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House of Commons

Tuesday 27 July 1993

The House met at half-past Nine o'clock


[ Madam Speaker-- in the Chair ]


Hertford County Hospital

9.34 am

Mr. Bowen Wells (Hertford and Stortford) : This petition of 60,000 odd signatures to save the Hertford county hospital has been gathered assiduously by the Save Hertford County Hospital Campaign Committee led by Raymond Slater. It is addressed

To the Honourable the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled. The humble petition of Raymond P. Salter ROH (RAOB) of 20a St. Augustines Drive, Broxbourne, Hertfordshire, vice chairman of the "Save Hertford County Hospital Campaign Committee" and the many thousands whose signatures are appended hereto, showeth that :-- The Hertford county hospital is under threat of closure by the local health authority. The Hertford county hospital is a listed building, as also the site, and is in a conservation area. It is the only hospital readily accessible by public transport to the many small villages surrounding Hertford and to the neighbouring town of Ware. There is a need for the Hertford County Hospital to provide a wide range of services, and to have the facility of recovery beds to ensure patients in the area are properly cared for and to include respite and long-term care.

Wherefore your petitioners pray that your honourable House support the refurbishment and retention of the county hospital on its present site.

And your petitioners, as in duty bound, will ever pray.

To lie upon the Table

Timex Dispute

Mr. John McAllion (Dundee, East) : I wish to present a petition from the sacked Timex workers in Dundee. The petition expresses their

support for early-day motion 2310 which condemns the Timex Corporation for the inhuman and brutal treatment

of the sacked Timex workers and which calls for support for a worldwide boycott of Timex products. Because of the legal shackles on British trade unions which prevent them from calling on the support of their fellow trade unionists, it is only by means of the petition and under the cloak of parliamentary privilege that the sacked Timex workers are able to make public their support for the boycott of Timex products.

The petition reads :

We therefore request that the House of Commons urge Her Majesty's Government to use its influence to persuade the Timex Corporation to reverse its policies towards its own employees in Dundee. And your petitioners, as in duty bound, will ever pray.

To lie upon the Table.

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Sub-Post Offices

Mr. Paddy Tipping (Sherwood) : I have the great honour to present a petition from the people of north Nottinghamshire. There are 12,500 names on the petition, which calls for the retention of sub-post offices in north Nottinghamshire. I should like to thank the people who have organised the petition and the 30 sub-postmasters in the Sherwood constituency who have made this petition possible. The petition reads :

The humble Petition of sub-post office users in Nottinghamshire sheweth that they are against the removal by the Government of the right to receive pension and benefit payments at local post offices. Wherefore your petitioners pray that your honourable House request the Government to give people the right to choose to receive pension and benefit payments at their local Post Office, recognising the benefit of this to the individual and the community.

And your petitioners, as in duty bound, will ever pray.

To lie upon the Table.

Mr. Charles Kennedy (Ross, Cromarty and Skye) : I wish to present a petition on behalf of individuals, local post offices and community councillors within the Ross, Cromarty and Skye constituency which is signed by more than 8,000 constituents expressing alarm and concern about the continued provision of a widespread local post office network.

The petition reads :

The Humble Petition of the undersigned Residents of the Ross, Cromarty and Skye constituency sheweth that we express deep concern that the Government proposes to privatise post office services and compulsorily transfer Social Security payments from post offices to banks, and we oppose these measures jointly and severally as they threaten the very survival of rural post offices and deny the efficiency and convenience of the present system, especially in rural areas.

Wherefore your petitioners pray that your honourable House will do everything possible to impress upon the Secretaries of State for Trade and Industry and Social Security the need for an autonomous post office service in the public sector and to abandon plans for the compulsory transfer of Social Security payments to banks. And your petitioners, as in duty bound, will ever pray, etc. To lie upon the Table.

Bus Services (Deregulation)

Mr. Alan Milburn (Darlington) : I wish to present a petition on behalf of residents in Darlington concerned about the effects of a local war between bus companies which has put up to 239 buses per hour into Darlington's town centre. Residents are sick of the congestion and disturbance caused by their once quiet streets being used as the battleground for that war between local bus companies. They have signed the petition urging the Government to take action because the Transport Act 1985 has created this mayhem by deregulating bus services.

The petition reads :

Wherefore your Petitioners pray that your Honourable House will halt Darlington's bus wars by ending the deregulation of the bus and coach industry and by returning to local councils the power to regulate bus services in the interests of residents.

And your Petitioners, as in duty bound, will ever pray, etc. To lie upon the Table.

