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House of Commons

Friday 17 December 1993

The House met at half-past Nine o'clock

PRAYERS

[ Madam Speaker-- in the Chair ]

Israel

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

9.34 am

Sir Thomas Arnold (Hazel Grove) : I am grateful for the opportunity to address the House on the subject of British policy towards Israel at the United Nations. This year's General Assembly is now coming to a conclusion, and the debate will give the Government an opportunity to comment on the ways that Britain is seeking to further the peace process, both at the United Nations and in terms of our interests and responsibilities in the middle east.

I am looking forward to hearing what my right hon. and learned Friend the Minister has to say about Britain's attitude towards the many resolutions on the middle east, which come up year after year at the United Nations General Assembly in New York.

As long ago as 1982, I was able to secure an Adjournment debate on Britain's responsibilities under the United Nations charter for our dependent territories. I did so because, in late 1982, I spent some two months at the General Assembly as the parliamentary delegate from the United Kingdom. That experience taught me that the United Nations is a Parliament. Like every Parliament, if it is to function properly, it has what we would call Standing Orders. It has precise rules and procedures. The countries that perform effectively at the United Nations are those which, like Britain, have mastered the fine print of the United Nations charter and mastered in turn the way that a country must learn the Standing Orders of the United Nations to undertake the day-to-day work with speed and efficiency.

At the time of the Falklands, the role of the British mission in New York was not only vital to this country's effort but exemplary in terms of the contribution that our diplomats made. I do not believe that that contribution could have been as successful as it was had they not been masters of the art of United Nations diplomacy, which frequently means having an understanding of the fine print, not just of documents but of the rules of the organisation.

I believe that the peace process needs every possible encouragement. It continues to be fragile and we should therefore do everything that we possibly can to assist. I want particularly to raise the question of Israel's participation in a regional group. That issue has come up on previous occasions, and requires some clarification as the peace process develops.

I should like to see Israel playing a fuller part in the work of the United Nations, not least because that might help to make Israel's response on some issues less defensive, and would at the same time try to encourage and assist the situation in which Israel and the Arab countries can be seen to be working more closely together.

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As I understand it, Israel is the only country which, unwillingly, does not belong to any regional group. That means that it cannot participate fully in the proceedings and work of the United Nations, with the adverse consequences to which I was referring earlier. I agree that Israel belongs naturally to the Asian group, but it is not accepted there because of Arab resistance.

As I understand it, Israel just wants to be treated as a normal country, in United Nations terms, and wants to be more involved and be elected to United Nations bodies. In that sense, Israel is isolated, because it is only by belonging to a regional grouping that a country can participate in internal United Nations elections or eventually become a member of the Security Council.

Israel has sought to deal with that problem by applying for temporary membership of the Western European and others group--temporary because, once peace in the middle east is established, Israel should join the Asian group. As I understand it, Israel is already accepted in the Western European and others group in other international organisations, such as the World Health Organisation, the International Labour Organisation, UNESCO and the Food and Agriculture Organisation.

I believe that rights bring responsibilities, and Israel's membership of a regional grouping within the United Nations would mean not only that it would take on the benefits of membership, but that its closer relationship with other group members could grant scope for a more responsive dialogue between the member countries. I attach weight and importance to that argument.

In that regard, the position of the United States is interesting. I note that in 1992, for example, a spokesman for the United States Department of State, Office of Assistant Secretary, was asked by the press the following question about Israel and the United Nations : "Does the United States have a position on whether Israel should be able to enjoy membership in the UN's elective offices, such as the Security Council?"

The answer was unequivocally

"Yes, the United States strongly favours full Israeli eligibility for UN elective offices such as the Security Council. This is why we strongly support Israel's membership in one of the five regional groupings at the UN, which propose candidates for elective offices. Israel is not now a member of a regional grouping. For a number of years we have supported Israel's membership in a regional grouping, and we will continue to do so."

