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best--the staff. I have witnessed that in my constituency. Many right hon. and hon. Members have had NHS staff from senior to junior level sidle up to them and say, "I really shouldn't tell you this because we are told not to talk to our MPs about it, but things are going sadly wrong."

Whereas the Tory party vice-chairman, Mr. Maples, proposed that the best tactic might be merely zero media coverage, the Secretary of State and the health quangos have introduced a new element, the contractual silencing of staff. Surely there could be a need to gag staff only if there were something to hide.

The one reassurance that we can gain from that concealment is that the Government are failing in any event to stop the failed reforms in the NHS from becoming a focal and vocal issue. A 300 per cent. increase in complaints from patients to hospitals tells us all that we need to know.

The mother of my constituent, five-year-old Rhiannon Louise Evans, telephoned me yesterday and gave an example. Rhiannon needs to have her tonsils and adenoids removed--the sort of thing that used to be done routinely, followed by a diet of jelly and ice cream, but these days it is not so common. Three times the mother has prepared that five-year-old child on the basis that the child was to go into hospital shortly, and three times the arrangement has been changed. That cannot be acceptable.

Indeed, hostility to the Government's reforms has even reached Dr. Jeremy Lee-Potter. We have heard the Secretary of State turn from praising Dr. Lee -Potter, which used to be the order of the day, to attacking him today. What did the Prime Minister's office do when Dr. Lee-Potter turned native on the Government and decided to give his real opinion? It telephoned the chief executive of Dr. Lee-Potter's trust to find out what it was going to do about him. The Prime Minister's office was prepared to interfere in the contractual arrangements that Dr. Lee-Potter enjoyed. Of course, there was not much that it could do, as Dr. Lee-Potter was in an advantageous position to leave the trust in any event, and he has announced that he will do so.

I see the hon. Member for Eltham (Mr. Bottomley) frowning in surprise, but I challenge the Minister to deny that someone in the Prime Minister's office telephoned the chief executive of that trust to ask what it was going to do about Dr. Lee-Potter.

Mr. Peter Bottomley: The reason I looked quizzical is that the hon. and learned Gentleman said that someone telephoned, as though one could do something about someone who has announced his retirement. What is the allegation to which the hon. and learned Gentleman refers? What was the Prime Minister's office supposed to have asked the trust to do? Will the hon. and learned Gentleman confirm that three quarters of the newspapers that referred to Dr. Jeremy Lee-Potter put his age at 59, whereas he had passed normal retirement age some time before?

Mr. Carlile: I said clearly that the Prime Minister's office was seeking to interfere with Dr. Lee-Potter's contractual arrangements. The Prime Minister, through his staff, has no business to telephone the chief executive of an NHS trust and ask, as though of Thomas a'Becket, "What are you going to do with this unruly priest?" That is what happened.

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I was about to refer to the development of a two-tier system. That has become irrefutable, as fundholding GPs have access to speedier provision than non-fundholders. It is a fact. In my constituency, treatment to be obtained in neighbouring districts on reference from non-fundholding GPs is being postponed until the next financial year, whereas fundholders' patients obtain treatment this financial year. What clearer evidence could there be of a two-tier system than that? The growing number of consultants who, out of utter frustration, are taking early retirement shows the extent of discontent in the service. Dr. Lee-Potter is not the only example by any means. Dr. Sandy Macara, chairman of the council of the British Medical Association, was mentioned. [Interruption.] I hear a few guffaws from Conservative Members at the mention of his name. If the hon. Member for Gillingham (Mr. Couchman) knew Dr. Macara well, he would know that Dr. Macara is no radical. He is a man of moderate opinions and great medical distinction. It is with a heavy heart that Dr. Sandy Macara criticises the Government, but he does so on the basis of fact.

The confusion of priorities in the NHS today arises inextricably from the operation of the internal market in a way in which patients are following money rather than resources following patients. I have referred specifically to problems in psychiatric care. In summary, the situation in London and in some other big towns and cities, but particularly in London, is that patients with psychiatric illnesses are placed in overcrowded wards. In some cases, they are moved out of overcrowded wards as far as 200 miles from London. They are forced to be treated away from their relatives, friends and communities. The right hon. Member for City of London and Westminster, South is right; demographic changes must be taken into account. In that context, the provision of psychiatric care must be a major consideration.

