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Mrs. Bridget Prentice (Lewisham, East) : I am both pleased and saddened to have an opportunity to speak in this debate on the national health service in London. I am pleased that Opposition Members have a chance to put London's case, which the Secretary of State has avoided for so long, but I am saddened that we should have to do so.

London Members could list case after case from our constituencies of people who have waited for months, if not years, for treatment, who have been returned to their homes too early, who have not been treated because of their age or who have been on waiting lists for too long because GP fundholders can jump the queue thanks to the two-tier health service. We could cite horrendous cases of people on trolleys in accident and emergency wards for hours on end, people whose coats have been used as pillows because insufficient pillows have been available and people whose families have had to provide food and drink because staff on the wards are too overworked to do so. There are examples like that every day of every week in London hospitals and Opposition Members are painfully aware of them. If they thought about it, Conservative Members, too, would be as aware. That is the state of the national health service in Europe's largest capital city. What an indictment of the Government's policies and the Secretary of State's handling of health in London.

I wish to look at the broad picture described by those who responded to the London Labour Members' inquiry into health care, and then say what is happening in my area. I shall not say how or why we conducted that inquiry, as that has been adequately covered by my hon. Friends the Members for Woolwich (Mr. Austin-Walker) and for Islington, North (Mr. Corbyn). Let me emphasise that London is not over-bedded, as both Professor Jarman and the Government's figures have pointed out. Will the Minister assure us that all hospital and bed closures will now cease so that a proper review can take place ? If the Health Secretary did that, she might restore some of her seriously diminished credibility in London.

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The Secretary of State made great play of funding for mentally ill provision in London, yet she totally ignored the Mental Health Commission's report, which said that there was a grave shortage of beds not only in inner cities generally but particularly in London. My hon. Friends the Members for Lewisham, West (Mr. Dowd) and for Lewisham, Deptford (Ms Ruddock) and I spoke last Friday to the chair and chief executive of Lewisham and Guy's Mental Health trust. They raised a number of concerns, the first of which related to disturbed children. They believe that they are reaching only one in 10 of the disturbed children in the local population. It does not take much imagination to work out the consequences of that. They were concerned about the serious blockages of beds and the problems that that raised and they were adamant that we must halt the reduction in the number of acute beds.

We asked those people directly whether there were enough beds for Lewisham's population and their answer was a categorical no. That has extremely serious consequences. A lack of beds means that voluntary admissions are increasingly difficult. That creates enormous problems not just for individual patients but for those who surround and support them. Lewisham and Guy's Mental Health trust said that it was forced to use private beds for people detained under the Mental Health Act 1983 and that 50 per cent. of the patients in Lewisham are detained under that Act, compared with only 7 per cent. nationally. Hither Green hospital in my constituency is part of the service that provides for those patients. Many such patients cannot get in Lewisham the in-patient treatment that they would get elsewhere in the country, so all the talk from Conservative Members about overprovision in London is simply not true.

The chief executive and the chair of the mental health trust also talked about forensic beds. They said that they had had to put nine people into private beds at a cost of £80,000 per person per year in order adequately to look after those people. Is that the best use of NHS resources in London ? I think not, and they think not. The chief executive and the chair said that they needed at least 15 more beds. That is not many to ask for, but it would make an enormous difference to the quality of care provided for our constituents.

The chief executive and chair recognise, as we do, that part of the problem lies not with the Department of Health but with the Home Office, which is transferring people from the criminal justice system into the health service without transferring the funds to go with them. What negotiations has the Minister or the Secretary of State had with the Home Secretary about ensuring that those funds are forthcoming ?

The Secretary of State berated us about accident and emergency units and mentioned in particular the accident and emergency unit in Lewisham and its funding. I shall return to that subject, but wish to mention a survey-- conducted by the Royal College of Nursing in January on overnight stays in accident and emergency units--which produced some horrifying results. Outside London, the chances of an overnight wait were one in five, but in London, 50 per cent. of patients were likely to stay overnight in an accident and emergency unit. The Royal College of Nursing's survey included representations from two London hospitals. The first stated :

"Two to eight patients stay overnight in the department every night, the waiting room has become a mini ward. Most patients

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wait about 24 hours for a bed. Recently, the problem has become worse due to bed closures."

Another London hospital stated :

"Four to eight people stay in the department overnight on a regular basis. The situation has become worse over the last few months, due to bed closures. The wait for a bed can be 24 to 36 hours."

