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for Feltham and Heston does not do a service to anybody who does that work to decry them constantly and say that their service is not worth very much. The hon. Member for Hornsey and Wood Green (Mrs. Roche) also made that point. She referred to the management costs of the NHS.

It is remarkable that no Opposition Member referred to the fact that yesterday we published the management statistics in the health service. They show that management comprises only 2.6 per cent. of the service. I can never understand how Opposition can expect a modern health service, with a budget of £32 billion, to be run properly and to deliver health care in a complex way unless it is properly managed. I look forward to the debate next Tuesday, when we will go into those matters in more detail than we should today. My hon. Friend the Member for Romford (Sir M. Neubert) raised a specific constituency point. He is aware that the regional health authority has approved plans to close the Oldchurch accident and emergency unit and to centralise at Harold Wood hospital. As my hon. Friend will be aware, the Secretary of State will take the final decision shortly. We will listen to what has been said and consider what has been written by hon. Members, especially in this debate, and a decision will be informed by that.

In response to the hon. Member for Barking (Ms Hodge), I reiterate the importance of minor injuries units. She referred to the fact that it may not be possible to replace A and E units satisfactorily with minor injuries units. With regard to my earlier point, where protocols are sorted out properly, it is feasible to do that. I do not wish to detain the House too long, but I want to deal with several points before I allow other hon. Members to speak. In particular, I want to deal with a point raised by the right hon. Member for Bethnal Green and Stepney (Mr. Shore).

We do take the position of the London ambulance service extremely seriously. However, when it is being criticised, we should recall that it is the one ambulance service in the country which does not have trust status and is not managed in the same way as ambulance trusts. I firmly believe that one of the reasons for that is that the work practices within the service are not conducive to delivering the best service.

I want now to consider the terms of reference of the inquiry set up by my right hon. Friend the Secretary of State. It will be a rapid inquiry, so that we can produce quantifiable benefits quickly. The inquiry will do several things. It will consider working practices, including staff deployment, rostering, crewing policies and timing of annual leave.

The specific problems identified in the tragic case which has attracted so much recent publicity must be addressed. The inquiry will consider systems and the use of resources. The right hon. Member for Bethnal Green and Stepney suggested that it should consider management, and it will do that. One of the inquiry's criteria is to examine management and staff training.

It is very easy for politicians--on occasion, I am as guilty of this as anyone--to use the buzz words and call for a full-scale public inquiry--I accept that the right hon. Member for Bethnal Green and Stepney has not done that in this context, but others have--but we must make some

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rapid progress to find a quick way to solve the problems. We agree with the right hon. Gentleman that what is happening is not satisfactory and must be changed.

The statistics of the London ambulance service show that the cost per patient transported is higher than nearly any other ambulance service in the country. There could be indicative reasons why that should be the case only in London, but on the outskirts of London the costs are less, and decently managed services can produce far better response times. The purpose of promoting the inquiry is to raise the London ambulance service at least to average standard, and I hope beyond, in hitting targets.

We recognise also the special problem of mental health services in the capital. The matter attracts intense media attention. In 1991, we introduced the mental illness specific grant to encourage local authorities to increase social care for people with severe mental illness. The mental illness specific grant was increased to £36 million for 1994-95, supporting expenditure of £50 million and funding 800 projects. This year, we have made an extra £10 million available to be spent on community mental health services in areas of greatest need in London.

I take this opportunity to underpin the principles of care in the community. Anybody who visits a Victorian institution in which people were almost locked up and the keys thrown away, will understand that a Government who had not embarked on the humane policy of introducing care in the community for the mentally ill would have been seriously at fault.

Everywhere I go around the country I see two things happening in common: better services, but concern from the public. Concerns must and will be addressed, particularly in respect of patients who are a special risk, and they will be taken seriously by the Government whenever problems arise. I hope that the basic tenet of the policy, which is broadly accepted by both sides, is not undermined by specific instances, no matter how much publicity they might attract. I shall say a word or two about the future of the London Implementation Group. I expect the LIG to transfer its functions during 1994 and the beginning of 1995 to other parts of the NHS executive, including the relevant regional offices. I shall say a special word about the primary care support force, which I launched two to three weeks ago. Its work will continue specifically, because Ministers have identified the improvement of primary care as a specific need in the city.

