During Question Time in the House of Lords this afternoon I intervened to try and get a straight answer from Earl Howe, the Parliamentary Under Secretary for Health, as to how many Accident and Emergency Departments will close in London hospitals over the next four years.  I also wanted to know who would take the strategic decisions for London as a whole and how they were accountable for those decisions.

Needless to say, I didn’t get a proper answer.

This was my exchange with the Minister:

Lord Harris of Haringey:My Lords, how many accident and emergency departments in London does the Minister expect to close in the next four years? If he does not know the answer, can he say who is responsible for that and how they are accountable for making a strategic judgment across London about the level of accident and emergency services?

Earl Howe:The premise behind the noble Lord’s question is that it is automatically worse to have fewer A and E departments in an area. I beg to disagree with that premise. In serious or complex cases, the noble Lord will know that patients need to access exactly the right care, so it is often better and safer for them to travel further to see specialists in major centres than to go to a local hospital. Although it may be closer, it may not have the right specialists, the right equipment or sufficient expertise in treating patients with their condition. The prime example of that has been stroke care in London, where 32 centres were reduced to, I think, eight and there has been a dramatic reduction in the number of deaths following admission.”

My colleague Baroness Janet Whittaker tried again a minute later:

Baroness Whitaker:My Lords, in the noble Earl’s answer to my noble friend Lord Harris, I did not hear an answer to any of his questions about numbers, who makes the decision and who is accountable. Would it be possible to hear that?

Earl Howe:My Lords, I apologise. The Question on the Order Paper relates to north-west London, so I do not have pan-London figures in front of me. The answer to the question is as I gave it in my initial response: those decisions are subject to local determination. That is right, because it is only local commissioners and providers who can assess the situation on the ground properly. As the noble Baroness will be aware, there is a system for escalating decisions—ultimately to the Secretary of State, if necessary, who takes advice from the Independent Reconfiguration Panel in the most extreme cases—but normally, we hope and expect those decisions to be resolved on the ground in the local area.”

So the Minister acknowledged that there would be a series of closures of A&E Departments in London, but couldn’t say how many there would be because he didn’t have the “pan-London figures” in front of him.  And, as all the decisions would be “subject to local determination” presumably as a result of the accumulated, but separate, individual commissioning decisions by local Clinical Commissioning Groups (whose less than satisfactory governance was debated last week), by implication there will be nobody who will take a strategic pan-London view of the level and distribution of Accident and Emergency Services in the capital.

Doesn’t inspire confidence……

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