Those problems are important because they have a direct effect on patients' health.

The Royal College of Nursing is concerned that waiting on trolleys in accident and emergency units will cause a deterioration in patients' health. It gives examples of the complications that arise due to pressure sores. It talks about the use on trolleys of mattresses that are not designed for long-term occupancy. It says that people who might have fallen and fractured their hip are well on the way to developing pressure sores before being admitted to an accident and emergency department, and temporary mattresses will exacerbate the problem. Such events are occurring in London hospitals day in, day out and night in, night out. I pay tribute to my hon. Friend the Member for Dulwich (Ms Jowell), who unfortunately cannot be here today as she is ill herself. She has done sterling work in studying what is happening at casualty departments throughout London's hospitals.

I shall briefly mention Lewisham and Hither Green hospitals. I shall not describe in detail the problems facing my constituents who have had to wait as operation after operation has been cancelled. I shall not go into the details of my constituent Mrs. Rew who, at 78 years of age, broke her arm and had to wait 31 hours without being told what would happen to her. She had little to eat and it was only thanks to the intervention of her daughter that any action was taken. I shall not go into detail about my constituent Mrs. Mountfield who suffered a detached retina during a cataract operation at Greenwich. Her general practitioner tried to send her to St. Mary's in Sidcup, but three weeks later she was told that she could not be treated there as she came from outside the area.

I want to nail the myth perpetrated by the Secretary of State about Lewisham's accident and emergency department. As my hon. Friend the Member for Lewisham, West said, it is the busiest accident and emergency department in south London, handling some 71,000 cases a year--40 per cent. of the total in the south-east region. The £4 million that the Secretary of State said was being invested in Lewisham's accident and emergency unit was invested only to cope with the extra expense needed as a result of the closure of other south-east London units.

Lewisham has the only 24-hour accident and emergency department for children--an important and unique provision. We must ask the Minister how Lewisham's accident and emergency department will cope when Guy's hospital closes. There is to be an expansion in capital projects at the accident and emergency unit. Where will the money come from to pay for the revenue costs of that unit ? Unless the Government fund those costs, we shall have an unused, empty white elephant. What good will that be to the people of Lewisham and beyond ?

How can Lewisham hospital be expected to provide the quality of care that we have come to expect when 70 staff--50 of whom are skilled and experienced nurses--are to be sacked ? My hon. Friends and I met the management of Lewisham hospital last week. They told us that they were £2.5 million adrift, which was why they were sacking

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nurses. They told us about the accident and emergency department, but said that they did not have the revenue to fund it.

I have mentioned the unique accident and emergency provision for children. Of the nurses to be sacked, two are paediatric night staff at the accident and emergency unit. How can sacking them improve the quality of care for children in Lewisham and beyond ? What will happen to the 24-hour service now ? Other nurses to be sacked include 12 grade E nurses who look after the elderly and younger disabled people at Hither Green hospital. They have been told that they will be sacked, but can apply for jobs as care assistants. There is something fundamentally rotten about a system that allows that to happen.

The hon. Member for Mid-Kent (Mr. Rowe), who is no longer present, talked about what most saps morale in London hospitals. What saps morale most is being handed a redundancy notice by a hospital that cannot match its budget. We know that the system is wrong. We have spoken to the commissioning agents and asked them to talk to the Lewisham trust to prevent the redundancies. We support the nursing and support staff in their fight to save their jobs, which is why we joined the demonstration yesterday. We are fighting to save those jobs, not just because the nurses and support staff deserve to keep their jobs but because we do not believe that the people of Lewisham will benefit if the jobs disappear. On the contrary, their health care provision will become decidedly worse.

As in life, much of politics is about perception. The perception of the people of London is that the Government are incompetent and do not care about their needs or aspirations. Their perceptions are the same as those of the members of the Royal College of Nursing, who today described the Secretary of State for Health as blind and deaf to the needs of the health service. Their perceptions tell them that the Government cannot and will not look after the national health service in London. Their perceptions tell them that they can no longer trust the Government with their health service. That is why they will vote against the Conservative Government and the Conservative party next week.

