House of Commons Hansard Debates for 28 Apr 1994

Mr. Andrew Rowe (Mid-Kent) : I have sympathy with one of the points made by the hon. Member for Islington, North (Mr. Corbyn). He is quite right to draw attention to the inter-relationship between the health of the nation, or the health of an individual, and the surrounding circumstances of his or her life. Indeed, much of what was behind the thinking of the NHS reforms was to make the links between the other services that impinge on somebody's life and health very much easier to make and build constructively than they were in the days when the NHS was dominated by the medical establishment and saw everything in medical terms. I shall return to that in a moment. The service is changing very fast--although in most of the speeches of Labour Members, it would be hard to recognise that. I hope that, as the service develops, we shall see changes in role

differentiation. For example, one reason for the logjams in some accident and emergency departments is that the medical profession is frequently very reluctant to delegate, as they are empowered to do, relatively simple surgical procedures to nurses with great experience and every capacity to perform them. I very much hope that the job specifications--rigid in many cases

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--that exist in the NHS will be undermined, as there is growing confidence in the professional capacity of other non- medically qualified staff.

There are important debates to be had about the extent to which a medical model is necessarily the best for the delivery of quite a lot of the services that impinge on people's health. I very much welcome the way in which the reforms have lowered the walls between the disciplines, but there is still a long way to go. There is still too automatic an assumption of superiority among doctors, conferred by six or more years of initial training. On the other hand, in too many other specialisms in the NHS, far too little account is taken of the necessity for good research. I believe that both parts of the NHS have a great deal to learn from each other.

The NHS remains far too hierarchical in the way in which decisions are taken. Again, I welcome the growth in co-operation between social services, education and the NHS, and the growing respect that is coming between the different professionals in their different ways. I urge my hon. Friend the Minister to strike a balance between the managers and the specialists, and ensure that decisions should not always go in favour of the managers. Genuine anxiety is felt by people who have given their lives to the NHS, and they sometimes feel that very enthusiastic macho managers do not pay them the respect that their experience deserves. That is a growing pain of the changes, but an important one to bear.

The hon. Member for Sheffield, Brightside (Mr. Blunkett) came down to my part of the world recently, and among other adjurations that he directed to a medical and quasi-medical audience was that we should be prepared for massive technological changes coming over the NHS. So we should. I believe that it is now only a matter of time before the professional expertise of a specialist can be beamed down to many areas of the country, so the need to be physically in contact with the specialist might well diminish.

I welcome that, because it will mean a further diminution in the necessity for the leading consultants' units to be within easy reach of Harley street, which, of course, is why most of the great teaching hospitals grew up where they did. It is an anachronism to have such a concentration of elderly--or antique, if one likes--specialisms in such a small area. It is conceivable, and I am sure that it is true, that there are probably too many managers in the NHS at the moment, but I do not see that as anything other than a necessary temporary phase, for a variety of reasons.

Before we take the numbers as an absolute, let us remember that many of the new managers are specialists--medical, nursing, speech therapy or whatever- -and have taken on a management function and been given a management title. The idea that they have become a different breed is nonsense. In the early stages of turning around an NHS that did not have the faintest idea how much any of its procedures or operations cost, we are bound to require a good crop of managers while we put in place the systems that are needed to work out that cost.

One source of great aggravation and hostility to the NHS reforms is that, for the first time, consultants are finding that their time is being managed. Far too often in the past, consultants were able to slip out of the hospital for long periods, leaving the responsibility with their junior

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staff. Of course, many have been enormously conscientious and work all the hours that God sends, but a whole crop among them have not. One of the best features of the NHS reforms has been the transfer of the consultant contract from the regional health authority to the local unit that worries about where its most expensive members of staff are. The other element of management that is new is the serious attempt to manage the assets of the hospital as a whole. In the past, consultants had beds and, if they had a good working relationship with one of their fellow consultants, they might allow them to make use of it if they were not using it. There have been many examples in the past when beds were managed not as part of a hospital's total assets but simply as part of a consultant's assets. That is a substantial potential change for the better.

The fact remains that we can see self-interest or vested interest when it appears in the debate. The Labour party has moved the motion out of naked self-interest. Every citizen wants to be healthy, preferably at no cost to themselves in terms of either cash or self-discipline. As none of us looks forward to getting old, and as each of us has a friend or relative who is old, ill or in pain, it is easy to strike a sentimental chord. We know that there is never as much resource as we could use in the national health service, so it is easy to create fear, anger or demand--and the Labour party cynically chooses to do so in the run-up to the local elections. Votes are one self-interest.