What will the future of London be? If it were to be left to yet more commissions, yet more full-scale inquiries, "let's wait" and "let's see", the future would be the spiral of decline that Tomlinson predicted. We must act. The Government must support the plans that need to be put in place to bring about the reconstructions in the broadest sense that we are able to. That support will be available. I inform hon. Members who take an understandably keen and direct interest in such matters that we are keen to proceed so that we can reach the conclusion of the problem. But to suggest that all we may do is sit back, have further inquiries and further delay, would be the worst possible thing for health care in London.

I am pleased to make this ministerial debut on such a matter of great importance. I assure the House that Ministers will continue seriously to consider what is happening in London health care and will ensure that the improvements that we are beginning to see with the

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projects that are coming on stream around the capital are given every impetus from the Government. I look forward to performing that duty in the coming months and years in the interests not only of those who practise in the service and who do such a great job but of those who are probably mentioned least of all, and that is the patients, who need to benefit from the changes.

1.13 pm

Ms Dawn Primarolo (Bristol, South): I congratulate my hon. Friend the Member for Leyton (Mr. Cohen) on initiating today's debate two years after publication of the Tomlinson report. I also congratulate other hon. Members who have participated in the debate. I welcome the Minister to his new post. I assure him that it will be exciting, stimulating and challenging. We intend to continue to place before him the difficulties that the NHS is experiencing. Hon. Members raise with the Minister constituency health care issues and problems because he is responsible for the national health service. As my hon. Friend the Member for Barking (Ms Hodge) said, detective work in the NHS is necessary to try to find out who is responsible for taking decisions. That leaves with us no option but to bring the matter straight to the Minister's attention. The Government's new approach to so-called accountability in the health service--the "light touch" as I think they like to call it--consists of the Government taking the credit when something goes right but ensuring that they do not take responsibility when it goes wrong.

Two very powerful themes have continued to emerge in all the speeches today. The first is the Government reforms and the impact of those reforms and of the internal market not just on London's health care but on a wider region. I, too, look forward to Tuesday's debate when we shall be able to broaden the issues covered. We shall also consider the Tomlinson report and its proposals, the reason and justification for what is happening in London.

I say to Conservative Members that it does not matter what we say or do: they will not allow the facts to speak loudly or change their commitment to dogma and faith in a market system that is destroying our health service. Many myths on health care--and particularly funding--continue to be pushed by the Government. I should like to pick up on the one on funding given that the Minister paid some attention to it himself.

The Government have always advanced the argument that London receives a disproportionate amount of funding for the NHS. They said that the population of London was not large enough to justify the resources that it was given. That is not the case. The Department of Health admits that that is not the case--or certainly that it does not know whether it is the case.

When we tabled questions to the Department asking specifically for the share of resources allocated to London as compared with the rest of the country, the answer was that

"It is not possible to apportion . . . spending

geographically."--[ Official Report , 23 June 1994; Vol. 245, c. 300 .]

If it is impossible to apportion spending geographically in working out where money is going, what is all this rubbish about London receiving too much money? Where do the facts come from for that assertion? Did every

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Conservative Member who advanced that myth contact every district health authority in London and ask it how much it receives? Did they then compare that with the percentage of national spending on health? I do not think that they can have done that. Had they done so, they would have found that London has approximately 15 per cent. of the population of this country and that it receives about 15.4 per cent. of the total allocation, so where is this rubbish about London receiving too much money coming from? It simply is not the case.

Mr. Jenkin: Will the hon. Lady give way?

Ms Primarolo: The hon. Gentleman has intervened a number of times. It is a long debate and I should like to make some progress. The Government claim that they want a non-partisan debate on health and that they want to consider the serious issues. When that is offered to them, however, they continue to ridicule. They should make up their minds whether they want a full ideological battle or whether they are prepared to discuss what is best for London and what is not.

