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Column 499By 1992, the net book value of British overseas investments was estimated at £360 billion. That comes from institutions, firms and citizens of the United Kingdom. When we compare that with the total value of the capitalisation of our stock market--which is put at £1.1 trillion, or £1,100 billion--we see that over 35 per cent. of our national assets are held overseas, and the amount is growing. Last year, we earned £26 billion in dividends and earnings from overseas investments.
It is an extraordinary story and it should be understood by the country. We should shout it from the rooftops. The growth of our direct investment abroad is shown by the fact that between 1987 and 1989 it reached 4.5 per cent. of gross domestic product, a percentage not matched by any European country. In the decade to 1990, the value of British corporate acquisitions in America stood at £90 billion, more than double that of Japan. I could go on, but I am conscious that some of my hon. Friends wish to take part in the debate. During the Christmas recess, I was privileged to be invited by the Government of India to visit India to see the progress of the India-British partnership initiated last year by my right hon. Friend the Prime Minister. As we heard in the debate, 70 memoranda of understanding have been signed and £1.2 billion of joint investment is being made. We have identified in India a new, emerging market of 200 million people with the purchasing parity of western Europeans, and they will be coming on stream in the next seven years. It is a vast opportunity, particularly because we have a common language, a shared history, the same institutional arrangements and the same commercial law and because the process of doing business is the same. India's huge industrial infrastructure needs to be upgraded. For example, British Aerospace has formed a joint venture to promote and sell software engineering processes to the rest of the world. Those are the sort of challenges that are being met by our business community. It is a story about which one should hear in the media. Our people should understand what is going on around the world while we sit here and debate other matters.
Mr. Heald : Does my hon. Friend agree that one of the great benefits of joint ventures and investment overseas by British companies is that this country can justify much greater research and development facilities than we might otherwise do, so that companies such as BAe, ICI and so on have substantial R and D facilities in Britain, which are servicing companies and sites across the world?
Mr. Deva : I am grateful to my hon. Friend for making that important point. Science parks are emerging in India, which will benefit from technical expertise, as my hon. Friend said. In summary, we are back and we will seize, for the betterment of the United Kingdom economy, the opportunity for growth, prosperity and jobs at home, a sound economy, sound money to keep inflation low, and a positive balance of payments so that we can go forward towards 2000 with one of the most successful, competitive productive economies in the world and again become the envy of the world.
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Mr. Dudley Fishburn (Kensington) : I should first, in what may be the last speech in the debate, thank the Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food, my hon. Friend the Member for Crawley (Mr. Soames), for such a wide-ranging and thorough speech. He stood in at the last moment and has shown that his grasp of international commerce is as good as his appetite for international cuisine. I also thank my hon. Friend the Member for Newark (Mr. Alexander) for raising the subject for debate. I shall not dwell on some of the more agricultural aspects raised today, as the warble fly, of which we heard from my hon. Friend the Member for Gloucestershire, West (Mr. Marland), is hardly the main topic of conversation in the wine bars of Kensington high street, although the well-manicured lawns of Kensington park are regarded with the same passion as my hon. Friend regards the forest of Dean.
The essence of the debate is not only the future prosperity of the United Kingdom, but something more important. It is about the very thing that makes us tick : in what direction do we want to take this country? In what way do we wish to bustle over the next generation? We make the choice either to bustle internationally and be fully part of the world, or perhaps retreat into a rather attractive theme park in which we let history pass us by.
One prediction that we can make with confidence during these next few years is that Britain's economy, relative to that of the rest of the world, will get smaller. That is not controversial. We are, after all, a static and aging population of about 56 million people. We live in a world that is ever younger, ever more capitalist and growing at a much faster rate than any of the countries of western Europe. The population of the United Kingdom currently constitutes just 1 per cent. of the world's population. Within the next generation, that will fall to a much lower percentage.