That is a clear statement of the United States' position. Canada and the Netherlands support that stance, and the remainder say that they would support a consensus to admit Israel, but will not lobby for it. I should be grateful if my right hon. and learned Friend could clarify the present position.

In July, in an answer to the hon. Member for Warley, West (Mr. Spellar), my right hon. and learned Friend said :

"We believe Israel should be allowed into the Asian group of the United Nations. But until they are, we would not object to Israeli membership of the Western European and others group of the United Nations if there was a consensus among other member states."--[ Official Report, 16 July 1993 ; Vol. 211, c. 725.]

On 13 August, I received a letter from my hon. Friend the Under-Secretary of State for Foreign and Commonwealth Affairs, which noted :

"We have discussed this issue with EC colleagues and it is clear that there is no consensus in favour of Israeli membership of WEOG"-- the Western European and others group--

"Our EC partners are fully aware of our own position."

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In those circumstances, I should welcome further clarification of how the Government see the British position and their view on the way ahead on this issue.

At this juncture, I should like to draw the attention of the House to the implications of the arguments about Israel's membership of a regional grouping for the chemical weapons convention. At the 47th United Nations General Assembly, Israel co-sponsored the resolution endorsing that convention. On 13 January this year, it signed that convention in Paris, therefore making Israel one of the original signatories. As a consequence, Israel decided to send a delegation to participate in the work of PrepCom-- the preparatory commission of the Organisation for the Prohibition of Chemical Weapons--which is based in the Hague. Israel signed that convention with strong encouragement from the west.

Israel believes that that act should have strengthened its case for membership of the Western European and others group, particularly since some of Israel's neighbours still have chemical weapons. I should be grateful if my right hon. and learned Friend could say how he sees Israel's position within the particular context of the chemical weapons convention.

The wider question of British policy towards Israel and the middle east, as expressed in resolutions at the General Assembly and with particular reference to those passed this autumn, should be considered. For as long as I can remember, the texts of Security Council resolution 242 of 22 November 1967 and resolution 338 of 22 October 1973 have been the bedrock of the United Nations position on the middle east and that of many member countries. As the years have rolled by, the references to those resolutions have multiplied. Time and again, the House and other Parliaments have had detailed discussions of those resolutions and their implications.

As I understand it, the news from New York this week is that a new resolution has been tabled, which seems to represent a welcome step forward. It enjoys 105 sponsors, one of which is Britain. The resolution was adopted this week, with a vote of 155 member countries in favour. There was only one abstention, and Libya and three other countries voted against- -Syria, the Lebanon and Iran. I should like my right hon. and learned Friend to say whether he believes that that new resolution will, in effect, be the bedrock resolution on which further debate and discussions at the United Nations will take place.

I note that the resolution refers to the earlier resolutions 242 and 338. It goes on to review the startling progress that has been made this year in seeking to bring peace to the middle east. It calls on member states to do everything possible to take that process further. I am sure that all hon. Members will attach great importance to that aim.

I should like to draw the attention of the House to correspondence that took place late in 1992 between a group of United States Senators and my right hon. Friend the Foreign Secretary, because it highlights a problem that still exists. Those Senators pointed out : "over 30 anti-Israeli resolutions are passed each year in the United Nations with the specific objective of condemning and embarrassing the government of Israel We believe these resolutions are unjustified In our opinion, Israel should be commended for its commitment to the peace talks rather than openly condemned in resolutions at the General Assembly."

My right hon. Friend replied :

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"We have made clear to the Arabs our view that ritual condemnation of Israel in United Nations' resolutions is counter-productive, hindering rather than promoting the peace process."

I invite my right hon. and learned Friend to comment on the present situation and whether he believes that the plethora of resolutions at the UN General Assembly could now be reduced. May we take it that, henceforth, the resolution that was passed this week will be the principal resolution, and that it will be possible to concentrate on its wording, rather than deal continuously with other anti-Israeli resolutions, which have done so much damage in the past?