8.28 pm

Mr. James Clappison (Hertsmere) : I welcome the opportunity to participate in the debate. I intend to draw the focus of the debate on to outer London health and hospital services whose voice has not been sufficiently heard so far in the debate. I particularly want to mention the outer London hospital, Barnet general hospital, which serves so many of my constituents in south Hertfordshire. We have had a debate on inner London health services and the strategic arguments relating to them. I welcome the fact that we are having a debate about the health service in London, which comes on top of the long-running debate about inner London's hospitals and acute care in inner London. When I saw that the debate was tabled for today I thought that it was not a complete coincidence that it should take place at approximately the same time as the local government elections. My suspicions increased when the spokesman for the Opposition in today's debate was not the health spokesman, but the transport spokesman and the co -ordinator of Labour's London elections.

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My suspicions were confirmed in greater force by the contribution of the hon. Member for Holborn and St. Pancras (Mr. Dobson). I was surprised by the extent to which he totally ignored all the familiar strategic arguments about the future of London's health care which were put forward in the Tomlinson report, the King's Fund report and the 18 other reports. Instead we had a ramble, familiar to connoisseurs of pre-election Labour efforts, around Labour's over-emotional and over-hyped approach to the health service. Many of the hon. Gentleman's arguments were not ones which I have come across before in the debate. He took even my breath away when he made a comparison between the health service and the police force, because I have not seen such a comparison in any of the reports or debates. If that is the sort of grasp of strategic comparison that the hon. Gentleman has, in the highly unlikely event that--heaven forbid--he were ever to be Secretary of State for Transport, I would have to make preparations to travel from Hertfordshire to Westminster by passenger ferry. His remarks were out of this world.

I suppose that I should have been on my guard when I saw the Labour motion for today's debate. Anyone who is familiar with the debate about London's health services will know that primary care lies at its heart. Today, the Labour party managed to frame a motion for this debate which omits primary care altogether. I am pleased that the amendment proposed on behalf of the Government, for which I will willingly vote, highlights primary care. It is absolutely right that primary care should be the starting point for a debate about inner London health services.

I agreed with some of the contribution of the hon. Member for Islington, South (Mr. Corbyn) when he spoke about health status and health conditions in London. However, he did not go on to make the connection which I think that he could have made between those conditions and the state of primary care in London. That connection has been acknowledged not only in the Tomlinson report but in many of the other 18 reports released over many years.

Primary care in London lags well behind primary care in outer London and in the rest of the country. Those people who seek primary care in inner London are likely to be seen by a single general practitioner who is likely to be older, whose premises are likely to be much more inadequate than those in other parts of the country, and who is less likely to be able to offer them the same sorts of preventive measures and other forms of health care as general practitioners in other parts of the country are able to offer. Primary health care measures such as minor surgery, screening, and immunisation for children are much less prevalent in inner London. I think that that important fact should be highlighted in this debate and the starting point of the debate should be how we will improve primary care.

The hon. Member for Woolwich (Mr. Austin-Walker), who has been assiduously following the debate, posed the question : is there any link between primary care and the use of acute services in inner London hospitals ? He said that he did not think that there was a link. In his absence, I hope that he will not mind if I address the point. I asked the same question when, as a member of the Health Select Committee, I heard Sir Bernard Tomlinson give evidence. I should like to draw the attention of the House to Sir Bernard's reply to me in that hearing. He said :

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"If primary care in London were readily accessible to more people, you would certainly relieve the intolerable strains we have witnessed in some A and E departments that are almost daily filled to overflowing. The seriousness of that is not that those that are there really for primary care cannot be dealt with adequately but that patients who really have pressing needs may have to wait a very long time to be seen."

He concluded :

"We do think there is a strong assumption that can be made that better primary care will deal with patients who, under circumstances of poor primary care, may well require hospital admission." There is plenty of other evidence to support Sir Bernard's contention. I invite Opposition Members to look at the consequences of the absence of proper primary community care at the other end of the admission spectrum. There is plenty of evidence that the absence of adequate and effective primary and community care delays discharge from hospital. It has been estimated that between 15 and 30 per cent. of those who occupy acute care hospital beds in inner London could be cared for in more appropriate settings if they were available. An improvement in primary and community care must occur. Such care is a more effective use of resources and it is better treatment for the patients concerned. Inevitably, that will create a change in the pattern of provision of health services in London and will reduce the demand for acute services.