Even now, China, Mexico, Brazil, India and Russia are, by the size of their gross national product alone, able or worthy of being members of the group of seven largest industrial nations in the world. All of them are larger than Canada and, in size of their gross national product, are biting at the heels of the United Kingdom. There is little doubt that in the next decade or so they will overtake the United Kingdom in size.
All those facts point to its being ever more important that Britain's future should be entirely cosmopolitan and international, part of a world that is flourishing and exciting. At the start of the century, 20 per cent. of the world's wealth rested within the shores of these islands. Despite all the great empire, it was not necessary to bustle in the world to be commercially successful because there was enough wealth within our borders. By the end of the century, Britain's wealth might constitute 3 per cent. of the world's gross national product. Therefore, it is all the more important for our prosperity, and our morale and feeling of vigour in intellectual and commercial life, that we should be entirely international. The prosperity of the United Kingdom rests on one thing and one thing alone-- whether other people over whom we have no control and over whom, thank goodness, our politicians have no sway, choose to buy British goods because they find them competitive, good value for money, the right thing. Success in terms both of the volume of British exports and of the fast growth in their value shows
Column 501that, at last, we are on the right track. It matters not at all whether the goods that we export are manufactured goods or service goods.
Mr. Michael Clapham (Barnsley, West and Penistone) : In this debate on exports we have heard some excellent speeches, but not one has referred to an industry which has made enormous steps forward--the British coal industry. We are now producing coal at world market prices. Does the hon. Gentleman feel that Britain could export its coal to Scandinavia or the European Union while ensuring strategic supplies and thus maintain the future productivity of British industry when, because of the change in world circumstances, gas prices are likely to be pushed up within the short to medium term?
Mr. Fishburn : I should be the first to welcome the export of British coal to any market in the world. What matters is that it should be desired by other people and purchased by them, rather than produced against that market. If there is that market for British coal, I only hope that it flourishes and succeeds. It does not make any difference whether what is sold abroad is a manufactured product or a service industry. The hon. Member for Middlesbrough (Mr. Bell) made that point, and we debated it.
In the early 19th century, a number of old buffers, most of whom would now be Labour Members, said that the new industrial revolution bringing in steel, coal and textiles was of no worth and that only agriculture mattered. What nonsense that was, and what nonsense it is today when people say that wealth lies in coal, steel and textiles rather than in services. Wealth comes from what other people are willing to buy. The most rapid developments in British exports have come in the service industry, but greatly to be welcomed is the growth in manufacturing industry as well.
Mr. Dennis Skinner (Bolsover) : The hon. Gentleman began by talking about the glorious halcyon days of the turn of the century when Britain was exporting all around the world and dominating all those pink parts of the map. Much of the exports were in coal, but the hon. Gentleman gives the impression that, somehow or the other, we have lost that wonderful position by accident. The truth is that most of the countries now exporting to us, and other countries, support their own industries. As the Parliamentary Secretary is here, that big bladder of lard [ Hon. Members-- : "Order !"] He has accepted it before, so it is surely in order.
Will the Parliamentary Secretary understand that if coal had had the subsidies that agriculture has had for decades we would not only be exporting coal to every part of the world but giving it away? Why does he not concentrate on the fact that it is possible to export? As my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) said, we are competitive, and productivity in the pits has gone up by 360 per cent. since 1984.
Mr. Deputy Speaker (Mr. Geoffrey Lofthouse) : Order. That was a long intervention.
Mr. Skinner : The hon. Member for Kensington (Mr. Fishburn) was filibustering.
Mr. Fishburn : Had the hon. Gentleman been in the Chamber for any part of the past four hours, he would have heard exactly how the Government are encouraging
Column 502exports that the world is willing to buy, which is making all the difference to Britain's export performance and balance of payments. The future for the next generation will depend not only on exports by traditional industries but on something greater. Britain must be the cosmopolitan centre for the eight hours in which the sun shines on our part of the world and the world market comes to rest here. That ambition is not just for London but for the whole of Britain. We have heard of the overwhelming growth in the population of Asia and the southern hemisphere, but there is no doubt that there will continue to be great prosperity and enormous opportunities in the peaceful and prosperous part of the globe that our eight hours of the market represent.