Mr. Jenkin rose --

Ms Primarolo: I have told the hon. Gentleman that I do not intend to give way at this stage. I hope that he has now understood that. The issue of who is responsible is important. The Minister is clearly surprised about the state of the health service, in London or anywhere else, and that is stunning. The Government have had 15 years in power and three years of reforms to make the health service better but they have only just noticed that it is not working. That is a measure of their competence and understanding of what is going on. Let us look at what Tomlinson proposed. Some of the data that he was given were subsequently shown to be inaccurate. He was asked not to assess the health needs of London and to find out what it needed but to assume the working of an internal market. He was to assume that there was too much money in London, which is incorrect, and that there were too many beds, which is also incorrect.

Tomlinson's mistake was to look only at acute beds and not at medical and acute beds, which in every other part of the country are put together. He said that 2,000 London beds should be closed but since the report was published, 2,500 have been closed. Why is there so much talk about the need to press ahead with a plan whose aims have already been achieved?

We are told that we need rationalisation of specialties, and of course it makes sense to have the best resources in the best locations. But why interfere with that at Guy's and at Bart's? Why destroy those services instead of allowing the local community to make known what it needs? The Government told us that they wanted to develop primary care. We agree that we need such development, but so far no resources have found their way into the delivery of primary care. Many great schemes have been started but there has been no measurable improvement.There are fewer GPs in London than there were three years ago. That shows the extent of the investment in primary care in that sector--let alone in the other health professions.

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A Conservative Member who is not a London Member said that he wanted to speak for his area. My constituency is not in one of the four London regions but when fighting for resources for it I am not prepared to engage in a divide-and-rule policy by saying that London should be cheated of its resources so that other areas can have them. I know from my experience in Bristol and from that of my colleagues in Manchester, Birmingham, Liverpool and Edinburgh that exactly the same case is now being used to cut services in those areas. It is about time that the Government looked at the facts and reassessed what is going on. We have asked for that a number of times, and countless reports with which we have not necessarily agreed have requested it, but the Government are not prepared to budge. They will not listen to Londoners or academics and they will not look at the facts and consider the views of the Opposition. In a desperate effort to achieve some sort of progress to protect London's health we have offered another way of finding common ground.

If Conservative Members do not like the idea of another review of available information with a moratorium while it is being held, why do they not at least listen to the evidence that is around? Two years ago the Government published their document "Making London Better" but the policy contained in that has become a sick joke. Access for patients and the quality of care have disappeared in sloganising about the internal market and the jargon of GP fundholding. That has happened because of the Government's constant need to think about privatisation and competition instead of collective provision. On the question of the London ambulance service, perhaps the Minister would consider reassessing his response to a written question from my hon. Friend the Member for Newham, South (Mr. Spearing) on 17 October. My hon. Friend received details from the Department of the number of times that emergency responses exceeded either 34 minutes or 45 minutes. For example, in London on 19 June 1994, 330 emergency calls took more than 34 minutes and 131 more than 45 minutes. The Minister would not agree to investigate the reasons for that or give categories of reasons why that happened. When he undertakes the wider consideration of the LAS, will he ensure that those issues are also dealt with?

Mr. Spearing: The figures to which my hon. Friend referred were for the week ending on 19 June. Nevertheless, is the Minister aware that when ambulance services were run by borough councils and the GLC, local councillors could find out the reasons for any delay? It is not right that the Government should deny that information to Members of Parliament.

Just for good measure, is the Minister aware that last Monday a call was made at the Finchley Tesco-- appropriately enough, about a man with a heart attack--and the ambulance arrived half an hour after the call? However, a fire engine that had been called in desperation because it had oxygen on board arrived first. The fire service is run by a London borough council; the ambulance service is run by the Secretary of State. She has had five years' warning of what has been happening.

Ms Primarolo: I am grateful for my hon. Friend's correction. I am sure that the Minister will study his points in Hansard and consider whether they can be dealt with in the inquiry.

