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Mr. Alan Keen (Feltham and Heston): I congratulate my hon. Friend the Member for Leyton (Mr. Cohen) on securing this debate. However, bearing in mind the Government's record on listening, I could not help

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thinking that he might as well have been speaking in an obscure language from the "Orient" for all the notice that the Minister will take of his well-crafted speech.

I shall speak a little about my local hospitals in west London, make a few points about the very important hospitals in central London, and then make one or two general points.

My constituency contains no hospitals, but it is very well served by Ashford hospital, which is about half a mile to the west. I compliment the staff and management of that hospital on the service that they provide for the public.

I should like to remind the House how trust hospitals were formed. Ashford hospital, which I presume was following Government guidelines, held consultative meetings to ask the public whether they wished it to become a trust. At those three meetings, the vote was overwhelmingly against trust status, but the hospital proceeded to form a trust board.

I made several points at all of those meetings, and asked whether, before the issue was decided, we could see the business plan that was being drawn up. I was told that we could not, because businesses did not allow competitors to see plans. Although I could understand why ICI would not show its business plans to Du Pont, I pointed out that the shareholders in the health service were the general public, who were paying for it and were entitled to see those plans.

Co-operation and partnership between hospitals is surely more productive than drawing up secret plans and they have to be more productive than one local hospital seeing how it can best damage another in order to keep itself to the fore.

I asked several other questions to which I received no satisfactory answer. At the final meeting held at Ashford hospital, there were only 20 votes for trust status, and about 90 against. One of those who voted in favour was the chairman of the local health authority. She was sitting with a group of other people, who I presume were also managers in the local health authority. I calculate that probably only three members of the public voted for trust status, and that all the 90 who voted against were members of the public. However, that fact was not taken into account, and Ashford became a trust hospital.

We thank goodness that the hospital is still going strong, and credit for that is in some measure due to the hon. Member for Spelthorne (Mr. Wilshire). When the Government were trying to stop the hospital signing a contract for building work, after it had sold part of the land for a Tesco development, he told the hospital to go ahead and sign the contract, and not take too much notice of the Government. We thank him for that.

Ashford was not a strong hospital and we feared that competition would reduce its status and set it on a slippery downward slope. Our fears were strengthened when the health authority later laughingly undertook consultation to ask whether Ashford should be transferred from North West Thames health authority to Surrey. Of course, the answer was an overwhelming no. We felt that the North West Thames authority purchasers' loyalties to Ashford would diminish, and that Ashford would not enjoy any loyalty from Surrey.

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It was not long before we discovered that Ashford hospital was under great threat from St. Peter's hospital in Surrey. My son was born there 24 years ago. I lived in Surrey at that time, but I did not know where St. Peter's was until I had to make my first visit. My constituents who do not have their own transport would find it impossible to get to St. Peter's. Thanks to a marvellous campaign by people in Surrey and in my area, both hospitals are now to be kept open. It is vital that people have accident and emergency services, but it is just as important that they have a local hospital, because one of the main factors in patients' recovery--especially that of older people--is visits from partners and relatives. Hospitals must be based where the patients are, not where the money goes.

The hon. Member for Edmonton (Dr. Twinn) says that he has found that money follows the patients. From at least half a dozen letters in the past two years, I know that that is not, unfortunately, always the case. Often the patient has to follow the money. I have had letters explaining that relatives who have a serious illness desperately want to be treated in a hospital in my area because that is where their family reside. Their specialists want them to be treated in the area and are happy to take them on, but the money is not available from their home base for them to transfer. Too often it is a case of patients having to follow money rather than the other way round.

I have been extremely disappointed to find that not one of the directors on the board of the Ashford hospital trust lives in my constituency, despite the fact that at least one third of the patients at the hospital come from the constituency. Not one director lives in the borough of Hounslow, an even wider area. If a public limited company appoints a non-executive director to its board, it appoints him or her to represent the shareholders. If the Prudential appoints somebody, his or her role is to look after the Prudential shareholders. I remind the Minister that the shareholders in the national health service are the public and the potential patients at the hospital.

When non-executive directors are appointed to a trust board, the people concerned should be the representatives of the patients and the people in the area, not people with specialist knowledge in some aspect of management. That flaw must be corrected, and I hope that it is being corrected.

I have some slight hope. I was recently contacted by the board because there is a vacancy and the board is allowing me at least to make a recommendation. We shall find out whether any notice is taken of it.

The non-executive directors should represent patients. There is now no democracy in the health service and we desperately need representation for patients rather than the provision of extra expertise. ICI does not employ non-executive directors for its personnel and marketing needs: it employs specialists full time. That is what we want to see.

