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health authority for London is a vital prerequisite for the planning of changes, and for future investment in primary and community facilities in the capital?Why is there nothing in the statement--bar a passing reference to "primary health care"--that would make anyone at all confident that the Secretary of State really believes that it is necessary to invest new resources in building up those inadequate facilities? Why does the statement make no mention of the need for improvement in accident and emergency facilities in the community, and in out-patient departments? Why has it nothing to say on such vital issues as how we are to invest the resources, and the time scale over which the changes will be made? Why was the Secretary of State unable to outline to the House the terms of reference of the implementation group, or its membership? The Secretary of State has had Sir Bernard's report for a long time, and the terms of reference are crucial to whether anyone in London or the country as a whole can believe a word that she says about good intentions towards the health care of the capital.
Will the Secretary of State acknowledge that the Government's actions over the past decade have turned a problem into a crisis for London's health care? Does she accept that consistent underfunding, lack of planning and gross neglect of primary and hospital investment lie at the heart of the problem with which the statement deals? Will she extend the totally inadequate consultation period to allow real participation by the people whose voice is seldom heard in the clamour of professional experts and vested interests--the voice of the people of London themselves?
Does the Secretary of State understand that, although Opposition Members understand that the status quo is not an option--[ Hon. Members :-- "Ah!"]. The inadequate health care of the people of London is not an option, and that is what the status quo would mean. The protection of the health service, the jobs of health workers and the safeguarding of any promises that are made will be the Opposition's absolute priority. We have set out our criteria. We have countenanced no closure and no change in service, unless and until those criteria are met. This morning's statement meets none of them ; it achieves none of the goals that have been acknowledged by many people to be a vital part of putting London's health care on its feet and building confidence in the future.
We are here not to dig the Secretary of State out of a hole of her own making, but to protect the well-being, the health care and the health workers of the people of London ; and that is what the Opposition will be doing in the months ahead.
Mrs. Bottomley : What we have just heard is the ranting of a NUPE- sponsored spokesman.
Sir Bernard's report--which I hope all hon. Members will read in great detail--identifies over-provision that has taken place in London for many years. There are, for instance, more acute beds in London--3.9 per 1,000 people compared with 2.5 per 1,000 in other parts of the country. Spending on London's acute services amounts to £260 a head, compared with £173 in other cities. Some 20 per cent. of health service resources are spent in London, which contains 15 per cent. of the population.
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The Opposition always come up with the same knee-jerk reaction that nothing can be solved without a larger cheque book. In the report, Sir Bernard states :"In 1992-93 spending per inner London resident on hospital services, after weighting for morbidity and mortality (which adds about 5 per cent.), and allowing for excess London costs, will be 20 per cent. greater than the average for England. The problems of the inner London hospitals are plainly not due to overall lack of resources." What we are considering--and it is a sensitive and complex matter--is how we can ensure that London services are matched more effectively to the needs of Londoners. The great institutions- -the teaching, postgraduate and acute hospitals, which go back for many years--are no longer appropriate to a health service where hospitals all over the home counties are able to offer advanced and sophisticated treatment. At the same time, the community services have not been adequately developed.
Clearly, the proposals have resource implications. When I return to the House in the new year to inform hon. Members of the decisions that we have made in regard to implementing the recommendations, I shall of course make the resource elements clear. At this stage however, the proposals constitute Sir Bernard's advice to the Government ; they are not yet Government policy.
Sir John Wheeler (Westminster, North) : My right hon. Friend will know that the news that St. Mary's hospital trust is to proceed is welcome news to my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) and myself. The good work of that hospital is already widely recognised.
Will my right hon. Friend confirm that her statement is not about cuts in London's national health service provision, but about restructuring and improving the service? What action does she intend to take to bring home to the people of London the nature of the review, as opposed to the disinformation that will undoubtedly flow?
Mrs. Bottomley : I am grateful to my hon. Friend, and also to my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke). I was able to make that announcement about St. Mary's, but I know that many of their constituents use other hospitals in the capital.
