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underplaying of recreation will be regarded as controversial by recreation interests and will be likely to lead to new controversy and conflict.Mr. Bill Walker : The hon. Gentleman is making a very important speech and certainly many of us would have wished that we could have heard some of it earlier. That is not a criticism ; it is just a comment.
On the very point of recreation bodies that have an interest in the use of a our Scottish land, does the hon. Gentleman join me in deploring the absence of proper appeals procedure, which is the point I tried to make in Committee, he will remember?
Mr. Dalyell : I was, as my hon. Friends know, very tempted when the hon. Gentleman approached me to support him on appeals. I did not do so. I took a lot of trouble about it. I asked around, and a number of those with whom I was in close contact were against the appeals procedure precisely because they thought that it might be abused. It did not help his case that Lord Pearson and others in the Lords had conducted this ambush. This is my personal opinion--I cannot speak for my hon. Friends on the Front Bench and they may take a different view--but had it not been for what happened in the Lords, the hon. Gentleman would have got his amendment through. But great resentment was caused by what happened in the Lords on this issue.
Mr. Walker : What about the Committee?
Mr. Dalyell : I think that the Minister will agree that, with the exception of himself, I probably occupied more of the Committee's time than anybody.
During the recess, I reflected on this matter with colleagues, who have been very helpful, with a view to making a submission to the House of Lords to think again. I make no bones about what I should like to see happening. I should like to see a general election in June, so that we could go back to the drawing board on this whole matter. In fact, I should like to see the Bill fall.
We have to reflect on the whole question of sustainable development and whether it can be delivered. By far the most interesting element of the new proposals is the emphasis on sustainable development. The Government's desire to move in this direction is to be welcomed, but the realism of laying this task on the new agency needs examination. It being Ten o'clock, the debate stood adjourned.
Ordered,
That, at this day's sitting, the Natural Heritage (Scotland) Bill [Lords] may be proceeded with, though opposed, until any hour.-- [Mr. Nicholas Baker.]
Question again proposed, That the Bill be now read the Third time.
Mr. Dalyell : First, there is the question whether the new agency is centrally enough placed to handle this major challenge. The central conservation issues of today pivot on the
consumption--particularly by the developed nations--of increasing amounts of the world's natural resources, and on all the consequent effects on pollution, population increase, health, hunger and the social cohesion of increasingly urbanised societies.
This is a heady agenda, on which a local agency with a limited remit might make progress. It can be argued that
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the scale of these issues places them at governmental or transnational level, although there is an important challenge here for a body to act in a missionary role. But this will be a provocative task, if only in defining, in a practical way, what sustainable development means. This will not necessarily lead to the kind of harmony that the Government seek in the debate about conservation and development.The concept of sustainable development is, on the one hand, simple and, because of this, attractive. But it is also difficult to define and difficult to apply to the kind of marginal land that makes up much of upland Scotland. Let me give some examples.
We cannot easily assess whether present approaches to the management of rural land are sustainable, because of the long time scale involved in understanding the effects of present practice, and because of the complexity of the systems--for example, the debate on whether conifer afforestation of poor, acidic upland soils leads to enhanced acidification. The hon. Member for Tayside, North (Mr. Walker) knows exactly what I am getting at, as it is highly pertinent to the kind of area that he represents.
In the assessment of gains and losses in the use of land, we cannot easily measure, or give monetary value to, the intangible benefits or values that we attach to, say, well-being and pride in our heritage, or to the enjoyment of recreation in fine countryside. It is unlikely that there is any methodology to do this with precision.
At this stage I want to pay tribute to a man I admire very much. I refer to George Lawson, a former Member of Parliament for Motherwell, and a Scottish Whip. He gave a great deal of his time to the question of land use, and published a report. I do not say that I have read the entire report, but during the recess I went back to it. I thought extremely highly of the work that George Lawson did.
