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Voters determine the issues, not political parties, and the voters of London realise that local authorities have responsibility for social services but not for health services. They also realise that the way in which the health service
Column 422is run has a direct impact on what local authorities can and ought to do. Many of the voters in London are extremely unhappy about the Government's proposals for the health service.
I should add a postscript lest it be thought that this is an inner London concern and not an outer London concern. An article--not written by politicians--appeared recently in a local newspaper in Kingston upon Thames entitled, "Ward Furore." The article discussed a subject of acute controversy in Kingston, which was reported as follows :
"Kingston Hospital is converting an empty ward into an exclusive unit for private patients and building a private operating theatre . . . The new private facilities may be paid for by the taxpayer . . . The hospital has had private patients since 1948, but the new unit and operating theatre will be the first exclusively for private use. At present, private and NHS patients use the same facilities." It is not just in inner London, but in other parts of London that there is considerable voter dissatisfaction with the Government's proposals for the health service.
Mr. Nigel Forman (Carshalton and Wallington) : The hon. Gentleman mentions the part that health is playing in the local elections. Will he take this opportunity to condemn unequivocally the action of his Liberal colleagues in the London borough of Sutton, where there are local elections, who are cynically scaremongering about the future of the excellent St. Helier hospital in my constituency ?
My constituency also benefits from an even more well-known renal unit which covers the whole region. Both those excellent units are enjoyed by people from neighbouring constituencies, who have been scared witless by Liberal propaganda suggesting that the hospital is likely to close. Will the hon. Gentleman take this opportunity to condemn that cynical scaremongering ?
Mr. Hughes : I happened to go to the Sutton civic offices today, and I have not seen any such scaremongering. The local authority in Sutton, which my colleagues run, has provided a direct bus service from St. Helier hospital--I went on the bus on the day the service was inaugurated--through the more deprived parts of Sutton into the middle of the borough. I do not think that such a policy is consistent with a belief that the hospital is about to close.
There is great concern in Sutton--as in Kingston and other boroughs, such as mine in Southwark--that the Government's policy towards the health service will not achieve the levels of resources which inner and outer London need.
Mr. Forman rose
Mr. Hughes : In answer to the hon. Gentleman's question, I will inquire. If the matter is an election issue in Sutton, it is because the voters of Sutton want the health service to continue with maximum resources, and not to be at risk.
Mr. Spearing : Would not the problems that we have had in the past exchanges be solved if the Government took account of the latest King's Fund report, and not the reports to which the Secretary of State referred ? The latest King's Fund report says :
"However, adjusting the balance between hospital and community-based care will take time. New services must be put in place before old ones are declared redundant."
Column 423If the Government would take the advice of that report, the situation that has just been described would not be relevant. Mr. Hughes rose
Mr. Deputy Speaker : Order. Before the hon. Gentleman attempts to answer, let me say that there have been two interventions since he began speaking and both have been lengthy. [Interruption.] Order. Many hon. Members are hoping to catch the Chair's eye before the debate finishes. If we continue to have long interventions of that nature, some will be unsuccessful.
Lady Olga Maitland rose
The voters, the people and the patients of London are so concerned because when the service is examined it is often found to be significantly wanting. A check on conditions in the acute sector of hospitals was carried out on 25 April. On that day, 58 Londoners faced delays of more than three hours in casualty wards while eight hospitals had clamped down on emergency admissions.
Hon. Members who represent London constituencies know that many people who need health care in London--usually because they live here, but sometimes because they work in London or are visiting--often cannot obtain that care in the way the NHS was intended to provide it. For as long as that remains the case, the Government must be much more careful about how they introduce changes in the health service. The problem is that Londoners simply do not believe the Government. I will give the Secretary of State an obvious local example. She knows in advance what I am about to say. At the end of the 1970s and the beginning of the 1980s, a small cottage-type hospital in my constituency serving people from Southwark and Lewisham, St. Olave's, was closed with the promise that the services would be preserved at Guy's. It is now clear that that will not happen if the Government's proposals go ahead because normal in-patient treatment will not be available under the reforms proposed at Guy's. It is not surprising that people do not believe the Secretary of State when promises made under one Administration are dishonoured under the next.
