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for Sheffield, Brightside (Mr. Blunkett), and, indeed, Baroness Jay. Most people involved in the national health service and with an interest in health matters have recognised for many years that there has been an over-concentration of teaching hospitals and resources in inner London. To one who represents an outer-London constituency, that has been only too apparent on the ground, since outer London has far fewer health resources than inner London.

There has been much bandying about of statistics, yet they appear to be a moveable feast, as reports are published two to the dozen. As far as I can make out, spending in inner London, as quoted on previous occasions, has been 47 per cent. above the national average per person, excluding spending on the special health authorities. Including spending on special health authorities, the figure rises to 57 per cent.

Much play has been made of beds. My understanding, again on figures previously quoted, is that in inner London there are 3.3 acute beds per thousand of the population, compared with a national average of 2.33 per thousand. Even today, in the second King's Fund London monitor report, which I received this morning and have studied at great speed to see if the statistics add up--

Mr. Nicholas Brown (Newcastle upon Tyne, East): They do not add up.

Mr. Congdon: The hon. Gentleman is right, they do not add up. The problem with the report is that it talks of London as a whole. None the less, it says that there are 8 per cent. more available acute beds per capita in London than there are in England as a whole. What is more significant is that 40 per cent. of those beds are in inner London. There is a preponderance of beds in inner London. We also know that the length of stay in teaching hospitals in London is 15 per cent. above the average for the provinces.

The right hon. Member for Derby, South made great play of the fact that, in a sudden surge of inspiration, she had managed to determine that somehow the figures for London were not valid, because London was no better off than comparable cities up and down the country. Yet we knew that, because it was clearly stated in the original King's Fund report, which preceded the Tomlinson report and "Making London Better".

Therefore, we are not debating London only, because the situation in London is comparable to that in other cities that also have to get to grips with problems. However, that does not negate the need to make progress in London. Despite all those figures--possibly because of the apparent over- provision--London has poorer primary care. I shall address some other aspects of health care in London. I was very pleased that the hon. Member for Southwark and Bermondsey (Mr. Hughes) mentioned the funding formula, because I think that it is important. Again, it was interesting that the right hon. Member for Derby, South did not remind the House that the original changes to funding, which have affected London so seriously, go back an awful long time, to the doctor who was a Minister of State for Health, Lord Owen. He introduced the resource allocation working party formula, which took funds away from London. Certainly Croydon has suffered from that ever since.

There have also been recent changes to the funding formula which benefit Croydon. Whereas, before, the borough was about on target, it is now £6 million under

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target. However, I was somewhat disconcerted to learn from figures that I received only today from the South Thames regional health authority that the South East London health authority, which was apparently £5 million under target, is now £4 million over target. I urge Ministers to look again at the funding formula. I know that they have relied heavily on work done by York university, but there is still concern that too much weight in the formula is given to the age profile of the population and the number of elderly people, rather than to deprivation factors, which clearly have a significant impact on health spending.

We are well aware of the other pressures for change. The switch from secondary to primary care is leading each purchaser to reduce the percentage of funding it spends on secondary care. There is a welcome trend of more patients being treated near home. I know that my hon. Friends who represent constituencies outside London welcome the fact that their constituents do not have to travel to London for care, and that they can receive such treatment at their local district general hospitals.

We have also heard about the significant switch to day surgery. It is obvious that beds are not needed for day surgery. At my local hospital, the Mayday University hospital, 90 per cent. of cataract operations are now carried out on a day basis, much to the benefit of the patient. Micro- techniques have led to much less invasive surgery, which also means shorter stays in hospital. All those pressures justify the general strategic direction that the reforms and changes are taking in London.

I mentioned earlier the King's Fund, the Tomlinson report and "Making London Better". It was significant that "Making London Better" scaled down the figures for bed losses as outlined in the Tomlinson report.

Although it was not really a target, "Making London Better" refers to a bed loss of between 2,000 and 2,500 beds in inner London in comparison with the 1990-91 figure. In last October's debate, I drew attention to the fact that, if London could improve its efficiency of bed usage to the level of other areas in England, that target could be achieved easily. If London could reach the level of 14 beds per 1, 000 in terms of the population in inner London, 2,700 beds could be taken out of the system.