Another self-interest is the grip that the national health service unions have on the service, which is being shaken by the reforms, and that of the British Medical Association. Unison--that is a curious misnomer--used to enjoy the privilege of striking when it suited. The professional associations generally lead the clamour for the status quo.

The status quo consists of a bland acceptance of the myth that all the ancient teaching centres are equally effective, whereas it is clear that the quality of the research done in some of those centres is very uneven, and some of it is downright poor. A good deal of the teaching in those centres no longer deserves the reputation that it enjoys.

The status quo consists of expensive services being provided where people no longer live. Sometimes it consists of a dependence on the old boy network, which certainly needs to be re-examined. It also consists of a concentration of services in inner London, to the detriment of services elsewhere, in areas such as mine, to which the people who used to live in London have now moved out, as the hon. Member for Islington, North said.

In Medway, we welcome the Government's courage to make changes. They have announced that £45 million will be spent on the Medway hospital. My three Medway colleagues and I are glad to welcome that. That £45 million will lead to the closure of beds and units, and I welcome that as well.

The paediatricians in All Saints, Chatham, who have coped magnificently in the passages of the old workhouse, will rejoice that, in a few years' time, they will be working in a new building in a modern hospital complex. I am prepared to bet that there will be a public outcry against the closure of All Saints, Chatham--that old workhouse--because it is in the nature of people who have been in hospital and come out well to feel a warmth towards that institution, which leads them to protest when it is closed, despite the fact that closure frequently leads to better provision somewhere else.

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One of the other consequences of the reforms has been the state-of-the-art oncology unit in Maidstone. We are also grateful for that. We shall soon see local centres of excellence growing up all over the country, rather than concentrated in a few large cities. We know that it can be done. Papworth hospital, Stoke Mandeville hospital, the hospital of East Grinstead, and Leeds general hospital have all shown how centres of excellence can be created well outside London. Modern technology will make that easier.

I also welcome the good news unit which the hon. Member for Holborn and St. Pancras (Mr. Dobson) was so pleased to rubbish. Nothing destroys morale more fundamentally than to have one's service portrayed as constantly in crisis, as Labour spend its life doing. Staff at all levels welcome good news. They welcome the chance to borrow successful ideas from each other and to show off their own. I hope that the flow of good news will swell until it drowns out the Jeremiahs in the Labour party.

Fortunately, the go-ahead, thoughtful professionals recognise the need for change, and the professional associations are finding themselves either increasingly co-operative or increasingly outflanked. Those that are being outflanked turn to the Labour party, which is as far away from being go- ahead and thoughtful as it is possible to be.

Of course, they do not turn in vain. Look at what we have been given--the argument that if an organisation is old enough, it must be preserved, and a total refusal even to consider the consequence of a fall in population from 10 million to 7 million. Labour have complete amnesia about the 25 reviews of London's health service which have taken place this century, and we now have a demand for yet another review. The Labour party resembles an old people's home, an elephant's graveyard and a place where radical ideas go to die. Finally, the national health service reforms in London are behind the rest of the country. What we need to see in London is the sort of development that we have seen in my part of the world, where, for example, with skilful management and good co-operation among our primary healthcare trust, our acute care trust, the general practitioners and social services, we now have a team working together to ensure that, when patients are discharged from hospital, they are properly looked after in the community, and that no patient leaves hospital without having full arrangements made for that discharge. That is absolutely right. I share Florence Nightingale's view :

"Never think you have done anything for the sick of London until you have nursed them in their own home."

7.36 pm

Mr. Jim Dowd (Lewisham, West) : The speech of the hon. Member for Mid-Kent (Mr. Rowe) was startling for its insensitivity and lack of appreciation of the problems facing London. If we are to believe Tory Members' claim that the population has moved away and the health care patterns have not, we would be witnessing a surfeit of services for the people of London--they would be spoilt for choice. There would be so much concentrated here to serve so few that people would be tripping over available beds in hospitals. The reverse is true, and that is why we asked for this debate today. Many of my hon. Friends wish to speak, so I shall chop my comments as much as I can, which I am sure will be appreciated by everyone.

