrutinise services effectively that are outside their own remit. I want to move on, because I want to pay tribute to my hon. Friend the Member for Hartlepool, who, as ever, is a strong advocate for health services in his locality. Importantly, he also raised the issue of NHS Direct. Over the summer, there was a lot of confusion because of the unfortunate way that announcements were made about the future of NHS Direct. So it was important that that issue was raised in the debate, because I think there is genuine concern in the community about it. The hon. Member for Newton Abbot raised the issues of minor injuries units and the need for appropriate networks of care. The hon. Member for Burnley (Gordon Birtwistle) gave a very full history of what had happened in his community. He discussed the problem of trying to define the difference between "urgent care" and "A and E services." However, I noted that the Secretary of State for Health has made it clear that the naming of facilities is very much an issue for the locality in which a facility is situated, so the local area needs to determine what title best fits the services that a facility provides. The hon. Member for Burnley also raised a number of points that I wish to discuss briefly regarding the confusion that exists at the moment about reconfiguration and the current Government's position on that issue. I think there is genuine agreement that all changes in health services should be clinically driven and, of course, locally led. My right hon. Friend the Member for Leigh (Andy Burnham) made it clear when he was Secretary of State for Health that tough decisions would have to be made about moving services out of hospitals and into communities, where they would be closer to people's homes, and about centralising specialist care where it made sense in terms of protecting patients' safety. The hon. Member for Southport referred to the great deal of research on patient safety that is available and he and my hon. Friend the Member for Hartlepool said that more consideration needs to be given to the transport links that are so vital if communities are to be able to access health care facilities. I do not wish to take very long to make my comments, because I want the Minister to respond to the particular constituency issues that have been raised today. I just want to raise more general issues regarding the concerns that exist about the Secretary of State's announcements on reconfiguration. Before the election, the Secretary of State made great play of touring the country and promising that A and E services would not be closed; he said that such closures would not happen under his watch. Two weeks after the election, he made an announcement at Chase Farm hospital that there would be a moratorium on service changes. The revision to the NHS operating framework 2010-11 was published on 21 June and it states: "A moratorium is in place for future and ongoing reconfiguration proposals." However, several local areas have pressed ahead and made decisions to downgrade A and E services and other facilities, including the downgrading of a maternity unit in Kent, which local GPs are opposed to, and the downgrading of a maternity unit at Chase Farm hospital, where before the election the Secretary of State had said that the plans for the north central London review would be scrapped. Now it appears that those plans are being brought forward again. Ministers in the coalition Government have made it clear that it is not their approach to intervene in health care services and reconfigurations. Curiously, however, despite the Government's saying that strategic health authorities should not take decisions relating to service changes, on 29 July David Nicholson, the chief executive of the NHS, wrote to strategic health authorities, asking them to "undertake an assessment of which proposals have successfully demonstrated the test and should proceed, which require further work and which, if any, should be halted. This initial assessment should have been completed by 31 October 2010." I just want to refer to the "test" mentioned in that letter. As I understand it from what the Secretary of State has said, it involves commissioners-the commissioners being GPs-having to reconsider whether or not they support the proposal that is being put forward. It also includes strengthening arrangements for public and patient engagement with local authorities; that is particularly referred to in the "test". There must also be greater clarity in the clinical evidence for any reconfiguration and the need to develop and support patient choice must also be taken into account. As I understand it, that is the "test" that the coalition Government are putting forward, which has to be gone through, step by step, for any reconfiguration. However, when we refer back to the statement on the moratorium, that is all rather confusing and contradictory.