It is important for us to take this opportunity to engage in an enlightened discussion of the challenges contained in the report. It is about the 20th report on London's health services to appear over the past 100 years. I am encouraged by what so many commentators, from the British Medical Association and even the NHS Support Federation, which is a politically motivated group that supports the Labour party, have said. Julia Schofield the director of the NHS Support Federation, said :
"It probably is the best decision to close one or more hospitals." It is important we have a reconfiguration of services, making it clear that the aim and the objective is improved health services for Londoners.
Mr. Brian Sedgemore (Hackney, South and Shoreditch) : Is the Secretary of State aware that her grandfather, who was a medical student at Bart's, is today turning in his grave because of the extraordinary act of betrayal by his granddaughter in the House? Does she not understand that Londoners will not let her close Bart's and
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that she has engaged upon a battle that she cannot win? If she does not believe me, will she go to the hospital today and see the tears of the patients?Mrs. Bottomley : My grandfather, who trained at Bart's and then went on to be a single-handed general practitioner in Chester, would have been enormously impressed by the developments in primary health care all over the country. There is concern, however, about London, where still more is spent, officially, per head on family health service specialties but where there is not a sufficiently advanced service available for Londoners. We have more GPs who are over 65, more single-handed GPs, fewer practice nurses and poorer community services, with fewer district nurses. I have no doubt that my grandfather would support the proposition that we should not hold on to institutions but should think of health services--but, of course, patients first, also education and also research.
Mr. Matthew Carrington (Fulham) : My right hon. Friend will know that the proposal to change the nature of or to close Charing Cross hospital will be met with considerable suspicion and much opposition. It will be hard to convince people that the closing of that hospital will improve health care in west London. When my right hon. Friend reviews the Tomlinson report, will she take into account the vital need to maintain, at the very least, the accident and emergency and primary health care facilities on the Charing Cross site?
Mrs. Bottomley : I well understand the great loyalty that every individual constituency Member of Parliament has to his or her own particular institutions, but, with 45 acute hospitals serving 250 beds or more and with 12 major undergraduate teaching hospitals, it is clear that there has to be change. My hon. Friend has made some extremely important points about Charing Cross. When my hon. Friend the Minister for Health visits the hospital to discuss the proposals and to consider the way forward, I shall make sure that he takes particular note of those points of concern that have been raised by my hon. Friend.
Mr. Simon Hughes (Southwark and Bermondsey) : Nobody doubts that the health service in London needs a shake-up, but I am sure that the Secretary of State is aware that some of the things that she has said will cause concern rather than comfort, not just to those who live in London but to those who work in London and visit London and use the health service. All services across the public sector cost more in the capital city than elsewhere, per head of use. I am sure that the Secretary of State is aware that there is a great need for the transfer of resources to primary and community care, but unless the reforms mean that when people who live in London need a hospital bed they can get one, and that when people who live in London need an ambulance they can get one and do not have to wait six hours for it, and that when people who live in London have an accident they can be admitted to an accident and emergency department, and that when people who live and work in London find that instead of a statistical analysis of how many beds are needed there is a proper working out of how to meet the daily needs of that part of the country which, paradoxically, serves its people least well, the people whom the Secretary of State seeks to serve will be caused the greatest worry. At the moment we have worry.
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It is up to her to make sure that she listens and ensures that the resources are there to improve services, not to make them worse as a result of these radical proposals.Mrs. Bottomley : There is nothing that the hon. Gentleman has said with which I do not heartily agree. They are all very important points. All of them are aspects which we shall consider when we hold our consultations on the proposals. However, the hon. Gentleman knows full well that his constituency is served by three outstanding hospitals--King's, Guy's and St. Thomas's. He knows as well as anybody who is remotely informed about the health service in London that it is not possible for all three to continue without changes. The sense of uncertainty is very damaging for morale. It is right that we should grasp the nettle and consult and that we should take decisions. There is no one who, in any half-informed way, thinks that the situation can or should continue as it is. Propping up the acute services often starves the community services. We have to take decisions that will bring an end to the uncertainty for staff and which, above all, will lead to a better health service for Londoners which meets exactly the criteria that the hon. Gentleman identified.
