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Point of Order
3.30 pm
Mrs. Anne Campbell (Cambridge): On a point of order, Madam Speaker. Have you had any indication of a Government statement on the allegations in the Independent on Sunday about suppression of a report by the Equal Opportunities Commission into Government policies and their damaging effect on women's jobs of compulsory competitive tendering?
Madam Speaker: I have not had any indication from the Government that they are seeking to make a statement on any issue today. No doubt those on the Treasury Bench have heard what the hon. Lady had to say.
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Opposition Day
[7th Allotted Day]
Health Care (London and South East)
Madam Speaker: I have selected the amendment in the name of the Prime Minister. I have not restricted speeches for either of today's debates. I leave it to the good sense of Back Benchers and Front Benchers to exercise some voluntary restraint so that everyone who wishes to be called is likely to be called.
3.31 pm
Mrs. Margaret Beckett (Derby, South): I beg to move,
That this House expresses its concern at the evidence of continuing crisis of health care in London and the South East; believes that the scale and nature of the crisis stems directly from the Government's failure either to assess the health care needs of the area properly or to plan a programme by which those needs can be met; believes that the process of the internal market and Government-driven so-called `reforms' are making matters worse; and calls for a moratorium on further closures until a fresh and thorough review has been carried out of the mounting evidence of serious misdirection of health care across the whole of the area. Yet again, it is the Opposition who provide the opportunity for a debate on health care in London and the south-east, both because it is important in itself and because of the light that it casts on the implications for Britain as a whole of Government health policy. It is important to flush out the Secretary of State for Health to give us her views on these matters. She is fond of talking about stewardship and responsibility, but less fond of exercising them. It is also valuable to have the debate at this time, because we are at a turning point, a crucial point of change.
On Saturday, a large conference discussed the crisis in London health care as the effects of Government policy begin to be felt. In two days' time, the consultation period on proposals to close Bart's hospital will come to an end, and we shall see whether the health authority meant what it said when it suggested that public reaction to those proposals would influence its decisions.
We are on the brink of other, greater change. Decisions will be made against the background of still greater cuts in funding for the authority which controls Bart's, and cuts for other authorities which rank high on the Department of the Environment's list of authorities dealing with high levels of poverty and deprivation. Of course, the debate is also held against the background of the final, full implementation of the Government's dogma-driven policies. In April, the special health authorities--hospitals such as Moorfields, the Bethlem/Royal Maudesly and the Royal Marsden, which have been cushioned until now from the full effects of Government policy--will face the impact of the Government's so- called reforms, as the full internal market finally comes to London. Londoners await that process with the same anticipation as they once awaited the arrival of Boadicea.
Five years ago, London was the undisputed health care capital of Europe. The French newspaper Liberation carried out a survey of medical research and teaching in 1989, which put London's medical schools at the top of
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the European league, above even Oxford and Cambridge. It ranked them as the best in the continent, not just in Britain, and said: "the density of its network is such that this premier position is in no way a surprise; the different colleges each on their own cover the full range of specialties."The report went on to refer, rather optimistically, to
"the one constant which does not change: the supremacy of British medicine."
London has always been the key to the top ranking of British medical science. It trains 30 per cent. of new doctors and a quarter of new dentists. Half of all the highest grades awarded in clinical medicine are gained by people who went to university of London medical schools. That is not accidental. London's large catchment population and the concentration of medical resources have enabled the maximum interaction between science and clinical medicine. That has provided the strong base needed to sustain the caseload required for training and development.
In fact, like that other great national institution, football, until recently the hospital service in London was one of our greatest assets--an institution in which London's citizens could take great pride. It is now threatened with disintegration and collapse. Several of the most famous teaching hospitals on which the medical schools depend face closure, including Bart's and Guy's, while others are to be amalgamated. The post- Tomlinson rationalisation could lead to a flight of research revenue and income. Dozens of professors and top consultants face redundancy, and many are leaving London, with the consequent exodus of medical talent.
As with football, so with health care--London is now in danger of being relegated to the international second division. Like hooligans at a Chelsea -Millwall match, the Government set out wilfully to vandalise a service that was once orderly, well managed and widely supported. The question that we want to ask is the same question as that behind the inquiries into the recent England-Ireland game--is the Government's sabotage of London's health service the action of mindless vandals, or are they motivated by extreme right-wing ideology?
