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hospital trust. I suspect that when Labour comes to power in a few years' time, it will be "hail, glad, confident morn" never again Sir Derek.In October 1992, we were told that Bart's would have an overspend of £12 million and that it would worsen with time. Bart's said that the figures were wrong, but Tomlinson repeated them--so did Ministers from the Dispatch Box. Again, if the Minister does not want to listen to me, I hope that he heard the point made by the right hon. Member for City of London and Westminster, South.
In the past two years, under the excellent work of the professor of medicine at Bart's, Professor Mike Besser, who was chief executive during that period, Bart's paid off all the outstanding debt and the accumulated deficit of £2.45 million. It repaid all the outstanding loans to the trustees. It put £1 million into the contingency fund. This year, it reported an operating surplus and it has brought the capital account into balance. In other words, Bart's did everything that Ministers asked of it; working--
Mr. Malone rose --
Mr. Sedgemore: May I finish this point? Working in the internal market, Bart's produced a surplus, got rid of its debts and showed that it was financially viable. What has happened to it now?
Mr. Malone: I assume that the hon. Gentleman is referring to the report of the accounts up until 1994. May I remind him that they apply not just to Bart's but to Bart's and the Homerton? In addition, the accounts include a special payment of £4 million in that year from the special trustees. What the hon. Gentleman has said does not fully represent the position as I understand it from the Besser letter.
Mr. Sedgemore: The Minister must look at the figures. The money from the special trustees has been paid back. Indeed, most of it was never drawn. The Minister will discover that if he checks the figures. I have carried out a detailed study of the matter and I beg the Minister to try to find out what is going on.
I am delighted that the Minister mentioned the Homerton, for two reasons. First, the future should lie in Bart's working closely with the Homerton and not in some kind of predatory relationship between the two. Secondly, we know that what are now called "episode costs" or patient costs are extremely high at the Homerton. The Homerton would benefit from a broader throughput, working in conjunction with Bart's, which would bring the average costs down. The Minister must go back and do his basic homework.
Professor Besser was the chief executive and he ran, along with the patients, a brilliant campaign against the closure of Bart's. He has just been overwhelmingly elected vice-president of the Royal College of Physicians. I am told that his vote represents a recognition of his clinical excellence and an overwhelming condemnation by all the physicians in the country of the actions of the Secretary of State. I have a petition which has only one signature. It is not a big petition and one may say it is not much of a campaign. It says: "We, the undersigned, support St Bartholomew's hospital as patients and friends. Bart's has provided essential services and must continue in its great work."
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There is just one signature, from one great man. It is the signature of John Smith.After John Smith died at Bart's, in an act of extraordinary spite, the chairman of the trust, who had decided that there would be provision on the site for the next 13 years, on instructions from civil servants at the Department of Health, reduced that to five or six years in an attempt to prevent a Labour Government from keeping the hospital open. That was a despicable act if ever there was one. However, that cannot work. First, the hospital cannot be shut within five or six years. Secondly, earlier this week Professor Lesley Rees met my right hon. Friend the leader of the Labour party and they had what might be described as useful and constructive discussions. Finally, my hon. Friend the Member for Bristol, South (Ms Primarolo), whom I regard as the closest thing one can get to a saint in this world, and who replied to the debate today, gave an assurance that when Labour comes to power in three years' time, the decision to close Bart's will be reviewed. At least I leave the House today with some hope; indeed, with considerable hope.
2.7 pm
Mr. Piers Merchant (Beckenham): I congratulate the hon. Member for Leyton (Mr. Cohen) on instigating this debate today, and on his luck. Had I been so lucky, I might have chosen a similar topic although not in exactly the terms of the hon. Gentleman's motion. The hon. Gentleman was rather premature at the beginning, when he said that he had "won" the debate. I do not think he meant it quite like that. I am not sure whether he had won it then, or whether he has won it now.