The right hon. Member for Chelsea (Mr. Scott) said how expensive Chelsea and Westminster hospital was. It was and is expensive. It is especially expensive for the other hospital that serves my constituents--the West Middlesex hospital. A good few years ago, we were promised that, when the South Middlesex site was sold--again, to Tesco--the money would go into the revamping

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of the West Middlesex. The hospital used to be a workhouse and some of the original buildings still remain today.

I ask the Minister to undertake, when he sums up, to hurry up the rebuilding of the West Middlesex. The hospital has raised £10 million itself by selling land. It is important that the rebuilding is pressed on with as quickly as possible, not only for the patients, but to try to recover some of the staff morale which has taken a fair dip recently as the delay has gone on and on. Following Government guidelines, the hospital raised the £10 million itself. I ask the Minister please to see whether he can hurry along the rebuilding. The Chelsea and Westminster hospital is expensive. I have heard--I hope that the Minister can confirm this later--that the Charing Cross hospital, which serves my constituents to an extent, is being plundered for equipment which is then being moved to the Chelsea and Westminster hospital, which should never have been built, as most people recognise.

The West Middlesex hospital rebuilding programme again shows the Government's short-termism. If the £10 million can be spent, £2.5 million will be saved on running costs. At the moment, there is a need to duplicate services in different parts of the hospital because it is on such a large site. We want the rebuilding to be pressed ahead with as quickly as possible.

We all know that, in many of its specialties, Hammersmith hospital is a world leader. We have seen damage to the research teams at Hammersmith because of the uncertainty of the past four or five years. We were all glad when no decision was taken to close either Charing Cross or Hammersmith; we were pleased when it was decided that they were both to be kept open. However, that has not really solved the problem.

We want a definite statement that both hospitals will remain open. We need accident and emergency facilities at both hospitals; that is vital. We must take action as quickly as possible to preserve the research teams who do work that serves the whole world, not just Britain.

I have some simple, basic points to put to the Minister in the form of questions. Why do we have to sell every piece of grass and every bit of shrubbery to raise money for further building at hospitals? Why do people at a time of greatest need have to visit hospitals where there is only concrete and brick? The hospitals could have retained some of the decent surroundings. It is a scandal that we have to sell off so much land.

What will be done to put some democracy back into the health service? What in the world is the purpose of a system that allows a health service trust- -Premier Health, based in Staffordshire--to tender for the provision of community care throughout Britain? There is no doubt that, with community care, which is labour-intensive, the only savings one can make are by getting district nurses to run faster and to drive their cars faster. Community care is labour-intensive, and the labour involved is skilled labour.

The district nursing sisters have years of experience. They are often the only people who visit those in community care. General practitioners do not visit many of those patients. It is up to the community nurses to notice signs of deterioration in their patients' health or to see that things are going okay. We cannot afford to

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de-skill by getting rid of those experienced sisters, yet that is happening throughout the country, and it will happen where Premier Health is quoting.

We cannot afford to replace those community nurses by newly qualified nurses coming out of hospitals. We need those skilled district nurses. I ask the Minister to give us a quick answer to those questions when he replies.

11.27 am

Sir Michael Neubert (Romford): The speeches this morning by my right hon. Friends the Members for City of London and Westminster, South (Mr. Brooke) and for Chelsea (Mr. Scott) show what an access of strength and influence has come to central London as a result of my right hon. Friends' return to these Benches. I am indebted to you, Mr. Deputy Speaker, for giving me the opportunity, as an outer London Member, to contribute to this important debate.

There is no doubt that the health service is of prime concern to my constituents in Romford, second only to their economic well-being. It is no surprise that, in consequence, we have a very full attendance of London Members for this debate initiated by the hon. Member for Leyton (Mr. Cohen), to whom we must be grateful for providing this relatively rare opportunity to discuss London strategy.

My contribution relates to Oldchurch. For most of my constituents, the national health service is represented and embodied by Oldchurch hospital. There is generally a high degree of satisfaction with the health service in my part of London. It is just as well there is. I have to tell my hon. Friend the Minister, whom I also welcome to his new responsibilities this morning, that for many people the health service is the criterion by which they judge the Government. My constituents generally have few complaints about the treatment they receive under the NHS. The complaints I receive are in the main about their failure to get treatment sufficiently soon. There are still two or three specialties in which there are unacceptably long waiting lists in my part of the world.

