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Ms Glenda Jackson : Will the Minister give way ?

Dr. Mawhinney : No I shall not.

Ms Jackson rose

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Dr. Mawhinney : I am quite clear that I shall not give way. My hon. Friend the Member for Broxbourne (Mrs. Roe) made a telling point when she said that people were moving from inner to outer London. People in outer London, too, want local services. In a somewhat deriding way, the hon. Member for Southwark and Bermondsey said that people in London would not want to travel to Brighton for cardiac services. Typically, he failed to mention that people in Brighton do not want to travel to London when they can have local services. That is the point at issue.

My hon. Friend the Member for Broxbourne was right when she said that the issue was not the number of beds, which should not be used as a measure of the quality of care. I shall not bore the House with statistics, but I shall give one. During the 1980s, the average length of stay in a hospital bed dropped from about 10 days to about six days. When we add to that the increase in day surgery and the other factors that my hon. Friends made clear in their speeches, the truth is that beds have become an increasingly meaningless way of judging the performance of the health service.

The hon. Member for Holborn and St. Pancras did not even know that the number of beds is dropping in all the countries of the Organisation for Economic Co-operation and Development--we are not running all those countries. The number is dropping all over the developed world because the medical profession is finding new, better and more convenient ways of treating patients. Yes, there has been a decrease in the number of beds. There has been an increase during the same period--the past 10 years--of 53 per cent. in the number of patients treated in London. There has been an increase of 208 per cent. in the past 10 years of the number of patients in London who have had day-case surgery. The hon. Member for Bristol, South was wrong on a number of counts. She was incorrect when she said that waiting times were increasing. They have dropped by 36 per cent. since December 1991, when we introduced the criterion of the 12-month wait.

I reaffirm the pledge that Ministers have given on many occasions that accident and emergency units do not and will not close until adequate and appropriate alternative arrangements are put in place. As one of my hon. Friends made clear, it is true that about 50 per cent. of the usage of accident and emergency services in London is inappropriate. By "inappropriate" I mean that in any other part of the country those patients would have gone to a general practitioner. That problem must be resolved.

My right hon. Friend the Secretary of State recently asked the chief executive of the national health service to reinforce to the whole of the service that it was unacceptable for people to have long waits on trolleys- -a common point across the Floor of the House. Opposition Members take a few cases and try to make it appear that they represent the health service, which is not what Conservative Members do.

In the past year, there were 840,000 accident and emergency cases in the 17 accident and emergency units in London. While I do not accept that any patient should get anything other than the best treatment, I deplore the Opposition's attempts to take a small handful of cases and use them to denigrate the service that is made available to 840,000 patients a year.

Professor Norman Browse, the president of the Royal College of Surgeons said :

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"I know what I would choose for me or my family faced with the choice between a short trip to a hospital with incomplete support facilities or five minutes longer in an ambulance to a fully equipped casualty department, backed up by the right specialist teams. At present, we are diluting our limited expertise. The proposed changes should put that right."

The Lewisham community health council said :

"We accept the closure of the accident and emergency department on the Guy's site provided that acceptable and appropriate alternative services are developed and working satisfactorily on the Lewisham and King's site."

Ms Primarolo : Where are the replacement facilities for the accident and emergency units that have already closed ?

Dr. Mawhinney : I have already given the hon. Lady and the House an assurance on that.

It has been interesting that tonight's debate has been virtually all about hospitals. We have heard virtually nothing about general practitioners and primary care.

I will give the House a few examples of what the Government are doing around London to address what is generally recognised to be the need to improve primary care. At the Chingford health centre, work will finish in August this year on improvements to the general practitioner consulting rooms, the reception area and the practice manager's accommodation. In addition, the centre will be made accessible for disabled patients.

As part of the Peterhouse project in Walthamstow, work will start in early 1995 on the development of a GP practice in conjunction with a church community building. Accommodation will be provided for visiting specialists and community staff. A substantial site has been purchased for the Forest road project in Walthamstow, with a view to developing premises for four GPs.