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I was a member of the area health authority for Lambeth, Lewisham and Southwark--I was first appointed in 1976. I subsequently served on the Lewisham and North Southwark district health authority, as it became known. I have therefore been closely involved in the development of health care in south-east London for a number of years. Like my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), I shall make a few personal and domestic comments. My sister and brother were born in the early 1950s under the aegis of the home care delivery unit at Lewisham hospital. My younger brother was born at King's College hospital. A few years later, my father died at Guy's, my mother died at King's College hospital, my daughter was born in Beckenham hospital, her son was born in Farnborough hospital, I had a nephew born in Lewisham hospital last year, and, sadly, my father-in-law died in Hither Green last October.

Fortunately, on the only occasion that I have ever had to be admitted for in-patient surgery, I attended St. Thomas's hospital for a bone graft about 30 years ago. I say that simply to show that my involvement in health care services in south-east London is both deep in political terms and personal in the way in which they have supported me and my family over many decades.

When we discuss health, and I am able to catch your eye, Mr. Deputy Speaker, I never lose the opportunity to point out that the Tory attitude to the health service is grossly compromised by the fact that the Tory party was against its establishment in the first place. All those years ago, the Tories opposed it.

Mr. Duncan Smith rose

Mr. Dowd : I will give way in a moment, but I am more inclined to give way to hon. Members who have been here for a considerable time, rather than to those who merely flit in and out.

The Tories are embarrassed because they opposed the establishment of the NHS. It has never been made plain at what stage that view changed and when they suddenly became its supporters. They would like us to believe that they are its instinctive and natural supporters, but the truth is very much the reverse.

Their experience is sad because the health service is the one area of public life in which the freebooting, rabid ideology of the right-wing element that holds the modern Conservative party prisoner cannot give that ideology full rein. It is the one area which accords most strongly with the highest ideals and fundamental needs of the British people, and the one area which affords the Conservatives the greatest difficulty.

Mr. Duncan Smith : I have been in a Standing Committee since the debate opened, which is why I was not present for earlier speeches. The hon. Gentleman says that the Conservatives were against the establishment of the health service, which is not true. The reality is that the doctors also opposed its establishment, yet we do not hear any condemnation of them, so the hon. Gentleman is making a spurious point.

Mr. Dowd : As most doctors are card-carrying Tories, it is hardly surprising that they opposed it. [Interruption.] That is my experience and recollection of 40 years ago.

Mr. McCartney : They are in favour of it now.

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Mr. Dowd : As my hon. Friend makes plain, their experience in the intervening 40 years has caused them to reconsider their view with some rapidity and regret.

To listen to Conservative Members, one would think that there had never been any reviews of the health service in London, or any changes in hospital formation and deployment. When I first joined the area health authority about 18 years ago, there were more than 16 hospitals in Lambeth, Lewisham and Southwark. Today, there are only four, or one quarter of that figure. That is why we were so concerned about the proposal to reduce it to three.

Change is an ever-present factor in London. It is bogus and completely bizarre for Conservative Members to try to pretend that that has never been the case and that they were the first to propose a far-reaching and dynamic view of Londoners' health care needs. Conservative Members have said that no change is not an option. They recite it like a mantra--I suppose that it keeps them happy. It is not an option in any walk of life. Change is permanent, especially in large organisations such as the health service, and it has to continue. Any competent manager in an organisation, whether public, private or any other kind, must consider its position in the changing circumstances of the world. Change is a perpetual element of the management of any service.

What we will not believe--but what we are being asked to--is that we must accept the Government's and the Secretary of State's recipe for what form that change should take. We resent that and we reject it. My hon. Friend the Member for Woolwich (Mr. Austin-Walker) mentioned the absence of a strategic health authority for London, although we seem to be moving slowly towards one with all the reorganisations under successive Conservative Governments. We are now down to two regional health authorities covering London--one in the north and one in the south. The next stage will be the transition to a single health authority for London, which will benefit from it. That regional view of health care needs will make the preparation and consideration of plans for London far easier.

Mr. Spearing : I think that we all want a London hospital authority that is directly accountable to Londoners. After all, London has a higher population than Scotland. However, does my hon. Friend agree that the North Thames and South Thames regional health authorities extend well beyond the London area, to the south coast in one direction and well into the south midlands in the other ? The Government are therefore not heading in the direction that we had both hoped.