The decline in psychiatric provision has happened since the Secretary of State took over at the Department of Health. The problem has become worse. The right hon. Member for Derby, South is not solving the problem; she is exacerbating it. Why are psychiatric patients in London suffering at the hands of the Government? If psychiatric care is to have its proper priority, it will not be dealt with simply by providing supervised release; that is but a footnote on the page. A proper, adequately funded service for psychiatric treatment is needed. It is astonishing that the present Secretary of State, whose professional background is as a psychiatric social worker--a respected one--has not been able to provide the level of funding, beds and community care which her very own profession needs.

I welcome the Labour party's choice of subject for the debate. It provides the House with a much-needed opportunity to challenge the Government's failing policy which threatens the very essence of the health service which provides health care free on the grounds of need, not on income. The debate is also an opportunity to discuss the new Labour party's view of the future of the NHS.

It is easy for Opposition parties to score political points on this issue and, with the record of the Government, it would be harder not to score. A bigger challenge in many ways is to address seriously the reform of our service which is required to ensure quality care for everyone.

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There are specific problems to be solved, but there is a much bigger issue--the strategy needed for the future, once those problems are resolved.

One of my concerns which is shared by many interested Labour-watchers is that the Labour party might attempt to return the NHS to a centralised, totally provider-driven institution. That the internal market in its present form is failing is not in question; what is in question is how best to provide health care that is sensitive to the needs of patients and their communities, and can balance costs and benefits in terms of value and quality. Labour in opposition may wish to sustain the myth that the NHS can be a fund without end, but that could not be the reality under a Labour Government.

Mr. Nicholas Brown (Newcastle upon Tyne, East): Will the hon. and learned Gentleman give way?

Mr. Carlile: I know that the hon. Gentleman is getting sensitive, but he must hear some more before I give way.

From the speeches we have heard from Labour Members, it seems hard to believe that there would be waiting lists under Labour, as there are with any Government. No amount of Beckett and Brown soundbites--we may be about to receive a dose of the latter--will avoid the reality that decisions must be made which involve choices, and that priorities must be chosen in modern health care.

The Government have failed by putting costs before provision. Inversely, Labour--while speaking in the language of fiscal prudence--has to tell us how it would deal with the problems which arise. I shall now give way.

Mr. Brown: No, I have lost interest.

Mr. Carlile: I shall say a bit more, and perhaps I shall tempt the hon. Gentleman to intervene.

Would Labour destabilise a significant part of our health provision by abolishing all trusts? If so, how much would it cost? Does the party recognise that, although the system is not one with which it would have chosen to start, it does not start with a clean sheet of paper? Would Labour abolish all fundholders, despite the fact that a large number of GPs like the fundholding principle? Would Labour abolish all competition in health care, despite evidence that competition can, in some circumstances, be healthy for the service? If so, what would Labour put in place of those things? What would the structural changes envisaged by the Labour party cost?

I share the Labour party's belief--I hope that it is also the Conservative party's belief--in the NHS. It is a straightforward principle. Those of us who believe in the NHS believe in a service in which health care is available to all, based on need and not on ability to pay. We need to have a rational and factual debate which is not based on soundbites, and which takes place across, as well as along, party lines. Ideological brick walls should not be built to block the development of a better health service.

Mr. Matthew Banks (Southport): The hon. and learned Gentleman says that he wants facts. Does he still agree with the drift of a consultation paper which the Liberal Democrats issued in the summer of last year which proposed the retention of the division between the commissioner of services and the provider of services? Does he still believe in the retention of trusts and modified GP fundholders? Some of us are concerned at the accuracy--again, the hon. and learned Gentleman asks for

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facts--of an editorial in the Health Service Journal in September last year which, commenting on the Liberal Democrats' health policy, said that, with luck, someone might be kind enough "to offer some direction". Could we have that from the hon. and learned Gentleman?

Mr. Carlile: The consultation paper was a part of the policy-making process, and I agree with what it says. I became the Liberal Democrat health spokesman in September, and I am seeking to provide the direction which the hon. Gentleman seeks. I hope that he will be more knowledgable about my drift by the time I sit down. The Labour party should address these questions. If a private provider can provide scanners--as is happening in some parts of the country--on a 24-hour basis more economically to the NHS than could be provided by a district general hospital, does the Labour party exclude that provision from the private sector? If it does, it would seem to be asking for serious trouble, as it would be going back to an old-fashioned view of the service. Would Labour drive the private sector out of the market? Would it renationalise cooking and cleaning services, scanners and all elective surgery?