That is not the end of the story. There is clearly a serious dichotomy between the strategic direction and analysis of the situation in London and what is happening on the ground today. I castigated Opposition Members earlier for over-exaggerating the problem. I believe that they do that, but it would be foolish to deny that there is pressure on beds in London.

One need only visit accident and emergency departments to witness the pressure that they are working under. I visited the A and E department at Mayday hospital recently. I did not visit at its busiest time, but it was very cramped. I am pleased that major redevelopment is going on at the moment to provide proper facilities. When facilities are cramped and there are problems with getting people into beds in hospitals, there is the dreadful phenomenon of people having to spend time on trolleys. That is clearly unacceptable.

The picture with regard to health in London is confusing, because it is rapidly changing. Reference has already been made to the report entitled "Hospital

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Services for Londoners" by the inner London purchasers. The report makes several points. Interestingly, it refers to the fact that accident and emergency attendances had not changed significantly. That is surprising, because, from anecdotal evidence, some people had felt that A and E attendances had increased.

It is noteworthy that emergency admissions, whether via an ambulance on a 999 call, or via an ambulance bringing in an urgent case from a GP, have increased significantly. One of the difficulties that I have found with the inner London purchasers' report is that it does not provide the figures. It does not give the scale of the increase.

I am aware that my district general hospital, Mayday in Croydon, has seen an increase of 25 per cent. in emergency and urgent admissions in comparison to January last year. We have had a very mild winter this year. As far as I am aware, there has been no great spread of illnesses, such as a large epidemic of influenza, which would have had a significant impact on such admissions.

I do not know whether the increase in Mayday's emergency and urgent admissions is mirrored across London. I would be surprised if it was, because the figure is extraordinary and it cannot be explained by straightforward demographic factors. I urge my hon. Friend the Minister to ensure that that aspect is considered.

I wonder whether all A and E departments in London are pulling their weight and taking their share of cases that come their way. I wonder whether some are closing their doors from time to time, putting pressure on other hospitals. If that is the case, it would clearly be unacceptable.

While we are right to press on with the strategic drift of the changes in London, we must be cautious about losing further acute beds too quickly in London. I have received figures only today--today seems to be my lucky day- -which show the bed position in London until March 1994. It would obviously be helpful if there were more up-to-date figures.

I was particularly interested in the bed loss figures in inner London. Compared with "Making London Better" and Tomlinson, and the target of 2,000 to 2,500 bed losses in five years, 1,400 beds have been lost in inner London. It is interesting that, between 1991-92 and 1992-93, the bed loss was comparatively small, but it accelerated between 1992-93 and 1993-94. It is possible that that, in conjunction with the implementation of care in the community, in respect of which we know that there is a problem in getting elderly people out of hospital quickly enough because of problems with discharge, is a factor in influencing the pressure on admissions to hospitals in London.

From talking to my district general hospital, my impression is that it is quite possible to reduce surgical beds even further, because of the advances in medical technology to which I referred earlier. However, it is difficult to reduce medical beds which tend to be used mainly by the elderly. Indeed, my hospital has had to open additional medical beds to cope with the demand, and I urge my hon. Friend the Minister to consider that aspect in more detail.

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In addition to the inner London purchasers' report, the clinical studies advisory group has produced a very useful report into A and E admissions and how A and E departments should be organised. I refer to those two reports because they make important recommendations. There is no doubt that there is a need to improve the management of A and E departments and to ensure that they have proper observation wards and, perhaps even more importantly, admission wards, so that people do not spend time on trolleys. The inner London purchasers' report states that some hospitals are operating to too tight a margin.

If there is very high demand in a hospital, particularly on the emergency admissions side, the inner London purchasers' report makes it clear that the occupancy level of beds must be lower than would otherwise be the case if the level of emergency admissions was lower. That stands to reason, because if a hospital caters primarily for elective surgery, with very few emergency admissions, it can plan for that, and it does not need the slack for emergencies. However, if a hospital has a very high percentage of emergencies, there could be a sudden surge, which could completely disrupt the hospital. That hospital therefore needs greater spare capacity.