It is crucial that the United Kingdom should be the chosen centre of that cosmopolitan and international trade. Already, one job in three in Britain rests with international trade. As time passes, it will be a major success if that proportion increases to one job in two, and eventually if every job in the United Kingdom--including in the coal and gas industries--is completely integrated with international markets. The world's future presents dramatic opportunities for Britain as an historic trading nation which trades more of its wealth overseas than Japan or the United States. If Britain can sustain the success that it has enjoyed over the past four years in terms of export volumes and value, it will provide for its citizens a truly excellent and valuable way of life and sense of purpose-- which we shall risk losing if we turn our back on the opportunities, grow smaller by comparison with other countries of the world, and become just a theme park. Opportunities exist, and my hon. Friend the Minister clearly spelled out the way in which the Government are seizing them.
Mr. David Amess (Basildon) : I congratulate my hon. Friend the Member for Newark (Mr. Alexander) on his choice of subject for this debate. Unfortunately, I was detained earlier by a constituency engagement, but I enjoyed the stirring speech of my hon. Friend the Minister, who sounded exactly the right note. Many of us are sick of people running this country down and suggesting that it does not produce fine goods and services that can be sold abroad.
The House will join me in wishing my hon. Friend the Minister well and every happiness in his marriage which took place during the Christmas recess.
Mr. Skinner : Is the hon. Gentleman aware that there is a plan afoot to get rid of the present chairman of the Tory party, who has been a bumbling idiot during the course of the past few weeks, and replace him with the hon. Member for Crawley (Mr. Soames)?
Mr. Amess : I had better not comment on that.
Over the past few years, I have done my best to promote the town that I represent. Last week, I was in Omaha in Nebraska, as the guest of First Data Resources, which has an office in my constituency but headquarters in Omaha. I was treated extremely well, and I was offered the key to the city and had talks with the governor and the mayor. As a result of my trip, businesses in my constituency have much to which they can look forward in respect of export opportunities in the months and years ahead.
Column 503Basildon is a thriving export centre of 20 manufacturing and service sectors. I have a long list of firms in my constituency that have achieved magnificent export records over the past year. The first is Hawtal Whiting, nearly 50 per cent. of whose turnover goes in exports. Some 25 per cent. of the turnover of Brentpak plastic packaging goes in exports. Gilbarco's exports are steadily growing--it exports all over Europe and throughout the world. Burlington air express, a new company formed last year, has quadrupled its labour force and exports more than 90 per cent. of its product. Fisherman's Friend is also in my constituency and 93 per cent. of its product goes in exports. The tractor plant, now run by Fiat, produces the finest tractors in the world and has managed to keep its export share. Last year, I was privileged to open an automated machinery company called Froehlich whose export sector is growing --
It being half-past Two o'clock, the debate stood adjourned.
That, at the sitting on Wednesday 19th January, notwithstanding the provisions of Standing Order No. 14 (Exempted business), the Speaker shall not later than Seven o'clock put the Questions necessary to dispose of proceedings on the motions in the name of Mr. Secretary Hunt relating to Employment and Training--[ Mr. Conway. ]
Motion made and Question proposed, That this House do now adjourn.-- [Mr. Conway.]
Mr. Simon Hughes (Southwark and Bermondsey) : I am grateful for what I hope will be a timely opportunity to discuss the future of Guy's Hospital. I am glad that the Minister has got here in the nick of time-- perhaps the debate, comes in the nick of time, too. It is the pride and privilege of the Member of Parliament representing Southwark to represent Guy's hospital, founded by a former Member of this House more than 250 years ago. In recent years, the hospital has gained pre-eminence as one of the great teaching and clinical specialist hospitals not just in this country and this capital city but in the world.