Unhappily, I have to report that Oldchurch is, once again, under threat, as it has been for many years. Oldchurch is the district general hospital which serves not only my constituency, but the constituency of Hornchurch next door and the London borough of Barking and Dagenham, as well as other parts of Havering. There is no question but that its future has been under challenge for some considerable time.

The most recent evidence was that, after the Tomlinson report, when surveys were initiated with regard to some of the major specialties, especially cancer and neuro-science, both working parties proceeded on the assumption that Oldchurch hospital was to close. I do not know where that information came from--I have not been able to pin it down--but it seems likely to be true, because some people in the higher reaches of the hospital administration, perhaps at regional level, have been dead set against Oldchurch hospital for decades and are trying to plant that uncertainty in the minds of those who are adjudicating on how the future health service of London should be arranged.

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As a consequence, it is proposed that Oldchurch is to lose both the cancer and the neuro-science services, as well as--now--its accident and emergency unit. It is on that point that I wish to make my relatively brief speech.

I can be brief because I had the good fortune to initiate an Adjournment debate on 18 July, which, in parliamentary terms, is only a few days' sittings ago. I also had the opportunity to meet the Minister, my hon. Friend the Member for Bolton, West (Mr. Sackville) two days later. As a result of that, and in deference to your wishes, Mr. Deputy Speaker, I can be brief. I shall also be narrow, because it is a matter that affects our part of London. It is one more piece in the jigsaw of the whole picture of London, and I am glad to be able to talk about it.

When one examines the issue of casualty services, one can see that there is a general strategy, which had not, as far as I know, been announced, but which was put in place by a series of decisions and pending decisions. An article in the Evening Standard on 23 August revealed:

"Managers have already closed 23 London casualty units over the last eight years,".

It is therefore no wonder that this morning one of the recurrent themes is the future of accident and emergency services in London. It concerns me that, apparently, the strategy is determined by a recommendation, made in 1988 by the Royal College of Surgeons in England, that there should be only one hospital with an accident and emergency unit in each NHS district. Whatever the technical, medical or professional reasons for that proposition, it is obviously ultimately arbitrary, because health districts vary in size, in character, in population density and in health need.

In our case, in Havering, we were part of the Barking, Havering and Brentwood health district. That was one of the largest in the country, certainly the largest district in London. Even now, with the excision of Brentwood, which has gone into Essex, the Havering hospitals trust claims to serve 500,000 people. It seems arbitrary to suggest that that figure should warrant only one accident and emergency unit. I warn the Minister against that sort of academic calculation, because it militates against the best interests of patients at local level.

If I talk about the distribution of health need, it is quite clear, from examination of the Barking and Havering health district, that the health need is greatly concentrated in the west, and not in the east where it is proposed that there should now be one accident and emergency unit in our district. Of course it is true that there are the considerations of casualty services being provided at King George hospital in Ilford, but that will take people well out of their way in many cases of accident and emergency.

The professional arguments are well understood, and can be seen from a professional point of view. It is to have the highest standards of equipment and the greatest number of staff of different skills available in one place, but in accident and emergency, above all, time is of the essence. The crux of the matter lies in ease of access by road and proximity to the main centres of population. That should be the overriding consideration when deciding on the location of a casualty unit.

To date, the community health council has reluctantly agreed that there should be one accident and emergency unit only in our district. The current argument, which is fierce and controversial, is about where that unit should

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be--whether at Harold Wood in the east of the district, on the periphery of the area of population, or at Oldchurch hospital, which has traditionally served the main bulk of the population and, certainly, has been closest to the health need of the district for so many years.

I urge my hon. Friend the Minister and our right hon. Friend the Secretary of State to pay heed to the recent letter from the chairman of the CHC, who pointed out the future prospects for demographic change in our area.

I see that the hon. Members for Barking (Ms Hodge) and for Dagenham (Ms Church) are present this morning. Perhaps they will be seeking to catch your eye, Mr. Deputy Speaker, and they may be able to speak more knowledgably about this matter, but I am advised that the Barking Reach development, which is part of the Thames Gate development, will result in an increase of 18,000 residents in that part of our health district. Furthermore, there is massive industrial development planned for Rainham.

It is therefore important that, when making a decision--we understand that a decision on that particular issue is imminent--those factors are taken into account as well as the access. Harold Wood is ill served by the network of roads approaching it, and it would be necessary for better access to be provided. That cannot, apparently, be taken for granted, because I learned this morning from representatives of the London borough of Havering, which would be the planning authority concerned, that the council would have technical objections to what is proposed for Harold Wood hospital, which may need to be tested at a public inquiry.