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Charing Cross Hospital

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Lightbown.]

9.41 am

Mr. Clive Soley (Hammersmith) : I am grateful for this opportunity to debate the future of Charing Cross hospital.

The underlying philosophy of the national health service often divides the political parties, but on the Charing Crosss there is an almost unique identity of views between Conservative Members and across the spectrum in west London. Liberals, community groups, management and medical staff at the hospital and trade unions have supported the campaign. Hardly anyone has not been involved in campaigning to keep Charing Cross hospital. I make no apologies for saying that our purpose in the debate is to try to influence events following the recent publication of the London implementation group and the review reports as well as, earlier in the year, the Tomlinson report which led to the hospital's possible closure.

I ask the Minister not to dismiss the debate as special pleading. I know how easy it is for people to assume that, just because a hospital is under threat, everyone will unite to save it. There are good and coherent arguments for saving Charing Cross hospital. I shall leave time for one or two Conservative Members to intervene, but I want to focus on the future role of Charing Cross hospital. Therefore, I hope that the Minister will see my speech not as a negative approach of special pleading but as showing the way forward.

I acknowledge, as do most people, that the NHS must change. I have never taken the view that there is never a case for closing a hospital ; that is not appropriate or realistic. I also accept and have long believed in the concept of community care. Properly funded community care reduces hospitals' workloads, as does changing technology, such as day operations ; they will inevitably increase patient turnover. All that is to be welcomed.

Counterbalancing factors include the aging population, resulting in people who need greater health care in the later stages of their life. Hammersmith and Fulham and its surrounding area has also been dramatically affected by the opening of the Chelsea and Westminster hospital. I shall not say too much about that. I had and have strong views about the cost of that hospital and the decision to build it when circumstances would obviously change. But that is water under the bridge : the hospital is there. However, that gives us the opportunity to consider the provision of health care in west London in order to make the best possible use of the existing resources. If the matter is approached from that angle, any proposed closures will, I hope, fit into that structure, rather than simply closing the hospital in order to remove the 2,500 beds that Tomlinson recommended should be lost in London, a proposal which is worrying many of us at the moment.

The hospital is 20 years old and that, in itself, makes it rather special. It was purpose built to a high standard with good facilities. The estimated cost of building and equipping it today would be some £450 million-- half a billion pounds. The hospital is on a 16-acre site, which is not only a good size but allows flexibility and development--an important factor in its favour. It is also, to use a

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phrase current in the health service, a one- stop shop providing many supporting services in addition to operations and treatment. The hospital has good transport links, which is not true everywhere in west London. Local people are acutely anxious that, if the accident and emergency department is closed, an ambulance may have to travel down Fulham Palace road, which will be particularly difficult if Chelsea and Fulham are playing at home, in order to reach the other hospital. That is a major transport problem. I know the arguments about ambulance paramedics' extra provisions, but I am not satisfied with the way in which they work out the figures for getting from A to B in ambulances to have enough confidence in their ability to transport a seriously injured person from Hammersmith Broadway to the accident and emergency department at the new hospital. The hospital has a high volume of patients, which is an asset for undergraduate teaching. It has eight lecture theatres which are linked by a unique closed circuit, fibre optic colour teaching system, which is one reason why Tokai university in Japan has selected the hospital as its United Kingdom centre of excellence for Japanese undergraduates. That fibre optic network links a number of hospitals, enabling undergraduates to watch operations in different settings without leaving the area in which they are being taught. That is part of the hospital's teaching facility which is of profound importance to the health service, not just in London but nationally. With all those advantages one might well ask why on earth we are even thinking of closing such a valuable asset. The answer lies in the Tomlinson report, which suggests the loss of 2,500 beds, and, to some extent, in the building of the Chelsea and Westminster hospital, to which I shall not return other than to say that it was justified on the basis that it would replace five other hospitals, and it did just that, taking up the services of those five hospitals. It was not intended to replace Charing Cross hospital. The concept was rather that there should be one hospital on two sites.

Clearly, the key issue is the Tomlinson report which basically suggested the closure of the accident and emergency department, the phasing out of the district general hospital approach and an emphasis on speciality services there. There are flaws in that argument, not just in the figures but in the philosophy behind that report. That is not to dismiss the Tomlinson report, which is a high-status report which deserves to be taken seriously, but there is a growing view, well founded on evidence, that some of Professor Tomlinson's figures are flawed. Perhaps the best example of that is the research done by Professor Jarman, which was published in an article in the British Medical Journal a few months ago. One of the critical factors in the Tomlinson report is the proposal to close Charing Cross and the need to lose 2,500 beds in London. The article said that London has about the same number of beds as the national average and the Charing Cross area is 20 per cent. below average for acute beds.