Following changes in the health service made since 1991 and the more recent changes set in train as a result of the Tomlinson report, there is now a suggestion that the future of the hospital may be less than secure. First, I shall explain why I believe that it is imperative that we do not close hospitals in London at a time when, and in a place where, they are needed. Secondly, I shall deal with the decision-making process that will determine the future of Guy's. A record number of people are waiting for hospital beds. The figure increased again in the last quarter for which figures have been published--more than 1 million people are waiting in the country as a whole and more than 250,000 in London. Those of us who represent London constituences can confirm that our constituents feel that the health service is not in good shape. The hon. Member for Dulwich (Ms Jowell) initiated a debate on London hospitals in December in which she recounted her experience of going round several London hospitals the previous day. She reported these experiences in a recent article in The Guardian. As she made clear in many cases, the way in which we treat patients admitted into our specialist hospitals is far from satisfactory : people are still being left on trolleys in corridors instead of being in beds in wards.
That is not just a politician's view. In its report in the London Monitor published this month the King's Fund reached a similar conclusion :
"The population of London might be forgiven for failing to recognise current changes to London's health care system as an improvement. Indeed neither would many of those working within the health care system. We do not argue that change in itself is wrong and support strongly for a body such as LIG"--
the London implementation group--
"taking an overall view of the process. However, a definite lead is now required, and urgently, with sufficient funds to drive change through to a positive outcome. The alternative is to risk the disintegration of the system of health care in London with detrimental consequences for the health of Londoners."
Guy's hospital opted to become the flagship NHS trust ; it was the first to set sail. It was much applauded, much watched and much regarded by the Government. It is a local district general hospital, it is the community hospital for Bermondsey and north Southwark, it is a speciality hospital for the region and its patients also come from much further afield. It has more than 800 beds and many of its departments have an excellent reputation. It is on a prime site at London Bridge.
Guy's became part of the Guy's and Lewisham trust. It began to build a phase 3 development, costing about £130
Column 505million, which is nearly completed and is called Philip Harris house. Earlier last year, as a result of Tomlinson, it renegotiated its marriage and became part of a new trust with St. Thomas's, and Lewisham became a trust on its own. In April 1993, Guy's and St. Thomas's, which is represented here by the hon. Member for Vauxhall (Ms Hoey), with whom I have had many discussions and who fights equally hard for her constituents, merged and became the largest hospital trust in the country, with 6,500 staff and an income of £230 million a year.
The trust was asked to make a proposal for future management, with the implication that it should try to find a one-site solution. It produced a consultation document in September called "Options for Change". The options were no change, a single-site hospital on either Guy's or St. Thomas's site and a two-site hospital. The deadline for consultation was the end of October. I, like many others, submitted a response to the consultation, reflecting the views of the community which I represent and the GPs. My argument is that two into one cannot go ; it is not possible to put a quart into a pint pot. We have a deprived area with a high incidence of admission. There is no guarantee that primary care is sufficient to take the load off the acute sector. The population in north Southwark and docklands is rising. We have good transport links and serve directly areas such as Kent and we are about to have significant new facilities, such as Philip Harris house and others. I argued that it would be illogical to decide the future of the accident and emergency units at either hospital until the London-wide accident and emergency review was completed.
I argued for a two-site option, preserving the best of Guy's and St. Thomas's, ensuring flexibility and, above all, giving a real opportunity for an academic acute and elective hospital with innovative community provision to be based on two sites relatively near to each other south of the river.
On 4 November, the board decided to put its proposals to the Government. It considered four options, which contained sub-paragraphs. It decided to pursue 3(b), a two-site option. That was the decision of the board. It was not what the Tomlinson report had intimated or what the Secretary of State had suggested that she required.
The option appraisal document, in summary form, was sent to the wider public in December and I was promised that the full report would follow. It never has, and on the very day when I read in my newspaper that NHS pay secrecy is to end and trust directors' salaries will be published, I received a letter from the Secretary of State. She said :
"I refer to your letter requesting a copy of the Trust's options appraisal document."