The fundamental problem of the reforms in the health service is that they are being carried out without the assent and approval of the people most affected. If a Government who were elected on a minority of the vote in the country and in the capital city are determined to go ahead with extremely controversial reforms and set up a structure whereby all the health authorities are appointed exclusively by the Government, and then set up a structure
Column 424whereby the providers are made into hospital trusts, all of which are appointed by the Secretary of State and their decisions taken in secret, it is not surprising that the people of London do not trust the management of the health service.
The health service employs many excellent people, including good administrators, but it is no longer an accountable service. It is accountable only to the Secretary of State, who neither listens nor hears. If she did, she would not go in the direction in which she is going and she would not lose the argument. Her speech today was a classic illustration. She spent five minutes discussing why the hon. Member for Holborn and St. Pancras (Mr. Dobson) had spoken. That was not of huge interest to the people of London, important though it may be to the Secretary of State. She should have tried to win the case instead of making party political points. The Labour party has, perfectly properly, used a day allocated to it to discuss a subject of huge interest not just to the Labour party but to all parties in London.
Mr. Hughes : Perhaps I should make an exception and give way to the hon. Gentleman as he, too, represents a Kingston constituency. Next week, the Tories may lose that borough to us, so this may be the last time he can stand up and say that Kingston council is Conservative controlled.
I beseech the Secretary of State to listen. I will explain why the London case is being handled so wrongly and what she needs to do. Exceptionally, I shall give way to the leader of the Conservative group of London Members of Parliament so that he can have his swan song before a substantial Conservative defeat in London next week.
On a more serious point, the hon. Gentleman has been putting forward what he believes is a rationalised, plausible whinge to the House. I have before me a map from the London initiative zone showing the capital schemes commencing in 1993-94. In the hon. Gentleman's area of Southwark, together with Lambeth and Lewisham, there is a mass of capital schemes. The hon. Gentleman goes on about Guy's and St. Thomas's, where the clinicians have said that duplication was making clinical services inefficient. Does he deny that vast numbers of capital schemes are coming on stream in Southwark, Lambeth and Lewisham ?
Mr. Hughes : It was not worth giving way to the hon. Gentleman. The answer is no, of course I shall not deny it. I have always given credit where it is due. The health needs of London are such that a huge amount of resources are still needed, for reasons which I shall briefly elaborate in a moment. If the Government listened to the needs of the users of the service, they would realise that running down loved and favoured centres of excellence with established teams of experts, which attract people from all over the country and the world, is not the way to develop the health service in the capital city.
A section at the beginning of the Tomlinson report sets out the health needs of London. It makes the clear case that, first, a huge number of people, other than those who live
Column 425here, come to London for treatment ; secondly, London has more under-privileged areas than anywhere else in the country ; thirdly, London has a more diverse population needing more special health care than elsewhere in the country. It goes on to elaborate on the number of homeless people, the standardised mortality rates and the people with special needs, such as HIV and AIDS patients.
The Secretary of State did not concede entirely the point that I put to her in an intervention--that it is the same throughout the public service in London. It is never an argument to say that we can run down the amount of money spent here and distribute it in the rest of the country if the consequence is that we do not have the funding to meet the higher costs of providing the service here. Neither my hon. Friend the Member for Rochdale (Ms Lynne), who speaks for the Liberal Democrats on health and represents a northern constituency, nor I have never argued that the Government should not develop the health service elsewhere. I put it on the record that, like the hon. Member for Holborn and St. Pancras, we have never argued that there should not be rationalisation in London. It is not logical to have four units dealing with the same specialty in four neighbouring hospitals if they can be concentrated in one.