John James is the chief executive of the Kensington, Chelsea and Westminster commissioning agency. He said :

"Living in this part of London, you are less likely to be admitted to an acute hospital bed than the average for London as a whole, or for the rest of the country. It is quite substantially lower." The problem is not that Professor Tomlinson was just plain wrong ; it is more complicated. He was asked to look

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at acute services in inner London. Charing Cross deals with a different area and other services. One of the failings of the report--this cannot be laid at the door of Professor Tomlinson--is that we needed a review of the wider London needs, not just acute services. He did not look at the whole of London or at services such as geriatric, psychiatric, maternity and so on. When one looks at those services, one sees a different approach to the argument. That is why we need a different philosophy.

Our argument--I say "our" because it includes community groups, general practitioners, management, trade unions, medical staff, some Conservative Members and others--is different and we want the Government to look at that carefully before making any decision to close Charing Cross. Our argument is that closing the accident and emergency and the district general hospital facilities at Charing Cross is a mistake, even if the Government concentrated other specialties there. Surely the growing weight of evidence, not just in this country but overseas, is for a move towards science-based hospitals. That is profoundly important in the west London area. Such hospitals would provide, as Tomlinson says, a one-stop health shop, accessibility--we all accept that Charing Cross has that and it is indicated in the reviews--modern buildings and site flexibility. All that is present at Charing Cross. Also, although I do not agree with the philosophy of a market approach for the health service, Charing Cross pays its way in the market. The Minister must address that point, as it is that by which the Government are saying hospitals should be judged.

Closing the accident and emergency facilities would inevitably undermine the hospital's other facilities. At present, cancer patients who have complications such as renal failure, respiratory failure or neurological or psychological difficulties can all be treated on site. That is important, because patients do not have to be moved from a specialist hospital to a general hospital for treatment and then moved back again. That is a big advantage and it is one reason why in so many areas that have large populations there is a move towards science-based hospitals which have a wide range of facilities on site.

In reality, Charing Cross hospital is already the trauma centre for west London. It handles some 60,000 new accident and emergency patients per annum. I obtained that figure from the hew health authority the other day. Over 100 major trauma cases per annum are admitted through accident and emergency and a further 200 per annum are admitted via neurosurgery. That is equivalent to the model trauma centre that the Government recommend people to visit in Stoke-on-Trent. If the Government want to save money, people from the south of England who want to visit a trauma centre could visit Charing Cross instead of travelling to Stoke-on-Trent.

Charing Cross has a high reputation. One of the medical staff was selected, with the hospital, to treat George Bush when he visited Britain as President of the United States. Charing Cross is well located should there be a major accident of the type that happened in Amsterdam when the aircraft crashed. It is well located to be the trauma centre for west London, or perhaps even for a wider area. The facilities are there. If the Government make the mistake of closing Charing Cross or forcing it to concentrate on particular services, at some stage they will have to focus on the need for a trauma centre in or near London. Why do that when the facility exists already?

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I want to put some positive proposals to the Minister. If the Government really want to improve health care in west London, they need to look at Charing Cross as not only a trauma centre, but as a hospital that should be linked, not so much with the Chelsea and Westminster hospital--although I do not rule that out--but with Hammersmith hospital. Hammersmith is an internationally known and world-famous hospital with enormously respected postgraduate teaching facilities. I am not arguing for the closure of Hammersmith, because the sites do not fit into each other and I am advised that it would take at least five years, or perhaps 10, to move one site to another. However, there is no doubt that a proper working link between Hammersmith and Charing Cross would produce a world-class hospital. Charing Cross could be used as the trauma centre with accident and emergency and district general hospital facilities, and Hammersmith could be used as the postgraduate research teaching and general research facility, together with some of its other functions. Such a hospital would offer enormously good facilities to the people of Hammersmith and Fulham and a much wider area of west London. I accept that decisions about how such a link should be developed and how close it should be would have to be made by medical staff, the management and so on. However, I have no doubt that such a link would be useful. I do not want to give the impression that there is a quick saving on all this. The Government have a problem about how much they are prepared to spend on the health service, but closing one site and moving to another is not a cost- effective argument. I do not want to anticipate the speech of the hon. Member for Fulham (Mr. Carrington), but I think that he may deal with that aspect. My argument is that we should have a science-based hospital in that area.

