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Mr. Nigel Spearing (Newham, South) : Will the Secretary of State give way ?

Mrs. Bottomley : Labour are, as ever, enthusiastic about their outrage but they are short on their analysis. Much of the pressure on accident and emergency departments is unnecessary and can be avoided. About half the patients using accident and emergency departments in London have minor injuries. They are not rushed in by an ambulance but walk in off the street, more often than not because the GP service locally needs to be better. I pay tribute to all those nurse-led minor-injury facilities such as the one at St. Charles's hospital which provides excellent, high-quality care and relieves the pressure on local emergency services. Similarly, I welcome all those

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Mr. Spearing : On a point of order, Mr. Deputy Speaker. You may have understood an oral request to the Secretary of State, but as she is so engrossed in her copious notes, I do not know whether she is

Mr. Deputy Speaker : Order. The hon. Gentleman knows that that is not a point of order.

Mr. Spearing : Will the Secretary of State give way ?

Mrs. Bottomley : I have had frequent lengthy discussions with the hon. Gentleman, not least on the Thames and on other occasions. I have learnt from experience that if he wishes to make his point, it is wise to let him make it in his own speech if he catches your eye later, Mr. Deputy Speaker.

The right thing to do is take a considered view of the development of accident and emergency services in London. The London implementation group is advised by Professor Norman Brouse, the president of the Royal College of Surgeons, with a team of experts on accident and emergency services. The Chief Medical Officer is advised by Professor Howard Baderman whom I believe works in the Holborn and St. Pancras constituency.

Mr. Dobson : He does a very fine job, too.

Mrs. Bottomley : I am pleased to hear that he does a fine job. In that case, I suggest that the next time the hon. Gentleman sees him, he listens rather than speaks, and remembers that he has two ears and one mouth because what he will hear from Professor Howard Baderman is that accident and emergency services need to be concentrated in centres of excellence with a back-up facility. The problem at Bart's is that it has such a small accident and emergency unit because the population has so substantially reduced that it becomes ever less viable as a full accident and emergency service. That is the full thinking behind the Government's decisions on the development of services in London.

What discourages me about Labour is its inability ever to look constructively and analytically. Do we ever hear from the hon. Member for Peckham (Ms Harman) or, indeed, the hon. Member for Dulwich (Ms Jowell) about the £8 million being spent on the accident and emergency department at King's College hospital ? Do we ever hear about the £40 million to provide 10 new operating theatres and extra intensive care at King's College hospital ? Do we ever hear that in the House ?

Mr. Dobson rose

Mr. Deputy Speaker : Order. Let us have a bit of order on the Labour Front Bench. [Interruption.] Order. The Secretary of State has made it clear that she is not giving way.

Mr. Dobson : On a point of order, Mr. Deputy Speaker. Is it orderly for the Secretary of State to challenge my hon. Friend the Member for Dulwich (Ms Jowell) to be here and say something when she has just come out of hospital and is at home ? She would like to be here but she cannot.

Mr. Deputy Speaker : The Secretary of State will answer for herself.

Mrs. Bottomley : The hon. Member for Dulwich, like the hon. Member for Peckham, is swift to embark on a catalogue of often vindictive criticism with a disregard for the facts. Labour is so lamentably slow ever to praise a

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hospital which is a good hospital and which stands to benefit greatly from the changes in London. Not only King's College hospital but Maudsley hospital stand to benefit from the move of the neurosciences to become a worldwide centre of excellence in neurosciences. However, that is something that Labour Members never mention because it does not suit them, even though it is a substantial investment in their own constituencies, directly benefiting their members.

Similarly, the hon. Member for Lewisham, East (Mrs. Prentice) does not mention the £4.3 million spent on the accident and emergency department and the £23 million development with 200 new beds, two new wards and a new children's unit. How many of my hon. Friends know about the developments of the Lewisham hospitals, which Labour so lamentably fail to recognise ? Mr. Deputy Speaker, I know that my hon. Friends will want to catch your eye later so they can tell us about the excellence of those services and developments.