It is likely that we have already passed the limits of sustainable use in the way in which we exploit land of the lowest
productivity--say, in the afforestation of the very poorest land, or in the carrying capacity of some upland habitats for recreation. So, while the sustainable development remit is attractive, it is not an easy route forward for any agency whose remit does not extend into a wide arena, and vigorous pursuit if this theme is likely to sharpen the conservation- development debate, not ease it. The Government have made it clear that the proposed new agency must temper its functions with economic developments in rural areas. That is not quite in accord with the definition of sustainable development in which human activities should be in balance with the capacity of the natural resources being used. The dilemma here is that the Government's approach to balancing duties places undue burdens on the lightweight and lowly funded conservation bodies as against the heavily resourced mechanisms for the support of the development. Yet evidence is lacking that conservation is a major constraint on development in Scotland. No such accusation can be made against the way in which the conservation of landscape has been delivered. For wildlife conservation, there has been a small number of high-profile cases of conflict, but that should not obscure the fact that most SSSI consultations, most management agreements and most other consultation arrangements for conservation are working smoothly. Any snags in the system should be eased through improvements in its administration rather than in its wholesale reorganisation.
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My ferocious defence of the NCC staff against accusations in the debate in the other place by people who should have known better was partly due to the fact that the NCC staff as a whole, with certain exceptions--the hon. Member for Caithness and Sutherland (Mr. Maclennan) referred to some unfortunate exceptions--had been very successful. It should be on the record that the NCC staff as a whole were deeply hurt by what was said in the debate in the other place. I say that having attended the estuary and other NCC presentations given by Sir William Wilkinson and Tim Hornsby.Mr. McFall : I suggest to my hon. Friend that the people who have been betrayed are the members of the Countryside Commission, with their mountain areas report. My hon. Friend is making important points about development and conservation. In the Loch Lomond area, there is £120 million-worth of development, but we do not have the necessary statutory laws for conservation and enhancement. The result is that, on the see-saw, the balance is very much on the side of development. Interest in conservation and the enhancement of the environment is negligible compared with the pressure for development.
Mr. Dalyell : I do not exaggerate when I say that, of the 30 to 40 mostly knowledgeable people I have met who read the Official Report of the debates that took place in Committee, and in particular who read the remarks of my hon. Friend, most said, in effect, "John McFall is absolutely right, and you people in Parliament had better understand that." I refer not only to Frank Bracewell, the planning officer of Central regional council, but many others who strongly agree with the proposal put forward by my hon. Friend, who is the constituency Member involved.
I leave out the rest of the argument. My hon. Friend the Member for the Western Isles (Mr. Macdonald) may be right in what he said about his area, and we do not quarrel with that, but some of us in the Central region desperately want a natural park. The whole tenor of the Government's proposals is to undermine the role of nature conservation and to give encouragement to the prejudiced view that the nature conservation movement must be brought to heel. That is nothing less than a major surrender of values. Adding to the commission's functions may be seen by some as one way of shifting the balance against nature conservation, but it is no way to create a workable merger. The early signs are that the merger is not working happily. The planning stage and the rest of what is going on are riddled with difficulties.
Mr. Nigel Griffiths (Edinburgh, South) : We all acknowledge my hon. Friend's expertise in the matter, but is it not the case that one of the tragedies of the Government's approach is that the vested interests-- landowners, and worse, those people who have only a financial interest in lands in Scotland, who may not be based in Scotland and who may not have any concern for the conservation of land in Scotland--seem to be listened to in the corridors of power rather than the hill walkers, the bird watchers and the other conservation groups who for over a century have had the real interest of Scotland at heart? Does my hon. Friend agree that, by his approach, the Minister is prejudicing the interests of people who enjoy, relish and have a great commitment to land and
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conservation in Scotland in favour of the interests of those who have only a financial interest? That is the nub of the difference between us and the Minister.Mr. Dalyell : I shall not stretch Mr. Speaker's patience by wandering to the question of Mar Lodge. The earlier discussion of Mar lodge completely encapsulated the point that my hon. Friend the Member for Edinburgh, South (Mr. Griffiths) had made. That is why we will talk about Mar Lodge on other occasions, but I undertook not to stray back to that.