If the site was closed and sold, even in the slightly expanding property market, I should be surprised if the site would fetch £15 million or £20 million. It may fetch more in a year or two, but it is not a particularly valuable site. Sadly, that is even more true of the Hammersmith hospital. Not many developers want to locate modern premises next to Wormwood Scrubs prison, although it may advise them of some of society's problems if they did. The capital invested in those sites and the expertise of the people working there should be used to produce the science -based hospital about which I have been talking.

The Bow Group is not something that I usually pray in aid. However, its paper estimates that there will be a cost of £100 million in additional capital expenditure simply to relocate services, beds and pre- clinical facilities if Charing Cross were to be closed. The Bow Group is watching the Minister. It has done its research well. I have read the document and I am impressed by the arguments.

Charing Cross has been able to reduce the cost of its 1993-94 services by 18 per cent. compared with 1992-93. It was an enormous burden for a hospital to have to achieve and it was difficult for a manager to make such a dramatic cut. That is one of the reasons for the morale problems in the hospital. Everybody was worried about the future of the hospital and their jobs.

There is a real opportunity to improve health care in west London. It could be done in the way that I have described with a science-based hospital providing world-class facilities in the west of London. I urge the Minister to consider the arguments seriously before any final decision is made.

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9.59 am

Mr. Matthew Carrington (Fulham) : I am pleased that the hon. Member for Hammersmith (Mr. Soley) has secured this debate and I am grateful to him for allowing me to intervene in it. He and I have been trying together to get Adjournment debates on the subject, and I am glad that his name came up. I congratulate him on his effective speech. Charing Cross hospital is in my constituency, but of course it serves a wider population than my constituents ; it serves the constituents of my hon. Friend the Member for Brentford and Isleworth (Mr. Deva) and those of the hon. Member for Hammersmith. In one sense Charing Cross is not a local but a regional hospital, although it serves a large local population as well.

As the hon. Member for Hammersmith said, the threat to the hospital originates from the Tomlinson report and from earlier reports on the future need for health care in London. The threat was based on the assumption that London had too many hospital beds for its population, because a decreasing population in London meant that fewer beds were needed, and also on the assumption that as health services outside London improved there would be less need to bus patients in to major centres of excellence in London. To some extent that is true, but the research by Professor Jarman of St. Mary's hospital in Paddington, to which the hon. Member for Hammersmith referred, shows that that process has already taken place. The British Medical Journal of 19 June revealed that the number of beds in London, especially in the north-west quadrant in which the Charing Cross hospital is located, has already been reduced, so that inner London now has no more beds per head than are available elsewhere in the national health service as a whole.

The reasons for that are straightforward. First, we have already closed a great many hospitals in London. The Chelsea and Westminster hospital replaced five other hospitals, resulting in a substantial net reduction in the number of beds. Moreover, London, especially west London, has certain characteristics which affect both my constituents and the constituents of the hon. Member for Hammersmith. There is a large transient population, a population of people commuting into work, and a tourist population. There are also refugees. All those people throw pressures on to hospitals as opposed to primary health care facilities and their needs must be catered for.

The length of the waiting lists for hospitals in the area proves that that is a reality. London waiting lists can largely be explained by reference to the nature of the population and the use that that population makes of health facilities. Nowhere is that more true than at the Charing Cross hospital, where the waiting lists are still substantial despite the opening of the new Chelsea and Westminster hospital. The accident and emergency unit is still heavily used. Another myth about London's health service has helped to cause the threat to the Charing Cross hospital. The story is that, with 15 per cent. of the population, London receives 20 per cent. of NHS resources. On one level, that is true. London does have 15 per cent. of the population and it does receive 20 per cent. of the resources. However, there are two straightforward reasons for that. First, teaching and research are carried out in London to a greater degree than elsewhere. The special health authorities have not yet been brought into the internal

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market, although that is about to happen. Although teaching and research are compensated for in the calculation of the sums allocated to London for health care, no one in teaching or research--or, indeed, in the NHS in general--believes that such calculations are an exact science. If anything, they do not compensate sufficiently for teaching and research.

Secondly, London has to cater extensively for commuters, tourists, refugees and all the other problems of inner-city life, which throw a greater weight of need on to NHS resources. Perhaps 20 per cent. is too high a proportion for London, but I have yet to meet anybody who understands what is going on in London's health care who believes that it would be possible to reduce London's share to the 15 per cent. that would equate with its 15 per cent. share of the population.