We have consistently argued for a rational provision across London, but it must take account of factors such as the difficulty of travel, the number of people without cars, and the time it takes to cross London, which is often congested with traffic. It must take account of the fact that once a team of experts is destroyed, it cannot be built up again. It must take account of the fact that, whatever the Secretary of State may wish to do, people will always be referred to top specialists who happen to be based in top London hospitals and those people will come from elsewhere in the country and from abroad.
It is no solution to tell people in London that their hospital sites at Guy's, St. Thomas's, King's or Lewisham happen to be too expensive because of the cost of land, so the purchasing authority for the south-east London health authority must buy a cheaper service and people will have to go to Brighton to receive the care. That is not what the health service is supposed to be about, but it is the danger of the Government's policies. As the advertisements on hoardings in London say, the service is so run by accountants and fundholders that everything is determined by cost rather than care. [ Hon. Members-- : "Not true."] It is true. Ultimately, services are no longer provided, because health authorities are told that they have no more money. It is true that the purchasers choose where to buy the service. They will close a service--just as they have closed the ophthalmology unit at Guy's hospital so that patients are now treated at St. Thomas's--because that is how they believe that they will get best value for money, but it may not be the best place for the patient, as it may not be near where he lives or convenient for him to travel to. As the patient no longer has any direct say in the health authority, decisions are taken that run increasingly away from the needs of the London community.
Column 426One bugbear is the fact that the Government have claimed great successes which have been fictional. I am delighted that this month the Government have announced that waiting times are to be be measured not from when the patient sees the consultant until when he or she is treated, but from the time a patient visits the doctor until he or she is treated. For the clock to be ticking only from the time one saw the consultant meant that, for many people, it was a year before the clock started to tick. I hope that we shall be honest about the assessment of waiting times. My constituents regularly come to me and say that they have been waiting for years, certainly for months, to be seen or treated. The same is true of constituents throughout the capital city. The test of the efficiency of the health service in delivering care to patients lies in the length of time taken between the need arising and the need being treated. I come now to the subject of greatest concern to me and my constituents. Ministers still think that the case being put for keeping in-patient beds and an accident and emergency department of some sort at Guy's hospital is being put by consultants. The consultants may be making a case and they have an interest, but they also have a concern and if Ministers think that their battle is with the consultants and that it is the consultants whom they need to head off, they are fundamentally wrong. It is not the consultants who are most concerned about the rundown of services planned for Guy's hospital, but the people who work in and use the health service. Our case is simple. We do not argue that there should be duplication. We do not argue that Guy's should stay open and Lewisham, King's or St. Thomas's close. That is definitely not our argument. We argue that, according to the Jarman scores, south London is under-resourced in terms of beds when compared with the rest of the capital city. When we consider the patients' needs, it is no good thinking about closing the accident and emergency department at one hospital unless it has been proved that there is spare capacity elsewhere. Above all, if the Government think that they can go on arguing that one hospital serving a catchment area and patients from much further afield can be closed without damaging Londoners' health care and putting their lives at risk, as well as a damaging the Government's reputation, they are sorely misguided.
I have always sought to be rational when putting the case for the health needs of my constituents in the capital city. My colleagues and I have always sought to be reasonable and have recognised that the health service is not a bottomless pit. But we want the Government to accept that there is still a good case for keeping the four hospitals in the south-east London health authority area and not taking out a hospital when such acute need is constantly and clearly not being met.
material--distributed by the "Save Guy's" campaign has been seen by some people as a campaign to close St. Thomas's hospital, not to save Guy's. It is important to state that that is not what is being put out. Will the hon. Gentleman give a firm commitment that the "Save Guy's" campaign is not about closing St. Thomas's hospital, as some of the denigrating literature
Column 427that has been circulating has been extremely badly received by people working at St. Thomas's who care very much about that hospital ?