As both Professor Tomlinson and the other reports have pointed out, at the same time other factors are likely to accelerate the trend towards a decreasing demand for acute services in inner London. My hon. Friend the Member for Broxbourne (Mrs. Roe) drew on her great experience as Chairman of the Health Select Committee. She told the House about some of the visits that the Committee had made to hospitals in London and some of the technological advances Committee members had seen. I was privileged to take part in some of those visits as a member of the Committee and I agree with everything that she said about the effect that changing technology and greater efficiency will have on patients' length of stay in acute health care.

I would go perhaps even further than my hon. Friend. There is very strong reason to believe that the changes will be more pronounced in London than in the rest of the country because there is greater scope for such change in London. The King's Fund report, which has been mentioned in other contexts by Opposition Members, highlights that. The report found that

"such changes will affect all hospitals, not just those in London, because already the capital is tending to lag behind in terms of efficiency and so the scope for productivity gains is that much greater. This is by far the most significant factor identified by the Tomlinson report as impacting on the required number of beds in London. It also plays a key role in the report by the King's Fund." I draw the attention of the House to the flow of patients into London. Opposition Members have made some derisory comments about that flow, saying that it is part and parcel of the much- derided internal market. But we did not hear a great deal of hard evidence from them about the flows and the most effective way of treating patients and deploying resources.

I invite my right hon. Friend the Minister to consider the fact that 21 per cent. of acute care beds in inner London hospitals are occupied by patients who come to inner London from outer London and outer Thames districts for acute care. Half that 21 per cent. are going into non-special health authority hospitals for the sort of routine acute care which could be available in the outlying areas. I think that

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that is a misapplication of resources when the cost of treatment in London, as we have heard today, is 46 per cent. higher than it is in outer districts.

That brings me to the fate of Barnet general hospital, which is of great interest to my constituents. There has always been a very strong case for the redevelopment of Barnet general hospital and I believe that that case is made even stronger and more compelling by the fact that patients will go to outer London hospitals for routine surgery when they might otherwise have gone to inner London hospitals.

The case for Barnet general hospital is a long-established one. It goes back more than 25 years when plans were first drawn up for redevelopment of the hospital. Since then, it has become something of a saga in the health service. Those plans did not come to fruition, which caused great disappointment. It was felt that other priorities took precedence ; but local people in Boreham Wood, Potters Bar and Barnet thought that progress had been made when the Health Minister wrote to Barnet community health council as follows :

"We are all aware of the pressing need for better hospital facilities in the Barnet area. It is the economic situation we face which prevents us remedying Barnet's particular difficulties." That Minister was David Owen, writing in 1975.

Since then, the redevelopment of Barnet hospital has been a continuing saga. Finally, last year, the Wellhouse Trust, which had become responsible for Barnet and Edgware hospitals, produced a proposal for the redevelopment of Edgware hospital, for the closure of the A and E department at Barnet and the transfer of patient services from there. The hon. Member for Holborn and St. Pancras got his facts wrong about that, incidentally.

Since then, there has been a change of heart by the Wellhouse Trust, and that has been widely welcomed in Barnet and my constituency. Fresh proposals have been introduced by the trust, involving a major redevelopment of Barnet hospital. I believe that they do justice to the health needs of the people in Barnet, in Hertfordshire and in the parts of Enfield that are also served by the hospital. All this is certainly in line with the long-term strengths of the hospital's case.

As one of the hon. Members, along with my hon. Friend the Member for Chipping Barnet (Mr. Chapman), who supported the case for Barnet's redevelopment, I might add that a crucial factor in favour of Barnet hospital has been the role played by the purchasing health authority, which did not accept the Wellhouse Trust's original proposals. I pay tribute to the role played by the South West Hertfordshire district health authority, which took soundings of local opinion, took a view of local health needs and acted accordingly.

I believe that the purchaser/provider split played a significant role in this. Indeed, I wonder whether, without it, the trust would have accepted change so readily. Strong purchasers certainly have a great deal to offer the health service.

I urge the Minister to consider the case of Barnet general hospital and the case for outer London provision. Above all, I invite him to think about the long-term strategic factors affecting the shape of health care in London. It is not an easy subject. There are many temptations for politicians to use the opportunities presented by change such as this. Today, the Opposition succumbed to those temptations. It is interesting to note that their health spokesman was banished from the Front

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Bench today. Could that be because he said that the status quo was no longer an option, while the rest of the Opposition still argue against change ?