The inner London purchasers' report states that hospitals should operate at a level of about 85 per cent. I do not know whether that is a good suggestion or a bad one, but it must be borne very carefully in mind. The report also suggests that, in assessing bed requirements, one particular formula to be applied across London is not necessarily the correct approach. The health authority should assess the needs in its area before reaching a conclusion about bed requirements.

The report makes another important point. We know that London has more acute beds per 1,000 of the population than elsewhere. Interestingly, it has fewer nursing home places. That causes more pressure on medical beds, and that is why we must proceed with caution before reducing those beds further.

The report by the clinical studies advisory group is interesting, covering issues such as bed management. That issue is crucial in any hospital. Too often, there are problems in getting patients on to wards. However, sometimes beds are being kept vacant by consultants. Hospitals must manage beds properly.

It is also important to ensure proper consultant cover in A and E. Too often, patients turn up in A and E and find that the more junior doctors are on duty.

The NHS does an excellent job catering for most people when they are ill. If one is seriously ill or in a major road accident, generally speaking one will be treated very well indeed. But it is not acceptable to have the main entrance to the NHS in A and E departments which are often not staffed by senior consultants and which are often short of facilities for getting patients out of A and E and into the main part of the hospital. That aspect of health care is critical, and it must be given priority.

I shall say a couple of brief words about some specific changes in London, of which great play has been made. There has been concern about the closure of Bart's A and E department, but I am bound to say that, given that it catered for only 30,000 attendances a year, it was right to centralise facilities elsewhere. Indeed, those facilities have been expanded. I welcome also investments in A and E at various centres within London, including King's, the Homerton, and the Mayday in Croydon.

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I do not think that there is a crisis in the health service in London. The changes that have been set in train are proceeding in the right direction. However, I agree with the hon. Member for Southwark and Bermondsey, who made the plea that responsibility for bringing about those changes in the configuration of particular trusts should be left to them, rather than be determined by the centre--but with the one key reservation that I have mentioned.

I hope that my hon. Friend the Minister will not agree to massive capital injections where they are not necessary. I urge my hon. Friend to be cautious in relation to further acute bed reductions, given the evident pressures on beds at present. I am happy to support the amendment.

Several hon. Members rose --

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. We have 39 minutes before the winding-up speeches commence, and four hon. Members hope to catch my eye. I hope that they will be successful. 5.51 pm

Mr. John Austin-Walker (Woolwich): The hon. Member for Croydon, North-East (Mr. Congdon) talked about Opposition Members whipping up fears, concerns and anxieties. If he had been at Saturday's conference, which was organised by the Evening Standard , to which reference has been made, he would have seen for himself that such fears, anxieties and concerns need no whipping up and that they are genuine.

I shall say something about the lack of strategic planning, control and accountability in London. I start with the London ambulance service. It has been apparent to the general public for many years that things are wrong with the London ambulance service. In 1991, I was involved in a report that was produced by the Association of London Authorities, entitled "London's Ambulances--a Service in Crisis". At about the same time, the National Union of Public Employees produced a report spelling out the difficulties that the London ambulance service faced. Those reports went to Mr. Wilby, the chief executive of the London ambulance service, and to the right hon. Member for Bristol, West (Mr. Waldegrave), the then Secretary of State for Health, and they did nothing about the matter.

We then had the computer crash in October 1992, when the Minister and the Secretary of State said that they would address the serious problems. Since then, we have had the Wells report, which confirmed what Opposition Members had been saying for a long time--that is, that there had been a history of underinvestment and a lack of funding within the London ambulance service. When the Wells report recognised that and made recommendations, the Secretary of State said that it was nothing to do with her and that it was a matter for the region. I now refer to the contrast in accountability in the London ambulance service and the London fire and civil defence authority. My hon. Friend the Member for Holborn and St Pancras (Mr. Dobson) has called it a tale of two services. The London fire brigade provides a first-rate service; the London ambulance service does not. The London fire brigade meets its performance targets; the London ambulance service does not. The London fire brigade successfully introduced a computerised mobilising system; the London ambulance service did not. The London fire

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brigade has successfully set about revising and improving its management structure and working practices, whereas the London ambulance service has not.