Mr. Hughes : I was not intending to give way, but I am happy to deal with the hon. Lady's intervention. I can expressly say to the hon. Lady, whom I respect and value as a colleague, although she is not in my party, that nobody involved in the campaign to keep Guy's open as an in-patient hospital and an accident and emergency hospital wants any reduction of services at St. Thomas's, King's or Lewisham. We believe that the figures, the evidence and the arguments advanced to Ministers show that there is a case for all the hospitals to remain without duplication and in a complementary way. Now that the initial misunderstanding is out of the way, I believe that increasing numbers of people at St. Thomas's--staff nurses, administrative staff and consultants--will realise that we must stand together or risk not standing at all.
The Minister for Health (Dr. Brian Mawhinney) : I have listened carefully to the hon. Gentleman's answer to the hon. Member for Vauxhall (Ms Hoey). We must clarify the position a little further. It is a matter of public record that when I conducted consultation exercises at Guy's and at St. Thomas's, the consultants on both sides said that their overriding desire was for a single, acute hospital site. Each side said that they would like it to be on their site, but when specifically asked by me whether they wanted to retain the services on their site or on a single site, the consultants on both sides said that for clinical coherence they attached greater significance to a single site. As both hon. Members know, this year we are investing £18 million into the Guy's and St. Thomas's trust to enable it to function. That is extra money which will not be available to anyone else in the health service. In the light of the experience that I have just related, does the hon. Gentleman believe that we should keep spending more each year--on top of the £18 million and on a rising curve, as it would be--in order to maintain the clinical incoherence that he advocates ?
Mr. Hughes : I am happy to answer that. The Minister knows that I want us to have a rational debate on agreed facts and figures. If we could consult on the facts and figures that led to the strategic decision announced in the House on 10 February by the Secretary of State, we would realise that there is no logic in the Government's conclusion. The logic of the Government's decision contains various anomalies, such as the Philip Harris house anomaly. A building was built for £140 million and it was then announced that it was not to be used for its intended purpose. It was also anomalous to open an accident and emergency extension on the very day it was recommended that it should be run down. There was an anomaly in the fact that people were asked to give money for a new building for a specific purpose. When it was announced that the building was not to go ahead, the people said that they wanted their money back, which increased the bill for taxpayers.
If the Government are willing to sit down with the people at St. Thomas's and Guy's, the local community, the community health council and people who care, including Conservative and Opposition Members, we can win the argument to show that the facts and figures--the cost benefit to the Government and to the taxpayer--show that it is better to keep fully functioning hospitals on both
Column 428sites. If the Minister will let us put the case, we believe that we can persuade him of it. My hon. Friend the Member for Rochdale, who speaks on health matters for the Liberal Democrats, and I have only ever asked that the Government's health service reforms should be the subject of consultation and should be based on agreed facts and figures. If the Government do that, their popularity may increase, but if they continue with their present policies I predict that the Government, as well as the patients who need the health service in London, will be the losers.
The Select Committee on Health, of which I am Chairman, has taken a keen interest in the national health service provided in London, with particular emphasis on the Tomlinson report. As my right hon. Friend the Secretary of State explained earlier, over the years, 19 reports on the future of health care in London have been produced. The Tomlinson report was the 20th such report. The Health Select Committee decided that it would not produce report No. 21, but would instead keep a watching brief on the issue. However, I am certain that everyone will agree that the Tomlinson report was necessary, and some will claim overdue.
As my right hon. Friend the Secretary of State said earlier, even the Opposition Front-Bench spokesman, the hon. Member for Sheffield, Brightside (Mr. Blunkett), admitted that the "status quo is no longer an option". Ministers need a great deal of courage to take the essential decisions, some of which are likely to be unpopular. I congratulate my right hon. Friend and her ministerial colleagues on grasping the nettle, because it had to be done.
In order to put the debate into perspective, I think that we should remember that the population of inner London requiring health services has changed dramatically over the years. In 1901, the population of inner London was 4,533,000. In 1991, the population of inner London was 2,080,000 --more than a 50 per cent. decrease. One million people have left London in the past 30 years. Many former Londoners have moved into the home counties and beyond, some of them settling in my constituency in Hertfordshire, and they are looking for high-quality national health services where they live now, not where they used to live.