I welcome the changes that have taken place this year. I draw the attention of the House to the resolution on Israeli nuclear armament. In 1992, Britain abstained on that resolution, the text of which deplored Israel's refusal to renounce possession of nuclear weapons and urged it to accede to the treaty on the non-proliferation of nuclear weapons convention.

That has been replaced this year by the call on Israel to renounce its possession of nuclear weapons and to accede to the treaty on non- proliferation. The United Kingdom and the rest of the European Community member states voted against that resolution.

What does my right hon. and learned Friend think will be the future approach to that resolution and others ? Will it be British policy at the UN to try to persuade other countries to forgo resolutions of that kind in the foreseeable future ? They do not help the peace process ; in many respects, they hinder it, for the various reasons that I have given.

I remind the House that, although the UN has at times not seemed an especially appropriate place in which to further the aims of British diplomacy and there are occasions on which it is easy to become bogged down in what my noble Friend Baroness Thatcher referred to as a procedural morass, times change and, in the middle east, the UN has always participated in the various peace talks and working parties that have been set up ; certainly, that situation will not change. An understanding and knowledge of the rules of the organisation are essential if Israel, Britain and other countries are to pursue their diplomacy effectively. If Israel were allowed into a regional grouping, it would bring about an improvement in the present situation in New York.

The more that Israel can be encouraged to co-operate and to look for means whereby she can further her diplomacy in a manner that is consistent with the objectives that we all want to see fulfilled, the more that the peace process will be enhanced. I believe that British policy at the UN has been directed towards furthering that wholly necessary objective. I look forward to the reply of my right hon. and learned Friend on those specific points.

9.52 am

The Minister of State, Foreign and Commonwealth Office (Mr. Douglas Hogg) : I am grateful to my hon. Friend the Member for Hazel Grove (Sir T. Arnold) for raising this subject and for giving me the opportunity to respond to the important points that he has made. It is a great pleasure to see my hon. Friend the Member for Leeds, North-East (Mr. Kirkhope) on the Front Bench; his interest in these matters and concern for the state of Israel is well known.

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My hon. Friend the Member for Hazel Grove began by speaking highly of the skills of the United Kingdom diplomats who work in New York. I entirely agree. I am sure that the House will agree that the reputations of Sir David Hannay and his colleagues are second to none. I pay tribute to Sir David Hannay and his colleagues, and thank them for the warm welcome they gave Members of the House who visited the UN some two or three weeks ago.

My hon. Friend concentrated at some length on the possibility of Israel's becoming a member of the Western European and others group, and also of participating in the organisation of the preparatory commission on the prohibition of chemical weapons.

Our position on Israel's admission to WEOG is as follows : like my hon. Friend, we believe that Israel's proper home is in the Asian group. We are at one on that. As my hon. Friend knows, there is a delicate balance to be struck between the regional groups in the UN system. WEOG has not accepted any member from outside the western European area in the past 40 years and, for that reason, there are natural inhibitions about doing so now. However, at the same time, we do not wish to be unhelpful towards Israel and we will not block a consensus in favour of Israel membership on a temporary basis. We anticipate that the membership will be renewed annually.

It is not for us to lobby for Israeli membership, but if there is consensus, we will not seek to block it, and will be content to see Israel as a temporary member of WEOG. The Government of Israel know that fact, partly because we have disclosed it to our colleagues and partly because, when I saw Foreign Minister Peres in Vienna earlier in the year, I stated our position clearly. I hope that my hon. Friend will be reassured on that point.

My hon. Friend also raised the question of Israel's membership of the preparatory commission of the Organisation for the Prohibition of Chemical Weapons at the Hague on 15 December. It was agreed to accept conditionally Israel's request for temporary membership, pending its admission to the Asian group. I hope that my hon. Friend will be reassured by that fact.