In consequence, the borough has sought an urgent meeting with the Secretary of State, at which Members of Parliament representing the district would be present, including my hon. Friend the Member for Hornchurch (Mr. Squire), whose ministerial role prohibits him from taking part in the debate, but whose support for the retention of Oldchurch is well known and highly publicised. I hope that that request for a meeting may be considered favourably, because the matters concerned are of the utmost importance to us and our constituents.

I return to the point about the strategy being based on an academic calculation. It seems quite wrong that it should be so formulaic an approach. To come up with the idea that there should be one accident and emergency unit for each district is a transparently artificial, desk-based exercise with a nice, neat conclusion reached by vested interest. The vast majority of the public, the CHC, the local authorities, even the medical staff at Oldchurch hospital itself are in favour--strongly in favour--of those services being retained at Oldchurch hospital.

I hope that that will weigh heavily in the balance. One thing is quite clear about such proposals to reduce the number of units: they do not put on the balance sheet the cost, effort and time involved in making people travel further to receive their services. That is a weakness in the system, because it does not up show up in the figures, yet it is a reality to people, because especially with accident and emergency services--it is a cliche --we are talking literally about life and death. It surely would be regrettable, not to say irresponsible, if, as a result of placing casualty services further away from people whom they are meant to serve, some people should suffer the ultimate penalty and die.

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I hope that my remarks will be added to those which have already been made as representations to Ministers on this issue and that the decision may be favourable to Oldchurch. On the merits of location, if location is given its high priority in the consideration, there can be no doubt that Oldchurch it must be.

11.38 am

Ms Margaret Hodge (Barking): Thank you, Mr. Deputy Speaker, for enabling me to participate at this stage in the debate as I currently feel in need of the services of the national health service. I want to address the specific problems about which the hon. Member for Romford (Sir M. Neubert) talked in relation to my constituency. But first, as a relatively new hon. Member, I should like to reflect a little on my recent experience of the London health service, as a non-executive director of University College hospital. The chaos and the absurdity of the Government's health reforms were a nightmare for any of us involved in trying to keep the services on the ground going in spite of those reforms.

We all know that an unregulated market in health is crazy. We know that it is particularly crazy in London. When I was a non-executive director at UCH, I had to live with the essential contradiction in the Government's policy and at the heart of the Conservative approach to the national health service: we had a market in theory and Tomlinson in practice.

For UCH, that meant that we lived from crisis to crisis. We were subjected to constant indecision, constant changing of the goalposts and instant planning on the back of an envelope by weak and inconsistent Ministers. The last thing I was able to do as a non-executive director was examine the quality of the health care provided for the patients in the hospital and the value for money provided by the resources expended there.

We lived under crisis management. Was the hospital going to survive? Was it going to be merged with the Royal Free? What was going to happen to Great Ormond Street and UCH? Which specialties, if any, were we going to be left with after the specialties review? When Camden and Islington district health authority threatened to withdraw its contract, we again wondered whether we were going to survive. The crises did not serve the interests of the patients or the Treasury. They were simply manufactured from the absurd reforms, and they had no purpose. In theory, the reforms are supposed to improve transparency and accountability for the public expenditure on health. In practice, our health service is forced by the reforms to work behind a veil of secrecy, and the reforms have failed in terms of their own objectives.

The first item on the agenda at my first meeting as a member of the UCH board was whether we should have our meetings in public or in private. I felt somewhat inhibited about contributing, as it was my first meeting. At the end of a lengthy debate on the matter, the chairperson asked me for my views. I said that, as we were spending about £20 million, it seemed to me that it might be a good idea to be accountable for that, and to hold the meetings in public. At that point, the other members of the committee said, "We can't do that, because the Royal Free would know what we were doing." That shows the absurdity of the situation.

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In theory, the reforms are supposed to put patients at the centre. In practice, the patients' interests were pushed to the bottom of the agenda in the way in which we were forced to manage UCH. Our customer was not the patient but the district health authority. Our prime concern was either the district health authority or the Audit Commission. Nowhere in the provider-purchaser split were the interests of the patients properly reflected. That appalling part of the strategy leaves the user--the consumer--of services out on a limb. As a representative of the customer on the UCH board, I constantly had to remind my colleagues that the district health authority did not necessarily reflect the views of local residents and users. I also had to say that the Audit Commission's indicators were not always the most appropriate for people in my locality.

Let me give an example to show how absurd the system was. When Camden and Islington district health authority threatened to withdraw the contract for accident and emergency provision at UCH, the chief executive decided to hold several consultative meetings. She went to a consultative meeting in Finsbury and began to talk about the needs of Finsbury Park down there in Finsbury. That was the extent of her knowledge and understanding of the local community whose interests she was supposed to represent.