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The Secretary of State has shown scant regard for public opinion. Even the London Implementation Group, the body that she set up 18 months ago to enforce her changes, has not held one meeting in public. It meets in secret to decide the future of London's services. It has 30 staff and an annual budget of £2 million. It is chaired by a former Conservative Member--what a surprise. Why do the Government continue to invest money in quangos in an attempt to justify the lack of strategic planning and accountability in London? Why do not they invest in a regional health authority that can strategically plan London's health services?

Mr. Malone: I would not usually intervene on a minor point, but it has been mentioned twice today. I was unaware that the chairman of the London Implementation Group is a former Conservative Member. I am sure that the hon. Lady wants to set the record straight on that.

Ms Primarolo: Is Sir Tim Chessels not a former Conservative Member? [Hon. Members:-- "No."] I stand corrected--

Mr. Jenkin: The hon. Lady should get her facts right.

Ms Primarolo: When it is pointed out to me that I am wrong, at least I am prepared to note it. I am grateful to the Minister for correcting me. However, I am sure that he would not deny that the chairman is a Tory. We must not go further into this matter; I should not have started it.

The people's lack of faith in the Department of Health is clear, as we hear at every public engagement in London. That is not surprising, given that "Making London Better" has become a policy under which operating theatres close so that the curtain on the theatre of the absurd can rise.

How absurd to waste the £140 million that was spent on Philip Harris house at Guy's just so that the Government can get their own way. How absurd that the Chelsea and Westminster hospital--a £200 million showpiece hospital--has beds empty while waiting lists rise. It then announces that it plans to open a new ward but--what a surprise--it is for private patients only. How absurd that, if one lives in Barking, one will be seen within weeks at King George's hospital, but in Redbridge, if one lives locally in Barkingside, one must wait 18 months. How absurd that there are fewer GPs in London, but a 57 per cent. increase in the number of managers running the system. How absurd that the Royal Brompton hospital, the national heart and lung hospital, can survive financially in the internal market only if it goes into a £20 million partnership which involves a private company building a 28-bed patient unit and running the NHS catering, domestic and laboratory services.

How absurd that Bart's should be scheduled for closure on a financial package that is so appalling that the current figures demonstrate that there is no financial gain to the taxpayer for 30 years at least. Then the Government have the cheek to tell us about effective use of resources, about making sure that patients get what they need. How absurd that a Health Minister, in justifying the closure of Bart's casualty, can say that the 10,000 extra attendances that the accident and emergency unit at University College hospital will have to deal with will be perfectly all right and that they will be able to be absorbed by the additional and existing facilities that UCH already has. That hospital is struggling to restructure itself under a lack of finance and constant criticism from the Government.

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Today's debate has been about trying to persuade the Government that their facts are wrong. If they do not agree with all our interpretations, we ask them to look at the reports and responses--indeed, we ask them to listen to members of the public and what they have to say about the health services that they want to see in London.

Alan Langlands recently told The Guardian :

"I find it very difficult to judge what the population of London thinks about the changes."

What utter nonsense. Where is he living--on the moon? How could he possibly not know? He has only to read the Evening Standard , which is not known to be a socialist rag--as yet anyway--to see the fantastic campaign that it has been running. He has only to listen to the three Conservative Members of Parliament who speak with one voice against the proposals for their local hospital in Edgware. He would have only to go to a few of the community health councils in London to find out what was going on, or perhaps attend some of the local authority meetings at which the difficulties that are being experienced because of the rundown of the health service and the provision of continuing care are being discussed. He has only to ask what the people think in the area of North Middlesex hospital. When he finds out that an employee acting as chief executive is paid £12,500 a month for a four-day week, he will know what people in London think about their health service.

Action must be taken now. The Minister should take this opportunity to announce an immediate end to hospital and bed closure programmes. He should publish in full the York report.

Mr. Malone: It has appeared.

Ms Primarolo: It is not published in full.

The Minister should allow a proper debate about the funding of the health service--about how much we are prepared to pay and how the funding formulae should be calculated. We must ensure that health funding is apportioned according to need.