The difference between the London ambulance service and the London fire and civil defence authority is that the London fire brigade is accountable to a body of responsible elected representatives from each London borough. We would not have had the crisis in the London ambulance service if we had had the accountability that we have in the LFCDA.

The London ambulance service has an appointed board that meets in secret. Not only are its minutes not available, but its agendas are not available for inspection, either. I understand that its minutes were not even available to the Page inquiry, which investigated problems within the London ambulance service.

Let me deal with another aspect of the lack of control and the lack of accountability. My hon. Friend the Member for Leyton (Mr. Cohen) has been trying to ascertain figures for the number of hospitals in London that have closed since 1979 and the number of beds that have closed. He has had a very hard task of that within the Library, because he has been told that there is no central source of that information. The Department of Health does not even collect the number of hospitals any more, let alone details of their closures. After much research, my hon. Friend the Member for Leyton found that between 1979 and 1993-94 the total number of NHS hospital beds in London fell by a staggering 49 per cent., from 64,850 to 33,120. Acute beds fell by 45 per cent. and non-acute beds by 53 per cent. That is one of the consequences of the Government's policies and one of the reasons why the crisis exists. Unlike the hon. Member for Croydon, North-East, I believe that there is a crisis within the health service in London.

I now refer to what some might think is a parochial issue, but it shows quite clearly the lack of accountability and the lack of control within the national health service in London. The catalogue of local disasters in the Greenwich area was put before the House in an Adjournment debate on 28 January last year. In that debate, I expressed my concern about the management of Greenwich health care trust. Indeed, my hon. Friend the Member for Greenwich (Mr. Raynsford) and I called for the chief executive's resignation. I felt that somebody should be responsible. Somebody should be accountable, particularly when that person, Mr. Bruce Joyce, appears to have been one of the 10 highest-paid chief executives in the country. I was pleased to learn from the new trust managers that Mr. Joyce had not claimed any performance-related pay when he left the service. What a pity. On the record of his negative performance, he probably would have owed us something.

I am disturbed to read, however, in the Woolwich and Plumstead News Shopper that a BBC documentary alleges that Mr. Joyce, who retired to spend more time with his family, received a pay-off of between £200,000 and £400,000. Unfortunately, no one at the trust was available to comment. The Minister is available tonight, and I await his comment with interest.

Let me now deal with a matter that I have raised with the Minister. In April 1993, the Brook hospital took delivery of a second-hand magnetic resonance imaging

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scanner. In about September of that year, it came to my attention that the scanner was not working. It was alleged that there was something peculiar about the way in which the purchase had been arranged, that staff had not been properly trained, and that the scanner was incompatible with other equipment. I received assurances that the staff had been trained, that the scanner was compatible, that it was a shared purchase between the region and the Brook hospital, and that it was settling in and would be up and running soon. It was not.

I raised the matter with the Secretary of State on 29 October 1993. On the same day, I asked her how many beds had been closed and how many operations had been cancelled for financial reasons. The hon. Member for Bolton, West (Mr. Sackville), the Under-Secretary of State, told me that the Department of Health did not keep such information and that the scanner was nothing to do with the Secretary of State; it was

"a matter for managers and clinicians".--[ Official Report , 29 October 1003; Vol. 230, c. 835. ]

The Minister referred me back to the trust, which referred me to the region. The scanner--£500,000 of hardware--had still not scanned a single patient. On 18 January 1994, I queried the purchasing arrangements with the Secretary of State. That time, I was referred by the Under- Secretary of State to the chairman of South-East Thames regional health authority.