I listened carefully and with great interest to most of the contributions. They ranged very widely from listing the major London-wide issues, of which there are many, to equally relevant individual constituency cases which I am sure we have all come across. It was right that the debate should range that widely. I fear that there has also been a good deal of political point scoring. That is a great shame because no Conservative Member would deny that there are deficiencies, difficulties and problems which should be sorted out. However, it does not help the quality of debate inside or the wider debate across London to indulge in hyperbole because that discredits the people who follow that course. To suggest that the whole of the health service in London is not working or has collapsed is a gross distortion of the truth. Indeed, it demeans all those in the health service--doctors, nurses, clinicians and managers--who are working hard with the positive aim of improving health care in the capital. Also, that claim cannot be borne out by the hundreds of thousands of people in London who receive extremely good health care and who show their appreciation later. Like many of my colleagues in London, I receive many letters from people saying that they are delighted with their treatment. To suggest that all is doom and gloom is a grave misjudgment. The wider debate on London health care has been dominated too much by the understandably emotive issues of large and prestigious central London hospitals. There
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is a consensus that change must come, although of course there is no consensus on the detail of change. An example of that concerns the Guy's-St. Thomas's future, which is still subject to lengthy consultation which has highlighted a variety of viewpoints. The Guy's-St.Thomas's dispute, if I may describe it as that, affects even my constituency in south London. The majority of my constituents who need hospital care go to local hospitals. I shall refer to that matter in more detail later. On occasions, however, specialist treatment is needed in a central London hospital. There is certainly affection for such hospitals. From listening to my constituents, it is obvious that there is no clear view on the best way forward. Although I understand the views of those who wish to "defend" the future of Guy's, such views are by no means universal; some people would prefer to see emphasis elsewhere.I pay tribute to my hon. Friend the Member for Chislehurst (Mr. Sims), who has patiently attended most of the debate and has played a leading role in the Guy's campaign. From his and his constituents' point of view, it is an important campaign. However, I stress that such arguments do not necessarily apply to the whole of south London.
I cannot support the full campaign, which has strangely been called SICK-- saving casualty in crisis--the save Guy's campaign. Like my hon. Friend the Minister, I had an acute episode with the hon. Member for Southwark and Bermondsey (Mr. Hughes). The acute episode that I shared with him happened to be on a train, when he came up to me and handed me a leaflet, which I promised to read. I was interested to note that the hon. Gentleman's leaflet states that bishops and actresses support Guy's. It also states that African tribal chiefs support Guy's. I do not doubt that that is correct, but I find it puzzling; the hon. Gentleman's campaign has obviously gone much further than I thought.
The main reason why I take exception to some objectives of the SICK campaign is that the leaflet states that many people regard the closure of Guy's as part of a wholesale destruction of the NHS. That claim is wildly out of touch with reality and does nothing to assist the genuine objectives of those who want a different future from the preferred option for Guy's.
Ms Jowell: The all-party, hospital, trade union and community campaign to save Guy's hospital is different from the SICK campaign, which is based in Southwark communities. Ten years ago, they were promised that, when two of their hospitals, New Cross and St. Olave's, were closed, Guy's would continue as their district general hospital. There is very strong feeling in the communities of Southwark that the national health service is disintegrating and that promises are being broken.
Mr. Merchant: I thank the hon. Lady for clarifying that point, but it does not change my view on the leaflet produced by the Save Guy's campaign and SICK. It is a joint leaflet carrying both logos, so presumably everything that it says represents what both groups feel. I was making the point that such statements do not convince me that the arguments are genuine enough for me to lend my support to the Save Guy's campaign, even though I understand and have sympathy with many of its objectives.
Mr. Jenkin: All hon. Members feel an emotional attachment to these great institutions with their established
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history and worldwide reputations. Even my constituents, who are on the fringes of a Thames regional health authority, write to me on occasion about their concern about the possible closure and rationalisation of London's teaching hospitals. When I explain to them, however, that rationalisation of London teaching hospitals is necessary in order that more of their health services should be based locally, they understand that it is not the emotional but the practical case that must rule our hearts. We must go on advancing the practical case and not allow emotion to rule over practical decisions.Mr. Merchant: My hon. Friend is right. I am grateful to him for making that point, to which I was about to move. If it applies to his constituents, it applies also to my constituents, who are London constituents and who, nevertheless, would always prefer, if possible, to have treatment locally.