Mr. Dowd : I thank my hon. Friend for that intervention. I was saying that there had been movement in that direction, and that the next stage would be to recognise that London has needs that cannot be dealt with in the same breath as Brighton's or Bedford's. However, I accept my hon. Friend's point.

The Tomlinson report was a substitute, because of the lack of an organisation able to give that strategic view. Tomlinson was forced on the Government because of the colossal damage that was being done to the acute sector of the health service in London by the so-called reforms and the emergence of the internal market. As my hon. Friend the Member for Islington, North (Mr. Corbyn) said, the Conservatives have wasted the opportunity that that report provided.

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I was a member of the health authority when the flagship trust of Guy's and Lewisham was created. The Lewisham end of the operation was certainly told that it could survive only with a closer, umbilical link with Guy's, and that if it tried to go it alone, it would have no future.

There was a totally bogus consultation exercise. The health authority, of which I was a member at the time, undertook that the consultants would each be given a vote on whether the Lewisham and Guy's trust should be created in 1990. They were asked whether they wanted the flagship trust to be established.

Some of us managed to get a second question put on the ballot paper. We asked whether the Government's planned reforms of the health service would be in the best interests of patient care. The consultants--highly skilled and knowledgeable people, who one imagined knew what they were voting for-- voted by a majority of two to one for the formation of the trust, which subsequently came to pass. About 200 or so took part in the ballot.

However, they voted by four to one against the premise that the Government's proposals to change care would be in the best interests of patients. I felt, to put it mildly, that it was an act of considerable hypocrisy, but they felt that they could do naught else.

The flagship set sail, but we now know what came to pass. The flagship has been scuttled ; it was sailing under a flag of convenience and nothing more. When a greater imperative fell upon the Department of Health, it decided that Guy's needed to go in with St Thomas's. However, as I said on the last occasion that I spoke on the matter in this Chamber, the Guy's and St Thomas's merger was nothing more than a mask for the closure of one of the two. We now know which one.

It also decided that Lewisham was well placed to go it alone. The recommendation said that it was extremely well placed to survive as an individual, independent trust, which is the very reverse of what it had been told not three years before by exactly the same people. Either they were lying in 1990 or they are lying now, because both cannot be true

Mr. Deputy Speaker : Order. Will hon. Members on both sides forget the word lying ? As I have said before from the Chair, it leads us all into difficulties, and there are ways to rephrase it.

Mr. Dowd : Very well, Mr. Deputy Speaker. I accept your admonishment. Both statements could not have been true, as they were only three years apart.

I heard the Prime Minister mention Lewisham hospital in glowing terms today, as did the Secretary of State. Their optimism and their glowing remarks were not founded on one whit of knowledge about what is happening there.

I wrote to the hospital on behalf of a constituent who was waiting for an operation. Sadly, although the constituent was in pain, having waited a considerable time for treatment, the case was not out of the ordinary. The final paragraph of the letter that I received from the consultant ear, nose and throat surgeon says :

"In the light of the Secretary of State's recent announcements regarding Health Service provision for London, I would suggest that you join the campaign for the maintenance of medical and surgical beds in our vicinity as the problem for delivering services to your patients will increase substantially. While this may only put a strain on the community for those patients with recurrent

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infections, it will undoubtedly lead to the premature death of others, permanent disability for some and great sadness for those who are their dependants."

I have a copy of a report from the chief executive of Lewisham hospital, who was given an NHS leadership award--whatever that is--not long ago. Apparently only nine were given out, and she was one of only three women to receive one. I have come to the conclusion that nowadays the upper ranks of the NHS--the world of senior managers and accountants--resemble the Mad Hatter's tea party, in that everyone wins and all must have prizes, while those on the front line providing care are given redundancy notices. That is certainly happening in Lewisham.

As both the Prime Minister and the Secretary of State went out of their way to say how enthusiastic people in Lewisham were about what is happening, let me read a small part of that report :

"From Lewisham's perspective, despite the continued confirmation of our secure future as a fixed point' in South East London, (as emphasised by SELHA, Tomlinson and the Secretary of State) the reality feels somewhat different. Over the last four years, we have made savings of between 4 per cent. and 7 per cent. per annum to live within the available income and to fund from our own resources . . . This has resulted in staff reductions each year--a difficult action for a busy hospital to take, but one which we continue to believe necessary given our commitment to improving the range and quality of services we provide, and the need for financial stability to avoid in-year problems. At the same time, the hospital's clinical workload continues to rise. Unlike other hospitals"