Perhaps even more important, I am disappointed that the hon. Members for Hackney, South and Shoreditch (Mr. Sedgemore) and for Hackney, North and Stoke Newington (Ms Abbott) have failed to join us today. It is sad that when £25 million is being spent at the Homerton hospital

Mr. D. N. Campbell-Savours (Workington) : On a point of order, Mr. Deputy Speaker. May I set the record straight ? My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) has been here for the whole debate and has just gone to that hospital.

Mr. Jeremy Corbyn (Islington, North) : Further to that point of order, Mr. Deputy Speaker. My hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) is on an official delegation to South Africa to monitor the elections there. It should therefore be at least clear

Mr. Deputy Speaker : Order. We now have that on the record.

Mrs. Bottomley : The point is that the constituency of the hon. Member for Hackney, North and Stoke Newington stands to benefit greatly from the enormous investment in Homerton hospital. I appreciate that the hon. Member for Hackney, South and Shoreditch was here, but he has left the Chamber and has no intention of saying that the beneficiaries of the changes are not the 4,000 resident population of the City but the 190,000 people who live in Hackney. It is when Labour Members

Mr. Campbell-Savours : On a point of order, Mr. Deputy Speaker. Once again, the Secretary of State forgets. My hon. Friend the Member for Hackney, South and Shoreditch has gone to a meeting with all the staff at Bart's, which I understand will last for four hours.

Mr. Deputy Speaker : Order.

Mrs. Bottomley : I shall repeat the point.

Mr. Gorst : On a point of order, Mr. Deputy Speaker. May I ask you to make it clear that Labour's pairing arrangements have absolutely no part in our proceedings at present ?

Mr. Deputy Speaker : Order. The debate is not about Labour's pairing arrangements.

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Mr. Andrew Mackinlay (Thurrock) : On a point of order, Mr. Deputy Speaker-- [Interruption.]

Mr. Deputy Speaker : Order. I have listened to several points of order now. I hope that the hon. Gentleman's point of order is a genuine one. If it is not, I shall take a dim view of it.

Mr. Mackinlay : Oh dear. In that case, I shall sit down.

Mrs. Bottomley : I understand why Labour are so uncomfortable. Their betrayal of the achievements of the health service always corners them. I have visited Homerton hospital.

Mr. Sedgemore : On a point of order, Mr. Deputy Speaker. [Interruption.]

Mr. Deputy Speaker : Order. The House should settle down. If hon. Members stop behaving like schoolchildren, we might be able to get on with the debate.

Mr. Sedgemore : Mr. Deputy Speaker

Mr. Deputy Speaker : As I said to the hon. Member for Thurrock (Mr. Mackinlay) before the hon. Gentleman entered the Chamber, I hope that it is a genuine point of order.

Mr. Sedgemore : I apologise for leaving the debate as I am going over to St. Bartholomew's hospital.

Mr. Deputy Speaker : The hon. Gentleman's apology is accepted.

Mrs. Bottomley : I hope that the hon. Gentleman will not leave immediately because I shall repeat what a tremendous service Homerton hospital will be providing for the 190,000 people who live in Hackney, rather than the 4,000 people who live in the City, albeit that there is an important visiting population who work there. About £25 million is going to the Homerton hospital--more than £1 million of it is going to accident and emergency services. I am delighted to have the attention of the hon. Member for Hackney, South and Shoreditch because I know that he wants to know more about the 26-bed admission ward, the two new acute wards, the new paediatric and outpatient blocks, the CTMRI--computerised tomography magnetic resonance imaging--scanner, the radiology unit, the new pharmacy and the expansion of the special care baby unit.

When I visited Homerton hospital late at night shortly before Christmas, people there were only too pleased that we had taken the principled view that investment should go where the people are. People should not have to travel to buildings ; we should take services to the people.