Lord Sutch of the Monster Raving Loony party does not seem to be in any doubt. On Friday, he said how disappointed he was that the Conservatives had just pipped his party into fifth place in the Islwyn by-election. He said:
"We thought we would beat the Tories, but by mistake people voted for the wrong loony party."
I must differ from Lord Sutch--the Government are not just loonies, and they are not just hooligans, although the Secretary of State gets called before judges to account for her vandalism of the health service. She and her colleagues are guilty of wilful destruction, but it is not mindless hooliganism.
Just like many of the troublemakers at our football matches, the Government are driven by right-wing ideology, which they coldly and deliberately calculate will wreak havoc in our public health service, just as it will create opportunities for those who can profit if what is lost from the public sector is replaced in the private sector--and unlike many of football's troublemakers, the Government are carrying out their strategy with stealth, and in furtive secrecy.
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Unfortunately, the strategy's effect on London is especially acute. While London is a centre of medical excellence, it is also a city of harrowing deprivation and savage contrasts between rich and poor. Four out of five of the areas of greatest deprivation in Britain are, according to Department of the Environment indices, in London. Unemployment, a major cause of ill-health, in London is double the national average. Perinatal mortality in London is 74 per cent. above the national average. A third--Mr. Tim Yeo (Suffolk, South): Will the right hon. Lady give way?
Mrs. Beckett: In a moment--I am sure that the hon. Gentleman will want to hear the figures.
One third of all those who died from hypothermia in 1992--the latest year for which we have figures--lived in London. Some 75 per cent. of all HIV and AIDS cases are in London; 42 per cent. of United Kingdom reported cases of tuberculosis in 1992 were in London--in itself increased by 13 per cent. since 1988; and 60 per cent. of all Britain's homeless and people living in temporary accommodation are in London.
Being a great metropolitan city also means that London attracts huge numbers of visitors and commuters, all of whom increase the strain on its health service.
Mr. Yeo: The right hon. Lady mentioned perinatal mortality. Does she agree that it is one of the most objective indices of good health that can be applied to any nation and any region of any nation? Does she further agree that, since 1979, there has been a substantial fall in perinatal mortality across the whole of the United Kingdom, and that nowhere is that fall more substantial than in London, where the figure is down from 12.7 per 1,000 to 7.1--a drop of 44 per cent?
Mrs. Beckett: Improvements have been made in perinatal mortality rates. I am afraid that I do not have the figures or the report with me-- mind you, Madam Speaker, nor does the hon. Gentleman. He borrowed them from his hon. Friend the Member for Hertsmere (Mr. Clappison), who presumably had the briefing.
Mr. James Clappison (Hertsmere) rose --
Mrs. Beckett: I shall give way in a minute--one intervention at a time, thank you.
If one considers, in particular, inner-city wards where deprivation is highest, that puts those figures very much into the shade. The hon. Member for Suffolk, South (Mr. Yeo) knows that my point is about the deprivation level across London. The overall average figures have improved, as they have elsewhere. That is what we expect. They improve year on year, century on century; there is nothing new about that.
The hon. Gentleman said that the figures had improved, but he knows that they have not done so where greatest deprivation exists. Although I do not have the figures with me, my recollection is that, under this Government, the position has worsened in some areas of greatest deprivation.
Mr. Clappison rose --
Mrs. Beckett: I shall give way to the hon. Gentleman. Has he now found some other figures?
Mr. Clappison: Will the right hon. Lady take it from me that the standardised mortality ratio shows that
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London has an above-average performance in mortality rates? Contrary to what she has said about deprivation areas, the most recent statistics show that the biggest reduction in infant mortality has been among the lowest social classes 4 and 5. The best improvement has been made in those social classes.Mrs. Beckett: I give the hon. Gentleman the undertaking that I will read carefully what he has said, but it contradicts much of the other published evidence. I hope that neither of the two hon. Gentlemen who have intervened are contesting my basic point about the deprivation level and about the serious problems that occur in London and are concentrated in London, disproportionately even to other inner-city areas in the United Kingdom.