Charing Cross is a large hospital, with 790 beds on a 16-acre site. It is also an excellent hospital, which came out well in the London specialty reviews. Its cancer services, neurosciences, plastics and burns units and its renal work were all highly commended. Closing the hospital would be extremely expensive and difficult. One would be closing more than just the acute beds. About one third of the hospital caters for geriatric and mental health patients of one sort or another. All those services would have to be relocated elsewhere.

Mr. Nirj Joseph Deva (Brentford and Isleworth) : Does my hon. Friend agree that Charing Cross is also a major trauma centre? For example, one of the busiest international airports in the world is at the other end of the motorway and if an accident such as happened in Amsterdam were to happen in London, Charing Cross would be the only hospital capable of giving the appropriate emergency treatment.

Mr. Carrington : My hon. Friend is absolutely right. What he said highlights one of the key factors affecting Charing Cross hospital--its superb location. It is on the A4, which is one of the best routes out of London, and is easily accessible. Three underground lines service it and five bus routes pass its front door, so it has good connections with the public transport system--better, in fact, than those of any other hospital in west London. Tomlinson was trying to achieve two things--to improve patient care and to save money. Closing the Charing Cross hospital would not improve patient care. The hospital services a deprived population which continues to use it extensively. The need for such a hospital in that inner -city area has never been greater. As my hon. Friend the Member for Brentford and Isleworth and the hon. Member for Hammersmith have said, the hospital is also ideally located as a trauma centre.

The Tomlinson report was also about saving money. There is no question about the fact that closing Charing Cross hospital would cost a considerable amount. Simply relocating the facilities at the Hammersmith hospital site would cost a substantial sum, and relocating the medical school would cost £60 million, so there is no saving of money to be made. I urge my hon. Friend the Minister to consider the proposals carefully and to decide that the Charing Cross hospital has a future role in west London's health care.

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10.7 am

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : My main role today is to congratulate the hon. Member for Hammersmith (Mr. Soley) on initiating a debate of enormous importance to his constituents and to tell him that I have listened carefully to what both he and my hon. Friends have said, which will be carefully studied. I was glad that the hon. Member made such a constructive speech. I especially noted his remarks about Professor Jarman and about trauma centres--a subject of considerable importance and one of great personal interest to me --and his views on the future of the Hammersmith and Charing Cross sites.

As the hon. Gentleman said, this is not a partisan matter, and that fact should be taken carefully into account. I was impressed by his tribute to the views of the Bow Group on this subject--I see that two former members of the Bow Group are sitting on the Benches behind me. The alliance between the hon. Gentleman and my hon. Friend the Member for Fulham (Mr. Carrington) is impressive and demonstrates the intensity of their feelings on the subject under discussion. The hon. Gentleman has not rejected the concept behind Tomlinson. He spoke constructively about the report and is aware of the need for change. Therefore, I shall not go over all that ground. He is also aware of the six specialty reviews that were set up as a result of Tomlinson to form a major part of the decision-taking process. With all these outstanding decisions he will forgive me if I do not go into detailed arguments on the points he raised. Everyone is aware that there is a problem of substantial duplication of some specialty services in London which may work against the provision of long-term, high-quality, patient care. Therefore, decisions must be taken. Where are we now ? The London implementation group under Sir Tim Chessells will make recommendations to Ministers in the autumn in the light of the specialty reviews, the option appraisal of central London hospital sites, which is already under way, the outcome of the recently published review of special health authority research and the views of health care purchasers and academic interests. There is a great deal of work to be done before proposals are developed further and there will be full public consultation on any major changes that are proposed as a result.

What, then, are the implications of those various processes for Charing Cross hospital ? As the hon. Gentleman knows, there has been no decision as yet.

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Many factors will be taken into account. We have asked the London implementation group, working with the regional health authority and local health authorities, to bring forward detailed proposals by the autumn for the future of Charing Cross hospital, having regard to the Tomlinson report's option for closure, the site appraisal and the local review of accident and emergency services. The recommendations of the specialty reviews will also need to be fed into the consultation process on the joint Charing Cross-Chelsea and Westminster trust application, which ends in early August. No decision will be taken on that application until the other reviews in west London have been completed.

If I had more time I would have said more in detail about the extent of accident and emergency services at Charing Cross hospital. All that I will say is that in the light of the outcome of the reviews and other outstanding decisions, the district health authority has concluded, rightly in my view, that it would be premature to make a decision on the future of those services at Charing Cross at this stage. I listened carefully to what the hon. Gentleman said on the subject and I can assureson is that if London has too many acute beds and there needs to be a reduction in their number, it must be accompanied by the provision of better primary care. The hon. Gentleman probably knows that there are plans for an additional £43 million for improving primary care in London and £170 million over the next six years for capital developments. Some of that money is earmarked for the Hammersmith area--in other words, the area of the Charing Cross hospital.

