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Mr. John Marshall (Hendon, South) : My family has twice used Edgware general hospital and the concern that my hon. Friend expresses is shared by many electors in Hendon, South. They recognise that there are very poor travel links between Edgware and Barnet and, as my hon. Friend the Member for Chipping Barnet (Mr. Chapman)

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used that fact to emphasise the need for a new Barnet hospital, so we must use it to emphasise the need for Edgware hospital to remain.

Mr. Gorst : I am most grateful to my hon. Friend for endorsing a point that I shall make also. I hope that the Minister will take it on board when he hears it twice.

There has been an overwhelming expression of public sentiment which contains a very simple message : why is Parliament, the Government, or whoever, setting up a consultation process to allow all interested parties to have their say and then turning a deaf ear to their arguments and opinions ? Patients pay through their taxes for the use that they make of the national health service. They should not be treated as numbers in an accountant's ledger.

Some of those people are sick or elderly, infirm or disabled or perhaps distracted by family worries. Governments have a special responsibility to them : a duty to ensure that desk-led proposals do not supplement patient- led preference. Those present and prospective users of the national health service have not been standing alone on this issue. Doctors, too, have had their opinions brushed aside. Local GPs in the borough of Barnet--highly trained professionals who, every day or night, deal face to face with their patients on health matters--have expressed their concern also.

The medical profession should be both a linchpin and a starting point for any serious reform. Without its backing, reform in that sector is not just unwise or unworkable but likely to be stillborn or crippled. To steamroller through the changes without the whole-hearted support of local doctors would be a mixture of folly and foolhardiness.

Ms Tessa Jowell (Dulwich) : I join the hon. Gentleman in expressing concern at a hospital closure that would have an impact across London. Local Labour party branches and community groups share the hon. Gentleman's concern and the worries of general practitioners. I understand that they are also anxious that the decision has been based on highly flawed data. The figures on which the proposals are based are not even regarded as sound.

Mr. Gorst : I thank the hon. Lady for her endorsement of an issue to which I shall, I promise, turn in a moment.

It was once famously said that what we see depends mainly on what we look for. In the case of Edgware general hospital, it seems that answers were decided long before questions were formulated and certainly long before opinions were canvassed. All the public hearings that have taken place have had the appearance of trying to justify a predetermined, inflexible decision from which there would be no subsequent departure. One is reminded of the words of the queen in "Alice's Adventures in Wonderland". "No! no!" said the queen. "Sentence first--verdict afterwards." That is how it has all sounded. It is little wonder that my constituents have been so enraged by the semblance of a show trial in which the verdict for the prosecution has preceded the hearing in court. The proposals to close Edgware hospital are clearly unpopular, but they are more than that : they are misguided.

Residents in north Hendon are not opposed to change in itself. No one welcomes disruption with open arms, but provided that it leads to a betterment in the quality of life, the residents of north Hendon, like everyone else, will accept it with good grace. But the proposals do not offer

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any betterment ; they do not offer any quid pro quo. Something is removed, but nothing tangible is being put in its place.

To be fair to the Barnet health authority, there is talk of a shift to primary care and of replacing care in hospital with care in the community. It is obviously prudent to prepare our health care for the realities of the 21st century, but to disguise a disinvestment in secondary care as an investment in primary care seems nothing more than a sleight of hand. Robbing Peter to pay Paul is not a straightforward or viable way to run a health service. It is far from clear that Barnet's primary health care system will be able to cope with any additional work load.

In the longer term, there are pitfalls in believing that technology and primary care can have more than a marginal effect ; they can do only a certain amount. It is rather like what used to be known as the penicillin trap. In 1948, when penicillin was first invented, it was believed that from then on, sending people to hospital would become a thing of the past. Of course, it did not ; penicillin did not stop people from becoming ill. In the same way, day care or out-patient treatment will not remove the need for hospitals.

Behind all the plans lies a false assumption that Barnet is over-bedded, which is far from true, as has already been said. Since 1982, Barnet has suffered a 37 per cent. cut in the total number of beds and a 46 per cent. cut in the number of acute beds. Indeed, the North West Thames region already has the lowest per capita number of acute beds anywhere in the country. That has been confirmed by the recent reports by Professor Brian Jarman, who has pointed out that Greater London does not have an overprovision of beds. Therefore, it is not only unwarranted, but highly debatable to propose further cuts. Where, for example, would last year's 100,000 or more accident and emergency cases in Barnet have gone ? Where would last year's 44, 000 self-referrals at Edgware general have gone to ? Would it not have been a dangerous underprovision of resources to have had only three quarters of the beds required for a worst-case scenario ? There is yet another objection to the proposal to close Edgware, which in many ways causes most worry among my

constituents--accessibility. The proposal to close Edgware general hospital and to rely, in its place, on one hospital on a site that can be more than an hour away by public transport, creates real problems, especially, but not uniquely, for people without cars. The most deprived localities are those that are nearest to Edgware general. They are the places that use its services the most, yet, should Edgware general close, those will be the very people with the furthest to travel to reach their hospital and who are the least able to afford to do so.

