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monetary policies and report to Parliament. An independent bank would make things very tough, because politicians would be held responsible for an organisation--the bank--over which they had no control in certain respects.

I am not always in total agreement with Lord Healey, but, on this occasion, I have to support him. He gave evidence to the Treasury Select Committee. The report states :

"the transfer of responsibility for monetary policy to the Bank is essentially a gimmick', supported by previous Chancellors of the Exchequer as a way of putting major responsibility onto somebody else'. In this view, the successful conduct of monetary policy depends on individuals'".

I must support him on that matter.

That is not to say that times have not moved on sufficiently for greater openess. It is already happening and it will develop even more. We can see that the relationship between my right hon. and learned Friend the Chancellor and the Governor of the Bank of England is running along very nicely. There is almost the mutual patting of heads--so much so that my right hon. and learned Friend announced that, in future, when decisions on interest rates had been taken, he would leave it to the Governor to decide when to move.

But a word of warning. On 7 January last year, Anatole Kaletsky warned that we cannot always rely on independence as an aspirin for future ills. He told us to beware

"of the search for a single silver bullet' to deal with all of our economic problems ; the eagerness to replicate off-the-peg foreign models ; the disregard of practical experience in examining the claims made for theoretical miracle cures."

He is not alone in his remarks. Indeed, analysts in the City are not overwhelmed by the notion, and many see no merit in change. Mr. Neil MacKinnon, chief economist at Citibank, said in the 10 June edition of the Financial Times : "In the late 1980s everyone thought that ERM entry would be the answer to inflation. I think it is rather depressing that we are again looking for a holy grail. In the end it boils down to whether we have the right policies or not, and an independent central bank isn't going to change that." That view was echoed in the same article by Mr. Kevin Gardiner, the United Kingdom economist at S. G. Warburgs who said : "I am not sure that an institutional change--

Mr. Deputy Speaker : Order.

It being half-past Two o'clock, the debate stood adjourned.


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Remaining Private Members' Bills

MERCHANT SHIPPING (AMENDMENT) BILL

Bill read a Second time, and committed to a Standing Committee pursuant to Standing Order No. 61 (Committal of Bills).

CONSCIENTIOUS OBJECTION (PUBLIC EXPENDITURE) BILL

Mr. Deputy Speaker : Not moved.

BUSINESS OF THE HOUSE

Ordered,

That, notwithstanding the provisions of Standing Order No. 14 (Exempted business), the Speaker shall--

(1) at the sitting on Wednesday 2nd February

(a) not later than Seven o'clock put the Questions necessary to dispose of proceedings on the Motions in the name of Mr. William Waldegrave relating to Scientific Research ; and

(b) put the Question necessary to dispose of proceedings on the Motion in the name of Mr. Secretary Lilley relating to Child Support not later than three hours after their commencement ; and the said Motion may be proceeded with after the expiry of the time for opposed business ; and

(2) at the sitting on Thursday 3rd February, not later than Ten o'clock put the Questions necessary to dispose of proceedings on the Motions in the name of Mr. Secretary Gummer relating to Local Government Finance ; and those Questions may be decided after the expiry of the time for opposed business.-- [Mr. Andrew Mitchell.]


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Health Care (Greenwich)

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

2.31 pm

Mr. Nick Raynsford (Greenwich) : I am pleased to have this opportunity to raise a matter of the utmost concern to my constituents--the present state of the NHS in Greenwich. I am also pleased that my hon. Friend the Member for Woolwich (Mr. Austin-Walker) is present this afternoon, as he has a long-standing interest in the subject. He will, if he is successful in catching your eye, Mr. Deputy Speaker, have a valuable contribution to make to the debate.

There is widespread concern in Greenwich about the NHS. In particular, there is concern about the impact of the Government's so-called reforms and the performance of the Greenwich healthcare NHS trust since it was set up fewer than 10 months ago. Over the past three to four months, a substantial number of cases have been brought to my attention by individuals who tell me that the standard of health care that they or their relatives have received has been far below the standards that they have a right to expect.

The most highly publicised case involved 83-year-old Elsie Westron, who was lost for four hours after being admitted to Greenwich district hospital on 1 September. When she was eventually located, she was found to have died. The circumstances leading up to her death were described by the coroner as

"an appalling catalogue of disasters".

