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Mr. Alun Michael (Cardiff, South and Penarth): I congratulate my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) on stimulating a debate that has brought into focus the cross-Chamber consensus about the importance of this issue. He made a carefully targeted speech, and gave notice of the serious issues that he

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intended to raise. I shall be brief, in order to give the Minister plenty of time to respond. Domestic violence is a wide topic, but I shall keep to the specific issues raised by my hon. Friend. My hon. Friend the Member for Bristol, East (Ms Corston) highlighted a series of legal complexities. I hope that the Minister will assure us that the Government will do all they can to simplify the law in this sphere. The legal system should benefit the victims rather than the perpetrators.

Victims feel that they are at sea in what is virtually a minefield of complexities, and we need to simplify the way in which we deal with such matters. I also agreed very much with my hon. Friend's strong point about the need to talk to men, and not only to women, about the issues which are the focus of this debate.

The hon. Member for Sutton and Cheam (Lady Olga Maitland) referred to the Government publicity campaign, which, of course, was one of the recommendations by the Select Committee on Home Affairs. She was right to say that people need to be continually encouraged not to stand for domestic violence, but that message needs to be backed up. People need to be confident that, if they choose not to stand for it, the necessary systems will support them and the police, local authorities and voluntary organisations will have the resources as well as the training, the understanding of the problem and the ability to provide help where it is needed. It is a prime example of how central Government need to reward as well as demand co-operation and a partnership approach at local level.

Since dealing with domestic violence is difficult and complex, time is needed to develop expertise and local strategies, which several hon. Members have said are vital if the problem is to be properly addressed. A fragmentation of responsibilities does not help. People who work in education, social services, housing, health, the police and voluntary organisations all feel under pressure, but they need some flexibility, so that they can spend time listening to the way in which problems arise for other agencies and fully understand how to implement effective strategies.

It is probably true to say, as I have found, that many hon. Members have been shocked by the experience of dealing with constituency cases of domestic violence. Two things stand out. One is the number of women who continue to suffer in the matrimonial home, long after the situation seems to have become totally unreasonable and unacceptable. They continue to try to maintain the structure of the marriage and the family long beyond what could be expected of them. The other aspect is the number of women who leave home and fend for themselves after violence has reached breaking point. Instead of putting themselves at the mercy of different departments and expecting the local authorities or the police to sort out their problems, some women try to fend for themselves and thereby compromise their rights to housing. Following the split of a family, women may find themselves in unsatisfactory housing, being told that they are adequately housed. We need to shift priorities. It is difficult for housing authorities to deal with domestic violence, but in many ways it is a special case, and ways to deal with it should be found.

As hon. Members of all parties have said, the police take domestic violence much more seriously nowadays. However, on occasions it remains difficult to distinguish

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in practice between domestic disputes in which it may be six of one and half a dozen of the other, and those cases when one of the partners is a vulnerable and damaged victim. Such incidents are very difficult for officers to deal with, and it puts them under great pressure. Officers need training and background in the subject, and they should have the opportunity to give time to such incidents, so that they may understand properly what is happening.

There have been several references to the work of Women's Aid and the role of refuges. We need to ensure an adequate network of such facilities up and down the country, but we must also understand that we are not just considering temporary or crisis housing--an immediately available roof, important though that it is. Sympathy and support should be given through a traumatic period that may often go on for a considerable time following the short time in a refuge. That is a specifically targeted activity, during which knowledge and experience--down-to-earth approaches--are needed. It is a good example of how the voluntary sector has the flexibility to respond often much better then statutory services are able. Support for the voluntary sector needs to be guaranteed and continued, so that services do not become fragmented.

My hon. Friend the Member for Perry Barr specifically referred to the way in which victims are treated in court. He was absolutely correct. Often, victims and public-spirited individuals who come forward as witnesses feel that the system damages and violates them a second time.

Efforts have been made to improve the situation, but victims are still marginal in our courts and criminal justice system, and there is no room for complacency. I hope that the Minister will be able to comment positively on that. If he is able to say that he will press further to make the court and criminal justice system generally more sympathetic to victims, he may be assured of a positive response from the Labour party.

My hon. Friend the hon. Member for Edinburgh, Leith (Mr. Chisholm) made a powerful reference to domestic violence as a problem which pervades all classes of society. We need to take that very much to heart. There is still a general impression that violence takes place in only one section of society. He is right to say that examples fall in all parts of society.

The zero tolerance campaign, to which my hon. Friend referred, is in many ways showing the way forward in raising public awareness, and I commend it. It is a co-ordinated and high-profile approach to informing public opinion. My hon. Friend was absolutely right, however, to go on to say that we need a strategic approach which starts by tackling attitudes in society as a whole, rather than simply saying that domestic violence is some sort of aberration which may be dealt with in isolation.

I hope that the Minister will also be able to tell us a little about how the Government and his Department intend to press forward with giving effect to the important recommendations of the Home Affairs Committee. One of the main recommendations was to upgrade the quality of national statistics on domestic violence. Indeed, the whole question of research is important. It is necessary to conduct research on what works, as well as the nature of the problem, to understand changes and to have the results of that research quickly available to practitioners.