The debate in the General Assembly took place against the background of the developments in the middle east. Is the hon. Member for Clydebank and Milngavie (Mr. Worthington) seeking to intervene? Mr. Tony Worthington (Clydebank and Milngavie) indicated dissent.

Mr. Hogg : I am grateful. I would have truncated my remarks if the hon. Member had wanted to intervene.

The breakthrough in the negotiations between the Palestine Liberation Organisation and Israel was a tremendous achievement and has unquestionably affected all our attitudes to the problem of the Arab-Israeli dispute. The handshake on the White House lawn on 13 September is an image which will rest in our minds for a long time, as will the visit of Chairman Arafat to London.

My right hon. Friend the Foreign Secretary gave a lunch for Chairman Arafat and, in many ways, it was an extraordinary occasion. Chairman Arafat was a welcome guest to lunch, and also present were the Israeli ambassador to London, the President of the Board of Deputies of British Jews, Judge Finestein, and the hon. and learned Member for Leicester, West (Mr. Janner).

We should give credit to the United States. In a sense, the breakthrough was the result of the Madrid process. It

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would not have begun without the initiative of Secretary Baker and President Bush, which was carried forward by the Norwegians in the Oslo talks. The process in Madrid that began in October 1991 was based on Security Council resolutions 242 and 338. Those resolutions and the principle of land for peace which is reflected in them, remain the basis for all negotiations.

In the declaration of principles signed by Israel and the PLO, the aim of the negotiations is described as a permanent settlement based on Security Council resolutions 242 and 338 and the permanent status negotiations aim at the implementations of those resolutions. Against that background, we and our partners in the European Union have taken a fresh look at all the resolutions that concern Israel--as have the Arab states, which drafted many of those resolutions. My hon. Friend the Member for Hazel Grove referred to the new resolution. We were delighted to be able to co-sponsor that new resolution, which we thought was forward looking, in that it welcomed the developments in the peace process. My hon. Friend rightly said that that resolution was adopted by a huge majority, with 155 votes for, three against and one abstention. Israel herself voted in favour. I hope that that is symptomatic of a new atmosphere of co-operation and relative harmony in New York.

I am glad to say that this year's resolutions have been much less condemnatory in tone than those in previous years, and that has made it possible for more resolutions to be adopted by consensus. I hope that people will be careful not to draft or seek to push through one-sided resolutions in the context of the debate in the middle east.

We must all be conscious that there are constituencies on both sides--in the state of Israel and in the occupied territories--that have to be carried if the peace process is to survive. It is unhelpful to pass one- sided resolutions that alienate one or other of the constituents. We need to be even handed in this matter. Lebanon's opposition to the new resolution came about because there was no express reference to Security Council resolution 425--which does, of course, require Israel to withdraw from Lebanon. I should like to take this opportunity again to reiterate the support that Her Majesty's Government give support to resolution 425 and to the need for a peaceful solution to the Lebanon track of the peace process. In that context, it was a great pleasure for me to welcome yesterday to London the Foreign Minister of Lebanon. I am pleased that the hon. Member for Clydebank and Milngavie had the opportunity to talk to him. My right hon. Friend the Foreign Secretary had a substantive meeting with him yesterday afternoon, which was no doubt extremely helpful, I hope for both sides.

The recent euphoria that has come about because of the agreement between Israel and the PLO emphasises the value that everybody places on movement. However, the Government adhere to the belief that peace in the middle east requires more than just a deal between those two parties. I have always taken the view that one cannot get a lasting settlement in the middle east unless and until there is an agreement between the Palestinians the state of Israel. It is a mistake to suppose that there is the possibility of making bilateral agreements between the state of Israel and individual Arab states unless there is agreement between the state of Israel and Palestinians.