All that must be done if there is to be real hope of long-term improvement. Aspirations must be tempered by analysis, research and strategic thinking. The Conservatives' ideological commitment to the internal market and to setting one health authority against another and one hospital against another prevents sensible planning and stops patients receiving the excellent services that they expect and deserve. Unless the issue is resolved, the people of London and the Government will face not only a winter of discontent but a winter of desperate disappointment.

Yet again we ask the Government to establish a strategic planning authority for London--elected, accountable and responsible for delivering the capital's health service--and to call a halt to further bed closures. We make it clear in respect of Bart's, Guy's or any other hospital that when we are elected as the Government, we will have the guts to review the present Government's decisions on the basis of information and research, not prejudice.

Mr. Malone: Before the hon. Lady sits down, perhaps I may point out that the York report was published in full by the university. The hon. Lady can have the abstract that I obtained from the British Medical Journal this morning.

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There is no question of the report being suppressed. It was not for the Government to publish that report, which was the work of York university. It has been published in full and is available.

Ms Primarolo: The report was prepared for the Government in considering their funding formula. The Government have had that report a long time. Everyone agreed, when this point was made in the House, that any funding formula must be fair and understandable and must work in terms of supplying a strategic base for the health service. If the Minister is so confident that the new formula can be succinctly explained--although I understand that nobody in the Department of Health can manage to do that--I trust that he will present the shorter version in next Tuesday's debate, so that we may be clear as to what is on offer.

Again we ask the Government to consider the best needs of London's health service based on information and listening to the public, and to plan strategically for the future. We ask the Government to stop putting up Aunt Sallys which are irrelevant to this debate, which confuse and which help the Government to avoid answering the real questions. The people of London want quality care and access to it when they need it, as do people in the rest of the country. 1.37 pm

Mr. David Congdon (Croydon, North-East): One disappointing feature of the debate has been the failure of Opposition Members to face up to the real difficulties that are confronting London and to the need to rationalise services. Those difficulties have been recognised in more than 20 reports on London's health care published over 100 years. The problems were recognised before the establishment of the NHS in 1948.

Everyone is clear that a key problem is over-concentration of resources in central London, particularly of specialist hospitals. Many people are prepared, however reluctantly, to accept the need for rationalisation, but when it comes to their local hospitals, they can inevitably find 1,001 reasons why they should not be affected. It is easy to support a strategy but much harder to support specific proposals.

The hon. Member for Bristol, South (Ms Primarolo) spoke of establishing a strategic planning authority, as if that would avoid the need to take action now. That is simply a device for avoiding difficult decisions, which the Opposition want to do all the time. I will not go into all the reasons- -outlined in the original 1992 King's Fund report--why change had to occur, but I must emphasise some of the additional pressures in London at this time. We know that the pressures of the funding formulae have led to resources moving away from London and I will certainly welcome a positive response from the Government to the York university research. My experiences in Croydon and the work done by the director of public health there lead me to conclude that the formulae do not give sufficient emphasis or weight to social deprivation factors.

There has been much criticism of the internal market, but critics have failed to recognise that it is leading to patients being treated nearer to where they live, rather than having to come to central London simply because it is the only place where the facilities exist. Also, resources have rightly been transferred from primary to secondary

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care and everyone seems to support such a change. Many people are being treated for minor ailments in their doctors' surgeries, rather than having to go to hospital.

Another additional pressure is community care and the problems that some authorities, especially those in inner London, seem to be having in avoiding bed blocking. Those social services authorities experiencing difficulties should get on with it and use the transitional funding that they have received from the Department of Health to ensure that they stimulate the private sector in their areas, rather than doing everything that they can to impede change. On the number of beds in London, much misinformation has been spread around about the situation and about Government policy in that respect. In 1992, the King's Fund report, "London Health Care 2010", used 1989-90 figures to argue that the number of beds should be reduced by 10,000 in Greater London as a whole--I stress that the figures were for Greater London. When Tomlinson reported in October of that year, he concentrated on inner London, which is important because certain recent commentators have forgotten that key fact. Tomlinson was talking about inner London and suggested a loss of between 4,000 and 5,000 beds over a period that could be five years, although he was not precise about the exact time scale.