At Question Time today, the Leader of the Opposition came along to say that the Tomlinson report was discredited. Perhaps he and the hon. Member for Holborn and St. Pancras, who also derided change, should have consulted Labour's spokesman for health in the House of Lords, Baroness Jay, who said not long ago that

"nearly everyone who has looked at London's health services agrees with Sir Bernard Tomlinson's general conclusion that some rationalisation and reorganisation should occur."--[ Official Report, House of Lords , 13 December 1993 ; Vol. 550, c. 1221.]

The question is : will the Opposition listen to her ? Will they listen to Sir Bernard or read any of the reports that have been drawn up ?

Of course, Opposition Members are not interested in listening ; they are interested in whatever advantage they can extract from manipulating opportunities before the local elections. They will, however, not gain a single vote as a result of their efforts today. They have merely damaged even more their long-term credibility as a party genuinely concerned about the health needs of Londoners and of outer Londoners.

Opposition Members have indulged in some badinage about Conservative Members who may lose their seats. The electorates of my constituency, Barnet and many other parts of outer and inner London will be unimpressed by the way the Opposition have sought to use this debate.

8.44 pm

Ms Glenda Jackson (Hampstead and Highgate) : Perhaps, in the light of the closing remarks of the hon. Member for Hertsmere (Mr. Clappison), this would be an opportune moment to introduce a voice not much heard in today's debate--that of the patient, the user of the national health service here in London.

A pensioner constituent of mine wrote about a hip operation as follows :

"Admission was cancelled on December 21 1993 and on February 15 of this year. I was admitted on March 15th . . . At about 11 am on the next day I was given a Pre-med. When I woke up about 90 minutes later in the ward I was absolutely horrified to discover that my hip was untouched by human hand! The next day I was sent home."

In response to a letter from me, the chief executive of the Royal Free hospital trust in my constituency, where this occurred, wrote :

"The decisions to cancel your first two admission dates on 21 December 1993 and 15 February 1994 were taken because . . . the Consultant Orthopaedic Surgeon had to admit other patients as emergencies from our Accident and Emergency Department."

That, in essence, refutes the arguments adduced by the Conservative Members who actually took this debate seriously and did not attempt to use it purely for party political purposes.

The hon. Member for Hertsmere mentioned the King's Fund. Perhaps he missed today's report in the Evening Standard , which said that the King's Fund Institute has discovered evidence that, far from a £70 million overspend in London, London is underfunded by almost £200 million.

The one thing Londoners can be sure of is that, since the Secretary of State published her document "Making London Better", waiting lists have grown longer, proposed hospital closures have come thicker and faster, A and E units have disappeared, the number of doctors and nurses

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has decreased while the number of managers has increased, and, far from the capital becoming better, evidence is growing at an alarming rate to show that health provision in our city is becoming worse. In my North East Thames region, acute hospital beds have decreased in number by 34 per cent., from 13,644 to 8,959. Department of Health figures show that in December 1993 there were 106,026 people waiting for hospital treatment, 12,805 of whom had waited more than 12 months.

Percentages and figures in thousands have become almost meaningless. My worry is that the Secretary of State in particular has lost sight of the fact that these numbers are made up of real people--a concern exacerbated when I heard today what I considered one of the most shameful performances ever by a Secretary of State at the Dispatch Box. It was shameful in its total lack of concern for the real needs of Londoners--and the most vulnerable Londoners at that. In evidence given to the Select Committee on Health on London's health service, on Wednesday 2 March 1994, the Secretary of State asserted that among the overall objectives announced in "Making London Better" was that of preserving and enhancing London's reputation as a centre of excellence for treatment, teaching and research. As ever, Tory words are belied by Tory actions. It took a campaign organised and supported by patients, staff and hon. Members of all parties to ensure that the renal unit at the Royal Free hospital in my constituency was retained-- this the hospital where the first successful kidney transplant in the world, outside the United States of America, was performed. That was despite the recommendation from the London implementation group--put in place by the Secretary of State--that it should be moved. The Royal Free is still waiting to hear whether its cancer, cardiac, paediatric and haematology units will be saved. Perhaps the Minister will answer that point directly tonight. Those threats are particular to the hospital in my constituency, but there are equivalent threats hanging over all London hospitals and the ensuing anxiety and drop in morale is felt not only by the doctors, nurses and ancillary staff, who give far more than a fair day's work for the far from fair day's pay allowed them by the Government, but also by patients.

In response to a question from the hon. Member for Belfast, South (Rev. Martin Smyth) during the same Select Committee debate on London's health, the Secretary of State said :

"There is no doubt at all in the NHS all emergency and serious cases must be seen immediately indeed 47 per cent. of the work in London is admitted at once".