Secondly, the Government realise how unsettling and difficult all these outstanding decisions are for staff, patients and hon. Members' constituents. These are difficult times while decisions are awaited. I must make it clear that it is the Government's intention to come to a decision at the earliest possible moment, depending on all the reviews that are now under way having reported and all the information being taken into account.

What is happening in London mirrors what is happening in the great conurbations in the rest of the country. These are painful decisions, but where they are necessary, they must be taken with a view to the best operation of the health service over the coming years

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse) : Order.

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Adoption Leave

10.15 am

Mrs. Cheryl Gillan (Chesham and Amersham) : I am delighted to have the opportunity before I take my bucket and spade to the seaside to raise a matter on the Adjournment which concerns me and several of my constituents.

I introduced a ten-minute Bill earlier in the Session for which I was privileged to have cross-party support, and I should like to follow up some of the general points that I made then. I welcome my hon. Friend the Parliamentary Under-Secretary of State for Employment to the Front Bench. I am delighted that she is in the House to listen to the debate and I hope that when she replies she will indicate that she has an open mind on the subject.

Adopting mothers do not have in law the right to return to work or to maternity leave. We need to pay attention to this group because this small section of the population has dropped through the net. In many respects, they have a raw deal.

I want to highlight a specific problem relating to two constituents, Dr. Estelle McAndrew and her husband Graham Anderson. Dr. McAndrew met her husband in Dundee in 1983 and went on to qualify as a general practitioner in 1985. He became an interior designer and they married in September 1988. They now live in my constituency. Both want a family but, sadly, no happy event has been forthcoming. As a doctor, Estelle McAndrew realised that all was not right. After many tests the only diagnosis was unexplained infertility. The couple decided to try gamete intra-Fallopian transfer, which is similar to in vitro fertilisation, but it has not worked. It is fair to say that only a miracle could give them the child or the children that they want--a miracle or adoption.

Armed with that thought, in June last year they decided to attend an open day for couples interested in being considered for adopting a child. They were fortunate, as Dr. McAndrew acknowledged, to be chosen to start the assessment procedure in August. By November, they had been approved by the panel as suitable potential parents. I am sure, Mr. Deputy Speaker, that you can imagine their great joy at receiving this news and their great disappointment at what has transpired since.

Dr. McAndrew is a GP at the Cowley community surgery in Uxbridge. On hearing that she and her husband had been accepted for the adoption process, her senior partner, Dr. Haydn Daily, duly approached the Hillingdon family health services authority to obtain locum payments. Yesterday, I telephoned the FHSA warning it that I was raising the matter on the Adjournment, but I have not received any response. Locum payments are put towards the cost of another doctor when, for example, a GP is on pregnancy leave. Dr. Daily wished to cover Dr. McAndrew's absence when a baby was eventually located for the couple to adopt. The FHSA rejected the application. In February, Dr. McAndrew appealed to the family health services appeals unit, but to date no decision has been forthcoming. Since discovering that she did not qualify for the same treatment as a doctor giving birth, Dr. McAndrew decided to consult other interested bodies. She has received the support of the general medical services committee of the British Medical Association and the Medical and Dental Defence Union of Scotland. The BMA supports the view

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that payments should be made to women GPs who take time off for adopting a child and who employ a locum during that time. That would bring them in line with the regulations concerning confinement and even those concerning sickness.

The BMA has put forward recommendations to the Department of Health that an appropriate amendment be made to the regulations, in this case the statement of fees and allowances. However, the Department rejected that view, which seems hard to understand, particularly in the light of the successful Opportunity 2000 scheme, which is benefiting women throughout the country. With one hand we seem to be giving opportunities to women and with the other we seem to be taking them away.

The Whitley councils for the health services have also been in correspondence with my constituent. Special leave for adopting a child is covered in section 12 of the General Whitley Council handbook, but when they contacted Hillingdon FHSA they received the same reply--that the decision not to grant payment during adoption leave was based on the absence of any such provision in the FHSA. Hospital doctors, trainees and nurses can all get cover and leave for adoption under those rules, but the provisions do not apply to GPs. My constituent would be better off in that respect if she were a hospital doctor, which is hardly an incentive for women to become GPs. At the same time, however, she was hearing that other FHSAs were using their discretion and giving leave and locum cover to GPs who were adopting children.