There are organisational imbalances to address in the merger. Those imbalances might be catalogued. There is a major imbalance in staff numbers, with the NCCS at the time of merger being at least six times larger. The organisation will be starting life essentially in the old offices of the NCCS, but with a new nameplate, so there will be an image issue which will run against the interests of the Countryside Commission for Scotland. The NCCS has complex and well focused legislation on designation, control licensing, land management, and so on, and those functions will still have to be delivered, while the commission's functions under statute are relatively open, and will be overshadowed by the need to achieve these key wildlife tasks. There is a very vigorous voluntary sector lobby on behalf of nature conservation, which will be pushing hard for no relaxation in the way in which nature conservation is delivered. Far from being a true merger of equals, the prospect is that the CCS functions will become overshadowed in the new arrangement.
We have a complex system for administering and overseeing land use matters. Some people think that there should be an all-embracing land use department, but there are good arguments against whole scale amalgamation of functions. Principally, the key sectoral interests should be seen to be separate and visible, without the concealment of debate that would exist in an all-purpose land-use department where controversy was balanced internally. The all-purpose approach would be bureaucratic and less efficient.
Maintaining two Government agencies would allow those functions that may be subordinated to have their place and to be visible--as in the case of recreation--to the large constituency with an interest in it. Objectives would be more focused : indeed, divergence of views on matters like conservation is to be encouraged, as fostering debate and providing the widest spectrum of views to Government. The risk of subordinating key functions is the key argument in the White Paper "This Common Inheritance" against an equivalent merger in England, and one has to ask why that argument does not apply in Scotland. The new agency, SNH, already promises to be a small bureaucracy, with complex systems of political control and oversight. The Minister may interrupt if he thinks that I am being unfair, but there are those dangers.
Less dramatic but more cost effective, more efficient and saving of confusion and morale would be to address any need for change through administrative action. To do that, the Government should endorse the present structures as the basis for change, and encourage administrative fine-tuning of existing mechanisms where snagging points occur, such as the need for a route of appeal when promoting new designated areas.
They should provide some of the extra resources required for the merger with the relatively underfunded
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Countryside Commission for Scotland and should direct that its two agencies collaborate closely on those topics where joint working makes good sense. They should promote and strengthen the commission's work in the countryside around towns where it has already made an impact and, with major dereliction now tackled by the Scottish Development Agency, direct the commission to a new role in leading smaller scale landscape improvement work in collaboration with the local enterprise companies to create a richer and more accessible landscape close to where most Scots live.The Government should also encourage the commission to continue to develop a stronger design-based approach in its work, particulary to promote higher standards of built development in the countryside. They should release more funding to the commission to strengthen its work to promote recreation and facilitate harmony between visitors and those who own and work the land.
Finally, the Government should encourage stronger working between the conservation agencies and those agencies and Departments responsible for primary land uses. They should begin a debate about sustainable use as a collaborative venture in that way rather than through a single agency approach as proposed.
Underfunding of the Countryside Commission in recent years has left it in a weaker position than the Nature Conservancy Council because the commission's mode of working through others has led to it spend little of its resources on building up its own staff and internal activities. Although small in size, the commission has operated efficiently and prudently and chosen partnership as its main working theme. The extent of duplication of effort between the commission and the NCC is limited, and that could be eased by more collaboration. There is a role for an agency to link caring for the countryside and its use for recreation. That is not always an appreciated role because it involves bridge-building and compromise as well as avoidance of confrontation. Recently, however, the commission has been leading lively debates on issues like caring better for mountain areas, and has been reviewing arrangements for access to the countryside.
Given a modest increase in staff and funding, the commission could play a more vigorous role and develop a distinctive approach to enjoyment and conservation of Scotland's scenery, which is the crucial resource underpinning tourism and outdoor recreation. There has been little general debate about the technical merits of the proposed merger of the CCS and the NCC in Scotland. In part, some people may see the merger as simply a good way to simplify public administration. Some may see it as providing a new face to conservation, while others undoubtedly see the merger as a means of blunting what is perceived to be a sharp edge to conservation. But there must be a serious review of fundamentals and practicability. I hope that the House of Lords will reconsider the Bill thoroughly, as it is entitled to do. Having read the Official Report of the Standing Committee, I hope that, saved by the gong in the form of a general election, the Labour party will put forward different proposals from the
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ill-thought-out, ill-conceived and exceedingly expensive Conservative party proposals, which will cause a great deal of hassle.Mr. Galbraith : I shall put everyone's mind at rest by reassuring them that I have no intention of following that tour de force, but shall simply make a few closing remarks.