Mrs. Marion Roe (Broxbourne) : After many weeks of uncertainty, speculation and rumour, I am pleased that at last the Tomlinson report has been published. There is no doubt that during the consultation period my right hon. Friend will be lobbied by those who are affected by the proposals. However, I ask her to bear it in mind that in my Hertfordshire constituency there has been concern for many years that our local hospitals have been disadvantaged because London hospitals have been demanding too great a share of the resources available. [Interruption.] We are all looking after our constituency interests. That point must be made. I remind my right hon. Friend that my local hospitals are treating former Londoners who have moved out of the capital. They also deserve to be considered.
Mrs. Bottomley : My hon. Friend is exactly right. There are hospitals throughout the home counties that wish to treat patients who traditionally were sent to London. In the home counties we have encouraged those health authorities in the outer London ring to continue this year with the traditional patterns of referral, but it makes no sense to continue with a pattern of referral, unless it is what the patient wishes, simply to prop up institutions because nobody has been brave enough to make the necessary decisions. My hon. Friend speaks for very many throughout the home counties who say, "Please can we now reorganise the health service to meet the needs of the population today and tomorrow, not those of the last 50 or 100 years?"
Ms. Kate Hoey (Vauxhall) : May I tell the Secretary of State that the report and her statement will be received by the users of London's health services with anger, horror and fear--fear in the area that I represent, where some 728,000 people who work and live in the area served by St. Thomas's know about the waiting lists in that area and cannot, therefore, see any justification whatsoever for even contemplating closing or merging St. Thomas's and Guy's hospitals. If St. Thomas's accident and emergency service
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closes, the Secretary of State will make Londoners move around in ambulances and die in ambulances in London's traffic jams on their way to hospital.Mrs. Bottomley : I do not accept what the hon. Lady says. When she studies the report she will see that it makes special mention of the Lambeth community hospital, which she has brought to my attention in the past. The report makes it clear that, for that small area to have such an intensity of acute services, without sufficient community services, is inappropriate. She will know how her constituents frequently use an accident and emergency centre instead of using a GP resource ; there is a need to bring forward development in that area.
As I told the hon. Member for Southwark and Bermondsey (Mr. Hughes), knowing the area well, I believe that the staff know full well that the situation cannot continue and that, above all, what people want is a decision. In an editorial, The Guardian, said :
"Only political ostriches would refuse to recognise these facts. London's health service consumes more money than anywhere else but provides its citizens with a worse deal."
Dr. Charles Goodson-Wickes (Wimbledon) : I congratulate my right hon. Friend on the inevitable, if uncomfortable, logic of her argument. Decisions on these matters have been postponed for far too long. Will she assure the House that alternative medical use of Bart's, which has been a centre of international medical excellence for the past nine centuries, will be explored before the recommended disposal, to ensure that its long- standing traditions can continue, consistent with today's changing health needs?
Mrs. Bottomley : I can only assure the House that our decisions will be determined, above all, by the needs of patients. Their needs must come first, but the Tomlinson report makes it clear that education and research occupy a similarly important position. We must make decisions according to those criteria. There is no doubt that hospitals in locations where the population has moved away are having great difficulty matching their activity to their resources. Bart's is certainly one such institution. Nobody will make decisions on any of these matters lightly. My hon. Friend the Minister for Health will visit Bart's and the other crucial sites to discuss the way forward. I have already announced that we shall consult on the merged management of Bart's and the Royal London hospital, but that does not prejudge long-term decisions on the sites.
Mr. Peter Shore (Bethnal Green and Stepney) : The right hon. Lady's failure to mention in her statement the crucial question of resources and her subsequent quotation of the opinion of Sir Bernard Tomlinson that London was over-provided in terms of finance will be greeted with dismay and cynicism throughout London. No adequate evidence has been produced for that assertion, and almost everyone who has hospital connections fears that the Government will use the allegation that there are too many hospital beds in London to cut basic health services under the guise of switching resources to primary care. She placed much emphasis on the centres of excellence. Will she assure us that at least one of the centres of excellence in postgraduate medicine that deals with heart and lung disease, which is a high priority in the
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nation's health--the special health authority which includes the Brompton and the London chest hospital in my constituency--will be preserved and not forced into an unwanted merger with adjacent hospitals?Mrs. Bottomley : I am saddened that the right hon. Gentleman should present the report in that context because he is well informed about the long-term dilemmas facing the London health service and about the excessive provision of institutions. I am sure that he is well aware of the independent King's Fund report, which considered even more dramatic changes than those outlined in the Tomlinson report. I cannot make any announcements except that we shall consult on the proposals. These are Sir Bernard Tomlinson's proposals, not Government policy. It is proposed that the London chest hospital should work with the Royal London because of the view that single-specialty centres increasingly benefit from a close association with a hospital where all the other specialties are available. That, again, is a matter on which there will be further discussions.