Under the Carisbrooke road project, the intention is to purchase a site this year to enable the development of a purpose-built medical complex, which will accommodate five GPs. In Leyton and Leytonstone, work will start in 1995 to build a primary care unit on the remaining wing of the Langthorn health centre in order to accommodate GPs and other primary services.

I shall deal now with the hospital-at-home scheme. It has the advantage of not only enabling patients who would otherwise go into hospital to remain at home but enabling patients who are in hospital to return home early. In Wandsworth, an intensive patient support at home scheme which deals with orthopaedic cases is due to become operational later this year. It will handle 300 patients in a full year, reducing their average length of stay in hospital from 22 days to 11 days.

In Kensington, Chelsea and Westminster, an orthopaedic and paediatric hospital at home service expects to prevent 78 hospital admissions and enable 177 early discharges from hospital. The Parkside hospital-at-home scheme expects to prevent 48 hospital admissions and enable 144 early discharges. In the Brent and Harrow area, the hospital-at-home scheme enables the early discharge of patients who have had hip replacement operations.

In Camden and Islington, the home choice scheme operated by the community trust has a capacity to provide health and social services care for up to 24 patients. The scheme providing post-hospital and intensive care for children at home expects to treat 100 patients this year. The Ealing hospital-at-home scheme is expected to prevent 20 hospital admissions and enable 180 early discharges. The

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Hounslow hospital-at-home scheme will enable 250 early discharges. I could go on and on, as we reconfigure primary health services. We have had a look at the caring face of the Labour party when it comes to health. The care of the right hon. and learned Member for Monklands, East (Mr. Smith) stretches just as far as the television camera flex. We have had the opportunity to listen to the hon. Member for Holborn and St. Pancras. Judy Bennett will be disappointed tonight. In his election address, she wrote :

"Frank Dobson really knows what he's on about when it comes to the NHS".

He could have fooled us.

We know what the hon. Gentleman thinks about Londoners. He thinks "we have failed those people, we have a lot to answer for. If we are honest we have a lot more to answer for in London than they have in some other parts of the country." We know what he thinks about business men. He thinks that they are stinking, lousy, thieving, incompetent scum. But we have no idea what he thinks about the health service. He got his facts wrong, he did not mention patients and there was no recognition of GPs.

Then there was the hon. Member for Sheffield, Brightside (Mr. Blunkett). They seek him here, they seek him there--he must be there because he is not here. The hon. Member for Dunfermline, East (Mr. Brown) told him that he could not speak and the right hon. and learned Member for Monklands, East told him not even to bother to come.

There we have them : the right hon. and learned Member for Monklands, East, the hon. Member for Holborn and St. Pancras and the hon. Member for Brightside--the Foggy, Compo and Clegg of the Labour health team. We have heard today the last of the summer whine. I am not so unchivalrous as to identify the hon. Member for Bristol, South with Nora Batty. They are interested in beds ; we are interested in patients. More patients are being treated in fewer beds--that is what separates us. Londoners want patients to be treated and that is what they are getting, to a quality unmatched as never before. That is what we offer them next week.

Question put, That the original words stand part of the Question :

The House divided : Ayes 201, Noes 279.

Division No. 227] [10.00 pm


Adams, Mrs Irene

Ainger, Nick

Ainsworth, Robert (Cov'try NE)

Allen, Graham

Anderson, Ms Janet (Ros'dale)

Armstrong, Hilary

Ashton, Joe

Austin-Walker, John

Banks, Tony (Newham NW)

Barnes, Harry

Battle, John

Beckett, Rt Hon Margaret

Bell, Stuart

Benn, Rt Hon Tony

Bennett, Andrew F.

Benton, Joe

Bermingham, Gerald

Berry, Roger

Boyes, Roland

Bray, Dr Jeremy

Brown, Gordon (Dunfermline E)

Brown, N. (N'c'tle upon Tyne E)

Burden, Richard

Byers, Stephen

Caborn, Richard

Callaghan, Jim

Campbell, Ronnie (Blyth V)

Campbell-Savours, D. N.