I raised the matter in an Adjournment debate in January 1994. Half a million pounds-worth of scanner was sitting idle while £116,000 a year was being paid to a private hospital to provide a scanning service. Eight months after the scanner was purchased, the Under-Secretary of State said:

"I share the concern expressed by the hon. Member for Woolwich about the commissioning of the MRI scanner, but, following the trust's inquiries into the matter, we will ensure that any procedural shortfalls are addressed. I understand that a meeting is to be held shortly."--[ Official Report , 28 January 1994; Vol. 236, c. 600.] On 15 December 1994--18 months after the scanner was delivered, 15 months after I raised the matter with the trust, 14 months after I raised the matter with the Secretary of State and 11 months after the Under-Secretary said that a meeting was to be held shortly and that shortfalls would be addressed--Greenwich health care trust and the South Thames regional health authority put out a joint press statement that they would be disposing of the scanner, which had never worked. Following an independent district auditor's review, they admitted weaknesses in the procurement procedures, breaches of the region's standing financial instructions and weaknesses in the trust's management of the project. Both the chief executive and the chairman of the trust have now departed. At least the new incoming acting chairman, who inherited the mess and a variety of others, admitted that the episode had

"hurt the Trust and the taxpayer."

It has been revealed that of the £416,000 purchase price, £117,000 came directly from the region and the other £299,000 came from Greenwich health authority's charitable trust funds. That one third of a million pounds was not taxpayers' money, but money donated by local people and grateful patients with an affection for their local hospitals. The money was often left in wills and legacies for improvements to local health services and added comforts for people at local hospitals.

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That piece of equipment--although installed in a local hospital--was not for a local purpose. It was for the region's specialist neurosciences department, which the region and the Secretary of State had already agreed should move to King's College hospital in Lambeth in the spring of 1995. Why was the local health authority inveigled by the region into using local charitable moneys for a regional service that was about to transfer out of the area?

I have asked the region to reimburse the local charitable funds, but the regional chairman tells me that that would be impossible as it would be ultra vires. But if the region breached its own standing financial procedures, and that went unattended by the Secretary of State for so long, was not the purchase ultra vires in the first place? If the region cannot reimburse the funds, I believe that the Secretary of State should.

I shall refer briefly to psychiatric services. It is a year since the report into the Clunis affair, and a year since the Health Select Committee published its report, "Better Off in the Community". Both pointed to the fact that there is a crisis in psychiatric care within the capital.

Psychiatrists across the capital have warned in recent months that the Government's care in the community programme cannot cope with the tide of demand for hospital beds for people with mental illness in London. Studies have shown that, across the capital, the average unit has a bed occupancy rate of between 100 per cent. and 120 per cent. What are psychiatrists to do in a crisis when all the beds in London are full and there are no beds throughout the south of England? Last September, a survey by the Royal College of Psychiatrists revealed that, during one week, 84 people in London who needed hospital treatment were turned away, while a further 24 were prematurely discharged. The college calculated that an extra 426 beds were needed immediately to deal with the unmet need.

In my area, the bed occupancy rate is 120 per cent. When space runs out, patients are referred to other hospitals--often private hospitals--as extra -contractual referrals, sometimes as far afield as Woking or Oxford. Finding an extra-contractual bed is no easy task. Local psychiatrists have told me that it is not uncommon for calls to be made to up to 35 different hospitals before a place can be found, with patients having to wait 24 to 36 hours to be placed. In 1990, researchers at Central Middlesex hospital predicted a bed famine if London's mental health beds continued to be closed. I do not dispute what the hon. Member for Croydon, North-East said about the need for change, but it is the pace of change that concerns us. It needs to be balanced change. The rundown and closure of beds and institutions without adequate alternatives being provided is causing the crisis in the capital's health services, and a crisis it is. In support of the plans to cut beds still further, the Secretary of State relied heavily not only on Tomlinson but on an earlier report by the King's Fund. She appears less keen to accept the King's Fund's subsequent findings in "London--The Key Facts", which was published last April. The document stated that

"the capital's health care needs have been underestimated. There are now good reasons for believing that London merits a larger--not smaller--share of the NHS cake".

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The Secretary of State also appears unwilling to accept the King's Fund's proposition that purchasing power for hospital and community health services in London

"should be increased by approximately £200 million".