Mr. Harry Greenway (Ealing, North) : When considering provision in outer London, will my right hon. Friend take full account of the very important links between, for example, a community such as Ealing and Ealing hospital and do all that she can to shake up the emergency and ordinary sections of the London ambulance service, which are causing enormous distress to many people and which need enormous improvement? If such improvements resulted from the review, it would be most valuable.
Mrs. Bottomley : The health care needs of my hon. Friend's constituents and those across London will be a high priority in reaching decisions. My hon. Friend asked about the London ambulance service, which was not considered by the Tomlinson inquiry. There has been much investment in a new computer system and vehicles and increased resources. Like my hon. Friend, I am determined to see an improvement in the standards that are achieved.
Mrs. Bridget Prentice (Lewisham, East) : Would the Secretary of State like to comment on paragraph 125 of the report, which deals with St. Thomas's and the Guy's and Lewisham trust? Sir Bernard makes it quite clear that, in his view, Lewisham hospital should have a secure future. I hope that the Secretary of State agrees with that. Where does that leave Lewisham hospital if the amalgamation of St. Thomas's and Guy's goes ahead? What will be its status?
Mrs. Bottomley : The proposal in the Tomlinson report is that Lewisham hospital should become a NHS trust on its own, leaving Guy's and St. Thomas's to be managed jointly. We shall consult on the report's proposals, and no firm decisions will be taken until we are satisfied about the outcome of that consultation. I remind the hon. Lady that, before the establishment of any NHS trust, the primary conditions must be that the trust will lead to improved services for patients.
Mr. John Marshall (Hendon, South) : Will my right hon. Friend confirm that we are talking about a reallocation of resources in London and not a reduction? Does she accept that many people in London want to see better general practice and more resources put into the care of mental health patients? Does she accept that there
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has been a movement of population out of central London to the surburbs and that outer London boroughs want more and not less?Mrs. Bottomley : My hon. Friend puts the case correctly. An editorial in The Times said :
"Londoners need basic, unglamorous health care from GPs, nurses and community health centres. That can only be paid for with the money raised by making London hospitals better suited to the needs not of their doctors but of their patients."
That has been known for decades.
Mr. Tom Cox (Tooting) : The Secretary of State must be aware that, week by week, every London Member receives ongoing complaints from constituents about the lack of services and about waiting times and waiting lists. So much for her comments that we are overprovided for in London. If the proposals that she has announced today are implemented, they will be disastrous for the people of London. She specifically mentioned St. George's hospital in my constituency, which is not threatened with closure, but yet again faces reductions in expenditure and bad provision. I take very much the point that was made by the hon. Member for Fulham (Mr. Carrington) about Charing Cross hospital : hospitals such as St. George's are being expected to take over from hospitals that are being closed, yet they cannot provide sufficient facilities in our constituencies.
Mrs. Bottomley : The point is that health care in London uses more resources to less good effect in terms of bed usage and the number of consultants per patient than health care elsewhere in the country. All the indicators show that in London there is a great investment of resources without the same output in terms of patient care. Take, for example, varicose vein surgery. In one London teaching hospital the cost was about £1,300 compared with £210 at one hospital outside London. Resources are inappropriately used.
I made it clear that we shall go forward with the consultation on the separation of the community services from the acute services at St. George's. Time and again, acute hospitals dominate the agenda, and the community services are under-resourced and not given the autonomy and priority that they need. Many independent experts have made the same comment, and I have no doubt that the changes will lead to improved services for the hon. Gentleman's constituents.
Mr. John Bowis (Battersea) : I welcome my right hon. Friend's statement about St. George's, with its long-overdue approval for moving ahead with the application for hospital trust status. That will enable the hospital to meet the extra demand referred to it. I also ask my right hon. Friend to do two things on behalf of my constituents. The first is to explain to Puzzled of Lavender Hill the relationship between the recommendations of the Tomlinson inquiry on transfer to the community and the improvements to waiting lists. The second is to ensure that when her ministerial colleague goes round London, and especially when he visits St. Thomas's hospital, he has in his back pocket a map of London bus routes, so that he can see where patients come from and whether there are alternative bus routes to other hospitals that may be asked to take them on.