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Therefore, the agreement made between Chairman Arafat and Prime Minister Rabin is important not just because it opens up the possibility--even the probability--of a long-lasting accord between those two peoples, but because it unlocks the door to the wider, more comprehensive peace settlement that is essential. We need a comprehensive settlement that covers all tracks of the peace process and is freely agreed to by all the parties. I hope that, by next year, the General Assembly will be considering resolutions welcoming further progress on all tracks, including that of Syria and that of Lebanon.

Let me say a word about the Syrian track. The General Assembly resolutions have this year continued to address the question of the Golan Heights. We abstained on that question, as we have in the past, because we thought that the language would not help progress in the negotiations. But there can be no doubt about our support for attempts to resolve that problem as part of a comprehensive settlement.

An agreement between the state of Israel and Syria is, in my view, essential and urgent. Two key questions have to be addressed--first, the withdrawal by Israel from the Golan Heights and, secondly, the establishment of a full state of peace between Syria and the state of Israel.

One of the key problems at the moment is that both the negotiating parties are unwilling to make plain exactly what they mean by the concepts. What does the state of Israel mean by withdrawal? The Syrians are entitled to press the Israelis on that. And what does the state of Syria mean by peace- -is it a full relationship between friendly states or is it merely a cessation of the state of hostility? The state of Israel is entitled to press President Assad on that.

Those negotiating positions must be opened up and disclosed as soon as possible. In that context, I welcome the fact that the parties are returning to talks, and that President Clinton is to hold a summit with President Assad. It is most important that the parties move urgently in those negotiations.

This week, we have seen the implementation of another resolution--Security Council resolution 799, which, as the House will recall, calls for the return of all those who were deported to south Lebanon at about this time last year. I am glad to say that all those who were deported and have spent the past 12 months in south Lebanon have now returned to the state of Israel.

Certain problems remain, however ; they stand in the way of a peace process and need to be addressed. Perhaps most prominent of all is the Israeli settlement building in the occupied territories. It is true that settlement building has been reduced, but it has not been wholly stopped. That is particularly true of east Jerusalem. Not surprisingly, the Palestinians are deeply concerned by that. We have taken every opportunity--I take the opportunity now--to say to our Israeli friends that the construction of fresh settlements is an obstacle to the peace process and we very much hope that it will stop. We voted for the General Assembly resolution condemning the settlement building.

In the light of the new situation this year, we have reconsidered how to vote on a number of Arab-Israeli resolutions. On the subject of Israeli nuclear armament, for instance, we felt that in the present situation it was no

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longer appropriate to refer only to Israel. The issue of security is an important one. Laying the foundations of the region's peace and security falls to each and every state in the area. All of them, without exception, need to be active in arms control and disarmament. All countries must play a full part in preventing the spread and build-up of weapons of mass destruction, which we regard as a major threat to security and stability in the area.

Nuclear non-proliferation is one of our highest security priorities. We fully support the concept of a nuclear weapons-free zone in the middle east, and we and our European partners supported the resolution calling for that at the United Nations General Assembly this year.

We do not, however, consider it desirable to single out one particular nation for condemnation. We prefer the subject to be dealt with in the overall context of peace in the middle east, so we voted against the resolution specific to Israeli nuclear armament. That is not, however, a sign that we take the issue less than seriously. We continue to call on Israel and all other states in the region to accede to the nuclear non- proliferation treaty and to place all their nuclear facilities under full safeguard agreements with the Internationl Atomic Energy Agency.

Accession to the treaty by all states in the region, and their full compliance with its obligations, would be the best way to prevent the proliferation of weapons of mass destruction in the middle east. Similarly, we urge all states in the region that have not already done so to accede to the bilogical and chemical weapons convention as soon as possible. We fully support the work of the multilateral working group of the peace process on arms control and regional security.