I hope that Conservative Members will pay particular heed to this

"we are not experiencing a drift of patients away from Lewisham, (reflecting the predominantly local nature of our workload) indeed we currently have the busiest A and E department and the highest proportion of emergency workload in South East London. Our frustration results from our being unable to see recognition and support for what we are trying to achieve in the context of an extremely fluid external environment. You will be well aware of the pressure Lewisham was under last winter--we have every reason to believe that this winter will be similar . . . Our frustration is encapsulated by the lack of a shared vision of how acute services should be shaped over the next few years . . . Our arguments for much-needed capital investment at Lewisham have been well supported, but there is no sense of how Commissioners will support this growing level of demand through contracts and income . . . We continue to believe that the service, quality and financial arrangements all point to the need to reduce the number of major . . . sites to three, but can understand the overwhelming lack of public confidence in this view, given the lack of recognition and support for the pressures that hospitals like Lewisham are facing even now."

Those are the people who were in the front rank in the establishment of trusts. They are the true believers, not the moaning Minnies and carpers ; they wanted to get on and make the new health care market work. That is what they are saying now about the position in which the acute services of south-east London's hospitals have been placed.

Much of what the Government have done in London has seriously undermined the principles of the national health service, and seriously shaken public belief in the kind of service that is being provided. A constituent of mine went, with his wife, to discuss the possible removal of a metal plate that had been inserted because of an earlier injury. They were told that that was not possible. In a letter, my constituent wrote :

"This has made my wife quite worried because no mention of these complications had been commented on previously. Of course one has to listen to the advice and have faith in their doctors but with all the financial and budget problems, especially

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at the end of the financial year, in the back of our minds we have this constant worry, is it really down to medical reasons" or, asks my constituent, is the non-removal due to lack of finances ?

That is typical of the doubts and suspicions put into the minds of patients by-- [Hon. Members :-- "You."] I was going to say, by the current disposition of the health service. Health service workers have written about it in the light of their own experience at a real hospital : real people are saying real things. If Conservative Members are too stupid to absorb that, I suggest that they go out of here more often, rather than less, and actually speak to some of those people.

Yesterday, I received a letter from my local general practice enclosing information received from the Guy's and Lewisham trust. It states :

"I am horrified to think that we are expected to behave in the way suggested by the Guy's and Thomas's Trust."

The practice wants to display a tariff brochure in the surgery. It resembles a holiday brochure : it shows all the possible medical procedures, giving the prices and even including the wholesale rates for bulk purchasing. It also wants to place a card in local surgeries, advertising the Guy's-St. Thomas's special deal for private patients. On the back is written,

"Please display this notice on your patient notice board." The GP says :

"It does not take much imagination to realise the massive bureaucracy which is being created to run all this. I remember when the Labour Party said the Health Service was being privatised they were laughed at. If this is not going a long way towards it I don't know what is. You may rest assured these brochures will wind up in my bin."

I will write and thank her.

The Government's problem with the health service in London is that, despite all the flannel and all the noise, Londoners do not believe them. The people of London realise what is happening to their NHS ; they know who is responsible. They will make the Conservative party pay a heavy price for the damage it has done to some of the finest centres of medical excellence anywhere in the world.

7.55 pm

Mr. Toby Jessel (Twickenham) : I shall return in a moment to the anecdotes of the hon. Member for Lewisham, West (Mr. Dowd), which did not impress me. I wish that he--like the hon. Member for Woolwich (Mr. Austin- Walker)--had referred to the greatest danger to health in London, which without doubt is smoking. According to the Government's White Paper, "The Health of the Nation",

"At least 80 per cent. of lung cancer is associated with smoking, some 26,000 deaths a year."

That would be nearly 3,000 in London.

"On top of this, the habit kills more than twice as many people than other diseases. It has been estimated that among an average 1, 000 young adults who smoke cigarettes regularly ; about one will be murdered, about six will be killed on the roads, but about 250 will be killed before their time by tobacco. Despite the substantial fall in smoking prevalence over the last twenty years, smoking remains the largest single cause of preventable mortality in England."

Ms Mildred Gordon (Bow and Poplar) : The hon. Gentleman is making a very good point, but can he explain why his Government refuse to ban tobacco advertising ?