Mrs. Bottomley : I can certainly give my hon. Friend that assurance. Clearly, travel times and transport routes
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to hospitals are fundamental to hospital usage. That was considered by the Tomlinson inquiry and will form part of our deliberations when we consult on the proposals.Health waiting lists in London have been substantially reduced over the past year--by about 10 per cent.--but my hon. Friend is right to say that his constituents want an ever better service. When hon. Members have time to study the report they will see that many aspects of it identify the way in which difficulties have emerged in London--for example, the different relationships with GPs, and the difficulties they often have in securing a bed ; people often use admission through accident and emergency departments as a route into hospital. All sorts of inappropriate patterns have developed in London, all revolving round an inappropriate use--indeed, a misuse--of the substantial resources put into London's health service.
Mr. John Fraser (Norwood) : May we take it from the tenor of the right hon. Lady's remarks that she contemplates closing either St. Thomas's hospital or Guy's hospital? In those considerations, what part will the development value of the site, as well as the costing of London's services, play?
The right hon. Lady recently had on her desk a report on King's College hospital which showed that the conduct of its accident and emergency department was a shambles in terms both of management and of facilities. How is that hospital supposed to cope with accidents and emergencies if one of the adjoining hospitals with similar facilities is closed?
Mrs. Bottomley : I hope that the hon. Gentleman will have detected from the tenor of my remarks that I regard that as a serious matter, and as a problem which must be tackled. It has existed for generations, and now is the time to take a view on how we can improve health services for Londoners. That is exactly what I intend to convey. No decisions have been made, and no decisions will be made until my hon. Friend the Minister for Health has had the opportunity to visit the institutions involved, and we have had the opportunity to examine the report, the costings and the resources, and to think carefully of how decisions will affect patients, what the implications are for health service staff, and what the issues are with regard to education and research. The subject is complex, but the needs of patients will come first.
I hope that the hon. Gentleman is aware that I have placed in the Library a copy of the report mentioning the accident and emergency services at King's College hospital. To King's College hospital's credit, it has already provided the service recommended by Sir Bernard Tomlinson in that it has a general practitioner available at the accident and emergency department, because A and E services in London are often used in the way in which people outside London use their GPs.
Mr. John Wilkinson (Ruislip-Northwood) : I thank my right hon. Friend for coming to the House on a day when there is the maximum number of London Members present. It is good that she should seek to share the benefits of Sir Bernard Tomlinson's advice with us in that way.
Am I right in my optimism that the consequences of Sir Bernard's recommendations for community hospitals, which do an outstanding job, will be that St. Vincent's
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hospital at Eastcote, and Northwood Pinner and district hospital in Pinner, in my constituency will have an even better future? Thirdly, will general hospitals, such as Mount Vernon in my constituency, which takes patients across the borough boundaries from the home counties, such as Hertfordshire, have a better future, too? Demographic trends suggest that their catchment area will become more populous.Mrs. Bottomley : Community hospitals are strongly advocated by Sir Bernard, because of the inappropriate use often made of acute hospitals and a relative lack of nursing home care in London. There are fewer district nurses in London, too. The report raises a number of issues in which, although the resources spent are way above the average elsewhere, the service delivered is not appropriate to the needs of Londoners today and tomorrow.
My hon. Friend will want me to give him an absolute assurance that his hospital stands to do nothing other than benefit from Sir Bernard's proposals, but, of course, I cannot give any hon. Member such an assurance, because it is only right to take forward the proposals by consulting on them and thinking about the detailed implications. However, I can say to hon. Members whose constituencies are outside the inner London ring that although they have traditionally sent patients to the costly inner London teaching hospitals, increasingly they want to treat them within local facilities, where treatment can be given more cost-effectively. I suggest that those who argue that the quality of service in such outer London hospitals is not of the highest standard should have that argument out with some of the clinicians at those hospitals.