Setting aside the fact that presumably 53 per cent. of the work is not, that reply would be no comfort to my constituent, who is 71 years old and, having had an operation cancelled three times, wrote this to the Secretary of State :

"It seems likely I shall predecease my hypothetical next appointment. Is this perhaps what your department means by market forces ?"

The letter was passed to Charles Marshall, chief executive of the UCH Middlesex hospitals, to whom my constituent had also written direct asking :

"Are there beds or not ? Ministers seem to believe that the number of beds is excessive. If so, why are so many people still awaiting treatment ?"

Mr. Marshall's reply was :

"Whether there are enough beds or not is . . . a moot point. We are of course delighted to provide as much care and open as many

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beds as the district health authorities wish to purchase. They, however, are subject to cash limits and are unable to authorise us simply to respond to demand. The result is that there is an element of rationing in the system."

That is rationing care, not on the basis of need but on the basis of health authority purchasing power. The Government's initial error in pursuing the policy of an internal market for health provision is patently failing to deliver--not only to the individual patient, but to that patient's family.

A mother in my constituency had her operation cancelled. The cancellation of that operation affected not only her but her husband and her two young sons. Her operation was finally rescheduled only to be cancelled on the day she was admitted. Her husband works as a waiter and has no time off with pay, but had managed to agree unpaid leave to look after the boys and his wife during the period of bed rest that doctors said was vital for her after the operation. I am happy to say that my constituent has now had her operation. Many health care professionals in my constituency responded to the Labour party survey on the health service in London, including the professors of preventive medicine at Bart's, of leukaemia biology at Hammersmith, of thoracic medicine at the Royal Brompton and of surgery at the Royal Marsden, the consultant physician in intensive therapy at Bart's, a consultant at the Elizabeth Garrett Anderson hospital, and several local general practitioners, including the chair of the Hampstead GPs forum. Those GPs, doctors and consultants to a person concurred with Michael Laurence, president of the orthopaedic section of the Royal Society of Medicine, when he said :

"It must be generally appreciated that a national health service is precisely what the word means, a service--not a business. It requires a communal decision by a population to do the best for every member of that population."

I should like to read a short paragraph from a letter from one of my constituents who is a doctor :

"I feel now much as the ancient Romans must have felt as the vandals, who understood little of the culture of the city, rampaged through, leaving much destruction in their wake. The aim of the NHS was, and I hope will be, to treat the sick when necessary . . . My grandfather, who was a general practitioner in Liverpool at the introduction of the NHS, thereafter refused to treat private patients in case they thought they were getting a better deal."

What a change all those of us who can remember the NHS being introduced have lived to see.

One of my constituents reminded me just how significant the creation of the NHS was for the vast majority of people in Britain. "You cannot imagine, Miss Jackson", she said,

"What it was like before when you had to wait to guess how ill your child was before you called the doctor because you were worried about his bill."

The NHS lifted that worry and the fear that it will return makes those of us in London fight so hard for what we still have. In her shameful speech, the Secretary of State referred to issues in local elections as though they were not part and parcel of the struggle that is taking place in London to preserve the basics principles and tenets of the NHS.

London needs its hospitals, its general practices and its primary care, but good health for London requires more than that. Londoners require a home that is warm and dry and a job to pay for decent, nourishing food ; a job that can pay for warmth and for the prescription charges that the Government have raised so often since coming to office. They need a job that can pay for eye tests, spectacles, dental check-ups and treatments ; a job that is carried out in

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conditions that do not in themselves endanger health. Our older citizens need a pension that does not force them to make a choice between food or fuel and an environment that is not hazardous to health, causing all manner of chest complaints.

As our capital city, London has the problems that face Britain but on a larger scale. Londoners do not suffer from different medical conditions from citizens in the rest of Britain. They do not need different operations or different doctors, nurses or anaesthetists. The high standard of health care and the jobs and homes that Londoners need and deserve are vital, too, for those others in cities and towns across the country. To provide those things for Londoners, they will have to be provided for all in Britain. I regret that they will not be provided by the present Government.