Professor Jarman's findings have been mentioned by my hon. Friends, and they were reinforced by a recent update by James Raferty of the Merton, Sutton and Wandsworth health authority and Nigel Edwards of the London Health Economics Consortium. They stated that in 1992-93, the loss of 400 beds would have equalised London's position with the rest of England, but 1,499 beds were lost. They identified particular problems for elderly people, as London has a severe shortage of nursing home and residential care.

Those problems are leading to a crisis, but it will not be solved by cutting more beds. We must provide the resources and facilities elsewhere, and my hon. Friend the Member for Dulwich (Ms Jowell) was absolutely right on that matter. If there is validity in the theory that improvements in primary care will lead to a lessening demand for hospital beds, let us have those improved community GP services up and running before the beds are taken away.

The Parliamentary Office of Science and Technology bears out the view that if we improve primary care--particularly access to primary care for those who are currently denied it--we increase the demand upon hospital beds and specialist provision.

I started by talking about accountability. Despite assurances that primary health care would be prioritised as hospitals close, there are now fewer GPs and health visitors in London than there were three years ago. Londoners have no voice in the current arrangements. The patients charter promises patients a greater say in their own health care, but, with no democratic accountability, Londoners find themselves on the receiving end of chaos and cuts.

6.7 pm

Lady Olga Maitland (Sutton and Cheam): I am an enthusiastic supporter of the NHS. My children took advantage of the NHS, and my parents also take advantage of the service. I can say unreservedly that my family is entirely satisfied with the treatment that we have received.

I do not see a crisis in the NHS. I see challenges and opportunities in today's world. Modern medicine is making tremendous advances and is giving us untold opportunities to provide the very best patient care. I congratulate my right hon. Friend the Secretary of State on her positive and caring speech. She has given many examples of investment in the health service and in patient care. I do not believe that anybody could have any doubts about her commitment.

This debate has been full of gloom and doom. Opposition Members have run down the health service and have tried to frighten potential patients into believing that they will never get real service and care. The facts provide a totally different picture. More patients are being treated than ever before. Why do not the Opposition give credit for that? The length of time for which patients must wait for treatment has fallen sharply. Why do not the Opposition give credit for that? Health care and health have improved dramatically in the past few years, while life expectancy has risen by two years for men and

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women. The perinatal and infant mortality rates have fallen by more than two fifths since 1979. Why do not the Opposition give us credit for the work that we do in the health service?

Why do not the Opposition even mention that for three years in succession our immunisation programme has been so successful that no child in Britain has died of measles? Why do not they tell us that services at doctors' surgeries have improved, that there are now fewer patients on a doctor's lists and that the number of practice nurses has risen from 900 in 1978 to more than 8,500 in 1992? Why do not they give us credit for that?

Why do not the Opposition tell the patients the good news rather than try to terrorise them? Why do not they admit the success of the patients charter? Should not the patient have the right to know the success and the results produced by a hospital? Should not patients have the right, which we have now given them, to be guaranteed a standard of service? I have not heard the Opposition mention once the success of the patients charter this afternoon. Are they simply frightened to admit success when it is happening?

Why do not the Opposition accept that once again the Government have increased spending in real terms both last year and in the forthcoming year? The Opposition talk about a shortage of beds. I put a question to the Opposition, which I am sure will be answered during the replies to the debate. If they are so worried about a shortage of beds, as they allege, I am sure that they will support the Government's NHS reforms, their fight against waste and their battle for efficiency in order to provide more money for the very beds that the Opposition seek.

Mr. Nicholas Brown: I can answer that now. We do not support the Government's reforms, and we do not support their waste either.