In 1993, the Government published "Making London Better" and recognised the difficulties involved in bringing about some of the changes. They aimed, therefore, for a much more modest target--a reduction of between 2,000 and 2,500 beds, based on the more up-to-date 1990-91 figures.

We moved away from the original base figures in the King's Fund report and had more modest targets. Many of those targets were due to a revision in the number of patients who would come into inner London because of the implementation of the internal market and the fact that people were being treated closer to home, to the changes in the funding formulae that I mentioned and, perhaps more significantly, to the increased efficiency that hospitals throughout the country have achieved.

Despite what has been said this morning, it is important that all hon. Members realise that London is overbedded in comparison with other parts of the country. The average inner London district health authority uses 19.7 beds per 1,000 episodes of acute care, which compares with 1989-90 figures for the rest of the country of 14 beds per 1,000. I mention that because even if London achieved only the latter figure, which is already being bettered elsewhere because of improved efficiency, it could reduce the number of beds by 2,700. If that factor alone were taken into account, the targets laid down in "Making London Better" would be achieved.

I understand people's concern that, despite all that and all the talk of bed numbers, there does not seem to be a surplus of beds in inner London hospitals. We have heard stories of people left on trolleys in accident and emergency departments. Sometimes that is undoubtedly due to pressure on beds, but it might also be due to bad management of services. That does not mean that the strategy is wrong, but I accept that it means that we must be cautious of the pace of change, and aware of it.

Professor Jarman, who has been quoted at length today, argued that we should look at Greater London as a whole. As a Greater London Member, I have some sympathy

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with that, but the real problem of overbedding and over-resourcing is in inner London. Croydon has never been overfunded. Whenever a formula has shown that we are underfunded and we have begun to get a bit more money, the formula has changed and we have had money taken away. We must look primarily not at Greater London but inner London. The hon. Member for Bristol, South quoted Jarman to suggest that we have achieved 2,500 bed reductions since Tomlinson reported. That is not correct. Jarman based his figures on a large drop experienced in the late 1980s, but since Tomlinson reported there has been a very small drop in inner London. Between March 1991 and March 1993, surprisingly, inner London lost only 304 beds. My only criticism is that we do not have more up-to- date information, but that shows, first, that Jarman was not correct and, secondly, that he was talking about Greater London rather than inner London.

I was concerned about the issue of bed numbers, so when the Secretary of State appeared before the Select Committee just before the summer recess I asked about bed numbers in London, and, rightly, to a certain extent, she was mildly critical of the fact that I was focusing on bed numbers, which are not the key factor in the provision of health care. Nevertheless, I argue strongly that the rate of change in bed numbers is important, and therefore we need to look carefully at that.

Many figures have been bandied about on funding health in London, but figures from parliamentary answers and from answers given to the Select Committee show that in inner London spending per head is £603, compared with £415 in outer London. Indeed, outer London is only marginally above the average for England, whereas inner London is 57 per cent. above the average.

I do not subscribe to the theory that it is wrong for London to be better funded than the rest of the country. The issue is achieving the right level of funding for London to take account of its particular needs. The figures that I gave earlier suggest that funding is too high, but we need to look carefully at the funding formulae to see what would happen in the next four or five years if all the effects of the current weighted capitation formula arose, and I am concerned about the pace of change.

The King's Fund was quoted earlier as saying that London is underfunded by £200 million. That was based on a report that it published the day before our last debate on health in London in April. Despite a meeting with the King's Fund and the author of the report, and despite having read its latest report, that figure seems to be an assertion rather than a detailed analysis of the situation in London.

The key to the changes in London was the decision to set up the joint trusts for Guy's and St. Thomas's and other hospitals. My plea to the Minister is that, as much as possible, we should leave the decisions on the exact configuration of sites in central London to those trusts. It is difficult for others to judge what is the right configuration, whether for Guy's and St. Thomas's or Bart's and the Royal London hospital. I should like the trusts to take such decisions.