Mr. Jessel : That is a matter for the whole House, and I hope that the whole House will support the private Member's Bill next month. It seems to me that in 50 or 100

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years' time future generations will think that we were absolutely batty to allow this poison to go on destroying so many young lives. We know from the Royal College of Physicians that, of every cohort of 1,300 15-year-olds in any constituency of whom a quarter smoke, a third of that quarter will, at the current rate, die from smoking or smoking-related diseases. We must get a grip : this is a cross-party matter, and I hope that we shall deal with it before long. The central point of the motion is whether London's health service cares properly for patients. So far, the debate has largely been on the producer side--about provision, money, the number of beds, buildings, institutions and how it all looks from the point of view of doctors and nurses, administrators and other national health service workers. There has been comparatively little in the debate about the consumer point of view--the point of view of patients. What patients want, above all, is to stay alive for as long as possible. We should not mince our words about this. We all have to die sometime, but most people want above all else to delay the onset of death. Death is the great enemy, and to defer it must be the prime object of the NHS. Nothing else, such as the control of pain, is anything like so important.

In the Gilbert and Sullivan opera, "The Yeoman of the Guard", the character Fairfax, who is under sentence of death, sings : "Is life a boon ? If so, it must befall That Death, whene'er he call, Must call too soon."

He was a young man who was awaiting execution, and sometimes the young say that they do not want to live over the age of 80. They may feel different when they are 79.

These days, thanks to better health in London and the rest of the country, far more people survive to reach old age. That is also true at the other end of the age spectrum. The infant mortality rate--the number of babies who die before they are one year old--was 11.2 per thousand in 1981. By 1991, it had dropped by one third to 7.4 per thousand. That is by any standard a substantial and significant improvement in the health of babies and in their survival rate. At the other end of the scale, the expectation of life for a person aged 70 is 11 years for a man and 14 years for a woman, and it is going up by nearly one year every five years. Deaths from pneumonia dropped by a half from about 54,000 in 1981 to 28,000 in 1991, and that is an enormous improvement.

In 1981, the year in which we brought in the compulsory wearing of seat belts in the front seats of cars--I played an active part in that, as you may recall, Madam Deputy Speaker--there were 5,500 deaths in car accidents. By last year, that had dropped to 4,500--a drop of about 20 per cent.-- despite a substantial increase in traffic in that decade.

The national health service in London, as elsewhere, has other objects-- preventing pain, respite care, care in minor illnesses and so on--but the prevention of death must always be the main one. The King's Fund report published in 1992--I have had a quick look at the report published in April, which does not in any way contradict the 1992 report--refers to the health of Londoners.

The report refers to the health of Londoners. It comes to some definite conclusions which have not been

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contradicted by anything that has come out since. The report says that the rate of mortality due to all causes within the capital is better than elsewhere. It also says that London districts have consistently and significantly lower levels of mortality from circulatory diseases, lung cancer, cervical cancer and motor vehicle traffic accidents. However, it also says that London districts have significantly worse records of mortality due to avoidable breast cancer and suicide. The report states that Londoners as a whole experience significantly fewer illnesses and symptoms as do residents of comparable areas, and that the overall health of Londoners is no worse--and may indeed be better--than that of people in similar parts of the country.

We all know how Opposition Members will react to such information. If they see that health is better in some way in London than in the rest of the country, they will argue that the rest of country is deprived. If they see that health in some other respects is better in the rest of the country, they will argue that London is deprived. Of course, it is impossible to bring about precise equality in the matters because there will be variations in the incidence of smoking or in the consumption of cholesterol -carrying food in different parts of the country. One is bound to get some variations.

It is established in the report that general health in London is no worse than in the rest of the country. What matters in the end is how healthy people are and what their prospects are for survival and for the avoidance of illness and pain, rather than building up the interests of professional people and institutions.

We know from the debate that the number of beds is no longer to be seen as a crucial factor in looking after any given number of people. It is little short of dishonest to make the number of beds the main yardstick.

That is partly because of the increasing amount of day care. I obtained today a comparison of day cases with all admissions at the West Middlesex university hospital--it is not in my constituency, but it serves it--which compared 1992-1993 with 1993-94. In gynaecology, 22 per cent. of cases were day cases--a figure of 666--in 1992-1993. In 1993-94, the year just ended, it had increased by a massive 32 per cent. to 54 per cent., and the number of day cases for gynaecological operations was 1,714.