My next criticism as a non-executive director of UCH relates to value for money. The last thing we were able to achieve in our capacity as non- executive directors was value for money for the resources over which we had control. Let me give examples. A very good day surgery unit has been established at what used to be Middlesex hospital. We had to staff it fully, but it was used at only 50 per cent. capacity, because there were insufficient purchasers around with the resources to take advantage of that brand new facility. University College hospital was spending money on the unit, the beds were lying empty, and the need was out there in the community. The last thing that reflected was value for money. The reforms also failed to address issues such as how to ensure appropriate staffing for the hospital one is running. Those are the issues that Ministers should address. University College hospital, Middlesex was the result of a merger between Elizabeth Garrett Anderson, the Middlesex and UCH. We therefore had one gynaecological unit merged from three. However, because of the absurdity of the system under which we had to operate, we were unable to ensure that we could rid ourselves of the 15 consultants who worked in the merged hospital, although there was a need for only three consultants, given the number of beds that were finally available.

If Ministers addressed the real issues which constrain decent value for money, we might obtain better value instead of concentrating on the absurd reforms which achieve very little in respect of putting value at the heart of the system in London and patients first. I thought that things could not be as bad elsewhere in London until I came to Barking. As the Member for Barking, I know that the state of the national health service in my locality is the issue of greatest concern to the greatest number of my constituents, and it is a terrible verdict on the Government's lack of care for the people whom the Government are supposed to represent. Bluntly, as they have become prisoners of their own dogma, the Government are betraying thousands of my constituents.

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My first duty as Member for Barking was to try to come to terms with the issues around what I gather from the hon. Member for Romford (Sir M. Neubert) is a long threat to the accident and emergency unit at Oldchurch hospital. The absurdity of the situation is that I still cannot discover whom I should really be talking to, to establish who is responsible for the decision.

My hon. Friend the Member for Dagenham (Ms Church) and I have tried--I believe we have probably managed it now--to meet all the components of the health service in our area. We have been to the district health authority, the hospital trusts, the regional health authorities, Ministers and the family health services authorities. However, it is unclear who is really driving the decision process. Is it the hospital trust or the district health authority? Is it the regional health authority or is it the Minister? Responsibility is unclear, and accountability non-existent. The complex web of bureaucracy through which I have had to wade in trying to tackle that constituency issue is absurd. The reforms have created fragmentation, which in turn is creating chaos.

Before I refer further to the specifics of the Oldchurch accident and emergency unit, I want to refer to another issue which arose from the case load in my surgery. This issue again shows how absurd it is to proclaim that the health service reforms ensure that the money follows the patient.

I was surprised when people came to my constituency surgery and told me that they could no longer attend the London Homeopathic hospital, when they had been attending it for treatment for 20 years. When I inquired into this, it emerged that an individual in the district health authority--I believe I got to the bottom of this one--simply did not believe that homeopathy worked.

That is fine for that individual. However, for my constituents who believed that the homeopathic treatment was helping them to deal with long-term problems and illnesses to have access to that service constrained by the prejudice of a person whom Ministers have put in charge of taking decisions on their behalf is just nuts.

I ask the Minister to intervene in that instance, because he must have some responsibility somewhere along the line. He should instruct the district health authority to reinstate choice for my constituents in Barking, so that they can take advantage of the services offered by the London Homeopathic hospital.

In July, the hon. Member for Romford initiated a debate on the threatened closure of the accident and emergency unit at Oldchurch hospital. In that debate and in subsequent meetings with Ministers and the regional health authority, we were assured that no action would be taken to prejudge the decision, first, on whether there should be only one accident and emergency unit in that area and, secondly, on whether it should be located at Oldchurch. At a meeting, the regional health authority said that it was not satisfied that it could decide because it was not satisfied that there had been a proper audit of usage in the area. It was not satisfied that the proposed minor injuries unit would have capacity to deal with sufficiently serious cases to complement the existence of only one accident and emergency unit. It was not satisfied that traffic management facilities would enable the hospital accident and emergency unit to be located at Harold Wood hospital.

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I went away on my summer holiday thinking that we had bought a period when there could be rational debate, first, on whether one accident and emergency unit would be sufficient for the area and, secondly, on whether it would be appropriate to close the unit at Oldchurch. Suddenly, in August, the local hospital trust closed the accident and emergency unit at Harold Wood and started to spend a cool £6 million on improving facilities, one assumes subsequently to close the accident and emergency unit at Oldchurch. Somewhere, someone along the line made the decision that we thought that we could debate: it was pre- empted, and public money--our money--is being spent on improvements at Harold Wood, one assumes with the sole purpose of closing the accident and emergency unit at Oldchurch. My postbag and my surgery are inundated with cases relating not to the quality of health care in the health service but to access to such health care.