I have spent the last part of my life in the mountains, and I have a love affair with the mountains and the countryside--in other words, Scottish Natural Heritage, which is what the Bill is about. Therefore, I was pleased to be part of the process of taking the Bill through its stages, along with the courteous Under-Secretary of State. The merger between the Countryside Commission and the Nature Conservancy Council is a natural one. On that I disagree with my hon. Friend the Member for Linlithgow (Mr. Dalyell). There are conflicting functions within the organisations, but both establishments are concerned with the good use, management and preservation of the countryside. The conflicts are best dealt with when taken together in a committee rather than being set apart, which often generates false conflicts.
My first contact with the Nature Conservancy Council was during my visits to the Isle of Rhum, which I have already mentioned. The council has always been a delight to me and others, and looks after that island very well ; access to it is free and easy, and I have never had any problems. Its management of that island is an excellent example of just what the Nature Conservancy Council can do. Therefore, all in the House can trust in an organisation constituted, in part, by the Nature Conservancy Council to provide good management and ensure the preservation of the countryside in the mountain regions of Scotland. Therefore, I wish the new organisation well. It has the full-hearted support of Opposition Members.
10.22 pm
Lord James Douglas-Hamilton : I agree with the hon. Member for Cunninghame, North (Mr. Wilson) that the Bill enjoyed a good Committee stage, and that Magnus Magnusson will be a dedicated, conscientious and determined chairman of the new organisation and willl make a complete success of it.
I am glad that my hon. Friend the Member for Dumfries (Sir H. Monro) has participated as he started this theme with the Wildlife and Countryside Act 1981. As he said, the Bill provides great hope and possibilities.
The hon. Member for Linlithgow (Mr. Dalyell) has a particular interest in environmental matters. I have been unable to convince him on the justification of merging the two organisations, but I think it is fair to say that the House as a whole welcomes that proposal--most Scottish Members of Parliament do. I certainly agreed with what the hon. Member for Caithness and Sutherland (Mr. Maclennan) said on that issue. As the hon. Member for Linlithgow well knows, we amended the Bill with regard to the built heritage.
I believe that we have created a stronger environmental agency in practice that will make more use of existing mechanisms. To the hon. Member for Dumbarton (Mr. McFall) I say that the working party will be established before long. As a first step, we have commissioned review papers from the relevant interested parties on the issues facing the management of the region and what should be done.
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To my hon. Friend the Member for Tayside, North (Mr. Walker) I say that the new organisation will have to operate with much more sensitivity in relation to future non-statutory appeals.The protection and conservation of landscape and wildlife are closely linked and cannot be separated from access and enjoyment of the countryside. We believe that an integrated approach by one agency will provide a more effective means of stimulating the sustainable use of Scotland's natural heritage. The new agency will maintain and extend the work of both organisations, building on their existing strengths and staff expertise. We expect Scottish Natural Heritage to bring about changes in attitude towards conservation and the enjoyment of Scotland's natural heritage. With its network of offices throughout Scotland and its regional structure, it will be well placed to play a responsive and sensitive role.
The hon. Member for Linlithgow raised a number of issues, including recreation. I shall be happy to respond to him in detail later. I think that that is probably the best way to proceed because he raised a large number of issues relating to structure.
The agency will be a much stronger environmental organisation and will be greatly in Scotland's interests. I thank hon. Members for participating in our debates on the Bill.
Mr. Dalyell : I do not expect any answers tonight, but I would ask for a letter to reflect the careful consideration that will be given to the matter.
Lord James Douglas-Hamilton : The hon. Gentleman will most certainly receive the answers, but I again stress that this will be a much stronger environmental agency for Scotland.
Question put and agreed to.
Bill read the Third time, and passed, with amendments.