The hon. Member for Suffolk, South is sitting there smirking. Does he disagree with that basic case?
Mr. Yeo: When the right hon. Lady responded to my previous intervention, she tried to imply that I did not know what I was talking about. She may not know this, but other hon. Members will know that, before I came here, my full-time job involved running the Spastics Society, whose major research and publicity campaigns dealt precisely with this point. That is why I have the figures in my head and why she does not.
Does she agree, as I asked her to agree before--she dodged the question-- that the perinatal mortality rate is one of the most objective statistics on the measure of health in any country, and in the regions of those countries? Does she further agree that, under this Conservative Government. in the past 17 years, there has been a substantial fall in the rate throughout the UK, and particularly in London? I quoted the figures, which were kindly supplied by my hon. Friend the Member for Hertsmere (Mr. Clappison). They demonstrated that there has been an even improvement across the country.
Mrs. Beckett: I did not dispute what the hon. Gentleman said about perinatal mortality rates, because they are an important indicator. I am never in danger of forgetting that the hon. Gentleman was a director of the Spastics Society before he came to this place, because, as he will recall, I sat with him on a Committee where the Government made savage cuts in the benefits paid to people with disabilities, and I waited for him to protest on their behalf, which he failed to do.
Mr. D. N. Campbell-Savours (Workington): I am sorry to intervene on my right hon. Friend, but, before she concedes anything on that front, may I tell her that, some years ago, I challenged those statistics in the northern region? The statistical base was rubbish, so let us be careful before we concede anything on those statistics.
Mrs. Beckett: I am most grateful to my hon. Friend. I note that, despite all that the hon. Member for Suffolk, South has said, he does not appear to be disputing either that deprivation is concentrated in London, or some of the indicators of that deprivation.
There is, of course, much more to London's health service than its hospitals. The glory of the health service in Britain, what is unique, what possibly has made it--or did make it--the most cost-effective health service in the world, has been the emphasis on primary care, in particular in relation to general practice. Unfortunately, in London that has long been an area of weakness.
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In the early 1980s, reports identified some 15 per cent. of general practitioner premises as being sub-standard, but, under this Government, that problem has got worse. By the time of the Tomlinson report in 1992, 46 per cent. of general practice premises were said to be below the expected standard, yet such a development must have been foreseen. As early as 1982, the Acheson report drew attention to deficiencies in primary care in London, and to the need for those deficiencies to be addressed. Nothing happened. Not one of the report's recommendations was implemented. Thirteen years on, matters are substantially worse.I hope that the Secretary of State will neither try our patience nor further undermine her reputation by pretending that the Government's determination to strengthen general practice has led to the attack on London's hospitals. Throughout the Government's period in office, general practice in London has deteriorated, and there is little to suggest that the current Secretary of State will do better than her predecessors.
I cite the precedent of the London Ambulance Service. Two years ago, the right hon. Lady told the House that she would be taking a close personal interest in the service's work and improvement. It is one of the few policy areas for which she has taken any responsibility, and I do not think that even she would claim that an outstanding success.
Mr. Nigel Spearing (Newham, South): After the LAS area collapse two years ago, I sent the Secretary of State a copy of my memorandum to the Page committee. Last week, I sent the right hon. Lady the 50-page memorandum published by the Select Committee on Health, to which I gave evidence 10 days ago. Does my right hon. Friend agree that the Secretary of State should reply to my letter asking her to point out any errors of fact in my conclusions or where she differs from them? Is not the Secretary of State responsible to the House, and should she not give an undertaking to reply when she speaks today?
Mrs. Beckett: I am sure that the Secretary of State heard my hon. Friend, and that she will reply to his point. I share my hon. Friend's view that it is part of Government responsibility to deal with such matters and to respond to queries from hon. Members. After all, the Government are accountable to this place.
The Government's continuing implication that improvements in general practice, if and when they come, will lead to reduced demand for hospital beds is indefensible, as is their justification for a further massive reduction in the provision of hospitals and beds throughout London and the south-east. Beds are already being closed at breakneck speed, before investment in general practice can provide an alternative.