Ms. Tessa Jowell (Dulwich) : What the Secretary of State has said about the London ambulance service shows that she greatly underestimates the scale of the crisis in public confidence now besetting it. Does she agree that it is unacceptable for GPs to have to wait for many hours for ambulances for sick people? GPs see getting through to the ambulance service as an endless problem--often they have to deal with answerphones. Does the Secretary of State accept that urgent steps must be taken to restore safety levels to the London ambulance service, and that before any improvement in London's health service can be secured she must give urgent attention to the improvements needed in the ambulance service?
Mrs. Bottomley : The Tomlinson report is not about the London ambulance service, but I am happy to say that I expect to see improvements in the service which it delivers. The issues involved are complex. For example, the absentee rate in London is much higher than in other ambulance services. There has been a great investment in technology and equipment, and I have made it clear that I expect to see an improvement in the standard of service available to GPs and patients in London.
Lady Olga Maitland (Sutton and Cheam) : Does my right hon. Friend agree that the over-provision for London hospitals has been made at the expense of hospitals in the region, and that at St. Helier hospital, in my constituency, the changes proposed by the Tomlinson
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report will be welcomed? Does she agree that habits have now changed, and patients get the best possible care at their local hospitals, so that is where the resources should be concentrated?Mrs. Bottomley : My hon. Friend is exactly right. In the past, many patients might have travelled from the outer London areas into London, partly because London was the centre of all the expertise and also, frankly, because from the point of view of the local health authorities, the teaching hospitals were effectively a free good. The whole point about the health reforms is that the local districts now have to make informed decisions about where to send their patients. They will also want to take into consideration the cost effectiveness and the quality of that service. The patients concerned would rather be treated near to home than have to get on a train and go to London for the benefit of medical students or anyone else who might want to see them. There is a different pattern of health service available today. The Tomlinson report seeks to ensure that we take the decisions to ensure that in the home counties generally, as well as in London, we can have a service that is more appropriate to the needs of today and tomorrow.
Mr. Tony Banks (Newham, North-West) : It is no good the Secretary of State coming here like Florence Nightingale fresh out of charm school and expecting us to swallow this garbage that she has given us today. No one in the country trusts a word that this lying, incompetent Government say these days--
Madam Speaker : Order. I am not having those remarks. I am sure that the hon. Gentleman will withdraw them-- [Interruption.] Order. I think that I am fairly capable of dealing with this matter if hon. Members will allow me to do so.
Mr. Banks : If it upsets you, Madam Speaker, I withdraw the remark of course.
It is no wonder that Bart's cannot compete, given that its services are based on tremendous skills. The Secretary of State is just creating a squalid market in the national health service. Will she give a guarantee that every penny saved from hospital closures in London will go into primary and community care?
If the Secretary of State has not made up her mind, what is the implementation group under the chairmanship of a Tory party member doing?
Mrs. Bottomley : I shall pass over the hon. Gentleman's earlier comments. On the implementation group, many hon. Members who have constituents who work in the health service know that they will be concerned about their job prospects. If there is to be redeployment from the acute side into the community side, there will need to be changes. Some of the consultants will need to think about their future. There are complex issues around the redeployment of staff. Complex issues are also involved in ensuring that we have a proper provision of accident and emergency services. Sir Bernard in his report identifies 14 cancer services and a similar number of cardio-thoracic services. There is much duplication of specialist services, often on isolated sites. We need a review of those specialist services.
Tim Chessells and the implementation group will do much of the ground work, so that when recommendations are made in the new year, he is able to take forward the
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proposals. He will, for example, discuss matters with the BMA and with the Royal College of Nursing--with all those who are saying that we need to take decisions, but that we need to treat the staff and services properly.Mr. Peter Bottomley (Eltham) : May I remind the House that in the final four years of the previous Labour Government, they proposed to close five of the six hospitals in the borough of Greenwich, so there is not much new in this? In terms of the implications for services, may I remind my right hon. Friend that within four miles of the House there are six neuroscience units? The previous system led to the proposal that more than £50 million should be spent on getting another neuroscience unit at the Brook hospital.
May I specifically ask my right hon. Friend that the implementation does not take place until it is clear from the Ministry of Defence whether there is a long-term future for the Queen Elizabeth military hospital? That may have implications for the future of the Brook services and for the Greenwich district hospital services.