Bart's has developed great excellence, which will be strengthened and consolidated by its merger with the new trust, which is to be made up of Bart's and the Royal London hospital. When one talks to the people involved in the work, who look outward and are involved in developing primary care, one finds that that expertise and those traditions, which go back many centuries, will continue to benefit patients and staff for many generations.

Mr. Tracey : I must underline the excellent argument of my hon. Friend the Member for Twickenham (Mr. Jessel). If the people of Hackney and other parts of inner London are ungrateful for the vast extra resources that my right hon. Friend is describing, perhaps she should put those

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resources in the outer London boroughs of Richmond, Kingston, Croydon, Enfield, Brent, Harrow and Redbridge, where we will thank her for them.

Mrs. Bottomley : My hon. Friend tempts me, because allocating resources in a principled way is an unrewarding pursuit when it comes to the Opposition.

On the same lines, we heard nothing from the hon. Member for Holborn and St. Pancras about the Government's commitment to University College hospital in his constituency, which has been given £10 million in transitional funding. I am afraid that that money cannot be spent in the constituency of my hon. Friend the Member for Surbiton (Mr. Tracey) or in that of any of my other hon. Friends. That hospital will rightly remain a great world centre of teaching, research and treatment.

Did we hear about the 92 primary health care projects, the £12 million being spent in Camden and Islington in the first two years, the Brunswick square and Hunter street developments and the work in the King's Cross area to help homeless people or the local Bangladeshi population ? Did we hear about the Crowndale development for general practitioners there, or about their new practice nurses--the number of practice nurses has increased by three times. We did not hear about any of those great achievements or the programme of changes that are under way in the health service in London. All hon. Members are right to be concerned when things go wrong. The hon. Member for Holborn and St. Pancras asked about the people who provide information in the national health service. It is a very large organisation and it is important to have information available. Last week, we heard about the tragedy involving children in a Manchester hospital. People at the centre need to know swiftly and urgently about the state of affairs.

When something goes wrong at an accident and emergency unit, urgent action needs to be taken. I made it clear much earlier this year--when we were worried about unacceptable trolley waits--that NHS management is to improve and that managers must ensure that patients are admitted to, or discharged from, hospital more effectively. Do the Opposition understand that we can relieve pressure on accident and emergency departments by investing in primary care ? Above all, do they criticise local authorities, whose failure to agree proper discharge arrangements with hospitals so often leads to patients staying longer than necessary in hospital ? Patients in accident and emergency departments have to wait for beds as a result.

Are the Opposition aware of the fact that when we last had problems at King's College hospital 40 patients were waiting to be discharged ? Perhaps they could help me to encourage the local authorities of Lambeth and Southwark to use the extra money that they get for community care to fulfil their commitments to make effective discharge arrangements. The Opposition should concentrate more on that subject in their pre-local election gimmick run.

In London this year, an extra £135 million will be available for community care--77 per cent. above the level of grant last year. I do not recall--I do not know whether my hon. Friends do--the hon. Member for Holborn and St. Pancras mentioning that Camden has had a 100 per cent. increase--£5.3 million--for community care this year. I wonder whether any of my hon. Friends did. [Hon. Members :-- "No."] Did my hon. Friends hear about the extra £5 million for community care in Greenwich ? Did they

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hear about the £5.4 million for Hackney, the £6 million for Lambeth and the £6 million for Southwark ? Did my hon. Friend the Under-Secretary of State hear about the £6.5 million for Wandsworth ? The Opposition should be ensuring that Labour-controlled councils provide the services that they should be providing and that they do so more thoroughly and vigilantly.