I agree with the hon. Member for Romford, who said that the allocation of one hospital for 500,000 people is completely arbitrary. Again, someone has secretly decided, one assumes in ministerial meetings, that we in London need only one hospital for every 500,000 people. I was interested to hear the hon. Member for Edmonton (Dr. Twinn) refer to a similar set of proposals being discussed by the New River authority. Where is the justification for allocating one district hospital for 500,000 people? How can that meet the health needs of people in London?

If there is such justification, why can we not see it and debate it in public so that London Members can play their part in determining appropriate hospital provision for the health care of Londoners? For my part of London, one hospital for 500,000 people is not appropriate. The proposal is to close the accident and emergency unit at Oldchurch, despite the view that it does not mean the end of Oldchurch hospital, and I am convinced that, in five years' time, hon. Members will discuss the death of Oldchurch hospital. The proposed closure of the accident and emergency unit at Oldchurch hospital comes after the death of other hospitals in the area. In my constituency, we have no hospital at all--Barking hospital has been closed. My predecessor, Jo Richardson, fought hard to save that hospital. It was built out of the voluntary effort of local people. It is unacceptable that they should face the closure, in 10 years, of yet another hospital in the area, involving them in travelling greater distances and having worse facilities. I agree with the hon. Member for Romford on another point. If, as it appears, Ministers have decided to locate the accident and emergency unit at Harold Wood, they will implement Dr. Hart's inverse care law. We will have the hospital located where it is least needed, and where need is greatest there will be no hospital provision. I am very keen to improve primary health facilities in my constituency. At present, they are appalling. For example, we have three times the national average of single-handed practices--32 per cent. Also, 25 per cent. of our GPs have lists of more than 2,000 patients, which is more than twice the national average, and 67 per cent. of our local practices are classified as poor. Only five are classified as good, and none fits the category of best. Despite those poor primary care facilities and despite the

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long time that it will take to improve them, even if the investment is available, we will face the immediate closure of one alternative to primary health care, which is an accident and emergency unit in our area.

The proposed minor injuries unit will not be an appropriate substitute. At the meetings which my hon. Friend the Member for Dagenham and I attended, it was interesting to note that different bits of the health service had different views of what role the minor injuries unit would fulfil. After we talked to the regional health authority, I thought that a broken leg could be treated at the minor injuries unit. When I talked to the district health authority, it told me, "No way. The only thing that could happen is that a plaster could be put on a scratch." They are two different facilities. If those bits of the health service that are charged with making the decision cannot agree what purposes the minor injuries unit should fulfil, how can they decide to close the accident and emergency unit at Oldchurch without being secure in the knowledge that there is proper alternative provision?

People involved in health care in the area have placed King George's hospital on the agenda to treat my constituents who go to Oldchurch hospital. On 19 September, the Secretary of State for Health visited Ilford Conservatives. She spoke about King George's hospital being a shining example of excellence. That night, patients were turned away and ambulances were diverted. Patients had to wait 10 hours at the accident and emergency unit at King George's hospital. In her embarrassment, the Secretary of State has since ordered an inquiry into what is happening. She would do well to start by considering the weekend of 15 and 16 October. Again, the accident and emergency unit was closed, and again a patient had to wait 22 hours before being seen. That has occurred in the context of the Havering hospitals trust having the worst performance in respect of seeing people within the terms of the patients charter, that is, within five minutes of their arriving at an accident and emergency unit.

We also know of the chaos in the London ambulance service. The ambulance service could not cope with the greater distances that it would have to cover if we closed that hospital. The ambulance service has said that the time taken to reach hospital, if Oldchurch A and E is closed, will increase by 72 per cent., from 11 minutes to 19 minutes.

It is difficult to choose one case out of my case load to highlight the crises in east London, but there is the terrible case of an elderly man who has lung cancer and is bedridden. The ambulance arrived at 8 o'clock in the morning to take him to hospital for treatment. It was decided that he could not be taken because the ambulance had a one-person crew and two people were needed to get the wheelchair into the ambulance. Eventually, he was picked up at 11.30 am, having waited from 8 o'clock in the morning. After he had had an X-ray, he was ready to go back home at about 1.50 pm. He waited for seven and a half hours to be taken home in his wheelchair. His feet were bleeding from resting on the footplate for so long. At 9.30 pm, a St. John ambulance with a one-person crew took him home. In the end, neighbours had to assist in getting the gentleman out of the ambulance and into his bed.