Mrs. Bottomley : My hon. and close Friend makes a good point. He is an extremely diligent and dutiful constituency Member whose constituents are extremely well served by his championing of their interests. I can ensure that at every level of my Department, the particular needs of the constituents of the hon. Member for Eltham will be properly recognised and understood.
Mr. Clive Soley (Hammersmith) : The Minister will know that it is suggested that the proposals for Queen Charlotte's and Charing Cross hospitals in my constituency and the neighbouring one will save considerable money. I want to be assured that if any money is saved, either by selling sites or as a result of other changes proposed in the report, it will not be used simply to mop up the existing deficit. If the Secretary of State uses the money for that purpose, she will not be able to stand at the Dispatch Box and say that the changing patterns, which are necessary in many respects, are being used to provide the services necessary for existing patients, for those in queues waiting for operations and for those needing community care.
Before the Secretary of State answers, may I remind her that the reason why no one trusts the Government on such issues is that when they closed the long-stay psychiatric units, the money from the sites was supposed to go into community care. It did not ; it went to subsidise the Government in other areas. As a result, the changing pattern of health care in London and elsewhere has not been financed properly and that is why we are in trouble. I want a guarantee, please, that money saved will not be used to mop up the existing deficit, but will provide the new services to which the report refers.
Mrs. Bottomley : For the hon. Gentleman to question the Government's commitment to the health service is bizarre in the extreme. After all, we are the Government who have increased funding for the health service to the tune of well over 50 per cent. in real terms. We have a
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record of which we can be proud, unlike the Labour party. Every time we discuss funding, there is no doubt that this party can hold its head high and that the Labour party has to retreat from the statistics.It is also the case that we need to ensure that resources are used effectively. I cannot make detailed announcements about resources at this stage. However, I accept the point made by the hon. Gentleman and by many hon. Members that to take forward the changes, we need to ensure that the patients are safeguarded. Patients' needs come first. We want a more appropriate and, frankly, more cost-effective service which meets patients' needs. As well as the needs of patients, there is also the need for education and research.
I am sure that the hon. Gentleman is aware that for some time there have been proposals to bring the Queen Charlotte's unit within the main Hammersmith hospital, although it would still keep its identity. It is part of the general movement in health care to realise that single-specialty hospitals are an area in which improvement can be gained by bringing them into the site of a hospital where all the disciplines are available.
Several Hon. Members rose --
Madam Speaker : Order. We must now proceed with the Adjournment debate--[ Hon. Members :-- "Oh !"] I will take the House into my confidence. If questions and answers were shorter, I should be able to accommodate more hon. Members.
Mr. Harry Cohen (Leyton) : On a point of order, Madam Speaker. May I remind you of Speaker Weatherill's regular comments in the House when hon. Members were not called during an important statement such as this? He promised to take them first when there was a subsequent debate on the issue. Will you adopt the same procedure?
Madam Speaker : I do not give such hostages to fortune. However, I have a very good memory for faces. The hon. Gentleman had better leave it to me when I go back to my office to remember the faces that were here today.
Mr. Jeremy Corbyn (Islington, North) : On a point of order, Madam Speaker. I am sure that you will not forget beards either.
Mr. Corbyn : Or badges. Thank you. Further to the point of order raised by my hon. Friend the Member for Leyton (Mr. Cohen), will you tell us whether you have had a request from the Government for a special debate on the Tomlinson report so that those of us who were unable to ask questions today can develop our arguments in defence of London's health service?
Madam Speaker : I have not had such a request from the Government. As we heard the Secretary of State say today, we shall come back to the matter on another occasion when I hope that we shall have a full debate. As I said, I remember the friendly faces around me today.
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Policing (London)
Question again proposed, That this House do now adjourn. 11.58 am
Sir John Wheeler (Westminster, North) : I welcome the annual review of policing in London. This is a general debate and it is not possible to be specific--only to refer to a number of key points about the state of policing in the capital.