Elsie Westron's case shocked not just Greenwich, but the whole nation. Responding to the concerns that had been voiced, the junior Minister for health, the hon. Member for Bolton, West (Mr. Sackville), expressed regrets, but claimed that it was a single, isolated incident. I am afraid that he was wrong. A month later, a 93-year-old woman named Mrs Edmonds was left waiting for 10 hours in the accident and emergency department of the same hospital for an X-ray after being admitted following her involvement in a vehicle accident. The chairman of the healthcare trust, in responding to my letters about the incident, referred to it as "a totally unacceptable delay'. I agree.

Long waits and delays are not just a problem in the accident and emergency department. At the same time, I was having to take up with the chairman of the healthcare trust cases involving patients who had been admitted to the Brook hospital for elective cardiac and neurosurgery. The patients found that their operations were cancelled not just on one occasion, but on several because of the lack of qualified staff.

Responding to a complaint lodged in one of those cases, the chief executive of the trust wrote

"to apologise for the distress the cancellations must have caused ... regrettably, in the case of your wife's surgery, we have not achieved the level of quality we would wish."

Many other similar disturbing cases have been brought to my attention, but it is not only patients and their relatives who have been voicing their concern. I have received a steady stream of complaints from nursing staff, GPs and hospital consultants about the increasingly severe pressures under which they work. Nurses complain of chronic staff shortages and the replacement of qualified


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nurses by auxiliaries. GPs complain about the hours they spend trying to get patients admitted to the two local hospitals, where beds are in increasingly scarce supply.

One GP wrote to me :

"it has been absolutely clear to every doctor working in London that any reduction in the number of hospital beds would cause great problems. It seems that that situation is now upon us."

Consultants complain about long-established and effective working procedures being undermined by the closure of hospital wards and the cancellation of operating theatre sessions prompted solely by financial constraints. One wrote not only to me but to the Secretary of State to complain that for the first time in 14 years working as a consultant gynaecologist in Greenwich he had had to establish a waiting list.

No impartial observer of the health service in Greenwich could conclude other than that health care in Greenwich faces a crisis. That crisis is not of the making of the medical, nursing or auxiliary staff. In my experience, the overwhelming majority are exceptionally hard-working, highly motivated, dedicated people desperately trying to do their best in increasingly difficult circumstances. Not surprisingly, they feel a growing anxiety at the poor public image that Greenwich health care is attracting. They long to be able to provide the high-quality service that they came into the profession to deliver. That they are unable to do so to the extent that they would wish is a tragedy not just for them but for the people of Greenwich who depend on them. The blame for that lies squarely with the Government, who are savagely cutting the funds available for health care in Greenwich, and with the healthcare trust, which has spectacularly failed to live up to the promises that it made when trust status was sought.

Those promises are not dim and distant pledges made many years ago. The trust has been in existence for only 10 months. The prospectus that it issued is only 18 months old. In that document, the trust promised

"to treat each user of the service with respect and dignity at all times".

That pledge must have a hollow ring to the relatives of Elsie Westron.

The trust pledged :

"to deliver services of excellence to users whose needs will always come first."

That is now revealed to be far from the reality to all those whose operations have been cancelled or delayed as a result of staff shortages, ward closures and the creation of waiting lists. The trust pledged :

"to develop on the Brook hospital site an elective resource centre, an integral part of which will be the regional specialty cardio-thoracic services."

That pledge contrasts sadly with the current position. The Brook hospital is to be closed and the regional specialty cardio-thoracic and neuroscience units are to be lost altogether from the district. The trust pledged :

"Greenwich District Hospital would be upgraded to become the main Acute General Hospital for the district, with a major accident and emergency department, supported by the full range of the necessary specialities and modern high technology support services." Now the trust proposes to close Greenwich district hospital. The trust pledged that its first objective was


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"to secure by contract the current service activity".

Its second objective was to

"identify opportunities to improve the quality of service to our local population".

The third was

"to seek to identify those areas where we can build on and expand our service to patients from outside the district."

Instead, we are now told that ward closures, staff cuts, operating list cancellations and hospital closures are inevitable because the trust is failing to attract sufficient contract activity to sustain its existing resources. Neighbouring areas are increasingly withdrawing their residents from the Greenwich hospitals. In other words, the service is being killed by the market.