I had previously contacted the trust and its chief executive, then the chairman, then officials in the Department of Health and, finally, the Secretary of State, but had got nowhere. The letter continues : "This is a technical document prepared confidentially for the London Implementation Group. I have been advised that it contains a level of detail about the Trust's business that it would not be appropriate to release. You may be assured, however, that any proposal for a material change in the pattern of Guy's/St. Thomas's will be subject to public consultation."
We know that because, thank God, in Britain one cannot yet close a hospital without some consultation, but it is clear that the full appraisal document is not in the public domain and is not going to be. That is a matter of sufficient concern, but other matters have come to light that are
Column 506extremely worrying and which, I contend, should not be secret or the subject of negotiations behind closed doors. I therefore bring them to light now.
It has long been the view of nearly all the clinicians that there should be a single site. The clinicians at Tommy's argue that it should be at Tommy's and those at Guy's argue that it should be at Guy's. Great concern was expressed as the analysis in the appraisal document of the two-site proposal was considered by those lucky enough to see the document. Objectively chosen, a single site would potentially find favour among clinicians at both hospital sites, but that solution is not acceptable if the issues have been badly analysed and decisions made in secret and through an inaccurate process. Indeed, some clinicians have said that the two-site proposal would be disasterous, but the way in which they are attempting to bring the issue to a one-site conclusion is equally unsatisfactory. Some management consultants were asked to consider the appraisal document and they produced a report at the end of November. It is a damning indictment of the document produced by the trust and makes it clear that a great deal of fundamentally important work was not done or was not done properly. I shall cite only a few examples although I have the whole document.
Under the heading "Benefits, Costs and Evaluations", the report states :
"In non-financial terms there are serious problems associated with the service specification associated with the preferred option ... aspects of the capital costs, especially of the single site options, do not withstand detailed scrutiny and look unduly high ... and estimated revenue savings for all of the options are not matched by agreed, planned, efficiency improvements and cost estimates for the preferred option in particular may suffer from optimistic bias." The report contains consistent criticism of each part of the proposal and states :
"There are considerable clinical disadvantages in the model proposed the option is dependent on the acquisition of all the neurosciences work coming from the Brook hospital it is not possible to assess accurately on the basis of the information supplied the importance assigned to the financial and non-financial issues."
Much of the proposal is dependent on, for example, the neurosciences coming to Guy's. It would have helped if Guy's management had put their case for the neurosciences some months earlier instead of doing it so belatedly that, by default, the neurosciences will go elsewhere, despite the fact that those involved wanted to go to Guy's
Apparently a meeting took place in December between the regional health authorities at which there were some interesting revelations, including the fact that the Treasury was anxious to avoid any implied commitments to future capital expenditure in any of the review announcements. The Treasury is therefore saying that there is to be no more capital money. There was an acceptance that the strategy for London hospitals was "salami slicing" in respect of the Treasury and public expectations. I interpret that to mean that hospitals are picked off one at a time in the hope of deflecting the flak. There were also suggestions that the solution might be determined by whether, for example, the special trustees of St. Thomas's dug into their pockets and put £30 million into the kitty, which would clearly make St. Thomas's a more popular option for the Government if there were to be a single site.
There are other factors which make it clear that work will be driven out of London all together. What is certainly clear is that if the option that we were meant to be considering was of one site and if we were all allowed to
Column 507address our minds to the matter, each of the three regions in London, apart from the relevant south-east region, has a clearly expressed preference for Guy's rather than St. Thomas's, for all sorts of reasons, not least strategic guarantees that health service provision would be spread evenly around London.