I have already referred to WEOG and the chemical group. The 12 member states were pleased to be able to support the Israeli candidate for election to the UN administrative tribunal, and Mr. Gabay was elected on the first vote. The role of the United Nations in the middle east goes further than a string of resolutions. Hon. Members will be aware of the work being done by the United Nations Relief and Works Agency for Palestinian refugees. It is important work, which will not be diminished by the peace accord. We fully support that organisation--politically, with bilateral donations and through the European Community--and we will continue to do so. The peace process is of historic importance. No part of the world is more volatile and dangerous than the middle east. The economic interests of the whole world are focused on it. Years of history, tradition, hostility, fighting, murder and religious divide make it an extraordinarily difficult problem to resolve.

There are very legitimate concerns on all sides. Israel has a legitimate concern for security and we must keep that very much in mind. The Palestinians have a legitimate concern to assert their political rights as a people to acquire land of their own and create a political entity. The Arab states also have legitimate concerns. Syria's territory is occupied, as is that of Lebanon.

There are problems not only of history and tradition but of current needs and priorities. Against that background, what Prime Minister Rabin and Chairman Arafat have done is an extraordinarily courageous and statesmanlike act. Chairman Arafat has put his personal security on the line, as well as his political reputation. President Rabin has also put his political reputation on the line. They were right to do so. It was no small matter and they both deserve credit.

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It is for that reason, at least in part, that my right hon. Friends the Prime Minister and the Foreign Secretary were pleased to receive Chairman Arafat in London as a guest of the Government. My right hon. Friend the Foreign Secretary is looking forward to his visit to Israel and the occupied territories in January.

We must rally behind the peace process, politically and financially. We can do some good by sending messages and making clear what we believe to be true. The central problem is that important constituencies, in both the territories and the state of Israel, must be carried if the peace process is to last. People in the occupied territories must realise that powerful benefits flow from the accord and that it is not the end of the matter but the beginning. To the state of Israel, I say, "Be generous ; make progress with all possible speed ; make it plain that you are withdrawing and that Jericho-Gaza is but the first step. Press on, be generous." To our Palestinian friends, I say, "You must take account of the genuine security interests of the state of Israel. Do not press for more than public opinion in Israel can currently give. If you do, the process will collapse. Encourage your Arab friends to get closer to the state of Israel. Relax the trade embargo that is seen as a major obstacle to the establishment of proper relations. Do your utmost to ensure that there is no further violence in the territories."

We will do all we can to make sure that the negotiating parties recognise those facts. It is an historic moment and all parties deserve credit for what they have achieved. We believe that the process is irreversible and we will reinforce it as much as we can. I am pleased that my hon. Friend the Member for Hazel Grove has given me the opportunity to say that and that my hon. Friend the Member for Leeds, North-East was here to reinforce that message.

Hospitals (London)

10.15 am

Ms Tessa Jowell (Dulwich) : I am grateful for the opportunity today to speak about the situation in London's hospitals. We have two contradictory views of reality--that of the Secretary of State for Health and everyone else's. The Secretary of State tells increasingly bewildered and angry Londoners that all is splendid in the national health service ; another version is played out, day by day, in the casualty and acute wards of London's h the Secretary of State seems to have a particular mission to close. His letter was written on Wednesday of this week. He says :

"You may be interested to know that the situation here today has been chaotic. There have been two patients waiting in casualty since Monday afternoon, that is for 40 hours, for beds to become available in the hospital. A further 11 patients were in casualty overnight as there were no beds available for admission to the hospital, and therefore 13 of the 16 casualty trolleys and cubicles were occupied prior to the working day commencing. In fact I visited the department and, as you can imagine, the situation is chaotic. Accident and emergency or casualty departments are not adequately staffed or in fact geared to having in-patients as there are no facilities for this. With regard to hospital admissions today, five out of 10 admissions have had to be cancelled for elective surgery. This includes two of my patients with gynaecological cancer."

Is that what the Secretary of State means about making London better?