In recent years, there has been conflict over the distribution of funds within the NHS London regions, the bone of contention being equity between inner London on the one hand, and outer London and the home counties on the other. It has always been claimed that too large a slice of the cake was being taken for central London hospitals and not enough was being distributed to the areas where the population was now living.
I welcomed the Government's policies in "Making London Better", which stated that their overall objectives were to improve the quality of patient care for Londoners, to improve the services provided by the family doctor and other community-based health services, to ensure that hospital services responded to the changing demands of patients, to ensure that changes in medical practice--such as the growth of day surgery--were accommodated, to ensure that the high costs of overheads in London hospitals
Column 429are progressively addressed and, importantly, to preserve and enhance London's reputation as a centre of excellence in treatment, teaching and research.
Of course, change of any sort is always difficult to accept in some quarters and sometimes it is even more difficult to implement. Many groups will lobby for their local hospital to remain as it is and support their local medical team in this endeavour. But I believe that the greatest problem caused by the reforms was the pall of uncertainty for the future which hung over many of our great London hospitals. However, when final decisions were taken by the Secretary of State for Health, I found that a return of confidence was quickly evident and an enthusiastic approach to "getting on with the job" was stimulated.
In 1993, the Health Select Committee visited the Lambeth community care centre and the Chelsea and Westminster hospital in May, and the Queen Elizabeth hospital for children and St. Bartholomew's hospital in July. In 1994, we visited the Charing Cross hospital in January ; the Royal Marsden hospital, Chelsea site, in February ; and the Hammersmith hospital and the Royal postgraduate medical school in April. We are planning to visit St. Thomas's hospital in May, and Guy's and King's College hospitals in June.
Wherever we have gone, we have been given a very warm welcome. I must place on the record the fact that I have not witnessed the atmosphere of total doom and gloom within these establishments which is being promoted by the press and Oppostion political parties. We have also called before us as witnesses members of the Tomlinson inquiry team, including Sir Bernard in December 1992 ; the London implementation group and its chairman, Sir Tim Chessels, in July 1993 ; and the Secretary of State and her ministerial team in March 1993 and March 1994.
Over the past week or so, there has been a great deal of controversy relating to the numbers of hospital beds available in inner London and the criteria that are being used to provide the exact figures. There is no doubt in my mind that, from what I have seen on my visits to London hospitals, the "number of beds" criterion should no longer be used to measure quality of care and effectiveness of health services. It is the number of patients who are treated and the quality and outcome of that treatment which are important. Beds are a very poor indicator of what can be and is being done in the NHS.
I will explain my reasons for saying that. On 13 April, members of the Select Committee visited Hammersmith hospital and were very impressed by the work that is being undertaken there. During our visit, Committee members were provided with the opportunity of learning about a procedure called interventional radiology, which is the branch of radiology dealing with non-invasive curative procedures under imaging control--for example, blocking or unblocking arteries, and removing gall stones or renal stones percutaneously and so on. These procedures are usually done under local anaesthetic and do not involve surgical incisions.
We saw for ourselves a procedure called embolisation, which is the branch of interventional radiology concerned
Column 430with the occlusion of blood vessels in the treatment of bleeding, tumours or arteriovenous malformations. I will outline the case that we saw.
The man was in his early 40s. He had had pulmonary arteriovenous malformation since birth--that is, a hole between the opolmonary artery and vein. In his case, it was solitary, but in most patients they are multiple, often affecting both lungs. He was blue because 20 per cent. of his blood was shunting through the hole instead of being oxygenated. Many patients have strokes, as would probably have been the case with this patient, as a result of the condition because little clots of blood--we all have them-- which should be filtered from the circulation by the lungs go through the hole and end up in the brain. That happens to 60 per cent. of patients with this condition. The operation that took place was this : a tube, or catheter, was passed from the femoral vein in the groin, through the heart and into the hole in the lung vessels. This was done under local anaesthetic and was painless. The patient watched the procedure on television. The hole was plugged with a metal device called an embolisation coil, which was developed at the Hammersmith hospital. He did not feel anything and his blood oxygen saturation improved immediately--that is to say, he went from blue to pink.