My party and I share many of the aspirations of the right hon. Member for Derby, South for the NHS, but, just as the Liberal Democrats are asking how and why a changing NHS can be sustained, so, too, must the right hon. Lady and the hon. Member for Newcastle upon Tyne, East (Mr. Brown). The right hon. Member for Sedgefield (Mr. Blair) has led the Labour party for only a few months, but it is now becoming time for those of us who watch the Labour party with considerable interest to see whether we will continue to have from it only the sound and fury born of 15 years of opposition, or whether that sound and fury will signify something for the health service, which certainly needs something new.

The service needs a fresh sense of direction and a commitment that will convince staff that it will survive and that it will enable them to continue what they do very well--serving the public whom they have to treat. The Government have failed the national health service, but the Labour party has still to give us a sign that it has something viable to offer. The NHS will remain positive only if the policies for it and the structure envisaged for it are also positive. 6.18 pm

Mrs. Marion Roe (Broxbourne): There is no doubt in my mind that the Government's record regarding their health reforms shows clearly that there has been an increase in the quantity and quality of patient care, and also better value for money. My right hon. Friend the Secretary of State has already given the details, and even independent surveys have demonstrated patients' growing satisfaction with the NHS. I am referring to the "British Social Attitude Survey" last November and a survey that the National Association of Health Authority Trusts carried out in June 1994.

The "British Social Attitude Survey" shows that the trend in falling public satisfaction with the national health service during the late 1980s has been reversed--1993 was the first year since 1986 when more people were satisfied than dissatisfied with the way in which the NHS is run. As we have had plenty of quotes from newspapers,

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I shall quote The Guardian , which reported that the survey suggested that the NHS reforms have achieved "considerable success" in helping to restore confidence in the NHS.

The other survey by NAHAT showed that nine out of 10 patients who had attended hospital in the previous year found the service very good, good or average, and three out of four found it very good or good.

We have a more accountable NHS because the Government have considerably strengthened the mechanisms of the service's independent audit, especially by extending the remit of the Audit Commission, and have also set out standards and rights in the patients charter. More information and more patient involvement in the decision-making process, especially through GP fundholders, are required. All those factors add up to putting the patient first--a sound philosophy. To that end, the all-party Select Committee on Health, of which I am the Chairman, has also been playing its part in monitoring and scrutinising the performance of the NHS, as our contribution to identifying the challenges and improving the service.

A common theme in several of the Committee's inquiries during the present Parliament has been priority setting in the national health service. Last July, we published a report that concentrated on the implications of a continued increase in the cost of drugs to the NHS for priority setting. The report presented a package of radical recommendations on the drugs budget.

I am delighted to have this opportunity to draw the attention of the House and of the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) to the fact that we published a report today on the wider issue of priority setting in relation to the purchase of health care within the NHS. I am pleased to be able to say that that report was agreed unanimously. In addition to thanking all my colleagues on the Committee for their help in producing that report--I see one, the hon. Member for Halifax (Mrs. Mahon) in her place--I thank our five specialist advisers and our secretariat.

The report deals with issues of major importance to the future of health care. In our opening paragraph we state:

"As medical developments open up new opportunities for treatment, it is widely believed that pressure upon resources will continue to increase. Coupled with an aging population and changing patient expectations, these issues are likely to become ever more important. The way in which priorities are set within the NHS affects everyone. This report reviews how NHS purchasers have decided priorities in the midst of competing demands upon resources."

The principal conclusions and recommendations of the report are, as usual, set out in an annex. I will not attempt to recite all of them, but will concentrate on a brief summary of the report. It begins by considering how other countries are grappling with setting explicit priorities. We discussed the radical experiment in health rationing that is under way in the American state of Oregon, which the Committee visited as part of its inquiry. We also explain the systematic approach to priority setting that is being attempted in two other countries--New Zealand and the Netherlands.

Next, we studied some of the factors that might influence future demand for health services in the United Kingdom. For reasons that we explain, we do not make

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judgments on future demand, nor do we enter the debate about current or future funding levels--they reached an all-time high of £37 billion in 1993-94.