All too often, it is Labour's neglect that builds up the pressures on our emergency services. Today, the King's Fund produced another report on the state of the health services in London. The hon. Member for Holborn and St. Pancras mentioned one report, but it is hardly worth explaining to him how he misunderstood it. Well over £2 billion is spent on the health service in London. The King's Fund report endorsed the need to spend money on community and not acute services--albeit that the report was discussing how the weighted capitation system works. The report, "Giving Voice to Londoners," is perhaps even more important and I am sure that the Opposition would have quoted if it had suited their partisan needs. It said that Londoners want a combination of well-resourced central hospitals, centres of excellence, more primary care offering minor surgery, specialist clinics, social care and community support. Those are also our policies and they are the right policies.

By pursuing the programme of strategic change that we have put in hand, we shall be able to put an end to uncertainty, and uncertainty is very hard for people working in the health service in London. We shall be able to realise that vision for the health service in London which is set out in the King's Fund report. Baroness Hollis, the noble Friend of the hon. Member for Holborn and St. Pancras, supported that report. Perhaps when he has compared notes with his party's spokesman on health, he may wish to go for further advice to Baroness Hollis, who played such an important part in presenting the original case.

As the independent specialty reviews last summer recognised, centres of excellence are created by bringing specialist services together and linking them to other hospital care. That is the expert medical view and the view that underpins our approach. We have honoured our commitment to protect the excellence of London's medical research, by providing generous funding for the special health authorities to support their research as they make the transition to trust status.

The hon. Member for Holborn and St. Pancras rightly referred to the Marsden, Brompton and Great Ormond Street hospitals--those special health authorities of such great standing. They have been very warmly funded. We have been able to bring the medical schools together successfully with the multi-faculty colleges. The hon. Gentleman's motion referred to education, so I was surprised that he failed to recognise the great significance of medical schools becoming part of a wider team with postgraduate centres and the broader scientific base. If we want to continue to have world-renowned doctors, that is an important step forward. That is why, when we propose to concentrate services, we also want to release further investment in research and education. It is not that we will lose some excellent teams. The point is that they will be moved to an environment that better supports their work and improves services for patients. That involves upheaval

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during the change, but that is not a reason why we should lose those teams or why they should not continue to grow and prosper in a different setting.

Far from destroying centres of excellence, our policies are designed to create, enhance and strengthen them. Indeed, every hospital that the hon. Gentleman mentioned will be combining with other teams. Those hospitals will be stronger, more effective and better able to engage in research and teaching. At the same time, we shall continue to give Londoners the better primary care that they want. That is why we have unleashed a formidable programme of investment to improve premises, build new community services, provide more and better-trained doctors and nurses working in the community and target the vulnerable groups, such as the elderly and mentally ill, who most need that community-based help.

This year, investment in London's primary care has doubled, amounting to more than £85 million. Well over 700 projects are under way, contributing to arrangements in a variety of services.

An Hon. Member : It is all waffle.

Mrs. Bottomley : I find it extraordinary that an hon. Gentleman should mutter "It is all waffle" under his breath. As I have said, 700 projects are under way, all detailed and documented. In my view, that constitutes a clear and substantial investment in change. The amount exceeds what we were asked to provide either by Professor Tomlinson or in the King's Fund report.

We have always been clear about the fact that we could bring about change only when we were able to make such an investment in primary care, and could be sure that change would lead to improvements and a better balance of services. Londoners hear nothing about that from London Labour Members.

Mr. Nick Raynsford (Greenwich) : Will the Secretary of State give way ?

Mrs. Bottomley : I think that I have given way very much more than the hon. Member for Holborn and St. Pancras. A number of my hon. Friends were desperate to intervene in his speech. I pity him, because his sudden ascension to his current brief must have made it difficult for him to give way. I have tried very hard to be patient with Labour Members, but I am worried about cutting into the time of my hon. Friends.

Mr. Raynsford : On a point of order, Mr. Deputy Speaker. Is it in order for the Secretary of State to complain that she has not heard from Greenwich--as she did earlier--when she has repeatedly refused to give way to me on points directly related to her speech ?