Visiting sick relatives or friends will require a nightmare journey across a borough sliced in half by a major motorway. Such an imposition on patients--who may be elderly--or on their relatives is hardly likely to help their recovery process. That transport difficulty, which is compounded by London's radial rather than cross-town transport system, has been treated dismissively by the health authority planners.

That is extraordinary for another reason. The health authority recognises that the greatest need for, and use of, hospital services occurs in the Colindale and Burnt Oak areas, so why is it siting the hospital for my constituents at the other end of the borough, where people are affluent and comparatively have less need of those medical resources ?

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Cross-borough travel is far from simple. A hospital is not like a shopping centre. One cannot expect an out-of-town hospital to be a success, as though it were a well-endowed supermarket.

All those circumstances and considerations lead inexorably to one conclusion--Edgware general must remain open for the foreseeable future. It should be a principle in reform, in all sectors affecting basic feelings of security, where vulnerable people are concerned, that Governments and their agencies do not play havoc with people's fear of illness and infirmity. Faced with the outcry that the threatened closure of Edgware general has caused, it behoves the Government to tread softly ; to plan the way ahead with reassuring moves ; not to engage in disruptive innovation.

It is not for Members of Parliament to usurp the function of civil servants, but I need convincing that all possible alternatives have been fully and adequately examined by the Barnet health authority. I strongly urge my hon. Friend the Minister to ensure that that has been done before irreversible, draconian solutions such as a hospital closure are given any more consideration. If my right hon. Friend the Secretary of State has boxed in her agents--the Barnet health authority--let her, like some 20th century Pandora, release those geniuses from the confines and constraints of their box. Then, at the very least, some hope will remain for a more acceptable solution to the dilemma of the Department's accountancy problems.

In short, I am asking for my constituents to be freed from the present agonies of impending deprivation. There is a real danger of making a huge irreversible decision, affecting the lives of thousands of people, on the basis of a half-baked, pseudo-scientific manipulation of figures devised by a team of over-educated boffins. As no less a figure than Sir Winston Churchill said, we must beware of needless innovation, especially when guided by logic.

This is neither the time nor the place for experiment, because lives are at stake.

2.55 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : First, I congratulate my hon. Friend the Member for Hendon, North (Mr. Gorst) on the eloquent, portentous, almost Churchillian way in which he made his case for retaining the acute services at Edgware hospital. Clearly, there is enormous concern among his and other hon. Friends' constituents. If I were not aware of that already, I certainly am as a result of this debate. Anything involving major change in the health service is bound to cause enormous concern and I well understand why my hon. Friend has spoken as he has. At some stage in his speech he gave the health authority some credit. Its intention is to improve health services overall for those who live within the area that it covers. As he knows, it means to invest substantially in improved primary health care to reflect the fact that more care will be delivered in a primary health context.

The health authority certainly means to take a number of steps to bring health care closer to people's homes in the sense that many more people will be treated as out-patients and will recover at home, rather than during long stays in hospital. Most importantly, the health authority will try to ensure that it has the resources available to reduce waiting

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times for everybody, if possible to an absolute maximum of six months, which would be well in excess of the national standards and guarantees that now prevail.

To do all that, the health authority must live within its means. It has a budget of some £164 million a year, which is spent on local residents' health care. It must therefore decide how to spend that budget in order to deliver some of the aims that I have just enumerated. It must think carefully about whether it wishes to contract with the two acute hospitals within the area. It must take account of the fact that health care is changing. Whereas a few years ago a patient might have spent 10 days or two weeks in hospital, today that patient may spend only two days in hospital or even be treated as a day patient. All over the country, including in Barnet, the proportion of surgery, particularly elective surgery, being carried out as day cases is rising rapidly. It must be understood that demand is also rising.

However, the acceleration of day surgery and day treatment generally is having a dramatic effect on the demands for beds and we cannot ignore that. Barnet health authority has clearly arrived at the conclusion that it would like to concentrate the acute services on one site and it appears that it has agreement with the trust that that would be the proper way in which to proceed. Therefore, over a period of time, it would put all acute services at Barnet and, on the Edgware site, it would invest in a number of services including those for minor injuries, a great range of out-patient consultations, out-patient rehabilitation and

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therapy services, diagnostic services and a number of day-care services. It is its belief that that is the best way in which it can offer a complete range of health care to all those living in their area.

I must preface all that by saying that no decisions have been taken. An intention has been expressed by the health authority and if it is to make any major changes in service of that sort and there are statutory objections to such a scheme, Ministers would have to decide because the case would before them. In that eventuality, we would want to be certain that, as my hon. Friend the Member for Hendon, North said, all alternatives had been examined thoroughly. We would want to see a major improvement in primary care for everybody in the area. That would be a prerequisite.

If there were a concentration of the acute services on one site from the present two acute hospitals, we would want to see that the services available at the other hospital, which would cease to be acute, would cover the needs of the population living in that area as much as is possible. We would want to see a well-worked out plan for services across the whole area.

I stress that that matter will have to be decided by Ministers if there are objections and we will take all factors in the case into account. The comments of my hon. my hon. Friends the Members for Hendon, North, for Harrow, East (Mr. Dykes) and for Hendon, South (Mr. Marshall) will form a substantial part of our considerations. Question put and agreed to.

Adjourned accordingly at two minutes past Three o'clock.

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