The pace of closures is accelerating. Between 1982 and 1990, 7,000 acute beds closed in London, but since 1990, another 3,200 beds--one in six of the 1990 figure--have closed. Since 1982, 39 per cent. of acute beds have closed in London, compared with a national average reduction of 23 per cent.
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Lady Olga Maitland (Sutton and Cheam): Will the right hon. Lady give way?
Mrs. Beckett: I will, but this may be the last time that I do so, because I am mindful of Madam Speaker's observations.
Lady Olga Maitland: In suggesting that those bed closures are a scandal, the right hon. Lady is totally misrepresenting developments in modern medicine. Does not she accept that they mean that patients can spend fewer days in hospital, creating less demand for beds?
Mrs. Beckett: Of course I accept that, but the hon. Lady will be aware of severe doubts about the pace at which beds are removed. Lady Olga Maitland indicated dissent .
Mrs. Beckett: It is no use the hon. Lady shaking her head. She must know the problems in London if she even looks at the Evening Standard -- never mind reads it. The Government anticipated reduced demand, rather than waiting to see whether it occurred. The hon. Lady must be aware of all kinds of problems, such as patients being re-admitted after being discharged too early, and of questions about day case surgery and the anaesthetics used. It is not a simple equation of changes in medical technology enabling beds to be taken out of use. Most people in London accept that readily.
There is not a shred of evidence that improvements in general practice are forthcoming to allow a reduction in beds. There is growing belief that primary care improvement in London may reveal substantial unmet need for hospital treatment. The assumption that London has too many beds is increasingly open to question, because of long waiting lists and continuing reports of overwhelming pressure for beds. The latest report shows that psychiatric beds are at 140 per cent. occupancy, with patients sent to centres as far away as York to be treated in the private sector because there are no psychiatric, acute or secure beds available in London.
Not long ago, we were told that not one intensive care bed was available anywhere in London for an adult or a child. The London health consortium has described the pressure on the provision of beds in London. It says that if there are further bed cuts--or a bad winter which, fortunately, so far, we have not had in London--they could prompt a full-scale crisis in London's health service.
The case is open to question--never mind comparisons with capital cities elsewhere in Europe, although those cast doubt on the Government's case-- because of comparisons with other cities in the United Kingdom which cast doubt even on the theoretical case for further cuts. Ministers used to argue that London and the south-east had a disproportionate share of hospitals and of beds, and used a disproportionately high amount of health service funds. Earlier studies by the King's Fund, like the Tomlinson report, seemed at first to confirm those assertions although they caused bewilderment among many who found them hard to square with the reality of London health care.
However, further work, most notably by Professor Jarman at St. Mary's hospital, which has been backed up by an even more recent study by the London health consortium, has demonstrated that if we compare like with like and city with city, it is not true that London is
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over-provided either with beds or with funds. In fact, the most recent figures on bed usage have Leeds, Newcastle, Manchester, Liverpool and Birmingham all above London in their use of health service beds. London has only a little above the average figure for the whole of Britain. The evidence on which the Government have relied for their changes is simply not there--quite apart from the huge and fundamental flaw at the heart of both reports to which I referred. The flaw is that they relied on the assumption that Government policies would of themselves, by the application of the internal market, remove beds from London. It was not a question of whether the beds were needed, but a question of the impact of Government policy.The figure I quoted for the comparison between London and other cities, which shows that there is not over-provision in London, squares with the day-to-day experience of Londoners. It squares with the 168,000 people on waiting lists for the main trusts and the 6,000 people waiting for treatment in the special health authorities. The figure squares with the 140 beds that were never opened at the new Chelsea and Westminster hospital where, in the seven months from April to November last year, there was an increase of 128 per cent. in numbers on the waiting list. It squares with the threat to the existence of University College hospital when the funds of Camden and Islington health authority were slashed. The figure squares with the revelation that in Redbridge, there is no elective surgery for those waiting less than 18 months and with the fact that Redbridge waiting lists have gone up by 46 per cent. It squares too with the fact that Whittington hospital is closed for non-emergency elective surgery, with little indication about where the people whom the hospital previously served are expected to go.