Only this month, literally days away from the expected date of the announcement, a new secret option, option 5, which is meant to be a modification of option 3b, emerged. Option 5 would bear careful public scrutiny if the public were allowed to see it and it bears careful scrutiny for those of us who have been lucky enough to have seen a copy, which, clearly, we were not meant to see. For example, it would effectively mean the closure of all but the mental health in-patient beds in Guy's. Not only would the whole calculation depend on the £30 million from the St. Thomas's special trustees fund, but it would depend on a capital payment from the Treasury, which has said that it is not keen to fund.
The capital payment from the Treasury is made up by a bid for the same amount of money which has no justification at all and appears to have been arrived at on the basis that somebody has said that if money was wanted, it could probably be provided--up to a total of £60 million--and that if a bid just short of that were submitted, it would probably be granted. Surprise, surprise, a figure of around £57 million appears as the amount of extra money that would be needed. There was no argument, no foundation and no substantiation, but merely a response to a hint from somebody who was given the wink. That would be bad enough, but one other factor makes the matter even worse. A lot of people have put money-- £130 million--into the planned development at Guy's. Philip Harris house, for example, has received £1 million which was contributed by kidney patients and their families for the renal unit at Guy's. Having had contact with the people who organised those initiatives, they were not delighted by the fact that suddenly the new unit for which they had been raising money for years is not to be built. The Imperial Cancer Research Foundation has raised money to contribute significant sums of money. It has not been handed over yet and it was not raised specifically for Guy's, but it was always assumed that that was where the money would go. There are other donors and some of them may want their money back if Guy's is not the site that is kept, or if Guy's is not a site that is kept as part of a network of provision which many of us believe is justified by the shortage of beds in London.
Ms Kate Hoey (Vauxhall) : I understand exactly the hon. Gentleman's point about the contributions made by many people to particular causes at Guy's. Does the hon. Gentleman accept that that has also happened at St. Thomas's and throughout London? As a result of Government policy, one group of patients is almost being played off against another group of patients and one group of hospital staff is being played off against another group of staff and, at the end of that, the management of the trust has been put in the impossible situation of trying to come up with an option that is acceptable to the Government rather than something acceptable to the people of the area.
Mr. Hughes : The hon. Lady is completely correct. As she knows, my view was that both hospitals should be kept.
Column 508Those of my constituents who live at that end of the constituency go to "Tommy's". The vision that the trust set out was one of creating an academic and teaching and acute specialist hospital, which would also be a district general hospital and would have all sorts of community initiatives. It would be consolidated with Guy's and St. Thomas's medical school and King's medical school would be brought in to join it. It would keep the dental school at Guy's, which is the best in the country, and would probably bring King's College on to that site, too.
We must have ambition and vision as well as meeting need. I shall mention only two more subjects as I am intrigued to hear the Minister's reply and I hope that he will tell us that what has been going on in secret will now go on in public, so that our constituents and those who use the health service can have a say, rather than merely those people employed in senior administrative posts in the health service.
The proposal to bring King's College hospital on to the site is the last part of the equation that clearly also does not work. The fifth option does not allow enough space for King's College on the Guy's site, as it would want all the site, which no one is arguing should be released from the health service entirely, or it would not be able to go there at all.
Proposals that do not add up financially and in space terms are just not good enough. I am making a plea to get the debate out in the open, to have the real facts and figures and to get to the truth of the matter before a decision is made, rather than do so inadequately afterwards.
When the trust was set up it was the flagship. The secret fifth option could mean that the closure of most of the beds at Guy's would be announced within a few days by the Secretary of State and would be decided on the basis of false facts and figures and in secret. One of England's premier teaching hospitals and part of the largest hospital trust in the country is in danger of being closed on the basis of secret discussions and deals. The public accountability of Ministers to the House for the health service means all but nothing. The facts should be in the public domain. Decisions about health service flagships should be out in the open. If we do not get the process out in the open there does not seem to be much hope for the rest of the health service, which is also facing reorganisation. It is our health service. It is the people's and the patients' health service and they all want to have a say in what happens to it.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I thank the hon. Member for Southwark and Bermondsey (Mr. Hughes) for the measured way in which he approached the subject, which is of enormous importance and interest to him and his constituents. I hope that he will accept that the Government do not intend him or his constituents to be kept in the dark. Decisions will not be taken on the basis of false facts or conclusions. After more than a year of careful examination of all the many complicated factors in coming to a decision on such a matter, I can assure the hon. Gentleman that we shall not decide it on the basis of anything but the best information most carefully worked over by many specialists in the subject.