As part of our inquiry, we commissioned a research paper from the Office of Science and Technology on "Factors Affecting Pressure on Health Care Resources". That forms the basis for our discussion and the paper is printed within the report as annex A, which we hope will help hon. Members and those outside.

We considered the potential impact on health costs of demographic changes, changing patterns of disease, advances in medical technology and changing patient expectations. Of those factors, demographic change is the most certain source of upward pressure on costs--in particular, the aging population, although the short-term impact of that change during the next 10 years is projected to be relatively limited. The Office of Science and Technology report makes clear the extent to which all such projects are subject to considerable uncertainty.

Of course, not all choices regarding the provision of services involve balancing competing demands in the light of increasing demand and restricted resources. Choices can often involve using resources more effectively. Against that background, we examined the process of making choices in the NHS--at national level, by individual purchasers and finally by individual doctors, nurses and other professionals. At national level, we began by asking the basic question, "What is the NHS for?" We set out previous attempts to answer that question and formulated our own set of fundamental principles for the NHS, based on the principles of equity, public choice and the effective use of resources. We expressed our view that an honest and realistic set of explicit and well-understood ethical principles is needed at national level to guide the NHS into the next century.

We considered the way that Ministers and the Department of Health communicate their priorities to the service and we shared the concerns of witnesses who complained about "priority overload". The Committee urged greater clarity when deciding which items are of crucial importance--those that should be regarded as priorities, while others, however urgent or desirable, should be regarded simply as initiatives. We called for a reduction in the total number of national priorities and initiatives.

In a helpful spirit, we recommended how the Government could improve the communication of priorities. We called on the Government to issue an explicit statement every year of how they expected the service to develop during, for example, a three to five- year period.

At the local level, we contrasted the decentralised approach adopted in the United Kingdom with methods used in other countries. Here, districts have had to develop their role almost from scratch. While that approach has encouraged innovation among the most able purchasing teams, we were struck by the seemingly enormous variation throughout the country. Some purchasers know exactly where they are going--others have yet to find the map and are drifting. Our conclusions on local decision making are based on detailed research. We received submissions in response to a questionnaire from all regions and from nearly half of all districts.

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We set out the criteria that the districts should adopt when decision taking and reviewed the development of local health strategies. We recommended that the NHS executive should take steps to ensure that, at minimum, epidemiological profiles, including variances from national averages, analyses of need and details of current provision, were open and accessible to public scrutiny and that the statutory requirements governing consultation over community care plans should be extended to cover consultation over health plans.

The Committee also stressed the importance of input from providers to good purchasing and called for GP fundholders to be required to sign up to an agreed set of local priorities each year prior to gaining access to their budgets. We examined the extent to which shifts in purchasing have occurred since the introduction of the internal market in 1992 and concluded that, to date, no major shifts have occurred. Districts have concentrated on setting priorities only at the margins. We believe that health authorities must develop the analytic tools to enable them to review existing services in depth and to redeploy resources from services of uneconomic or low health gain to services of real benefit.

We also reviewed how the NHS at district level has traditionally restricted access to non-emergency services through waiting lists and cost shifting and by giving particular services a low priority. We discussed the extent to which services have been excluded and concluded that, in terms of the impact on overall NHS resources, the absolute exclusion of services to date has been of marginal significance and is not appropriate.

We therefore recommend that the Department refines the operation of waiting time targets to increase flexibility and sets out clearly the framework within which purchasers will be expected to define the local package of services. We recommend that it sets out criteria by which decisions may be scrutinised, debated and, if necessary, challenged by individuals. We state that there should be no absolute exclusion of services from NHS provision. Whether a specific service should remain available must depend solely on whether there is a clinical need for that service and whether the service will demonstrably improve the health status of an individual.

Some of our witnesses argued that, instead of exclusions, greater emphasis should be placed on better value for money by making more efficient and appropriate use of existing resources. We draw attention to the large variations in the use of routine services across the country. There is a pressing need for greater information on those to be made available to purchasers and the public. The variations suggest that some routine treatments may be largely ineffective and a waste of resources, and even the most conservative estimates suggest that, by tackling that problem, there is greater potential to release resources for other services.