The proposals for our part of east London are a disaster for my constituents. My constituency has a preponderance of elderly people. They are just the people who require

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hospital treatment more than any other sector of the population. I represent a preponderance of people who are less well off. They do not have cars to take them to hospitals and the ambulances are not there to provide the service. As I go around the constituency, I find that they are giving up on the health service. They cannot afford to buy privately. They are giving up on health care because they cannot gain access to it. Sadly, they are not as vocal as people elsewhere in London; but the fact that they are not vocal does not make their need any less.

The Government's approach is blinkered and short term. It is failing Londoners and it is failing my constituents. I urge the Minister to call a halt to all these absurd proposals, particularly those on the closure of the accident and emergency unit at Oldchurch hospital, and to institute a commonsense review of health provision in the capital so that we provide value for money and properly meet the needs of Londoners.

12.1 pm

Mr. John Whittingdale (Colchester, South and Maldon): Unlike the hon. Members who have spoken so far in the debate, I am not a London Member. My constituency lies about 60 miles from London on the Essex coast. However, I make no apology for speaking. Despite the distance from London, my constituency still lies in the North Thames regional health authority area. As a result, the developments affecting health care in London have a direct bearing on the resources and facilities that are available to my constituents in north Essex.

My hon. Friend the Member for Edmonton (Dr. Twinn) said that one of the reasons why we are having to discuss changes in London's health care is the steady migration of population out of London. In the past 30 years, London's population has fallen by 1 million. Many people have decided to move out of the inner cities and have gone into the outer London suburbs, as represented by my hon. Friends the Members for Edmonton and for Romford (Sir M. Neubert).

Later in life, however, those people have often decided to move out further still and they have come to settle in constituencies such as mine in north Essex. The result of that has been that the population has grown in my area. A large proportion of the people coming into it are elderly people. They have come to retire in places such as Mersea and Maldon. That has put additional strain on the local health authority, which has had to cope with both a growing population and an increasingly elderly population. It should be borne in mind that the average health care cost of someone over 75 years of age is four times the average health care cost of someone over 45.

Unfortunately, the allocation of resources in the national health service has not followed the movement of patients. In the Thames regional health authorities, there has been a historical bias towards London at the expense of outer areas. Despite its falling population, London has received a disproportionate amount of resources. That has led to persistent underfunding in outer areas such as mine in north Essex. As a result, we have excessive waiting lists in north Essex for many treatments, particularly orthopaedic treatment and the treatment of cataracts.

After a lengthy wait to see a consultant, a further wait of 15 to 18 months has been all too common. Having taken evidence in the Health Select Committee, I know that that is not the case elsewhere. Hon. Members were

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told that Dorset has a maximum waiting period from the point of general practitioner referral of about 35 weeks. However, a GP practising in Wimbledon and Tooting told us that, as a result of competitive contracting, his patients do not have to wait for elective surgery and no patient waits for more than six weeks to see a consultant.

Mr. Jenkin: Speaking for a constituency that neighbours that of my hon. Friend and that is in the same health authority, I very much share the concerns that he has expressed. Is it not the case that, because we are in a Thames region, before the introduction of capitation funding, which has gone some way to help us, our allocation per head was about 10 per cent. below that of the neighbouring authority in south Southwark, which is not in the Thames region and does not suffer from the same London effect?

Mr. Whittingdale: I am grateful to my hon. Friend the Member for Colchester, North (Mr. Jenkin) He is right. Indeed, he has anticipated a point that I was going to make later on and so saved me from having to do so.

As my hon. Friend said, the move towards capitation funding as a result of NHS reforms has helped. He and my hon. Friend the Member for Chelmsford (Mr. Burns)--both of whom I am pleased to see here today--joined me in going to see the Secretary of State for Health to raise the need to divert more resources towards areas such as our own. She gave us an assurance that we would move to 98 per cent. of capitation target within three years. We have already reached that target as set by the health region's formula. That meant that we also received an extra £1.2 million last year and £1.4 million this year to reduce waiting lists, which is extremely welcome.

North Essex, however, has in the past continued to suffer as a result of the variation of the national formula employed by North-East Thames regional health authority. Although the formula employed to distribute resources between regional health authorities has only a small factor to take account of social deprivation, North-East Thames has added its own weighting factors to distribute in the region. Those factors have strengthened the social deprivation allowance and an additional homeless factor has skewed the distribution of resources still further towards London.