I took the matter up with the Department of Health and received a reply that does not satisfy me that we are taking the right approach. And it certainly does not satisfy my constituent. After all, she is asking only to be treated in the same way as if she were sick or pregnant. According to the Minister, maternity locum allowances to pregnant doctors were introduced to reflect the fact that there were clear physical and medical reasons why a woman GP should be absent from the practice around the time of confinement. They were also to see the baby through the perinatal period until it became stabilised in feeding and general care. The Minister went on to say that GPs were independent self-employed contractors and, therefore, did not receive separate payment in respect of absence from the practice, except during sickness and confinement.

That response does not go far enough and the reasons given are not the only ones for not allowing locum cover during confinement. The real reasons may be based on the needs of different parents, which is something we constantly hear about in connection with every other aspect of the health service except, conveniently, this one. I would suggest that sickness and maternity locum cover are also granted to help maintain the standard of health care given to patients of the practice, who may otherwise have less time spent on them if the other partners in the practice were forced to shoulder the case load while their female partner was absent. Perhaps it is also to ensure that general practice is an attractive career for women, with the same conditions as any other medical career. Surely it is obvious that one of the main reasons is to assist in the continued provision of the service to patients. But women practitioners are covered only when sick or biologically pregnant, not when they adopt. When they adopt, the FHSA regulations leave them on their own.

Dr. McAndrew and her husband have been approved to adopt a new baby or a small toddler whose needs will be indistinguishable from those of any other child of that

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age. Their needs as parents will be indistinguishable from those of any other new parents. If anything, they may be marginally greater, as there is no nine-month period in which to get used to having a baby in the family. Although Dr. McAndrew may not be breast-feeding, she will certainly find herself up during the night having to perform the same tasks that she would had she given birth to the baby. The family will have to get used to their new responsibilities extremely quickly. A baby for adoption may arrive at short notice.

Even if Dr. McAndrew wanted to return to work within a short period, that might not be possible as the adoption prerequisites often insist that the mother remains with the child full time until the adoption is approved. It does not take long to work out that giving that commitment may cause problems with the adoptive mother's job. Thus, the choice comes down to either adopting a child or keeping a job, which appears to be the choice that we are giving Dr. McAndrew and many other potential adopters. Can it be right? Let us consider the matter coldly and dispassionately. The child would be the state's responsibility unless adopted and would have to be looked after at the state's expense. Just when the state is relieving itself of a financial burden, it is potentially robbing the citizen who is providing the saving of the wherewithal to do so. That is not prudent or sensible.

Also to be considered within the cost equation is the investment that has already been made in training the individual--in this case, a doctor. A large proportion of that cost has already been borne by the state, which is potentially discouraging the individual from utilising her expensively attained skills. If she chooses adoption rather than adoption and career-- if that is possible--the state will lose.

The problem does not concern a large section of the population. A relatively small number of adoptions take place every year and, of those, only a handful are of babies or small toddlers. However, it is about time that we removed the uncertainty and extended the protection that the law gives to pregnant workers to adopting mothers by providing similar parameters.

I introduced a ten-minute Bill on adoption leave arrangements earlier in this Session and was pleased to have cross-party support. This is not a political but a common sense issue. A small section of our society has been missed out from protection and legislation. To consider the full implications we would need accurate statistics and, although both Barnardos and the British Agencies for Fostering and Adoption have helped me, I cannot get accurate statistics. The headline topic on adoption at present is the seemingly racially correct attitude of social workers to mixed-race adoption. That issue and the one that I have raised have highlighted the difficulty in obtaining accurate statistics on adoption since the Adoption Unit returns were abolished. We would have more accurate information if the Department still compiled statistics. We could then see how many children were being placed with inter-racial families and how many babies or toddlers were being adopted by working mothers. Although some information is available from local authorities and the agencies that I mentioned, the picture is not complete. It is another area which requires re-evaluation so that the extent of the financial implications can be accurately assessed.

There are many other issues on adoption, not least the prerequisites for terms and conditions of employers. For

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example, parents seeking to go on the adoption register must often approach their employers and ask what terms and conditions they would be given, were they accepted on the register. That often causes much strain between employer and employee. If the employee is subsequently not put on the register, it can cause difficulties in the workplace for the potential adopting parent. Those issues need to be sorted out, but today I have brought the matter to the House's attention for Dr. Estelle McAndrew and her husband. I hope that my hon. Friend the Minister can assure them of a satisfactory outcome to the deliberations on adoption and that she can ensure that the issue is covered in the forthcoming White Paper. I also hope that my hon. Friend will send a firm message to her colleagues in the Department of Health that locum cover should not be hit and miss. It should not be a question of one FHSA in one part of the country allowing the locum cover and another FHSA not allowing the cover. We want that cover to be extended to all GPs.