I imagine that it will always be necessary for some of my constituents to seek specialised treatment in central London hospitals, but I would prefer that far fewer of them need to do that in the future than have done in the past. It is interesting that the people who are strongest in campaigning to freeze, if you like, the position of the centres of excellence and central London teaching hospitals are the people who have had treatment there. Understandably, they have a warm feeling about that experience. When given the option, people who know that they might need similar treatment say that they would prefer to be treated locally, if possible, rather than centrally. We must take those people most into account. They are the future patients. We have to think of their interests in constructing the best possible health care system in the capital. My constituency is in outer London in the borough of Bromley, which has a population of just over 300,000. In terms of area, it is the largest London borough. The interests of my constituency are at least of equal importance to the interests of inner London, despite the fact that inner London so easily dominates the debate. I want the reorganisation of central London facilities, which is inevitable, to be carried forward strictly in tandem with the needs of outer London and with provision in outer London.
I should like to refer to existing health provision in the London borough of Bromley. As reference has been made to the largest and most prestigious hospitals, perhaps I can refer to one of the smallest hospitals in the Greater London area in Beckenham. I am not an expert in this, but the problem in that part of outer London--and I dare say that it is reflected in many other parts of outer London--is that hospitals are wrongly placed and in many cases very old. No one needs to be blamed for that. Population and health provision change. The sort of facilities that are available need to change and things will inevitably become out of date and need to be revised. It is important that, when that revision takes place, it matches present and future requirements rather than serves a purely nostalgic purpose.
There are four hospitals in Bromley. One is an accident and emergency hospital on a cramped site almost in the middle of the town. Access is extremely difficult, and physical reasons make it impossible to find a practical way to expand it. The second hospital is Orpington, which is on a very large site, much larger than the buildings need, and its location means that it serves only a corner
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of the borough. The third is Farnborough hospital, which is on a good site and reasonably well located. But its buildings are Victorian and some of them are huts and the like. It was badly planned and has been developed piecemeal over decades, and clearly needs to be improved. The fourth is Beckenham hospital in my constituency, which evokes great local support but could clearly never hope to provide all the facilities that are required nowadays. Since the setting up of the Bromley hospital trust, great efforts have been made on future planning to improve the situation for residents of the borough. I place on record my appreciation for the work of the trust's chief executive, Mark Rees, who has provided a first-class service to me and to my hon. Friends and who makes great efforts not just to provide the best service for today, but to improve it for tomorrow.There is clearly merit in centralising facilities in a borough, especially for the major acute services, and the provision of such facilities has caused the borough great problems. The original plan was to build a new district general hospital on the Elmfield site but, sadly, that opportunity was lost, though only on planning grounds. It was supported by the local authority and was obviously the best plan from the health point of view, but I am afraid that it was prevented by a rather cynical appeal to self- interest by local Liberal Democrats who put the advantage that they saw in stirring up their own back yard, if I may describe it that way, before the wider health interests of the borough. It was a great pity that idea was lost.
As a result, no other new sites are available on which to put a district general hospital--the planning position is as bad as that--and there is therefore a need to develop the existing hospitals. Luckily, there is a possibility of doing that and Farnborough hospital offers the best option. I support that option, provided that alongside it there is proper recognition of the role played by the other hospitals in the borough. They should not be seen as rival hospitals duplicating services but as hospitals providing different but necessary services for proper health provision for local people. The health trust has promised that the future of Beckenham hospital and that of other hospitals in the borough is guaranteed, so I am not in any sense fighting to prevent a hospital closure. I am seeking to stress the need for the future to be clear and for plans to be adequate. Although the term is not approved by current hospital administrators, I am talking about the provision of a proper cottage hospital in an area with a unique identity. That would provide facilities which would give, with much greater convenience, a whole series of health services to local people. The word that tends to be used now is "polyclinic." I do not like the term, but a small hospital of that type still has a relevant role. It could provide out-patient facilities so that consultants covering a wide range of specialties could come to the hospital and patients could see them there rather than having to travel long distances on public transport facilities which are not always ideal. That fits in with the pattern of overall health provision in London that we have been discussing. Day treatment should be provided at an enhanced level. Specialist clinics should be developed, not just for people in the immediate area, but to cater for wider borough
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needs. That would take pressure off the other hospitals--a sharing of specialist services. That is already beginning to develop. There should also be a full array of diagnostic services because that is usually the early stage of a patient's treatment. If that can be handled locally, so much the better for the patient and for the hospital treatment. Last but not least, I would like the hospital to have a small injuries unit. My hon. Friend the Minister referred to small injury units and clinics. I listened with great interest and I was pleased to hear him say that he envisaged an important future for them. There used to be one at Beckenham hospital and it provided a useful service. Sadly, it was lost some years ago, but there is now a real possibility that it might return. I know that the health trust has been examining the issue in detail. Indeed, I view it as a condition that I would want fulfilled if I am to support the overall development that the trust envisages for hospitals in the Bromley area.Provided that everything is understood, a clear distinction can be made between the sort of services provided by a small injuries unit and those provided by a major accident and emergency unit. Local people would be provided with a viable service, without in any way compromising the major A and E service that would be provided elsewhere. Since I have made that suggestion, I have received a tremendous response from local people, showing how strongly they feel about it and how large is the potential demand. Indeed, I have a file full of letters, which I do not intend to read, showing a clear favourable view.