My second plea is that we proceed with caution when considering figures given for the costs of changing sites. Experience suggests that estimates of the capital cost of providing improvements on one site will probably end up being at least double the original sum and that alleged

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savings will not materialise or will amount to only half the original estimate. In other words, we should treat such figures with great caution.

On behalf of my constituents, I am delighted to learn of the excellent news to improve and expand our accident and emergency department, but I do not want large sums of money spent on new building in inner London because the problem is not a shortage of buildings but a surplus. I urge caution in grandiose schemes for remodelling or rebuilding. As far as possible, we should maximise the use of facilities in which we have already invested.

Although I believe that we should proceed with caution, we should not lose sight of our strategic plans for London. The King's Fund's latest report stated that we should take stock, but it also urged Ministers not to change direction because we had got it right. I wish that more Opposition Members would recognise that the direction in which we are going is the right one.

1.51 pm

Mr. Brian Sedgemore (Hackney, South and Shoreditch): I welcome the Minister of State to his new post but I hope that it does not sound churlish if I say that, having heard him speak, it appears that he was offered the wrong job.

I wish to pick up some of the points made by the right hon. Member for City of London and Westminster, South (Mr. Brooke). As a free man, he will be a much better person than he was when he was caged in the Cabinet. I was sad that his remarks were answered irresponsibly by the Minister, but I shall go into more detail on that subject later. If it is a truism that Britain's future lies in the intelligence of its people, it is none the less one that is well worth heeding, and nowhere can it be more true than in medicine. Intelligence in medicine is at its best when individuals combine in centres of excellence such as Bart's medical college and Bart's hospital. The King's Fund medical audit of Bart's two years ago, which was produced just as the Secretary of State for Health embarked on her mission to break up Bart's, reported that the care of the hospital was such that we should "cherish" the hospital. "Cherish" is a strong word. In 1993, an astonishing 27 per cent. of the people at Bart's medical college got distinctions in their examinations and, in 1994, the figure rose to an amazing 33 per cent. In the seven years from 1988 to 1994, Bart's came first five times among the nine London medical schools according to the number of students with distinctions in examinations; it came second once and third once. That is excellence. Much of that excellence is due to the heroic work of the dean of the college, Professor Lesley Rees. Along with most other thinking people, I was mortified when she was made warden of the new combined London/Bart's medical college.

Further to the important point raised by the right hon. Member for City of London and Westminster, South, excellence does not pop out of a bottle like a genie. It does not come from performance review systems or league tables. At Bart's it has been polished and burnished down the centuries until it has become custom and practice, a matter of pride, and simply the right thing to

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do. If one shows contempt for such excellence, as the Secretary of State does, one shows contempt for civilisation itself.

I do not believe that the hospital will close, despite the best efforts of Sir Derek Boorman, who is now in charge of the trust. However, having been there three times in the past week, I cannot help saying that at Bart's, there is a kind of grief that speaks to pain and love alike in the hearts of people and personalities who cannot bring themselves to understand how it can be that those who run the political system no longer know the difference between right and wrong.

At about the same time as Rahere was inspirationally founding Bart's in 1123, masons and joiners were grappling with the problems of the hammer- beam roof at Westminster Hall in this building. Of the same age and born of the same spirit, Parliament and Bart's both went on to become wonders of the world. Yet, ironically, it is through Parliament and a merger that has turned into a takeover that the Secretary of State is destroying Bart's. As she does so, any sense that Parliament exists to shut out the bad and to bring in the good disappears.

Bart's faces three tragedies. The first is that the Secretary of State has not listened to the people of London or, indeed, to the right hon. Member for City of London and Westminster, South. For some reason that none of us can understand, she has taken a pride in ignoring the rational and emotional, but brilliant campaign of the patients. On Monday, in the House, it really was difficult to speak to them about some of the despair that they felt.

"To suffer woes which Hope thinks infinite;

To forgive wrongs darker than death or night;

To defy Power, which seems omnipotent;

To love, and bear; to hope till Hope creates

From its own wreck the thing it contemplates".