I am not asking for complex legislation ; I am asking merely for guidelines to level the playing field. Dr. McAndrew certainly seeks such assurances. As she told me yesterday on the telephone, she and her husband would like eventually to adopt up to three children, perhaps even a small family unit. We do not want any more barriers to be put in her and her husband's way.

In a recent letter, my hon. Friend the Secretary of State for Health said that GPs were "the cornerstone" of the NHS. Surely adoptive parents are the cornerstone of family life--a family and an opportunity that adopted children would not otherwise have. Dr. Estelle McAndrew is both a GP and a potential adoptive mother. Can we ensure that she gets a fair deal?

10.30 am

The Parliamentary Under-Secretary of State for Employment (Miss Ann Widdecombe) : I first congratulate my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) on securing this Adjournment debate on adoption leave. As she said, she made this matter the subject of a recent ten-minute Bill and before that she tabled an unsuccessful amendment during the Committee stage of the Trade Union Reform and Employment Rights Act 1993. She therefore has an extremely honourable record of trying to raise the issue successfully. She regards the issue as being of great importance both to her constituents and in general. I am afraid that I shall not be able to give her the categorical assurances of change that she seeks this morning. Nevertheless, the sheer determination and persistence with which she has addressed the subject will convince her constituents that they have an extremely worthy representative in my hon. Friend. I should apologise to my hon. Friend for being perhaps the wrong Minister to answer the debate. She has chosen to make the thrust of her debate the question of locum payments to GPs. Adoption, adoption prerequisites, the rights of those who are about to adopt, GP contracts, locum arrangements and FHSAs are all the responsibility of my right hon. Friend the Secretary of State for Health. However, I can give my hon. Friend an undertaking that I shall draw to the attention of my colleagues in the Department of Health the issues that she has raised today, including the specific issue of the White Paper and whether the matter

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might be addressed within those confines. I cannot anticipate my right hon. Friend's reply, but I can ensure that she is made aware of the many important issues raised in the debate. The reason why I am replying to the debate, perhaps to my hon. Friend's dissatisfaction, is that the issue of rights for adoptive parents goes well beyond the self-employed and GPs. If we agreed that any changes were necessary, they would be the responsibility of the Department of Employment and that is why I am answering the debate today.

Before I embark on the substance of my reply to my hon. Friend, I extend my congratulations to her constituent on being approved for adoption, and I wish her well in her desire to adopt up to three children. My hon. Friend referred to a miracle as being the only way in which her constituent could enjoy motherhood rather than rough adoption. I sincerely hope that that miracle takes place and that she will have that joy as well as the joy of adoption.

I now turn to the general issues raised so eloquently by my hon. Friend. My predecessor, the hon. Member for Derbyshire, West (Mr. McLoughlin), replied to the debate in Committee to which I referred earlier. He explained that the Government did not consider that adoption leave was an appropriate matter for legislation. We remain of that view despite my hon. Friend's eloquent pleading to the contrary.

The Government believe strongly in the need to recognise the contribution of working women and to assist those who wish to combine a career with family responsibilities. We committed ourselves in our election manifesto to taking action to enhance maternity rights and we have, of course, fulfilled that commitment. As hon. Members know, the Government introduced in the Trade Union Reform and Employment Rights Act 1993 provisions that will significantly extend and improve the already substantial package of maternity rights that women enjoy.

The Act gives all natural mothers, regardless of their length of service or hours of work, a new right to a minimum of 14 weeks of statutory maternity leave during which all their non-wage contractual benefits will have to be maintained. It gives them comprehensive new protection against dismissal on maternity-related grounds and new rights in relation to suspension from work on maternity-related health and safety grounds. Furthermore, a much longer period of absence remains available to the 62 per cent. of working women who meet the qualifying conditions : two years of service working 16 hours per week or five years of service working between eight and 16 hours a week. They will continue to be entitled to return to work after a maternity absence lasting up to 29 weeks after the week of childbirth. Those are important new provisions which will be a real help to many women who wish to combine a career with family responsibilities.

As always, there is a balance to be struck between increasing the rights of employees and placing extra burdens on business. We are convinced that the provisions of the new Act correctly strike that balance. To add further to employers' costs by making additional improvements in maternity entitlement or, as my hon. Friend suggests, extending it to a category of mothers who do not at present

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