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PETITION
Traffic Management Scheme (Great Harwood)
10.24 pm
Mr. Ken Hargreaves (Hyndburn) : I wish to present a petition to the House on behalf of the residents of Great Harwood. The petition expresses concern at the introduction of a traffic management scheme in the Park road and St. Hubert's road areas of Great Harwood, which residents feel is not only inconvenient but may result in an increase in the number of accidents. They feel that there is great danger to children and old people.
The residents feel aggrieved because they consider that they were not properly consulted and that their views were not taken into account by local councillors and Hyndburn borough council before thousands of pounds were wasted on a scheme that will increase the danger, spoil the environment and cause inconvenience to residents and loss of trade to businesses. They say :
We object to the traffic ramps in St. Hubert's road, Park road and the surrounding area. There is no parking space for residents and there is no indication whether pedestrians or motorists have right of way.
The petition continues :
Wherefore your Petitioners pray that your Honourable House do urge the Secretary of State for Transport to review the traffic management scheme in St. Hubert's road and Park road and the surrounding area in Great Harwood, taking into account the views of local residents, and to bring forward improved proposals. And your petitioners as in duty bound will ever pray, etc.
To lie upon the Table.
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Orpington Hospital
Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Neil Hamilton.]
10.25 pm
Mr. Ivor Stanbrook (Orpington) : Orpington hospital has its origins in a military hospital built with prefabricated buildings by the Canadian army for its troops during the first world war. Over the years, it has grown so that now it has, in addition to many of the original buildings, modern residential staff accommodation, a social centre and a substantial modern block, completed in 1982 at a cost of £9 milion and known as the Canada wing. It includes twin operating theatres and 264 of the hospital's 354 beds. The Canada wing is the most modern fabric of the entire Bromley health district, with all facilities for acute patient care. The entire hospital stands on a site of 38.8 acres, of which 12 are green fields. There is ample room for expansion. The whole site lies just off the A21, a main artery from London to Kent and the Channel ports, and only two miles from the M25.
The existing official plan for the hospital's future, as approved by the Government some years ago, is that it should be further developed into a modern district general hospital, providing all acute services and a full- time, 24-hour accident and emergency service, to serve the needs of the southern half of the London borough of Bromley and adjacent areas in Kent. The southern half is the growing half of the borough. The northern half is intended to be served by the expansion of Bromley hospital, a cottage- hospital style building presently standing on a site of only nine acres in urban Bromley.
The area served by the local health authority is coterminous with the London borough of Bromley. Besides Orpington and Bromley hospitals, it includes hospital buildings in Farnborough, Beckenham and Cane Hill. The object of the officially approved plan was to rationalise hospital services in the health authority area by concentrating acute services on the two main sites.
So far, so good. The Canada wing represented phase 2 of the development plan for Orpington hospital. My constituents and I were looking forward to the completion of the third phase, projected for next year, when it was anticipated that all the old hutted accommodation would be replaced and the rest of the services appropriate to a modern general hospital would be added. Successive Ministers in this House have assured me that Orpington hospital will retain its place in the plan.
However, we reckoned without the bureaucrats, administrative and medical, who have now screwed up that prospect and left us in a situation where the hospital is reduced to a shadow of what it could and should be : its status for the purpose of professional training removed, its provision for general surgery and intensive care withdrawn, its accident and emergency service, even on the scale of a minor injuries unit, abolished, its professional staff leaving and the morale of those remaining at its lowest.
The community health council has unanimously passed a vote of censure on the health authority. The general manager of the health authority, like his predecessor, has left to go further up the hierarchy, and the chairman has left office in somewhat mysterious circumstances. Both posts are now vacant. How the authority got into that mess is instructive. In 1987, the planners got it into their
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heads that the site of the existing Bromley hospital--nine acres--was too small to allow it to expand into a district general hospital to serve the northern half of the borough of Bromley.They therefore proposed a deal--fashionable in those Thatcherite days-- whereby the private sector could help to pay for the cost of a mammoth new hospital for all the acute services in the borough to replace both Bromley and Orpington hospitals. The new building, housing 820 beds and with parking space for 1,000 cars, would cost £100 million, which the planners of both the health authority and the borough council expected to raise by selling to private developers the surplus land at the other hospitals, which would be reduced to providing back-up services.