Yes, the words of Shelley say it all. I look the Minister straight in the eye as he tries to snigger. Shutting Bart's is evil. The second tragedy is that the King's Fund, once a respected independent research institute, allowed itself to be used and abused by the Government. It is now so embarrassed at how wrong it was that it has put two of its greatest critics, Professor Brian Jarman and Professor Lesley Rees, on its management committee. However, Professor Rees tells me that she will never forget and she will never forgive, and I understand that.

The third tragedy is the lack of trust generated by this unwholesome mess-- the breakdown of trust between competing predatory hospital chief executives, the breakdown of trust between the medical council at Bart's and Sir Derek Boorman, the chairman of the trust, the breakdown of trust between the clinicians at Bart's and the Secretary of State and the breakdown of trust between local Members of Parliament on the one hand and Sir Derek Boorman and the Secretary of State on the other.

The Minister referred to his visit to the London hospital yesterday. He had the temerity to read out to the House one letter from one clinician. That was a monstrous thing to do, as misleading as it could conceivably be, and I am not surprised that the right hon. Member for City of London and Westminster, South got up to correct him. Perhaps the Minister does not know the facts and if he does not know, perhaps I can help him because the information is in the document in the file. In fact, it is on top of the file behind me.

Column 591

In September, the chairman of the medical council at Bart's wrote to Sir Derek Boorman, the chairman of the trust, and said that he felt that what was being done now was not what they had agreed and that it would be damaging to medical care at the new merged hospital. He concluded first, that the time scale proposed by the trust board was driven by short-term political imperatives and secondly, that the medical council, which represented many more people than one, would strenuously oppose long-term plans that envisaged the eventual closure of St. Bartholomew's at Smithfield. Why, I wonder, was not the Minister told about that yesterday? Since he told us that he talked to so many people about Bart's, why does not he tell us about it here today?

As I said earlier, I have been to Bart's three times in the past seven days and about 100 times in the past two years. In the past seven days, I must have spoken to 30 doctors. None of them is giving the information that the Minister, using one letter, gave to this House. Do we want to give the House accurate information? Does the House deserve the truth, or is the Minister prepared to let down himself, his Government, the nation and Parliament?

Mr. Malone: What a lot of nonsense.

Mr. Sedgemore: The Minister says, "What a lot of nonsense," from a sedentary position. Is he telling me that what I say is not true? Is he really claiming that on a visit to the Royal London hospital yesterday he found out more about the views of every leading doctor, nurse and patient at St. Bartholomew's hospital? If so, that would be nonsense.

Mr. Malone: I am rather surprised that the hon. Gentleman refuses to recognise that there is another view and I think that it is perfectly proper to point it out. I did not for a second suggest that it was the only view. Clearly, it is not. The hon. Gentleman is a mite sensitive about any criticism of what he seems to think is an inevitable position with which everybody agrees. It is not.

Mr. Sedgemore: I do not know whether it is a mite sensitive of me. I am trying to represent the views of a million Londoners, the views of the overwhelming majority of clinicians, consultants, doctors, nurses and patients at St. Bartholomew's hospital. I am trying to put an accurate case to the House and, in fact, not to mislead the House, as the Minister was, on the position of doctors at St. Bartholomew's hospital. The position is not as he said it was from the Dispatch Box.

Perhaps I may go into more detail, since I know rather a lot more about the issue than the Minister. On 19 August, Sir Derek Boorman wrote to The Times and claimed that the cost of transferring services from Bart's to the Royal London was £113 million, made up from £25 million for renovation and £88 million for new building. That was not true. The correct figure, given in the Minister's brief yesterday, as he well knows, was £200 million. In fact, to be precise, in the statistical table that I have here, the figure is £202 million.

How can the chairman of a hospital trust write to The Times and get the figure so wrong? For a start, Sir Derek forgot the existence of the medical college. For someone who does not know much about medicine, it is an understandable mistake, I suppose, but it is not quite the sort of mistake that one expects from the chairman of a

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