I could give other examples, and I have picked the most striking one. In ear, nose and throat cases, 10 per cent. were day cases in 1992-1993. In 1993-94, they had nearly doubled to 18 per cent. An ever-increasing number of treatments require only day care, and do not require a patient to stay the night. For those treatments for which in-patient treatment is needed for acute cases, the patients often need a shorter stay than they would have needed 10, 20 or 30 years ago. A heart bypass operation will now often require a patient to spend 11 or 12 days in hospital, whereas 10 or 15 years ago the patient might have required 15 or 18 days in hospital. Smaller operations--either gynaecological ones which still require an overnight stay, varicose veins or hernias--very often entail a one-night stay in hospital, whereas a generation ago people went into hospital for three or four days. That is a major factor.

It is not just that the population of Greater London has declined by 12 to 15 per cent. in the last 30 or 40 years. That, I may say, is a secondary factor, although it is frequently cited.

I shall mention certain particular hospitals in which I am interested. The first is the Teddington Memorial hospital in my constituency, which is the smallest national health

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service trust hospital in the country. The amount of local support that it attracts is extraordinary. Its league of friends produced £2 million to augment the national health service provision for my constituents who use it. Kingston and Richmond, the local district health authority--the purchasing authority--has just agreed that it should provide all 49 of its beds as general practitioner beds, instead of the previous figure of 27.

Ten years ago, the hospital was going to close. I took a delegation to see the then Minister for Health, now my right hon. and learned Friend the Chancellor of the Exchequer, and he decided to intervene in the decision to close the hospital which had been made by what was then the Hounslow and Spelthorne district health authority. The hospital is now flourishing, and the support continues. its position as a trust hospital is provisional : it is on a two-year trial ; we have gone slightly over the first year of that trial. I draw its success to the attention of the Minister for Health and I hope that at the end of the debate he will say something encouraging about its future.

The other national health service hospital in my constituency, St. Mary's hospital, Hampton, is a smaller community hospital. Last month, I took a delegation to see the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville) about that hospital, which is not being provided with the support that it needs to continue providing GP beds. Its use is to be changed to provide care for the mentally ill, with priority given to mentally ill Hampton residents. The hospital has drawn tremendous support from its league of friends and local people. Will the Minister take a last look at whether its current use could be saved, as it is cherished and has tremendous community support ?

As the borough of Richmond has no general hospital, my constituents go to several different general hospitals outside the borough. I have already mentioned the West Middlesex University hospital. Some constituents go to Kingston hospital, Queen Mary's University hospital, Roehampton, Charing Cross hospital or Hammersmith-- [Interruption.] I believe that all those hospitals will survive. My constituents are intelligent enough to know that what matters is the treatment that they receive from the national health service and whether their illnesses will be cured so that they will survive and live to an old age. They see that the treatment is primarily provided by professional individuals and that the importance of buildings is secondary. I hope that in the rest of this debate, therefore, Opposition Members will show a little more appreciation for that common-sense point of view. When discussing health in London or any other part of the country, what really matters is the health of individuals who are treated by professionals.

We have made tremendous strides against waste in the national health service, but I still believe that more can be done. First, far too many people have cupboards and drawers filled with half-used bottles of medicines and pills. The British are a nation of medicine wasters. We need a change in culture and public attitude to that. The system of GPs holding budgets provides an incentive to GPs to be more careful not to prescribe wastefully. I wish to insult nobody in the medical profession : I have three doctors in my family, two of whom are GPs and I frequently argue

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that point with them and, in the end, they admit that I am right. Everyone knows that I am right. Too much medicine is wasted. Secondly, too much consultants' time is wasted. A consultant orthopaedic surgeon at the West Middlesex hospital told me recently that some 20 per cent. of the patients due to consult him are what an airline would call "no shows". A monstrous amount of valuable time of consultant orthopaedic surgeons or any other doctor is wasted by patients who are too idle, careless, inconsiderate or selfish to ring up and say that they cannot come so that some other patient can be slotted in. We should analyse the extent of that wasted time and try to achieve within the national health service a system of sticks and carrots to ensure that such patients are more considerate to other people who wish to make proper use of the time of consultant doctors.

I could say much more on this subject, but I know that other hon. Members are hoping to speak. I am grateful for this opportunity to address the House on the national health service in London. Longevity is increasing, health is improving, and Opposition Members should try a little harder to see the wood from the trees.

8.14 pm

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