I could, but will not, go on at great length cataloguing the broken promises and failures. The picture is already, sadly, too clear. However, I shall quote one last passage from the trust's prospectus. It said :

"An essential objective of the Trust is to ensure that it is very closely associated with its community The Trust will encourage and respond to users' views".

That was always a somewhat questionable claim, because the overwhelming majority of local people opposed the setting up of the trust in the first place. Sadly, the experience of the past nine months has confirmed that the trust neither encourages, nor responds to, the views and aspirations of the local community. On the contrary, it is seen as remote and unresponsive. It has forfeited the confidence of the local people.

The point was well put by one local resident writing about the experience that he had when trying to obtain a response from the trust on the delays experienced by a relative awaiting treatment. He wrote :

"I have been trying to reach an administrator at your hospital so that I can be furnished with an explanation. However, no-one seems willing to speak to me I have discovered that the NHS Trust is packed with tiers of bureaucrats all of whom are said to be at meetings and none of whom appear to want to be accountable." The consultant wrote :

"My observations on the organisation would be that there is panic, ignorance of the clinicians' own management expertise within their departments, and extravagance in virtually every aspect except where direct patient care is concerned."

That is sadly an all-too-familiar story, echoing the comments in the report of the Public Accounts Committee published yesterday, which catalogue the baleful influence of unelected, unaccountable quangos, whose cry is now heard throughout the land. The Government cannot pretend that they are unaware of this sad state of affairs ; nor can they simply pass the buck. Most of the evidence that I have outlined has already been submitted to Ministers as well as to the healthcare trust. Instead of acting on it, the Government offer only feeble excuses.

We are told not to worry about the threatened closure of the Brook and the Greenwich district hospital, because the trust proposes to acquire the Queen Elizabeth military hospital. I believe that it is right for the NHS to acquire the QEMH, but not as a substitute for two existing hospitals, whose combined capacity is more than twice that currently available at the QEMH. On present plans, the move to the QEMH means yet further reductions in the number of beds available, at a time when it is patently clear that the existing capacity is seriously overstretched.

We are told by Ministers--I refer to a letter dated8 December 1993 from the Parliamentary Under-Secretary of State--that

"there is clearly overprovision of acute services at this time."


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That is an astonishing statement. I remain fascinated to know where the Minister gets his information from, not least because, in answer to a parliamentary question from me about the availability of acute beds in Greater London, he replied just a week later to say that that information was not available centrally. Had the Minister taken the trouble to ask about the local situation, he would not have made his rash and wholly spurious claim about a surplus of capacity. The reality is exactly the opposite, as hospitals, beds and staff are all severely overstretched by a demand that is clearly causing the system to burst at the seams.

The other excuse that we get from Ministers is that resources have been transferred into primary care. I, for one, welcome the long-overdue recognition of the need to improve primary care provision in London. The extra funds coming in consequence of Tomlinson are welcome, but, as yet, they have not created any new capacity. It will be some years before the network of primary health care centres will have been developed to a point at which it might be possible to reduce some of the demands on local hospitals. As I outlined, however, the cuts are already biting deeply into our hospital services, and it will simply not do for Ministers to plead future improvements in primary care as a justification for cuts being made today which seriously damage the quality of patient care in Greenwich. The Government cannot justify washing their hands of the disastrous consequences of their actions. They are responsible for the financial cuts and ward closures. They are responsible for the damage caused by the workings of the internal market. They are responsible for the actions of the health care trust which they brought into existence and whose members they appointed.

Nothing less than a full public inquiry into the state of the NHS in Greenwich will suffice if public confidence is to be restored. I hope, therefore, that the Minister will belatedly recognise that the Government have a responsibility, that they cannot continue to pass the buck and that they must act now to set up an inquiry and ensure that adequate funds are made available locally if we are to avoid a further tragic decline in the standards of health care in Greenwich. 2.43 pm

Mr. John Austin-Walker (Woolwich) : I am grateful to my hon. Friend the Member for Greenwich (Mr. Raynsford) and to the Minister for allowing me to intervene briefly in the debate. The problem in Greenwich, as my hon. Friend pointed out, is not only the incompetence of those who are responsible for managing the health care trust but the total unaccountability of the structure. I think that the rot began to set in with the management changes that the Government introduced in 1990, which removed from the local health authority any semblance of local accountability. Local authority nominees were removed from the health authority, but those members had not only an interest in and lived in the area, but had a deep knowledge of local health authorities.