I do not dispute the need to take account of social deprivation in allocating resources in the health service. The former North-East Thames health authority included Tower Hamlets, Hackney and Newham, some of the most deprived areas in the country. I know from evidence that the Health Select Committee heard when examining mental health that increased social deprivation increases demand on health resources, particularly for the mental health service. However, the effect of that formula has been that outlying areas such as north Essex have, in effect, lost out twice. North- East Thames regional health authority does not receive the increased allocation of funds to reflect the fact that it contains deprived areas. In allocating its own funds, however, it does take account of that. As a result, outlying regions are penalised twice over.

If the national formula were used to distribute resources in the region, or if a regional formula were used to allocate funds nationally, north Essex would gain. As my hon. Friend the Member for Colchester, North said, that is most dramatically shown by comparing our region's level of resources with that of our neighbour, which is not in the Thames region. The position has improved as a

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result of the move to capitation funding, which has allowed waiting lists to fall, but it would be improved still further if we could move away from the current arrangements.

I believe that the Department of Health is considering a national single formula for capitation funding across the country. I welcome that and I urge the Minister to ensure that it is introduced as soon as possible.

Understandably, the specialty reviews have occupied most of the time today. As has happened, I suspect, to many hon. Members, several constituents came to see me on Monday to ask me about the future of Bart's hospital. They had all received excellent treatment at Bart's and I understand the loyalty that they feel to that hospital and their wish to see it continue. Similarly, I have had contacts from other constituents who have received treatment at the London chest hospital, the Hammersmith hospital and Royal Marsden hospital. All of them feel the same degree of loyalty towards those hospitals. I had to say to them, however, that I believed that it was wrong for them to have to come in the first place to inner-London hospitals to receive treatment.

I recently visited Bart's with members of the Select Committee and on arrival I saw an ambulance from the Essex ambulance service delivering a patient for treatment. Why do my constituents have to travel more than 60 miles into London to receive specialist treatment? The answer is that for cancer treatment inner London has 13 centres while Essex has two. Inner London has 14 cardiac treatment centres but there is none in Essex. London has 11 centres for renal treatment and Essex has one and for plastic surgery London has nine centres while there is only one in Essex. There are 13 centres in inner London for neuro-sciences and none at all in Essex. One of the reasons for the shortage of beds in London, despite the decline in the population, is that my constituents and those in areas similar to mine have to travel to London to obtain specialist treatment. But it is often far more expensive to provide treatment in London than outside it. I strongly welcome the publication of the specialty reviews. They will result in streamlining London's specialist services and I hope that they will also release resources to allow the provision of specialist services in Essex where many of London's patients live.

It has been suggested that a new cancer centre and possibly a cardiac centre should be established in Essex where both are badly needed. In the case of Bart's, it must make sense to consolidate on one or two sites the services that are currently provided on three. I welcome the formation of the joint trust covering the three hospitals and it must also be right that the management of those hospitals and the people who work in them should be asked to come up with recommendations about how the consolidation is to be achieved. Another recommendation of the specialist reviews on the future of neuro-sciences at Oldchurch hospital has been mentioned by my hon. Friend the Member for Romford and by the hon. Member for Barking (Ms Hodge). I recently visited that hospital to see the neuro-sciences department there and I pay tribute to its highly skilled team. However, the report of the specialist reviews recommends that the unit should be closed and the service relocated to the Royal London hospital at Whitechapel. That would move it even further away from

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my constituents and that would be contrary to the whole thrust of the Tomlinson proposals and what I thought we were trying to achieve. It would be ludicrous to move the centre further still into inner London. If Oldchurch is unsuitable in the long term for a neuro- sciences unit, it would be make far more sense to move it out to an area such as Broomfield which is rapidly developing as a centre of excellence for health care and serves the whole of north and mid-Essex.

Mr. Jenkin: I should like to deal with the issue of cancer. Has my hon. Friend digested the Cameron report, which vindicates the principle of moving centres of excellence away from conurbations such as London and into the regions so that people such as those in Colchester could continue to be served by a cancer unit that provides radiation treatment and would not have to travel to London?

Mr. Whittingdale: I agree with my hon. Friend. We both hope to see a new cancer centre in Colchester as soon as possible.

The London reforms cannot be viewed in isolation. For too long, people in constituencies such as mine have been paying the price for the over- allocation of resources and hospital beds in London. I urge the Minister to press ahead with the reorganisation of London's health services because they will benefit both Londoners and people in outlying areas in the Thames region.

12.14 pm

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