In February this year, I wrote again to my 72-year-old constituent who had been in correspondence with the Secretary of State for Health to ask whether he would like to contribute to the Labour party's health survey. A few days later, I received the following reply : "You sent your questionnaire to my husband but he was not well enough to respond and he has in fact died early this morning in Edenhall Marie Curie Centre, Lyndhurst Gardens. While he was there his consultant discussed it with him and took a photocopy. This is enclosed here and filled in by his doctor. It also represents my husband's views and mine. The subject is too serious for us to ignore".

How many other institutions in this country are so admired, revered and wanted that a widow would take the trouble to write to her Member of Parliament in its defence on the same day as her husband died ? If the state of the NHS in London is too serious for her to ignore, the Government have no excuse for their behaviour, for the scandalous scythe they have wielded, and are still wielding, through London's health service.

8.57 pm

Mr. David Congdon (Croydon, North-East) : Anyone listening to the speech of the hon. Member for Hampstead and Highgate (Ms Jackson) or to the speeches of many other Opposition Members might find it easy to forget that the national health service is spending more than £100 million a day and is treating 8 million patients a year in hospital--1 million more than in 1990-91.

All that the Opposition can do is trot out examples of individual patients being treated badly. No hon. Member wants to see people getting less than good-quality care from the health service, but why do Opposition Members fail to quote the many excellent examples of good care that occur in the capital day in and day out ? It is all too easy to find the odd bad example here and there and to forget the good ones. Even the hon. Member for Dulwich (Ms Jowell), who was unfortunately in hospital recently, had to say that she had been given good care. But she could not resist the temptation to carp about other aspects of the national health service.

As a London Member of Parliament, I am particularly interested in health issues, including the funding for health care in London. Despite the fact that some Opposition Members have sought to muddy the waters, it is beyond doubt that massive excess resources are put into the NHS in inner London. Available information shows that the expenditure in inner London is £603 per person, compared with £415 in outer London. Surely those figures themselves demonstrate the need to consider some change.

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Other hon. Members have referred to general practice or primary care services and have pointed out that London does comparatively badly, with a per capita expenditure of £124 compared with £132 elsewhere. It is for those reasons that we need change in London. As my hon. Friend the Member for Hertsmere (Mr. Clappison) has pointed out, successive reports have shown that London has too much money tied up in expensive teaching and specialist hospitals. The pressures for change cannot be resisted any longer.

Even The Guardian --not a hotbed of Toryism--had to comment back in January 1993 :

"Similar ideas in 20 reports going back over 100 years have been aired. Successive Labour Governments"

that is a long time ago

"have unsuccessfully pursued similar goals since the 1968 Royal Commission concluded that London's medical schools were too fragmented and isolated. . . . Only the ideologically blind" that must be a reference to Opposition Members

"are refusing to recognise the truth, set out last year in 12 volumes of research by the King's Fund, that London's health facilities do need to change and the present surplus cannot be allowed to continue."

It is against that background that this debate should be taking place.

The pressures for change, which have existed for a very long time, are compounded by the very significant improvements in surgery techniques, which have led to much greater use of day surgery. My hon. Friend the Member for Broxbourne (Mrs. Roe) referred to the situation in her area. Many procedures are now possible without invasive surgery. That has led to much reduced lengths of stay in hospitals in London and elsewhere.

Another very good trend, as part of the health reforms, is that more people can be treated near their homes.

All those factors show that fewer beds are needed. Opposition Members will rightly point out that there does not appear to be a surplus in London. It is true that there are problems in some parts of London. It can be difficult to get patients into some hospitals. Indeed, the less well- developed primary care is part of the difficulty, and we must strive to provide a solution. As my hon. Friend the Member for Hertsmere said, people go to accident and emergency departments when they could see the local GP.

Hospital beds are also clogged up with people waiting to be discharged. All that puts excess pressure on beds and demonstrates that we must get the balance right in London.

I congratulate the Secretary of State on taking courageous steps in terms of strategy. Because of the problems in the relationship between primary and secondary care, it is right to proceed with caution and to remember some of the warnings in the Tomlinson and King's Fund reports to the effect that changes must be implemented over a reasonable time scale.

I want to look briefly at the issue of resources for health care in London. I accept the argument that London should probably expect to have a higher than pro rata share of resources because of increased pressures there. However, it is hard to argue that London should consume 20 per cent. of resources for 15 per cent. of the population.

Recently, I was very disconcerted when the Evening Standard --no friend of the health service in London, so far as I can see--decided to leap with glee on the answer to a parliamentary question from the hon. Member for Dulwich, which appeared to show that London was not

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