In the health debate last week, the hon. Member for Chislehurst (Mr. Sims) said that the new arrangements were locally accountable. I do not know to whom they are accountable locally, because I was replaced on the health authority by a company director from his constituency. That man is a computer company specialist. On his appointment, he said that he knew nothing about the NHS,


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that he was a friend of the director of finance and the chair of the health authority and that he assumed that was why he had been appointed. He also pointed out that all his staff were members of BUPA and that he would be too, if only he had remembered to fill in the form.

The other person who replaced the local authority representative on the health authority was Mr. Hewitson, who runs a double glazing company in Bromley--a far cry from Greenwich and Woolwich. We have not seen much improvement in patient care in the Greenwich health district, but no doubt the windows have improved.

We have recorded a catalogue of disasters, including £8 million invested in the hospital information services system, HISS, which was supposed to deliver an internal management system. The health authority still appears to be totally unable to send out invoices for bills that are due.

My hon. Friend and I have repeatedly called for the dismissal of the chief executive of the trust. If the Government were looking for a job for him, perhaps MI6 might be appropriate, or perhaps he could become an adviser on secrecy to the Cabinet, because the trust, like the health authority before it, is run in complete secrecy. Is that trust accountable to local people? We asked the chief executive about the trust's proposals to sell off part of the Brook hospital site to Sainsbury. We were told that no such negotiations had taken place. A week later, the truth was revealed and we learnt that an agreement had been reached with Sainsbury.

I asked the chief executive about discussions between the health authority, the trust and the Ministry of Defence concerning the Queen Elizabeth military hospital. I was told that no such discussions had been held, but the MOD confirmed that they were taking place. The trust is dictating terms to a weak health authority which even occupies premises owned by the trust. My hon. Friend referred to the pledges made in the hurried attempt to draw up the trust. There was no public health input into those discussions. The Greenwich health authority drew up a commissioning strategy without any independent public health advice. It was done in such a hurry that no agreement was reached on a strategy for acute services : in fact, that strategy has not yet been published.

I wrote to the Secretary of State to ask her to defer the decision on the creation of the trust until an acute service strategy was agreed. No delay occurred and we found that the chair and chief executive of the health authority took up those posts in the new trust.

Whenever my hon. Friend and I describe the mishaps that have occurred and describe the frustration felt by the medical, nursing and ancillary staff, we are accused of undermining the morale of staff at the local hospitals. We are merely reflecting the views of the medical staff and nurses who tell us that morale is at rock bottom and express their frustration at the fact that they are unable to provide the standard of care that they believe that the people of Greenwich and Woolwich deserve.

I am still waiting for an answer about the purchase of the multi-resonance image scanner, at a cost of £500,000. The Minister has passed the buck back to the district health authority and it has passed it to the trust, which, in turn has passed it to the regional health authority. In the end, I have received letters from the company that supplied the equipment to say that there is nothing wrong with it. Why did the trust and the regional health authority spend £500,000 on an MRI scanner in May of last year, which has


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not yet scanned a single patient? Each year, £116,000 is being paid to the private sector to provide that scanning service.

No doubt, the Minister will say that the scanner is an isolated example, just like the catalogue of isolated examples that my hon. Friend cited. An inquiry is needed and the buck stops with the Government.

2.48 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Bowis) : I am delighted to respond to the hon. Members for Greenwich(Mr. Raynsford) and for Woolwich (Mr. Austin-Walker) and to have the opportunity to discuss health care in Greenwich. The debate enables us to look at some of the problems raised by the hon. Members, and also to consider the real progress that has been made in the provision of health care in the health authority and local authority area of Greenwich. It also gives me the opportunity to acknowledge the plans that have been agreed or are being considered for the future delivery of health care.

Important developments in primary and secondary care have been envisaged for the health service in south-east London, including, as has been mentioned, the possible transfer of the Queen Elizabeth military hospital at Woolwich into NHS ownership. Family health services in Greenwich have benefited from extra funding as a result of the Government's London initiative zone.