Lady Olga Maitland: The Opposition say that they do not support the reforms, but by the same token they try to take away the opportunity to succeed and provide more for the patients. Perhaps it would be a good idea if I told the House a little more about the successes that my constituents experience. I have in Sutton the St. Helier NHS trust. It is a proven success. It has made achievements that are well worth noting. Let us take waiting times for an operation. Now, 60 per cent. of our patients are treated within six months. The vast majority wait only nine weeks for a non -urgent out-patient appointment. As everyone knows, urgent appointments can be made within days or, indeed, hours if necessary. Let us consider the success that we have achieved in hip replacements. Now, no patient need wait a day longer than six months. Let us consider gynaecology. No woman need wait longer than six months for treatment. Let us consider treatment for the eyes. No patient need wait even as long as six months. Often patients are treated within four months. Let us consider the success of day surgery. Now, 50 per cent. of non-emergency cases are treated as day cases. That is the result of modern medicine and techniques. Five years ago, 20 per cent. of cases in the ear, nose and throat department in Sutton were day cases. Today we get through 60 per cent. of cases as day cases and

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more people are treated as a result. Let us go back for a moment to the patients charter. Does not the House think that it is marvellous that a patient can now expect to be seen within half an hour of arrival in out-patients? In my St. Helier hospital, 90 per cent. of patients are seen almost immediately.

What about accident and emergency departments, which have been so run down by the Opposition? At my local A and E department, 90 per cent. of the patients who turn up are assessed within five minutes. The nurse makes the initial assessment, reassures the patient and the whole system is put in motion. That is a tremendous advance. There is no longer that sense of fear, not knowing and not getting immediate help. My hospital trust is aware of the pressures at the A and E department and has managed already to allocate resources for a further 25 beds as a result of our efficiency reforms in that department. Curiously, we have the resources for an A and E consultant, but no consultant has come forward for the post. I find that a sad reflection.

Let us consider the success that we have had in children's medicine, which is an important area. Since the children's hospital was moved from the old Queen Mary building into St. Helier's, there is no doubt that children in Sutton have a much better environment in which to be treated. They no longer have to suffer the experience of being moved from one ward, loaded into an ambulance and taken to another building for an operation. Now they will be treated entirely on site. That gives the doctors more time for patient care and enables them to waste less time travelling around.

As a result of the revision of our management of child care, we now have an intensive care bed for children. The children are taken care of by dedicated paediatrically trained nurses. Such successes in Sutton are appreciated by my patients. Why cannot the Opposition bring themselves to admit the successes that can take place within the management of an NHS trust?

Mr. Peter Ainsworth (Surrey, East): Is my hon. Friend aware of the similar chronicle of achievement at East Surrey hospital, which is not too far away from St. Helier hospital? Does she agree that the rationalisation of health care within central London frees up resources and that hospitals such as St. Helier and East Surrey on the edge of London stand to be prime beneficiaries?

Lady Olga Maitland: I could not agree more with my hon. Friend. He is right that, when we re-examine the concentration of health services in the centre of London, it is appropriate that we recognise that there has been a depopulation of the centre and movement to outlying areas. Furthermore, patients no longer want to travel into the centre of London when they can receive excellent service and treatment close to home.

Another success in St. Helier hospital is in the provision of diagnostic equipment. We now have the most up-to-date diagnostic equipment that any hospital could wish to have. We have a new magnetic resonance imaging scanner and we are ordering a new computerised tomography scanner. With that combination of diagnostic equipment, the hospital will be in the world class in providing services for patients.

Let us contrast the success of medical care both nationally and in my constituency with the gloom, doom and fear-ridden material that has been fed to us by the Opposition. I find it stunning that the Opposition should

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seek to use what I can only call the Chinese water treatment. They believe that if they give people big, bad news often enough, people will believe that it is true. Every time that I am out on the doorsteps in my constituency, I ask people, "How are you getting on? What are your worries? What are your concerns?" They tell me that they are worried about the health service. I ask what experience they have had that upset them. Then they say, "Oh no, I have been well treated. I have an excellent doctor. I had wonderful treatment in the local hospital. The doctors were dedicated. The nurses were kind. I came home and I am now fit and well." I ask why they feel worried. They say, "It is what the politicians say on television." It would be more appropriate if the Opposition stuck to honesty and the truth and acknowledged success when it happened. Such success is abundant and widespread. It does not help patients if they hear endless scaremongering stories that create a tremendous amount of nervousness and fear.

I shall give the House an example. Hon. Members have only to look at the Opposition motion. In the first line, they refer to a "crisis". There is no crisis in the health service when it is moving along with the punch, the power and the impact of investment and resources. What do they mean by that?