I shall comment on the four police forces that serve the people of London and make some remarks about police strategy and the Metropolitan police. The Royal Parks constabulary serves Regent's park in my constituency, as well as part of the City of Westminster and London as a whole. The constabulary performs a useful role for the royal parks, and I warmly welcome the standard of service that it gives both to the residential community and to a large number of visitors to London. I would, however, ask my hon. Friend the Minister to pass to the Treasury my view that the employment of expensive Royal Parks constables on what amount to car parking duties needs to be reviewed, especially as the constabulary is to become responsible for policing Hyde park, for which the Metropolitan police have been responsible since 1866.
The other constabulary that performs an invaluable service in London is the British Transport police. That very efficient police service has shouldered a large part of the burden unwelcomely brought to London by the Provisional IRA's mainland terrorist attack on the capital. Every day, the British Transport police have to decide whether to close down part of the underground system or mainline railway stations. It is worth placing on the record the excellent job done by the chief constable and his officers. They make an often unseen but most commendable contribution to the safety and welfare of the travelling public in London. The 400 British Transport police officers on the London underground system, working with the management of London Underground, have continued with their three-year success story in reducing the fear of crime as well as the incidence of crime on the London underground system. Their work shows that crime can be controlled.
It is important to note that crimes of violence against the public travelling on the underground fell by more than 20 per cent., against the figure in the comparable period last year. The London underground is believed to be the only urban transport system anywhere in the world on which crime is falling. That is important news, because it means that people can travel on the underground system without a sense of fear and because it will encourage visitors to come to our capital--something which we warmly welcome.
London's second largest police service is the City of London police, with a strength of about 800 officers and nearly 400 civilians. That force is also in the front line in the fight against terrorism. I need only refer to the appalling incident at St. Mary Axe in April this year, which left three people dead and another 100 injured. The cost to property has been estimated at about £2 billion. The City of London police and the lord mayor responded to that awful incident magnificently. We should remember that the City force also has responsibility for dealing with
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major fraud and, in recent times, the force has accepted no fewer than 105 investigations into fraudulent activity. They have a very good record.The largest of the four police forces serving London, and the one that is traditionally the subject of our annual debate, is the Metropolitan police force. The funding of the work of this, the largest of our 52 United Kingdom police services, costs more than £1.6 billion, of which 84 per cent. goes on personnel costs. The costs of policing in London are certainly very high.
I welcome my right hon. and learned Friend's establishment of the Sheehy inquiry into aspects of the structure of the police service, especially in relation to police ranks and how they should be rewarded. That review is important.
There is an urgent need to re-examine the way in which resources are deployed within the Metropolitan police. I do not believe that there should be an increase in the authorised establishment for the Metropolitan police in London. That may seem a curious statement to make, but I make it because I believe that we still have a long way to go in improving the deployment of resources in the Metropolitan police. In that context, I refer to a written answer that I received to a question that I tabled earlier this week about the central command complex at New Scotland Yard, the 69 divisional control rooms and the 11 other specialist units, which employ a total of 726 police officers as well as 477 civilians. There seems to be massive duplication in the provision of control rooms. That is unnecessary and not efficient. I should like that to be reviewed as a matter of urgency so that we can deploy those expensive uniformed police officers to the front-line police duties in which the people of London want them to be engaged. We should employ civilians--including, perhaps, retired police officers with knowledge and expertise--in duties that do not require fit young men and women.
Let me refer to the problems of policing in London. I, too, thank Sir Peter Imbert, the retiring Commissioner, for his outstanding service to the people of the capital. I extend those remarks also to the excellent contributions made by police officers of all ranks and their civilian support services. There are many bright, able, talented people in the Metropolitan police eager to serve the people of London and to create the new style of policing that we have discussed today--sector policing. They recognise that it will be a real challenge in terms of management and the use of resources, but they are willing to take up that challenge.
Sir Peter has laid the foundations for sector policing through the implementation of the Plus programme, which has clearly shown that the police are willing to encompass change, however painful it may be. I wish that other elements of the criminal justice
system--particularly the lawyers--would be as willing as the police to consider new ideas about their working practices and the way in which the criminal justice system should deliver its services.
The poor listing of cases in the courts consumes police manpower at an alarming rate. It is probably one of the biggest wastes of police time and money in the criminal justice system. I repeat : let us have no more police officers, but let us have better deployment of those we have. I urge my hon. Friend the Minister to consider that point in consultation with the Lord Chancellor and his Department. If sector policing is to be a success, the police managers on the ground will increasingly complain about
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