Having visited Greenwich recently at the invitation of its local council, and having met the leaders and senior officers of that council, I am impressed by the fact that they generally see Tomlinson and "Making London Better" as a real opportunity for Greenwich and the development of its health care, particularly at primary-care level. They are working on some innovative projects ; I was particularly pleased to see their "family and carers" support work and centres. My right hon. Friend the Secretary of State was recently able to see something of the imaginative work that is being done in regard to mental health. What impressed me above all was the way in which the various agencies are working together--social services, health authority and trusts, police and probation services, the voluntary and private sectors and, of course, the users and carers themselves. I should have thought that that in itself would cause both hon. Members to salute a great deal of the work on health care in their respective constituencies, and to praise the dedication of health and care workers in primary and hospital and community care. The hon. Member for Greenwich mentioned staff morale. This week, people working in those hospitals have telephoned me, questioning whether some of his outspoken comments are doing anything for staff morale and telling me that staff at all levels are anxious to get on with the job. They are not being helped by some of the hon. Gentleman's comments.

I am pleased to say that Greenwich district health authority has been working closely with the Greenwich and Bexley family health services authority. That work has been helped by the setting up two years ago of the Bexley and Greenwich commissioning agency, which has brought the two authorities together with Bexley district health


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authority. As was recently announced, the two DHAs will merge in April. I am sure that the new authority will remain sensitive to the needs of Greenwich residents.

Both the commissioning agency and the Greenwich healthcare NHS trust support a proposal to transfer hospital services to the Queen Elizabeth military hospital, Woolwich, which is, of course, just across the road from the Brook. That proposal would involve bringing accident services and acute in-patient services together at the Queen Elizabeth hospital. Under that proposal, the Memorial hospital at Shooters hill would provide out-patient and residential care, and Greenwich district hospital would continue to provide out-patient clinics.

Negotiations are continuing with the Ministry of Defence, which has announced that it will leave the hospital in 1998, and I am pleased to say that good progress has already been made. The commissioning agency consulted on its acute strategy, and the trust has announced its proposals ; however, any change of use at the Brook or Greenwich district hospitals would require public consultation.

I know that there has been concern about some of the services provided at the Brook hospital. The neurosciences and cardiac speciality reviews recommended that those regional specialties be transferred to larger teaching units in south-east London. My right hon. Friend is still considering the advice that she has received, and hopes to be able to make an announcement soon.

It is entirely appropriate that the trust is planning hospital services to meet the requirements of those who are purchasing services on behalf of patients, and the recommendations of the specialty reviews. For their part, the Government are committed to ensuring that Londoners have access to appropriate, high-quality and cost-effective patient care.

The hon. Gentleman also referred to individual cases--one in particular--in which something has allegedly gone wrong, or services have fallen below the standards that we, health authorities, trusts, GPs and patients expect. Those are rightly subject to inquiry when appropriate, and the trust has committed itself to put right any failings identified by such inquiries.

Equally important is the development of primary care in Greenwich and Bexley. Greenwich, Woolwich and Thamesmead are within the London initiative zone set up as part of the Government's response to the Tomlinson report. The Government believe that family health services in Greenwich should achieve the standards of excellence that are common elsewhere in the country. To that end, the funding of projects totalling £22 million spread over six years is planned, with £3.1 million this year for Greenwich and Thamesmead and £4.2 million for 1994-95.

That funding will enable primary care centres to be established in each designated locality. The services planned for those centres include consultants out-patient clinics, pathology and investigative services, physio-therapy, chiropody, counselling and psychiatric services, and minor injury facilities. Work on the acquisition of the first centre will begin next month.

The family health services authority is contributing funding for practice managers to ensure that each practice has sufficient management skills available. A GP forum has been set up in each locality to determine priorities, identify and assess needs and discuss the commissioning agency's agenda. The FHSA is providing locum cover for


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GPs in each forum to enable them to attend meetings with local providers and commissioners. Similar arrangements have been established for community pharmacists.