Mr. Deputy Speaker : The Secretary of State's speech is clearly in order ; otherwise the Chair would have ruled it out of order.

Mrs. Bottomley : I have offered Labour Members an agenda, Mr. Deputy Speaker, suggesting some items that they might wish to raise if they are fortunate enough to catch your eye. I thought it only fair that, in the unlikely event of their again failing to recognise the great achievements of the health service and what is happening in their own constituencies, London residents should hear about some of the major investment that is taking place in the capital. I believe that, as this great raft of investment

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and projects becomes ever more public and visible, the Labour party's distorted, one-sided picture of the NHS in London will be exposed for what it is.

In 1992, the King's Fund report pointed to the need for fundamental change in London's health service, stating :

"Action is needed to safeguard London's proud tradition of healthcare and medical education, and to forge new patterns of healthcare, medical education and research to meet Londoners' requirements in a new century."

Commenting on what were radical recommendations in the King's Fund report to reduce hospital provision, one newspaper said :

"Paradoxically those recommendations could well help ordinary Londoners if the money spent on specialist services were diverted to basic medical care".

Mr. D. N. Campbell-Savours : It was the Evening Standard .

Mrs. Bottomley : The hon. Gentleman is right :

paradoxically--again--that newspaper was the Evening Standard . Many others made the same point, however. The Guardian said : "only the ideologically blind are refusing to recognise the truths set out in the King's Fund Report that has rightly concluded that the present surplus cannot continue."

The Independent said :

"Change cannot be avoided. London's hospitals have been absorbing too high a share of NHS resources at the expense of hospitals elsewhere and of primary care standards in the Capital. The balance must be addressed. Sentiments aside, it is the patients who will gain".

Mr. John Austin-Walker (Woolwich) : On a point of order, Mr. Deputy Speaker. I fear that the Secretary of State may be in danger of misleading the House by quoting the King's Fund Research Institute, given that it has published another document more recently. In that document, produced in April 1994, it states that it may have been wrong

Mr. Deputy Speaker : Order. That is not a point of order ; it is a matter for the Secretary of State.

Mrs. Bottomley : The hon. Gentleman has failed to understand the significance of the King's Fund report. I suggest that he, too, should consult Baroness Hollis, who will be able to speak at length on the matter. He might also wish to read the remarks of Robert Maxwell, head of the King's Fund : only this week, he again spoke of the need for change and commended the progress that we are making. The Times said :

"The structure of health care in the Capital is archaic". The medical profession as a whole has been equally supportive. According to Paddy Ross, chairman of the Joint Consultants Committee,

"As a result of meaningful consultations, ministers produced a Government response to the Tomlinson Report the broad thrust of which is supported by the medical profession at national level". Professor Chris Ham--who is, I believe, respected by hon. Members in all parties for his knowledge of health matters--said :

"The reality is that there is no alternative to a radical re-shaping of London's health services and only those out of touch with the direction of health policy would have believed otherwise". He continued :

"Sentiment and political lobbying should not stand in the way of a restructuring that most independent commentators would argue is long overdue".

These changes are indeed long overdue. Professor Ham was right, the King's Fund was right and 20 reports in the

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past 100 years have been right. All that Labour says, however, is that there should be a moratorium, and that a further inquiry and report should be delayed. Even the hon. Member for Brightside was right when he said that the status quo in London was not an option ; it is a sign of the Labour party's hypocrisy that he has been written out of the script for uttering such politically incorrect views. Labour has turned its back on that wide consensus today because it puts its own short-term interests above those of the NHS, and above those of patients. Next week's elections in London are not about the NHS ; they are about social services-- [Interruption.] Labour Members clearly wish to divert attention from the record of their own authorities on social services, schools, roads

Dame Elaine Kellett-Bowman : Housing.