Canavan, Dennis

Cann, Jamie

Carlile, Alexander (Montgomry)

Chisholm, Malcolm

Clapham, Michael

Clarke, Eric (Midlothian)

Coffey, Ann

Cohen, Harry

Connarty, Michael

Cook, Frank (Stockton N)

Cook, Robin (Livingston)

Corbett, Robin

Corbyn, Jeremy

Corston, Ms Jean

Cousins, Jim

Cox, Tom

Column 483

Cunliffe, Lawrence

Cunningham, Jim (Covy SE)

Dalyell, Tam

Darling, Alistair

Davis, Terry (B'ham, H'dge H'l)

Denham, John

Dewar, Donald

Dixon, Don

Dobson, Frank

Dowd, Jim

Dunnachie, Jimmy

Dunwoody, Mrs Gwyneth

Eastham, Ken

Enright, Derek

Etherington, Bill

Field, Frank (Birkenhead)

Fisher, Mark

Flynn, Paul

Foster, Rt Hon Derek

Foulkes, George

Fraser, John

Fyfe, Maria

Garrett, John

George, Bruce

Gerrard, Neil

Gilbert, Rt Hon Dr John

Godsiff, Roger

Golding, Mrs Llin

Gordon, Mildred

Graham, Thomas

Grant, Bernie (Tottenham)

Griffiths, Nigel (Edinburgh S)

Griffiths, Win (Bridgend)

Grocott, Bruce

Gunnell, John

Hanson, David

Henderson, Doug

Hinchliffe, David

Hoey, Kate

Hogg, Norman (Cumbernauld)

Home Robertson, John

Hood, Jimmy

Hoon, Geoffrey

Howarth, George (Knowsley N)

Howells, Dr. Kim (Pontypridd)

Hoyle, Doug

Hughes, Roy (Newport E)

Hughes, Simon (Southwark)

Illsley, Eric

Jackson, Glenda (H'stead)

Jamieson, David

Johnston, Sir Russell

Jones, Barry (Alyn and D'side)

Jones, Lynne (B'ham S O)

Jones, Martyn (Clwyd, SW)

Keen, Alan

Kennedy, Jane (Lpool Brdgn)

Kilfoyle, Peter

Lestor, Joan (Eccles)

Lewis, Terry

Litherland, Robert

Livingstone, Ken

Lloyd, Tony (Stretford)

Llwyd, Elfyn

Loyden, Eddie

Lynne, Ms Liz

McAllion, John

McCartney, Ian

McKelvey, William

Mackinlay, Andrew

McLeish, Henry

McMaster, Gordon

McNamara, Kevin

McWilliam, John

Madden, Max

Mahon, Alice

Mandelson, Peter

Marek, Dr John

Marshall, David (Shettleston)

Marshall, Jim (Leicester, S)

Martin, Michael J. (Springburn)

Martlew, Eric

Meacher, Michael

Michael, Alun

Milburn, Alan

Miller, Andrew

Moonie, Dr Lewis

Morley, Elliot

Morris, Rt Hon A. (Wy'nshawe)

Morris, Rt Hon J. (Aberavon)

Mowlam, Marjorie

Mudie, George

Mullin, Chris

Murphy, Paul

Oakes, Rt Hon Gordon

O'Brien, Michael (N W'kshire)

O'Brien, William (Normanton)

Orme, Rt Hon Stanley

Paisley, Rev Ian

Parry, Robert

Patchett, Terry

Pendry, Tom

Pickthall, Colin

Pike, Peter L.

Pope, Greg

Powell, Ray (Ogmore)

Prentice, Ms Bridget (Lew'm E)

Prentice, Gordon (Pendle)

Primarolo, Dawn

Purchase, Ken

Quin, Ms Joyce

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