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Last night I visited four of the major casualty departments in London, and another this morning--five in all. At none of those hospitals--the Whittington, Bart's, St. Thomas's and King's-- were any beds available. At King's, 16 patients were waiting to be admitted to the hospital and being nursed or cared for on trolleys. At Bart's a man who was clearly very ill arrived. The hospital had no trolleys and had to throw a mattress on the floor in order to treat him. Every hospital repeats the same story. When I asked the staff, "Has it got worse?" the unanimous answer from every nurse and doctor was, "Yes, it has got worse--much much worse."

What is needed to make it better? The answer is simple. More beds--so that hospitals can admit patients who need to be admitted. It is an irreconcilable contradiction that we have hospitals in London that can perform transplant surgery and give the hope of life to people who, even five years ago, would have been regarded as terminally ill--treatments that are more complex, more advanced than in almost any other part of the western world--yet we cannot guarantee that our hospitals can find a bed in order to admit an elderly lady with a broken arm, who needs to go into hospital only because there is no one at home to look after her.

For patients who wait on trolleys for admission to hospital in the middle of the night, their only hope of being admitted before the following morning--when other patients are discharged--is by filling beds left empty by patients who have died during the night. London hospitals regularly start the night with no empty beds.

None of that chaos has come about by chance ; it is the predictable outcome of the Government's being hoodwinked by their own rhetoric--the rhetoric that says that London has too many hospital beds and that market forces will now do what successive Governments, and 20 inquiries into the state of London's hospitals, have so far failed to do. The situation that is now unfolding is entirely the result of Government policy, although the Government are now distancing themselves from it.

Let the Secretary of State tell the people to whom I spoke last night-- nurses working in the casualty departments of London hospitals, consultants and the relatives of patients--that London has too many hospital beds. The Government are alone in believing that, when waiting lists lengthen, the answer is to cut the number of beds. That remedy will make matters even worse.

Moreover, Ministers do not even seem to know how many beds, consultants and staff are available, what the waiting times are for each unit and how many beds at any one time are "blocked"--which is the rather unpleasant term used when patients are waiting to be discharged, but are unable to leave the hospital. That information is not held centrally, although it is essential for Ministers to have it if they are to deal with the turmoil that they have created. What, then, is the actual number of hospital beds in London, and how has the position changed in recent years? In 1986, London had nearly 50,000 acute beds ; by 1991--the most recent year for which figures seem to be available--the number had fallen to 36,000, a reduction of more than 14,000. In the rest of the country--comparisons are constantly made with the rest of the country--the rate of closure was 80 beds per million people per year. In London, the rate has been three times as high : 240 beds for every million people close every year. That, too, is a direct result of Government policy, through the operation of the internal market.

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In his report following the inquiry into London hospitals commissioned by Ministers, Sir Bernard Tomlinson estimated that London needed to lose 2,500 beds. It is not clear where that calculation came from, what was the start date for the closure programme or, indeed, whether that figure has long since been exceeded--which the statistics suggest is very likely. Even Sir Bernard offered a cautionary note, stating :

"We do not make anywhere in the report the statement that there must be an immediate reduction in beds. We believe there have to be planned reductions in beds to go along with the other changes we have supported."

He offered the following warning :

"It will be essential that adequate transitional funding be provided to ensure that service changes take place in an orderly fashion. The level of such funding will to a large extent dictate the pace of change. Change that is not managed and funded in this way is likely to be chaotic, and will do serious damage to London's health services, and to its medical research and teaching."

Given what Londoners now confront daily in their hospitals, Sir Bernard's remarks were prophetic. There is nothing planned about the random, chaotic and disruptive closures that are now taking place. Rigorous and systematic research has been carried out on the required level of hospital beds in London. In April this year, Professor Jarman, of St. Mary's hospital medical school, published an article in the British Medical Journal. He concluded :

"Hospital admission rates for acute geriatric services for London residents were very similar to the national values in all age groups."

In inner London, acute services showed an admission rate at 22 per cent. above the average value--or the average rate--for the rest of England.