We warmly welcome the recent attempts to take effectiveness more seriously through research at Oxford and York, and by means of effectiveness bulletins. Feedback from our witnesses suggests a long untapped demand for greater information on effectiveness, and we make specific recommendations on how that information could be better disseminated. However much information is available, it is of no use if clinical behaviour does not change appropriately. We are convinced that persuasion rather than coercion must be used. We therefore make urgent recommendations on how that might be done.

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Our evidence suggests that previously implicit criteria are now becoming more explicit. Clinical guidelines and protocols are bringing those criteria out into the open. We see a need for greater explicitness also in the scrutiny of those criteria. Patients must be involved more fully in the choices regarding their own treatment. It is clear from our evidence that health authorities are making greater efforts than hitherto to involve the public in priority setting, but performance remains patchy. While some consultation exercises have led to welcome changes in local services, others are perceived to have had little impact on services. That has led to disappointment and alienation. Variation between districts is worrying. There are difficulties in gaining genuinely representative public views on priorities but we recommend that the Department sets minimum standards for involving the public in the development of services. I have now covered the report's main points but urge hon. Members to read the whole document. It is fair to say that, unlike last year's report on the drugs budget, this report does not contain a package of radical proposals because the issues involved are complex. They are taxing every Government in the developed world and, in many cases, as hon. Members will have gathered from my remarks, there are no easy nostrums or straightforward solutions; it would be dishonest for us to pretend that there were.

We hope that our report will be taken as a systematic attempt to review those difficult matters, take a snapshot of the current state of decision making in the health service, and contribute to a debate that will undoubtedly continue for years to come. We await with interest the Government's response to our report and recommendations in due course.

6.36 pm

Mr. Brian Sedgemore (Hackney, South and Shoreditch): When I went to St. Bartholomew's hospital this morning, an official sign in big red letters outside said:

"There is no accident and emergency unit at this hospital". The notice signalled, and was intended to signal, that everything about St. Bartholomew's hospital is to be destroyed. There were flowers and wreaths under the notice. A card on one of the bunches of flowers said:

"Sadly missed, from Whitecross street traders".

A card on a large wreath said:

"For all those who may become the victims of Bottomley's stupidity".

It was signed, "Local Residents".

Last week, a moving, beautiful, poetic candlelight procession moved off from St. Bartholomew's hospital to St. Paul's cathedral to pray that some good might come of the evil that was being done. The bells pealed out across the City. Heads were bowed, but people's faces shone with a sombre pride. Some cried openly and unashamedly in the street. We were witnessing a tragedy that should never have happened.

What a sad epitaph for the Secretary of State that she should go down in history as the person who hired a pathetic, second-rate, professional mafia --Sir Timothy Chessells; Admiral Staveley; Sir Derek Boorman; Gerry Green; and Francis Heidesohn--to destroy the world's

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oldest and possibly greatest hospital. If ever a Secretary of State failed to understand the true principle of conservatism--that of conserving excellence--it is this Secretary of State.

Today, the Royal London hospitals trust, which was born of the merger between the Royal London hospital, St. Bartholomew's and the London chest hospital, is an institution at war with itself--torn and driven by strife, caused, ironically, by the chairman and chief executive of the trust. That war and strife exemplify what is wrong with the NHS today.

On 11 January this year, Mr. David Maclean, chairman of the Royal London hospital medical council, told the St. Bartholomew's hospital medical council that a recent press conference, at which a gang of five consultants from the Royal London hospital had slagged off consultants from St. Bartholomew's to the Daily Express newspaper, had been orchestrated and initiated by the trust's chief executive, Mr. Gerry Green.

If anyone doubts the truth of that, I have the minutes of the meeting with me. Can anyone imagine the chief executive of a trust organising a press conference to destroy his own institution and to encourage one group of consultants to destroy the reputation of another group of consultants?

At the press conference, the gang of five--Wilson, Cunningham, Wright, Swash and David Maclean himself--lied, lied and lied again about their colleagues at Bart's, and did so at the behest of the trust's chief executive. They defamed Mr. Steven Miles, who ran the Bart's accident and emergency unit. In an even more bizarre twist, they defamed Professor Mike Besser, one of the world's top doctors, the former acting chief executive of St. Bartholomew's hospital and currently the deputy president of the Royal College of Physicians. If that is not bizarre, what is?