The Opposition also keep talking about failure. There is no failure when more patients are being successfully treated than ever before. It would be more worth while if the Labour party was a little more honest about what its plans would be, should it ever have the opportunity to run the country. Thankfully, the country will never vote for Labour.

I do not believe that the patients, about whom the Opposition say they are so worried, have any idea that Labour plans to put our medical care under political control. The Opposition want to abolish GP fundholding and break down national health trusts, and put them under the local authorities and town hall politicians. As a patient, I would not want my medical future to be controlled by town hall politicians--certainly not by socialist ones.

Thank heaven a Conservative Government are taking care of the health service and that there is not a hope in hell that the Opposition will ever take over.

6.20 pm

Mrs. Bridget Prentice (Lewisham, East): Tomorrow night we shall be debating Third Reading of the Health Authorities Bill. That Bill offered the Government the opportunity to set up a strategic health authority for London, which would have gone a great way to help to resolve the crisis in London's health care. Such an authority could have monitored health care throughout London, co-ordinated activity and avoided the duplication of services to which the Secretary of State referred. It could have targeted resources and developed a coherent health strategy for the capital, which would have benefited the people of London. The Government lost that golden opportunity because they do not listen, not only to the Opposition, but to the people of London.

It was interesting to hear the hon. Member for Sutton and Cheam (Lady Olga Maitland) say that people did not come to her with health care problems. In the past year, more than 60 people have come to my surgeries to

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complain about aspects of London's health service. If that were duplicated throughout every London constituency, it would add up to about 60,000 people with complaints about what is happening to them and to the health service. It might be useful for the Minister, and through him the Secretary of State, to hear a few examples. A Miss Beirne was admitted to Lewisham hospital in May 1994 for two hip replacement operations and was given a blood transfusion on admission, in preparation for surgery. Her operation was due to take place within a week or two. Six weeks later, she was still in hospital and had not had an operation. She spent more than eight weeks in hospital for an operation that should have taken no more than two. The hospital said that it was a painful decision when the surgeon had to choose on which cases to operate.

Mrs. Jean Anderson, a 78-year-old pensioner, suffered a fall in her home and fractured her leg. She was released into the care of her frail 80-year- old husband. No attempt was made to give her any form of care or back-up such as a home help. Thirteen days passed without any contact from medical services in the form of aftercare or otherwise. Mr. and Mrs. Anderson were left to fend for themselves and, not surprisingly, Mrs. Anderson's health deteriorated dramatically. Her son contacted Lewisham social services, which offered assistance and, finally, visits from a community physiotherapist and a district nurse were arranged, but she collapsed and died at home less than 24 hours later.

In a letter to me from the community health council, the acting chief officer said:

"Her chances of surviving would have been increased immeasurably if she had been receiving social, medical, nursing and physiotherapy support."

She received none of those.

I mention that case because the Health Secretary suggested that there was sufficient aftercare and enough beds for elderly patients. The "London Monitor", published by the King's Fund, states that there is a severe shortage of residential beds for the care of elderly people, which is not compensated for by the greater than average number of hospital beds in the capital. London has 5 per cent. more hospital beds for acute and elderly care, but 30 per cent. fewer residential care beds for the elderly. The chief executive of the King's Fund said:

"The complexities of the health care system in London require a high degree of co-ordination if change is to be achieved without paying a very high price in human terms."

It is not only patients, or even nurses, who come to my surgeries to talk about the state of the national health service. Two weeks ago, a consultant neurosurgeon sat in the waiting room of my surgery for more than an hour because he wanted to talk to me about the state of the health service in his hospital. It comes to something when a consultant neurosurgeon has to queue up to see his Member of Parliament to explain the sorry state that the health service has reached in London. He said that the internal market was falling considerably short of being a "free market" because of the substantial financial distortions. He told me about the interminable forms that he must fill in whenever he wants to refer a patient. He now employs two secretaries when previously he had none. He told me that competition in health care has resulted in such problems that the free exchange of information has all but disappeared, which is having a negative effect on patients. He also said that the NHS

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