Following the operation, the patient stayed in hospital overnight and went home the next day. He would be able to return to work in seven to 10 days, depending on his job. He has been cured and left with two healthy lungs.
Now I will tell the House what would have happened some years ago to that man with that condition. Half his lung would have had to be removed. Most patients with more than one lesion in the same lung require a pneumonectomy. If the lesions affect both lungs, which is usually the case, there is no treatment. A heart-lung transplant would be the only option.
The hospital can now treat these multiple cases--some patients have 60 to 100 plugs in their lungs. We should remember that chest surgery requires general anaesthesia and an operating theatre full of sterile instruments, people, blood to be cross-matched and so on. Chest surgery makes a large scar and requires stitches. It also involves a healing period and post- operative pain. It would thus have meant 10 days in hospital, with 10 or 12 weeks convalescence before returning to work. There would also be an increased risk of operative morbidity--that is to say, complications and a higher mortality rate than occurs with the embolisation method. Moreover, the patient would lose a normal lung, which means trouble in the future if the remaining lung goes wrong.
Interventional radiology can therefore reduce in-patient stay times and enable more patients to be put through the same beds. It can also abolish the need for the beds, as many procedures can be done on out-patients. The patient that I have described was in a hospital bed for one night instead of 10 days.
Let us not forget either that there are many other procedures which allow day surgery, because modern technology has created a completely different approach to illness and to many conditions--not to mention allowing some people to stay at home with their illnesses being properly controlled by drugs, instead of their being forced to resort to hospitalisation.
I repeat that bed numbers are not a reliable currency in health care. The concept is flawed.
Column 431The development of the procedure that I outlined earlier, however, requires centres of excellence to which patients can be referred for procedures to be devised and perfected by doctors. Whatever system the Government put in place, there must be provision to protect the resources of the institutions that generate the medical developments which will ultimately benefit the nation, in terms of quality of health care and of economics.
The good news from Hammersmith hospital is that the removal of the recent threat hanging over it has had important side-effects. Stability and confidence have been restored, and industrial and commercial financial support has flowed into the hospital for research. I am sure that the Government understand the enormous worry and disruption caused by the changes that are necessary in London's health care, and the importance of decisions being made as quickly as possible.
I hope that the Opposition parties, and others, will realise that times have changed dramatically and that the focus on bed numbers in inner London hospitals has become meaningless. There are fewer people living in London, following a continual population decline for 90 years. New procedures remove the necessity of long-term stays in hospital. New drugs keep patients at home instead of in hospital. Day surgery is now highly effective and efficient and the excellent facilities in hospitals in the provinces mean that patients need no longer come to London for sophisticated treatments. Primary health care and community services need to be the targets for improvement in London, and that is the area in which the Government should be promoting modern, high-quality health care--with support from all parties in the House.
Mr. John Austin-Walker (Woolwich) : First, may I pick up a point made by the hon. Member for Southwark and Bermondsey (Mr. Hughes). I join him in welcoming the decision to include the time spent waiting for a first appointment with a consultant in the waiting time before a treatment. Certainly, for patients who are suffering while waiting for hospital treatment, it constitutes part of the waiting period and I welcome the fact that the Government have decided to count it as such.
Last year, I obtained information about waiting times in my district, specialty by specialty, from the family health services authority. When I put a question to the Secretary of State about the general position in London, however, the response was that the Department of Health does not keep such information centrally. That is one reason why this evening I want to discuss the absence of any strategic plan--or the ability to draw up one --for London because of the absence of a strategic health authority.
Clearly, if there is no strategic health authority for London the Department of Health must be responsible for collecting the information and keeping the statistics, but time after time when Ministers are questioned about London, the answer that they give is that the information is not held centrally.