I want briefly to refer to two other important aspects of London health care. The first is primary care. I have already mentioned the role that a small hospital can play and the specialist services that it can provide. The general practitioner can also provide many of those services.
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Ms Judith Church (Dagenham): Perhaps the hon. Gentleman would be interested to hear about a constituent of mine, Mr. May. He is a second world war veteran who fought for his country, was a prisoner of war and escaped from the prisoner of war camp. He is a man of great fortitude and bravery. He is certainly not fainthearted in any way. However, when he went to his general practitioner to get pain-killing tablets for his back, he was told that they were now available only on private prescription. Perhaps the hon. Gentleman would like to comment on the general practitioner services available to patients such as Mr. May.
Mr. Merchant: It would not be right to be drawn into a medical judgment on one of the hon. Lady's constituents, much though she may tempt me. I was once visited at one of my surgeries by a constituent who complained about his knee. Before I had the chance to ask him what the problem was, he had rolled up his trouser leg to show me his knee and he asked me to examine it. I declined as I did not feel that I was sufficiently qualified.
My point about primary care is that GPs are increasingly able to offer services which in past decades only hospitals could provide. Indeed, a major GP fundholding surgery in my constituency--Elm road surgery--provides a whole range of services which in my youth, many years ago, one would never have imagined would be provided by a GP. Consultants go to that surgery and carry out what previously would have been an out-patient appointment at a large hospital and would have required the patient to travel. That is an excellent advance. Another point that I must make--I see that I have little time to do so--is about the London ambulance service. It has had serious problems and there are still difficulties, but I should like to record my gratitude--
It being half-past Two o'clock, the debate stood adjourned .
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Orders of the DayPrivate Members' Bills
PARLIAMENTARY ELECTIONS (NO. 2) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
UNFITNESS TO DRIVE ON MEDICAL GROUNDS BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
DATA PROTECTION BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
REPRESENTATION OF THE PEOPLE (AMENDMENT) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
CIVIL RIGHTS (DISABLED PERSONS) (WALES) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
SPORTS (DISCRIMINATION) BILL
Order read for consideration (as amended in the Standing Committee).
Hon. Members: Object.
Mr. Deputy Speaker (Mr. Michael Morris): To be considered what day? No day named.
ENERGY CONSERVATION BILL
Order read for consideration (not amended in the Standing Committee).
Hon. Members: Object.
To be considered upon Friday 28 October .
SOCIAL SECURITY REGULATIONS (CHRONIC BRONCHITIS AND EMPHYSEMA) (AMENDMENT) (NO. 2) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
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TRADE DESCRIPTIONS (AMENDMENT) BILLOrder for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
MARRIAGE (AMENDMENT) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
REGULATION OF COSMETIC SURGERY BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
HEREDITARY PEERS (DEMOCRATIC RIGHTS) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
HOMICIDE (DEFENCE OF PROVOCATION) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
CONTAMINATED LAND (REMEDIATION) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
TAMPONS (SAFETY) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
REGULATION OF DIET INDUSTRY BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
NURSERY EDUCATION (ASSESSMENT OF NEED) BILL
Order read for resuming adjourned debate on Second Reading [18 February].
Hon. Members: Object.
Debate further adjourned till Friday 28 October .
FREEDOM TO ROAM (ACCESS TO THE COUNTRYSIDE) BILL
Order for Second Reading read .
Hon. Members: Object.
Second Reading deferred till Friday 28 October .
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