A series of locality-based seminars on community care are under way, designed to facilitate joint working between GPs, community health services and social services. The FHSA is seeking to improve the quality of prescribing through postgraduate education and the development of disease management guidelines. A health promotion programme based on pharmacies is being established. Pharmacists will soon be able to use referral forms to pass information to GPs. From the beginning of this year, physiotherapists have been attached in five locations for approximately four sessions a week to assess the effectiveness of general practice-based physiotherapy. Evaluation will focus on the impact that service has on secondary referrals and the benefits that it achieves in terms of outcome. Similarly, counsellors have been funded sessionally in west Greenwich and Plumstead common to establish the effectiveness of attaching such services to general practice. The scheme started in June 1993 ; it will be extended to Plumstead High street soon.

An equal opportunities post is planned. The post holder will work with commissioners, providers and others to develop an advocacy role for local ethnic minority populations. While new contracts for sessional interpreting services are being finalised, the Greenwich interpreting service is providing services for GPs in London initiative zone localities.

The existing scheme whereby social workers are attached to GP practices is being extended to five more practices. In the longer term, the intention is to provide one-stop health and social care based in primary care centres to include all levels of community care assessment and care management. Since September last year, a primary care charter development officer has been working with local practitioners to facilitate the development of local charters relevant to the needs of service users and providers.

Developments in primary care services will see local residents provided with health care delivered in the most appropriate setting. That recognises that referral to hospital-based services should occur only when necessary.

Greenwich healthcare NHS trust incorporates both acute and community services, and I acknowledge the significant achievements of the trust's integrated child health service--the ICHS. Since that leading service was inaugurated in 1992 it has encompassed a wide range of services, including neonatal, special care baby unit, acute paediatrics, school health, family planning, immunisation and vaccination services and the establishment of a home care team and community paediatric nursing. The specialist clinical and nursing teams are supported by speech and language therapy and child dental professionals.

For children with severe learning disabilities, the ICHS has opened a sensory room at the Wensley close facility which provides stimulation for the children using state-of-the-art high technology equipment, and a child development centre is planned. Concurrent child mental health and paediatric out-patient clinics allow the joint investigation of psychosomatic disorders. Furthermore, the


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ICHS is a pilot site for the Audit Commission's well child project "Promoting the well being of children and young people".

Already the subject of widespread national and international interest and a recent feature in the Health Service Journal , the ICHS will host a national conference at the Queen Elizabeth conference centre later this year to discuss the issues of integration of acute and community child health services. Greenwich residents come from a wide range of social and economic backgrounds. The total integration of child health services facilities dialogue and close working with social and educational services, demonstrates a clear commitment to the devlopment of healthy alliances.

On the management of the Greenwich healthcare NHS trust, the appointment of senior nursing professionals as service managers for medical, surgical, trauma and orthopaedics, anaesthetics, obstetrics and gynaecology, radiology, pathology, neurosciences and cardiothoracic services allied to the development of clinical directorates means that those closest to patient care and service delivery are fully involved in the management of the trust. Those service managers lead multi-disciplined, patient-focused teams, which through individual and team-performance objectives, ensure that the planning for, and delivery of, patient care is the priority. In addition, rehabilitation and therapy services across the trust are managed by the senior occupational therapist, ensuring a fully integrated and seamless service for acute and community patients. Retention and staff turnover difficulties have been brought about by some of the uncertainties surrounding the future of cardiothoracic and neurosciences. The trust has run a successful campaign to recruit intensive therapy unit nurses, with the result that 15 appointments have already been made at the Brook hospital to staff fully six ITU beds.

The trust also provides a comprehensive staff and management development programme, and encourages the pursuit of professional and health care management qualifications. Furthermore, the recent removal of the operations director post and the subsequent reporting of the clinical directors to the chief executive will further integrate clinicians into the management process.

Those steps demonstrate the trust's commitment to the development of an organisation able to respond to the changing pattern of health care within Greenwich. The trust is working hard to achieve greater internal efficiency, meet its statutory financial responsibilities and present a case for further transitional funding. I share the concern expressed by the hon. Member for Woolwich about the commissioning of the MRI scanner, but, following the trust's inquiries into the matter, we will ensure that any procedural shortfalls are addressed. I understand that a meeting is to be held shortly.

The trust had a complex agenda in which progress on long-term issues and short-term pressures has had to be balanced. Nevertheless, I believe that the trust has been approaching those issues in a determined manner--

The motion having been made at half-past Two o'clock and having continued for half an hour, Mr. Deputy Speaker-- adjourned the House without Question put, pursuant to the Standing Order. Adjourned at Three o'clock.


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