Mrs. Bottomley : And on housing. I am not surprised : the so-called care workers of councils such as Lambeth bully the elderly and mentally ill in their care, while councils such as Islington allow the children under their protection to be exploited by pimps and paedophiles. In contrast, there are councils such as Kensington and Chelsea, which has advanced one of the most forward-looking health strategies in partnership with its local health authority. I was able to visit it last week. Such councils are responsible for the services that they provide, and act as good stewards of their local communities.

Where Labour is in power, it fails the vulnerable and deserts the sick. I need hardly remind the House that when it was in power nationally, it was the Confederation of Health Service Employees shop steward at the hospital gate who decided which patient was treated and which patients were not : if Labour Members are reluctant to remind the public of that, my hon. Friends will do so.

Once again, we have heard denigrating remarks about accountants. Only Labour believes that a health service can spend more than £100 million a day without needing good accountants. It is one of the largest, most complex organisations, providing vital services ; it needs good, effective managers and accountants. That is why we owe so much to Sir Roy Griffiths and his report on management in the health service. [Interruption.] Labour Members interrupt most when they are least comfortable with my remarks.

I was speaking of the COHSE official at the gate deciding whether or not patients should be treated. This was an NHS run by thugs with a union rule book in one pocket and a Labour Government in the other. Now, in opposition, the Labour party cynically manipulates the health service for its own narrow partisan purposes.

Conservative Members remember the last general election, which the hon. Member for Livingston unwisely said would be a referendum on the NHS. We have not forgotten the disgrace of Jennifer's ear, and nor have the public. Labour's scare tactics then earned it contempt and lost it votes : when Londoners come to judge next week, let them show their contempt for Labour once again.

5.39 pm

Mr. Simon Hughes (Southwark and Bermondsey) : I declare my interest, which the Secretary of State and the Minister well know. I am the Member of Parliament for Guy's hospital and, because of that, I have a somewhat front -line position in the debate about the future of the health service in London.

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Like all London Members, I have constituents who use other London hospitals and other parts of London's health service. I certainly have constituents who are patients at St. Thomas's, and constituents who use King's, Bart's and many others. Why do they go other than to their local hospital ? It is possibly because those are the best hospitals, and the London health service has some of the best health care in the world.

The background to the debate today may be divided into four significant considerations. The first was repeated in the more recent King's Fund reports, which have been alluded to today. A section in the King's Fund report has just been produced entitled, "Public Opinion" and a subsection called "Comparing dissatisfaction," which reads as follows :

"The King's Fund Institute has collected and analysed national survey data on the views held by Londoners and by people in the rest of the country concerning the NHS and constituent services . . . Londoners are consistently more dissatisfied with all aspects of their health services than people living in comparable metropolitan areas in the rest of England."

I remember when the senior nursing officer at Guy's came from Aberdeen. At the first meeting I had with her, she said that people in Aberdeen would not put up with the conditions of the health service in London and that the services in Aberdeen were considerably better. The purpose of today's debate is to try to bring about an understanding that there will be continuing dissatisfaction about the health service in London until the health care provided in our capital city is of the standard that it is in many other parts of the United Kingdom.

The second background point to today's debate is that 83 per cent. of people in the most recent opinion poll which I saw believe that there should be more money spent on the health service. Considerable numbers of people--more than 40 per cent.--said in the same poll that they were willing that 5p in the pound extra be spent. The opinion poll's support for the health service contrasts markedly with the lack of support in London for the Government.

It is a telling fact that, whereas at the general election the Conservative party's support in London was much higher than its average support throughout the country, the Conservative party's support now is much lower in London on average than in the rest of the country. That is not saying much, as the average in the rest of the country has come down, but more support has been lost in London than elsewhere.

The third obvious point is that the debate is all about the implementation of the health service reforms and the Tomlinson report.

The fourth point, about which the Secretary of State made a great song and dance, is that we are having the debate in the run-up to the London borough elections. If the right hon. Lady thinks that health is not an issue in the London borough elections, I do not know where she has been or to whom she has been listening.

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