Mr. Jeremy Corbyn (Islington, North): Is my right hon. Friend aware that the restriction on non-elective surgery does not apply to the patients of fundholding GPs and private patients? They can get treatment at Whittington hospital. Does my right hon. Friend agree that that is the disgraceful two-tier health service which so many people in my constituency are expected to put up with?
Mrs. Beckett: No one could disagree with my hon. Friend's point. The position is very worrying for those who are unable to be in practices that are eligible for the Government's scheme.
The examples of deficiencies in health care that I have given all come from the time before the most recent proposal for still further changes in funding for London's health authorities. Inner and outer London together were expected to lose about £100 million in the coming year. Outer London has had some reprieve, gaining about £46 million more than expected, but £41 million of that gain has been slashed from inner London.
Health authorities in areas which rank among the most deprived in the country now stand to lose still larger sums. East London and the City, the authority in which St. Bartholomew's is situated, now stands to lose a further--almost--£14 million from its funding. Kensington, Chelsea and Westminster stands to lose almost £15 million, and Camden and Islington, which was already set to lose £27 million, will now lose more than £30 million--getting on for £31 million. Every one of those areas was already the subject of concern expressed in this
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House, primarily by Conservative Members on behalf of their constituents, in the debate on London health care in October. Those new figures also show that London will receive just under 15 per cent.--14.9 or 14.8 per cent.--of the funding, despite having to cater for 15 per cent. of the population. So London is receiving an under- provision in revenue, especially when we recall the under-recording of London's population left as a legacy of the poll tax.That brings me to perhaps the most blatant example of the chaos over which the Secretary of State reigns, which directly results from the neglect, vandalism and incompetence of Ministers. When she launched the new patients charter, the Secretary of State was pleased to boast of a new trolley standard. [Laughter.] Under previous Governments, Labour or Tory, the notion that waiting hours on a trolley in a casualty department was a standard daily expectation was inconceivable.
In January, Bart's accident and emergency department closed. The week before its closure, patients were having to wait up to 36 hours to be admitted to the alternative facilities, and some 15 patients could not be found beds because of the pressure placed on those facilities. Guy's accident and emergency department is under threat. Many patients are expected to go to St. Thomas's. But, last week, even before the closure of Guy's accident and emergency unit, patients from St. Thomas's had to be sent back to Guy's, because there were too many to be treated at St. Thomas's.
All London has read of the child with an arrow in his eye, who spent eight hours being shuttled between hospitals before he was allowed into Bart's for emergency treatment.
Mr. Peter Bottomley (Eltham): Will the right hon. Lady give way?
Mrs. Beckett: Was the boy with an arrow in his eye one of the hon. Gentleman's constituents?
Mr. Bottomley indicated assent .
Mrs. Beckett: Then I shall give way.
Mr. Bottomley: The newspaper report said that a child in my constituency had been taken by air ambulance to Moorfields hospital, and that the doctors at Moorfields had been told by the paramedics that the child could not be taken to Bart's. When I checked with the local evening newspaper news desk, it said that, in fact, the child had been taken to the Royal London hospital, and that the doctors at Moorfields had not asked the London Ambulance Service whether the child should be transferred for neurological or ophthalmic treatment at Bart's. If the right hon. Lady is to read newspaper cuttings, she should check them, in the way that the constituency Member of Parliament does.
Mrs. Beckett: I do not think that the hon. Gentleman is in any way casting doubt on the point I made, which is that, right across London, there is huge pressure on casualty departments, and right across London there is strain. It is not surprising that, in such circumstances, people do not always make the correct decision--the decision that they should have made at the outset.
It does not alter the fact, whoever was at fault, that that child waited all those hours for treatment. Nor does it alter the fact that, as we heard in the previous debate, we can
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produce a string of lists outlining incidents of people waiting hours on end in casualty departments right across London, of which the hon. Gentleman is perfectly aware.In consequence, right across London and the south-east, there is fear and anger. There is anger at the loss of valuable facilities that people believe are needed, and there is real fear, especially among parents, as private surveys of opinion show, that, should their children be injured or fall seriously ill, the treatment they would need would simply not be there.