On 25 January, 86 consultants from the medical council of St. Bartholomew's hospital passed the following motion:

"That the actions of Mr. G. N. V. Green"--

the chief executive--

"and Sir Derek Boorman"--

the chairman of the trust--

"in respect of recent press allegations impugning the integrity of senior members of this Institution and their subsequent responses to them are unsatisfactory, have led to unnecessary divisions between consultants on the three Trust sites and are not seen as providing an even-handed approach to management of the Trust. Medical Council sees this as part of a wider inability to pursue, as initially promised, such an even-handed approach. Medical Council therefore resolves that it has no confidence in the Chief Executive and Trust Board Chairman and that each should resign forthwith."

That motion was carried nem. con., which means that 80 consultants voted for it and a few abstained.

The minutes of that meeting stated:

"It was further resolved that the Acting Chairman should write to each of the five consultants involved, expressing:

(1) Dissatisfaction with their actions and failure either to justify their allegations or to withdraw and adequately to apologise for them.

(2) To request those of them holding positions of authority such as Clinical Director and Ethical Committee Chairman, to consider whether they can continue to enjoy the confidence of their colleagues on this site in these positions."

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It is extraordinary that the clinical director and ethical committee chairman should act without ethics and morality, and five consultants may be suspended pending a full inquiry into their actions. What is going on at the Royal London hospitals trust? The Daily Telegraph subsequently carried an article in which it was alleged that the consultants at Bart's had misused funds from the Imperial Cancer Research Fund. That allegation was equally untrue. The Imperial Cancer Research Fund is about to write to The Daily Telegraph to say that it was untrue. We are witnessing a dirty tricks campaign--political and military games carried out on behalf of the Secretary of State by the chairman of the trust, who happens to have been a former joint chief of the intelligence staff. It is extraordinary.

The turmoil at the trust has continued with the appointment of the warden to the merged medical colleges. Sir Colin Berry, a pathologist, was appointed, even though he is subject to investigations on two serious cases of medical negligence involving two women who have had their breasts cut off as a result of his misdiagnosis. The general view is that Sir Colin should not have allowed his name to go forward while those allegations are being investigated. We need a full statement from Sir Derek Boorman, the chairman of the trust, to explain.

Mr. Couchman: On a point of order, Madam Deputy Speaker. I have been listening carefully to the hon. Gentleman, and I seek your guidance. Are the hon. Gentleman's accusations against a distinguished doctor's clinical judgment in order, in view of the fact that the matters are currently being investigated?

Madam Deputy Speaker (Dame Janet Fookes): The sub judice rule applies only to court action. I am assuming that there is no question of court action in this case. I have no doubt that the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) can elucidate on that.

Mr. Sedgemore: I am not aware of any court action, but I am aware of investigations currently taking place. I believe that it is appropriate, in the House, for me to say that it is my contention that Sir Colin Berry should not have put himself forward to be the warden of the joint medical colleges, given the nature of the allegations. One must be seen to be cleaner than clean and show qualities of leadership. I do not see how that can be done in such circumstances.

It is also unfortunate that Sir Colin was appointed when there was an infinitely superior candidate called Professor Lesley Rees, who is generally regarded in medical spheres as perhaps the best dean that this country has ever seen. I am convinced that she was not appointed partly because she is a woman--the male chauvinism of the Royal London college is legendary--and partly because, although she fought to make the merger of the Royal London and the St. Bartholomew's medical schools work, she also fought to preserve activity at Charterhouse square for the medical college and at the Smithfield site for the hospital.

Sir Derek Boorman has meanwhile shown himself to be paranoid and has set up an extremely expensive inquiry into the leaking of a document at the time the warden was being appointed. That seems bizarre. During the course of that inquiry, there was an extraordinary homophobic

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outburst, in which Sir Derek made it clear that he regards being gay as a human weakness. That seems to be beyond the pale for someone who is chairman of a hospital trust.

Recently, there have been more general allegations about Sir Colin Berry, and an investigation is taking place. We should be told the nature of those allegations, the evidence that was given and the results of the investigation. The right course would be for Sir Colin to stand down and for the post to be readvertised.

I was talking about war and contrition at the hospitals trust. No fewer than four consultants independently told me--wrongly, I am sure--that they believed that their telephones were tapped. Many people have a paranoia about the tapping of telephones, but is it not odd and undesirable that four senior clinicians should separately report to their local Member of Parliament that they think that that has happened? It seems to suggest that there is something radically wrong at the Royal London hospitals trust.