The Secretary of State today talked of the blinkered ignorance of the Opposition. I wonder who she was talking about. It seems to me that anyone who criticises Government health policy these days is accused of blinkered ignorance. Would the Secretary of State, for instance, use the term to describe Professor Sir Colin Dollery ? The right hon. Lady referred to the importance of
Column 432research and of centres of excellence. Sir Colin, giving evidence to an inquiry set up by a London group of Labour Members, said that the Secretary of State's NHS reforms posed
"a major threat to research in London."
He told our inquiry that the reviews carried out by the London implementation group had
"created low morale and had increased the problems of recruitment and retention of research staff in London".
Mrs. Roe indicated dissent .
The hon. Member for Broxbourne (Mrs. Roe) mentioned the excellence of the work at the Hammersmith. There is no doubt that such pioneering research and new techniques will lead, in a number of areas, to patients being treated more quickly, with less reliance on medication and with less trauma. It should, however, be recognised that modern techniques and research also mean that many more people can be treated in hospital for ailments for which there used to be no treatment. They used to suffer in silence and in pain at home. There is thus a double edge to these modern developments and they do not necessarily only mean that our reliance on hospital beds can be reduced.
The King's Fund has been quoted in defence of Government policies. My hon. Friend the Member for Newham, South (Mr. Spearing) quoted part of the King's Fund report, published this week, to the effect that
"adjusting the balance between hospital and community-based care will take time. New services must be put in place before old ones are declared redundant."
The Secretary of State was keen to refer to the previous report of the King's Fund, but I draw her attention to the most recently published one. It states that to achieve sensible change without reducing health care for Londoners will require substantial new investment of resources in the capital. The report points out that, hitherto, that has been resisted because of the argument that London was overfunded. The Secretary of State and other Ministers have in the past quoted the King's Fund to support their argument that London was over-provided for, yet now the fund says that
"the capital's health care needs have been underestimated. There are now good reasons for believing that London merits a larger--not a smaller-- share of the NHS cake."
Calculations by the King's Fund Research Institute suggest that purchasing power for hospital and community health services in London
"should be increased by approximately £200 million."
I hope, therefore, that since the Secretary of State has placed so much reliance on the excellence of the King's Fund in the past, she will also take note of what it has said most recently.
Mr. Congdon : I have read the report carefully, even though it was delivered to hon. Members only last night. Does the hon. Gentleman concede that the figure of £200 million is merely an assertion ? There are no calculations in the report to show how it was arrived at
Mr. Austin-Walker : I hope that other colleagues will pick up the points raised in the King's Fund report, but I would point out that all the assertions that the Government have made in the past, basing their evidence on Tomlinson,
Column 433were that London has been over-bedded and, therefore, overfunded. All the research in the King's Fund Institute report published this week shows that the argument that London is over-bedded is fallacious.
There have been suggestions that London is receiving too large a share of the cake. My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) said earlier that London was receiving something like 15 per cent. of the share of the NHS cake and that London accounted for something like 15 per cent. of the total population. It does not seem as though the allocation to London is out of sync with the rest of the country.
My hon. Friend pointed out that, in terms of the police services, the Government recognise that London has increased needs, and, therefore, increased costs. There is a disparity in the Government's attitude towards the police and the fact that 29 per cent. of national expenditure on the police force goes to London to serve 15 per cent. of the population. Many of the factors that influence that in terms of cost and needs also influence the cost of the health service and the health needs of Londoners.
I shall refer to my own locality. The Secretary of State referred in passing to the Brook hospital. Unfortunately, my hon. Friend the Member for Greenwich (Mr. Raynsford) was unable to intervene. Greenwich health district comprises the constituencies of Woolwich, Greenwich and Eltham. There has been a 25 per cent. loss of acute beds in the Greenwich health district in the past 10 years. Since 1982, the number of beds has decreased from 971 to 733. The number of beds in all specialties has reduced by 26 per cent. from 1,598 to 1, 181. Across London, there has been an average loss of one eighth in the number of beds and in the health district serving my part of south-east London, the reduction has been a quarter.