In our previous debate, the Secretary of State talked about her stewardship of our health service. Let us examine that stewardship for a moment, and look at her strategy for London and the south-east, especially for accident and emergency services.
Has there been an overall review of accident and emergency services as there has for other specialty services? No. How many hospitals in London provide such services? According to parliamentary questions, the Secretary of State does not know and, what is more, she does not think that it is any of her business.
How many accident and emergency departments are there in London and the south-east? The Secretary of State does not know, and she does not think that it is any of her business. How many accident and emergency departments are due to close in London and the south-east? The Secretary of State does not know that, either, and she does not concern herself with it. Stewardship? The Secretary of State does not know the meaning of the word.
The Government have abandoned the management, planning and co-ordination of change in London. They have abandoned their duty to those who live and work in and around the capital. The Government are always urging on us the virtues of private sector management, but no big business would act as the Secretary of State acts.
The manager of every branch of Woolworth and McDonald's has a degree of freedom to manage the unit, but that freedom can be practised only within a well-defined and clear framework, and within guidelines laid down by the parent company. As I understand it, nothing is more precisely defined than a McDonald's hamburger. There are varying degrees of autonomy for local business units in London's national health service, but with no strategic framework. Just imagine if the chairman of Kingfisher, the parent company of Woolworth, was asked how many Woolworth branches there were in London, and he had to reply that that information was not centrally held, which is the Secretary of State's stock reply.
Imagine that McDonald's was restructuring its business and downsizing its operation, and, when the shareholders asked how many branches were going to close, the chairman said, "This information is not held centrally."
A whole new vocabulary is developing. "Rationalisation" means--
Mr. Nigel Forman (Carshalton and Wallington): Will the right hon. Lady give way?
Mrs. Beckett: No: I have almost finished.
"Rationalisation" means closure. "Information not centrally held" means "I haven't got a clue", and instead of decisions we have strategic directions. We have a
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strategic direction for the Secretary of State: the exit is that way, and she can rationalise the door behind her as she goes.Mr. Forman: Will the right hon. Lady give way now?
Mrs. Beckett: I have almost finished, and I am mindful of Madam Speaker's observations.
Imagine if ICI had just invested in a new state-of-the-art building, the most modern in the industry, which had cost £150 million and had taken eight years to build. However, before it was even occupied, the chairman decided that the facilities would never be used by that part of the business for which it was intended. Just imagine what the shareholders of the company would say to such a cavalier and irresponsible treatment of their funds.
However, that is exactly what will happen to Philip Harris house at Guy's hospital, which the Secretary of State has decided will never be used for the service that it was intended to provide. That is typical of the Government's cavalier attitude to the use of public and private funds.
In London and the south-east today, there is no strategic planning, no overall investment strategy and little consideration of whether a wider national or public interest should materially affect decisions locally made. There must be a moratorium on further bed closures, in case they have already gone too far.
In the breathing space that such a moratorium creates, there must be a fresh and thorough assessment of the needs of health care in London, of needs driven by medical technology, which was the case made by the hon. Member for Sutton and Cheam (Lady Olga Maitland), and of the needs of elderly and frail people, particularly where, as in London, there is such a lack of alternative places. There must be an assessment of those needs, and further consideration of how those needs are to be met.
By no definition, and by no standard, can the Secretary of State's attitude to health care in London and the south-east be called stewardship. The Government are not stewards, because that word implies duty, responsibility and care. The Government are just incumbents, and the sooner they cease to be so, the better for London, the better for the south-east, and the better for Britain. 4.3 pm
The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
`recognises that, because of medical advance, shifts in the population and the changing needs of patients, reform of the health service in London is both necessary and long overdue; congratulates Her Majesty's Government for its resolve in addressing the modern needs of people in the capital and the South East, in sharp contrast to the vacillation and evasion of the Opposition; and believes that policies now being pursued have already delivered a better health service for the area, enhancing the excellence of research, teaching and treatment as well as improving local health services in the parts of greatest need.'.
I welcome this opportunity to describe the progress being made to modernise London's health service. We are improving the quality and responsiveness of hospital services. We are investing in primary care and we are enhancing the capital's status as an international centre of
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