The idea would mean the death of Orpington hospital as my constituents know it. The prospect of the loss of that marvellous hospital on their doorsteps and journeying six to eight miles into Bromley is anathema to us all. Unfortunately, those in the north of the borough who formerly relied on Bromley hospital found the idea attractive, and they provide a majority on the council and on the health authority. The medical professionals also liked the idea, for they thought that it would mean greater opportunities for higher professional standards. The site proposed, which is owned by the borough council, is 21 acres of open space in the centre of the borough, where the traffic is often congested.
The idea seemed unstoppable when I raised the matter in the House on 30 October 1989. The then Under-Secretary of State for Health--my hon. Friend the Member for Kettering (Mr. Freeman)--agreed that his predecessors had given me assurances about the future of Orpington hospital. He was sceptical about the chances of £100 million being raised for the scheme, but he did not want to intervene then. However, there was a hitch. The site for that massive piece of concrete jungle was in the green belt. It appears to be incredible that that fact was overlooked by the planners, but it was.
My right hon. Friend the Secretary of State for the Environment called in the planning application. His inspector reported, inter alia, in paragraph 55 of his report :
"I have come to the conclusion that whereas there is an undoubted need for new hospital provision in Bromley, the circumstances are not so very special as to overcome the strong presumption against inappropriate development in the Green Belt. There are to my mind other possible forms of development elsewhere which could achieve most of the objectives being pursued by the Health Authority." He also reported in paragraph 22 :
"My conclusion on the evidence available is that the best prospect of locating the proposed new hospital elsewhere would be to combine a small development at the existing Bromley hospital site with a large development at Orpington".
So planning consent for the super-hospital was rightly refused. Green fields are especially precious in urban areas such as central Bromley.
Unwisely, the person who wrote to Bromley council to convey the decision of my right hon. Friend the Secretary of State for the Environment stated that the refusal was because the site was in the green belt and that there would be no objection if the green belt excluded it. As a result, the health authority chose not to take the sensible advice of the inspector and get on with making Orpington the major hospital in the district. It chose instead to persuade Bromley council to agree to an alteration in the boundary
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of the green belt so as to exclude the site. This rather disreputable manoeuvre is now under way. I hope that local conservationists will be up in arms about it.The poor quality of management that was revealed by the error has been the cause of many of the health authority's decisions that have affected Orpington hospital. There is undoubtedly a reluctance on the part of the authority, which draws most of its members from the north of the borough, to give Orpington hospital a fair deal in respect of staff and other resources. I cannot count the number of times that I have frustrated efforts to change the official development plan to the detriment of Orpington by initiating Adjournment debates. In the financial year just ended, Bromley health authority was well over its budget. Drastic cuts, masquerading as rationalisation plans, were made to save money. Where did the cuts largely fall? You have guessed it, Mr. Deputy Speaker--they fell largely on Orpington hospital. They leave it without any general surgery, intensive care units or a casualty service of any sort. There is not even a minor injuries unit. There are fewer wards and fewer beds. The Canada wing is in danger of becoming a white elephant. In these circumstances, a ghastly tragedy could occur at any time for want of on-site surgery, anaesthetists and inter-hospital transport. It should be remembered that the nearby M25 is the scene of many major accidents involving casualties on a large scale. We need surgery services at Orpington hospital.
It is ironic that the money that is sought to be saved by the cuts-- £1.5 million in a budget of £82 million per annum--amounts to the same sum as that which is thrown away on surveyors and other expenses for the abortive super-hospital. As if to prove that it is indifferent to the waste of public funds, the regional health authority, South East Thames, whose general manager was general manager at Bromley when the bureaucratic scheme was launched, has recently given another £1.5 million to pay for continuing design fees and other expenses.
I have heard from one designer who is involved that the entire project is being scaled down because of escalating costs and falling land values. A 500-bed hospital is now being contemplated. Even if the hospital is built, the new Bromley hospital cannot be ready before the year 2000. What is to happen meanwhile? Orpington hospital has been truncated. The existing Bromley hospital is bursting at the seams. Queen Mary's hospital, which is just over the border in the area covered by Bexley health district, cannot cope.