The right hon. Member for City of London and Westminster, South (Mr. Brooke) mentioned the role of the East London and Hackney health authority. It is clear that the purchaser, in the form of Frances Heidesohn, has for the past year been working behind closed doors with the provider, Sir Derek Boorman, to close St. Bartholomew's hospital.

I went to see her for an hour and a half recently. The Evening Standard stated simply that such treachery would never be forgiven. I do not want to use such emotive language, but it seems that claims that there is competition--and that the purchaser-provider split has brought about that competition--cannot be upheld when the consultative document produced by the purchaser is identical to documents that were leaked to me earlier this year and were prepared by the provider. That is not competition, but collusion. Not only were the figures and the language the same, but so was every comma and colon. The right hon. Member for City of London and Westminster, South said--I am sure that he meant it--that he hoped that the Secretary of State would give serious consideration to the consultation process, where the purchaser and the provider jointly propose that the site of St. Bartholomew's hospital at Smithfield should be completely closed down.

No such examination of the proposals will be prepared. Within the past 24 hours, the acting chairman of the medical council at St Bartholomew's hospital, Larry Baker, has been to see the trust chairman Sir Derek Boorman, the chief executive Gerry Green and Dr. Duncan Empey. When Larry Baker said that the Bart's people were insisting that serious medical activity should continue at the Smithfield site, Sir Derek told him that the Government had made enough U-turns on medical affairs, and they were not going to make another one.

The chairman of the medical trust has said that he knows what the Secretary of State will do. Clearly, he is acting on the orders of the Secretary of State. I am confident about that because, before he took up his post-- before he had viewed any evidence or even entered his office--Sir Derek Boorman told me that he intended to close the St Bartholomew's site. They were his political instructions, and that was what he intended to do.

I trust implicitly the sincerity, honesty and integrity of the right hon. Member for City of London and Westminster, South, but he has to start asking a few hard

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questions about some of the people around him. I believe that the plight of St Bartholomew's hospital could end in tragedy, and I will fight against that.

At the meeting between the acting chairman and the chairman of the trust, the question was raised as to what would happen if a Labour Government were elected in two years. The acting chairman was told that those who board the train now will prosper, and those who do not will not prosper. That has nothing to do with medicine; it is dreadful politics, and it is an insult to this country.

The motion moved by my right hon. Friend the Member for Derby, South (Mrs. Beckett) clearly states that there should be a moratorium on hospital closures in London while the decisions are viewed rationally. There is no reason for the actions of the Royal London hospitals trust; it is gut and nasty politics, from which the House should disassociate itself completely.

6.52 pm

Mr. James Couchman (Gillingham): I do not wish to follow the line taken by the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) or that of my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) with regard to St Bartholomew's hospital. I do not know the arguments between St Bartholomew's hospital and the Royal London hospital, and I do not understand the circumstances. However, I do know that hon. Members as far afield as myself in my mid-Kent constituency have been lobbied by both sides of the argument.

As long ago as 1908, it was realised that there were too many large hospitals in a three-mile ring based around the central point of Harley street. Ever since that time, the rationalisation of the facilities in London has been a troublesome and contentious issue. A dozen years ago, I was the chairman of an outer London health district which was deprived of resources because so many resources were allocated to the inner-London ring. My constituency in mid-Kent and the Medway towns have been a most deprived district, vis-a -vis population size, for a long time. We are very pleased that we are to see a £45 million extension to our district general hospital in Gillingham. That will provide services to a population of 300,000 people which we expected a long time ago but which we were deprived of because of the over-resourcing of inner London.

I shall devote most of my speech to examining the pursuit of value for money in the health service, particularly with regard to primary health care. The debate has been very interesting so far. The spokesman for the Liberal party, the hon. and learned Member for Montgomery (Mr. Carlile), rubbished the Government's policy on the health service. He then asked the Opposition spokesman whether a Labour Government would abolish trusts and fundholding, as well as a number of other questions which I thought would be asked by those on my own Front Bench.

However, the hon. and learned Gentleman did not tell us what the Liberal party would do for the health service--although it is unlikely ever to have responsibility for the national health service. As I said by way of intervention during the Secretary of State's speech, running the health service is somewhat different from

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