I am glad that the hon. Gentleman did not seek to challenge the basic thesis behind the decision, which is
Column 509underlined by the Tomlinson report--the fact that there are many acute beds in the London hospital system and that the health service is changing in such a way that action needs to be taken. That fact has been underlined this week by another King's Fund Institute report. In its London Monitor, it stated :
"There remain dramatic differences between inner and outer London, and between inner London and the rest of England."
In particular, it points to the fact that
"Expenditure on hospital and community services in inner London, at nearly £600 per capita, is 80 per cent. greater than the England average."
Although the hon. Gentleman and the hon. Member for Vauxhall (Ms Hoey) are aware of some of that information, for those listening to the debate I stress that the Government must take action, difficult though it is in view of the affection in which many of the institutions concerned are held.
Many reports have pointed to the problems of an excess number of beds and sites at London hospitals. Some estimates--they were mentioned in the report by Professor Tomlinson--have suggested that between 2,000 and 7,000 acute beds need to be taken out of the hospital system.
The Government responded to the Tomlinson report with the document entitled, "Making London Better". We made it clear that we would look carefully at the proposals and take no decisions until we had done that. We particularly recognised that if we were to make changes to the acute hospitals, we needed to recognise the lack of primary health care and community services in many parts of London. We established the London initiative zone to focus new money and new ideas on primary and community services. My right hon. Friend the Secretary of State announced at that time that £43.5 million had been directed at primary care developments in the London initiative zone in 1993-94 and that £170 million has been made available for investment in capital projects during the next six years. In the hon. Gentleman's area this year, the family health services authority will be making available £7.5 million revenue and £2.5 million capital to resource the development plan that it has drawn up. Those resources will set in motion the improvement of more than 100 premises in the next five years and fund more than 150 nurses and 47 therapists. I am sure that the hon. Gentleman
Column 510will agree on the important part that primary and community services play in meeting the health needs of local people. When the trust covering the two hospitals was established in April, it was charged with bringing forward proposals for consolidating hospital services with a view to locating them on one site. The hon. Gentleman has outlined some of the stages of that process. The trust has now submitted an outline business case in support of its proposals for the future disposition of its clinical services. Lord Hayhoe, the chairman of the trust, explained recently in another place that it had been concluded that clinical services should be retained on both the main sites, but in a radically different manner from the current pattern. In essence, the trust proposes that St. Thomas's should provide accident and emergency services, along with associated support services and facilities, while Guy's should develop as the major specialist tertiary centre in south-east London.
The outline business case is now being assessed by the Department, specifically by the management executive southern outpost, and will be subject to the normal rigorous assessment. I cannot make any announcements or predictions to the hon. Gentleman, as I hope he will understand, about what the outcome will be, but I should draw attention briefly to a number of important factors which must be taken into account.
Accident and emergency services are of enormous importance to the public in terms of their assessment of their safety and that of their families. We must be sure that we have an adequate network of such services. The London ambulance service, which has had problems in the past, is being strengthened and substantial extra resources will be given to it.
The hon. Gentleman also referred to education, and it is clear that a decision must be taken about the possible transfer of academic facilities.
Many factors have to be taken into account. I regret that I cannot enlighten the hon. Gentleman as to what will take place, but what he has said so eloquently today will be a major factor in those deliberations. I can assure him that my right hon. Friend will not delay unnecessarily in reaching a decision on this important matter. Question put and agreed to.
Adjourned accordingly at one minute to Three o'clock.
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