Was there ever such a muddle? It is no wonder that, in January, the community health council passed unanimously a vote of no confidence in the health authority. It was alarmed at the authority's failure to consult and at the waste of management time and resources being spent on the new hospital before planning consent had been obtained. It said that the £1.5 million could have been better spent on existing services. The professional medical staff are extremely worried by what might happen in the present hiatus. They approved of the new hospital on the understanding that it would be under way before any rationalisation of existing services took place. We could be heading for the worst possible outcome--no new Bromley hospital because of insufficient funds and land, and no expansion of Orpington hospital, because the land available has been sold to private developers. The people responsible for this muddle should have been sacked rather than promoted, and members of the
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health authority who condoned the inefficiency and faulty judgment involved and failed to correct it should be censured. It is a pity that nowadays the members of a health authority are not drawn from the ranks of the elected councils in the districts concerned, where they could at least be called to account.My hon. Friend the Minister for Health told me a day or two ago that she has appointed a new chairman for the Bromley health authority, a Mr. Alan Cumming. She seems to have plucked him out of the air. I was not informed or consulted about his appointment. However good he is, he will not have the authority, let alone the experience, to do what is required to stop this nonsense. The Minister herself should intervene and tell the authority that it should stick to the existing plan and in any event get on with building up Orpington as a district general hospital without further delay.
10.40 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : My hon. Friend the Member for Orpington (Mr. Stanbrook) has, for many years, been a doughty fighter for Orpington hospital. In preparing for the debate, I looked over the speeches that he made. Both my immediate predecessor, my hon. Friend the Member for Kettering (Mr. Freeman), and his predecessor, my hon. Friend the Member for Wycombe (Mr. Whitney), were called to account by my hon. Friend for the way in which the health service has been planning the hospital facilities for his constituents in Orpington, and quite properly so. On both those occasions, and again this evening, he expressed vigorously and clearly the views that I am sure are widely held in his constituency, and did so in a way that leaves us with no option--nor should we have an option--but to take them seriously. Before I deal with the substance of what my hon. Friend has had to say about the circumstances in which the NHS finds itself in Orpington I shall set it in the context of the way in which the NHS has to be managed. You will know, Mr. Deputy Speaker, that the NHS is a vast organisation that cannot be run on the basis that every significant decision within it is made by one of four Ministers sat in Richmond house. It is, I believe, the largest organisation in the world in terms of the number of people that is employs, with two exceptions--the Red Army and the Indian railway, both of which made the mistake of over-centralising to an extent that we are determined to avoid in the management of the NHS.
For that reason, we have set up and recently reinforced a management system within the health service that delegates responsibility to district health authorities and, within health authorities, to the management teams within the hospitals, in order to ensure that the people who are responsible for using taxpayers' money to provide a health care system in each locality feel that they are responsible for the way in which the cash is used in the particular unit in which they work. That commitment to delegation, and then to accountability, which is the other side of the same coin, is something that we in the Department hold as a key objective in the evolution of our health service policy.
My hon. Friend, in talking about the impact of that on Bromley district health authority, regretted the fact that the passing of councillors from the health authority meant that, as he saw it, there was no local accountability to the local authority. I do not apologise for that, because,
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although we have a commitment to delegate, the NHS is ultimately accountable to my right hon. Friend the Secretary of State and, through him, to the House. That is why my hon. Friend is entirely right, despite that commitment to delegation within the management system of the health service, to call Ministers to account in the House for the way in which taxpayers' money is used within the health service and the solutions that are arrived at by that delegated system of management.There is a nice balance to be struck within the management of the health service. Ministers stress the importance of delegating decisions so as to ensure that resources are used effectively in each locality. Despite the fact that we emphasise the importance of that delegation, we do not duck our accountability for the decisions that the bureaucracy ultimately reaches. It is right and proper that the issues that are of obvious and continuing concern to my hon. Friend's constituents should detain the House this evening and that he should bring them to our attention.