"However, the admission rate of inner deprived Londoners was 9 per cent. below that of comparable areas outside London. For psychiatry, admission rates in London roughly equalled those in comparable areas. When special health authorities were excluded"--

SHAs will, incidentally, join the market next April--

"in 1990-91 there were 4 per cent. more acute plus geriatric beds available per resident in London than in England. Bed provision has been reduced more rapidly in London than nationally. Extrapolating the trend of bed closures forward indicates that beds (all and acute) per resident in London are now at about the national average. Data from the Emergency Bed Service indicate that the pressure on available hospital beds in London has been increasing since 1985." Information from the Emergency Bed Service, which compels emergency admission to hospital by some means or another when hospitals say that they have no beds and cannot admit seriously ill people, is generally regarded as one of the best tests of the adequacy of hospital bed provision in London. Since 1985, the number of admissions of seriously ill people through the service--people who have had to be "refereed" into hospital-- has risen threefold. According to Professor Jarman,

"Data regarding bed provision and utilisation for all specialties by London residents do not provide a case for reducing the total hospital bed stock in London at a rate faster than elsewhere. Bed closures should take account of London's relatively poorer social and primary health care circumstances, longer hospital waiting lists, poorer provision of residential homes, and the evidence from the Emergency Bed Service higher average costs in London, some unavoidable, are forcing hospital beds to be closed at a faster rate in London than nationally."

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In the light of the research evidence provided by Professor Jarman and his colleagues, and the daily experience of the Emergency Bed Service and London hospitals, I shall be interested to hear how the Minister will continue to sustain the case that London has too many hospital beds--given that waiting lists have lengthened, and the number of people waiting for more than two years for treatment has grown.

Waiting lists in London increased by a staggering 19.3 per cent. between June 1992 and August 1993. Within that average for the four Thames regions, there is a disturbing variation from 30.7 per cent. in North East Thames to 4.2 per cent. in South East Thames, with nearly 27,000 patients waiting more than a year for treatment at August 1993.

London's complex problem is made worse by the fact that six out of 10 hospital beds are occupied by elderly people over 65. The difficult relationship between acute care and community care in London must be understood, especially as two policies are heading for a collision. The loss of capacity to care for elderly people in hospital has not been matched by replacement facilities, or continuing care beds, as they are called, in the community--quite the reverse.

The health service has withdrawn, almost wholesale, from long-term care for the elderly. All that care--or virtually all--is now in the private sector, provided by private nursing and residential care homes. Many of my elderly constituents want to be looked after in the part of London in which they grew up and where they have always lived, but the nursing and residential care homes that they need do not exist in Southwark. For them, going into a residential nursing home means moving to Clacton, Bexhill or Eastbourne, many miles from their families and from what has always been their home. National comparisons shows that London has been specifically disadvantaged in that respect. In the rest of the country, about 12 beds are available for every 1,000 people, whereas in London the figure is little more than nine.

The way in which the Government chose to distribute the community care money last year--the special transitional grant--further disadvantaged London. My constituents lost close to £1 million because the Government chose to place the money where the homes rather than the elderly people and the needs were. That combined formula advantaged the parts of the country with large numbers of residential homes, but disadvantaged areas such as inner London where, for obvious reasons, the number of residential homes is very small. The crisis facing London's hospitals cannot, therefore, be separated from the crisis in community care

A consultant at one of the teaching hospitals told me recently that one needs to be very fit if one is leaving hospital at 85 and living in Southwark, Lewisham, Lambeth or any other part of our deprived inner city. The pressure on beds means that many elderly people are not fit when they leave hospital which is why the readmission rates are so disturbingly high. Elderly people may return to poor accommodation. They may live in poverty on a low and inadequate income, having to make daily choices between keeping warm and having enough to eat, and not have the support of relatives.

At King's yesterday, about 68 beds were occupied by people who were regarded as medically fit, but who were unable to leave the hospital because the community care that they needed was not available. Elderly people are often without the support and care at home which would enable

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