The way in which my hon. Friend presented his constituents' concerns highlights the fact that there are two issues affecting the provision of health care in his constituency. Those issues can perhaps be run together, but they are nevertheless separate. The first issue is whether it is right to centralise acute care on a single site, in this case, the Elmfield site to which my hon. Friend devoted a considerable part of his speech.
My hon. Friend suggested that there was an official plan that called for the continued provision of acute care on two sites within the health district. I think that he will accept--although he may disagree with it-- that for some time, it has been the established preference of the health service management in Bromley and within South East Thames to centralise acute care in Bromley on a single site. To describe the policy of providing acute care on two sites as the official policy of the health service management is no longer accurate.
The reasons why health service managers in Bromley have sought, or wish, to centralise acute care on a single hospital site in my hon. Friend's constituency, or serving his constituency, are not dissimilar from those in other parts of the country. They are familiar arguments. Advances in modern medicine provide us with a great opportunity, which we must seize and use properly, to provide an improving quality of acute care while, at the same time, employing fewer acute beds. There is a long-term decline--not merely in this country, but throughout the developed world--in the demand for acute beds and acute hospital space in the provision of an advanced health service. That argument, coupled with the increased dependence of acute care on high technology, has resulted in a pressure to centralise acute care into high-tech centres of excellence, not only in my hon. Friend's constituency but elsewhere.
That is one side of the argument, but my hon. Friend was right to stress the other side, which is to ensure that as acute care is centralised into centres of excellence, it is not allowed to become too divorced from the communities that it is supposed to serve. He was also right to stress the importance of considerations of local access, clinical viability and the development of centres of excellence.
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That nexus of substantive issues is important and cannot be ducked, for it should concern anyone who is interested in the development of an efficient, modern system of health care.The second set of issues that my hon. Friend mentioned involve planning issues related to the green belt. Quite reasonably, he quoted from the report of the inspector, who appeared to support the proposition that if acute care is to be centralised in Bromley, it should be centralised on the site of the Orpington hospital in my hon. Friend's constituency. As a distinguished lawyer, my hon. Friend will know the danger of relying on judges' obiter dicta. The question that the inspector was asked was not, "Where should the hospital be?" but, "Should the hospital be built at Elmfield?" Although my hon. Friend is entitled to pray in aid the inspector, I think that my hon. Friend will agree that the passage that he quoted from the inspector's report was of the nature of an obiter dicta. I am not sure what the singular of obiter dicta is. It was an obiter dictum, presumably.
It is not a factor on which we should put too much weight. Our planning system does not allow inspectors to tell us where we should build things ; it asks inspectors whether a particular proposal--in this case a proposal to build the hospital at Elmfield--should be allowed. It must be right that the local authority, as the planning authority, and the health authority that wishes to build the hospital should retain the power of initiative in deciding planning questions. The inspector can dispose, but he should not be able to propose. As my hon. Friend said, the London borough of Bromley, will vote on a proposal to change the nature of the green belt in the borough on 1 May, so it would be wrong for me to pre-empt what the council may say about a proposed change in the arrangements. It would also be wrong to pre-empt anything that may happen as a result of the change in the limits of the green belt.
However, it is fair to say that a decision on a major investment, such as has been envisaged by the health authority at Elmfield, would ultimately come to Ministers. Although this evening we can have a discussion that may illuminate some of the issues, I would not wish--it would be quite wrong to do so--to pre-empt the decision that my right hon. Friend the Secretary of State would make if a revised Elmfield proposal, which it was realistic to expect could be built because the planning law had been changed, came to him. There are a number of conditions in that sentence, all of which would have to be satisfied before a Minister could be asked to approve that proposal. My hon. Friend has raised a substantive set of issues around the question of whether there should be a single-site acute care provision in Bromley. There are many hurdles still to be gone over before Ministers could be asked to make a specific decision. My hon. Friend's debate has served to remind us of his continuing interest in the outcome of that decision and of the strength of his feelings and those of his constituents about the outcome of that decision, when it is made.
The second issue is the temporary closures announced by the health authority in January this year. It has always been part of the management model of the health service that we consult before we make substantial changes, but that the health authorities reserve the right to make changes without consultation when financial pressures require urgent action. That was precisely the position in which the health authority found itself in January.
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