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The Select Committee also placed great stress on the importance of Her Majesty's inspectorate of constabulary in discussing questions of poor and good practice and good management with chief officers of police. That needs to be followed through year after year, and not be only a one-off.

The Committee also recommended learning from good practice; ensuring that domestic violence units are not marginalised in the police force; learning from local approaches such as the experimental domestic violence crisis intervention team that is being established in Islington, to which it specifically referred; and generally disseminating best practice. I hope that the Minister will be able to tell us that more progress will be made in following through those recommendations, and that inter-agency approaches will be generally encouraged and helped.

My hon. Friend the Member for Perry Barr also referred to prosecution. Several Select Committee recommendations referred to the responsibilities of the Crown Prosecution Service. The Committee thought that the CPS should make itself better informed about developments in the area of domestic violence. The Committee specifically recommended that the CPS look at the possibility of duress causing the victim of domestic violence to withdraw the complaint. That is a very important and sensitive area, which my hon. Friend was absolutely right to highlight.

I hope that the Minister will give an undertaking that the Government will take the initiative, linked with the Crown Prosecution Service, the police and agencies, to try to tease out the best way in which to ensure that the law can be changed for the better.

Intimidation is a problem. We should take great care that we do not go too far, and perhaps force people to pursue complaints that they genuinely wish to withdraw, but also that we shift the balance towards protecting victims and finding how to assemble evidence when intimidation has happened more than once. That is a delicate area that needs to be dealt with, and I hope that the Minister will say that he will take it seriously and develop it for the immediate future.

I believe that the co-ordinating role of local authorities at chief officer level is right, too. My hon. Friend the Member for Perry Barr referred specifically to Northampton. It is clear that, where chief officers have taken a specific interest, there has been a shift in attitude and policy within departments. Where councillors have taken a specific interest in the development of policy, that too has produced good results.

There is a need for independent advice and help. For instance, the Cardiff housing help centre was specifically established to be independent of the housing department, so that it could focus on the interests of the people who came forward.

I should have liked to develop one more crucial area--the central question of how children are dealt with. But as I said at the outset, I shall be brief, so as to allow the Minister plenty of time to respond. I hope that he will say that he and his departmental colleagues will consider the issue again, and will keep it under review across the Department, encouraging local approaches across organisations, departments and authorities, and assisting in the development of effective strategies at local level to reflect a proper sense of priorities at national level.

I hope, too, that the Minister will show a full appreciation of the important role that the voluntary sector can play, and of the need for that sector--Women's Aid,

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victim support and other local organisations --to have the continuity and capacity to bring their knowledge and experience to bear for the benefit of victims, and therefore for the benefit of society as a whole in the long term.

11.11 am

The Minister of State, Home Office (Mr. David Maclean): I congratulate the hon. Member for Birmingham, Perry Barr (Mr. Rooker) on raising such an important subject for debate, and I thank the hon. Member for Cardiff, South and Penarth (Mr. Michael) for allowing me more time to enable me to respond as fully as possible to the subjects raised in the debate.

Let the House be in no doubt that the Government are in no doubt at all about the seriousness of the problem. Few people realise that domestic violence accounts for a large part of the nation's violent crime. The best statistics I have, dating from 1993, show that there were about 197,000 examples of domestic violence within the statistics on violence in general.

I have listened carefully to the various points made, and I am pleased to have this opportunity to set out the measures that the Government are taking to tackle that especially appalling crime. As everyone has said, domestic violence should never be tolerated, either by those suffering the violence or by the wider community. The effects of domestic violence can be especially devastating, as the suffering endured is often prolonged over many years, at the hands not of a stranger but of someone who is in a relationship with the victim. It is a crime that invariably occurs not out on the streets or in some public place but in the home, where we should all be able to feel safe and secure. The home is not a place where a woman, a child or any of us should feel a sense of danger or terror. Clearly, domestic violence involves a combination of physical, emotional, sexual and psychological abuse within a relationship, and can damage both the woman and her children. Victims of domestic violence are usually women, but that is not always the case. In most cases, the perpetrator of the violence will be a spouse, a partner or a former boy friend or girl friend.

To say that is not, however, to deny the existence of other forms of inter- relationship violence by other family members--for example, fathers, brothers or sons--and, as we know, there are a number of elderly victims. Feelings of guilt, hopelessness, fear and depression are common. Domestic violence is not limited to any particular social group or class, but, as has already been said, occurs across the social spectrum.

The Government recognise that domestic violence not only causes damage to its immediate victims but may also affect children within the relationship. Children may be at risk of suffering long-term psychological and emotional damage as a result of witnessing the violence perpetrated against their mothers, or of experiencing the stresses and tensions involved in living in an environment where the likelihood of violence is ever present. They may also become victims of violence and abuse themselves. Witnessing domestic violence may also have the effect of teaching children that violence is a legitimate response to problems.

There have been some calls to amend the Children Act 1989 to create a new category of "children in need" to encompass children who live in situations of domestic

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violence. I understand, however, that it is not necessary to amend the Act in that way, as each local authority already has a duty to safeguard and promote the welfare of children in need in its area, and evidence of domestic violence may be an indication that a child is in need.

Schools may address issues of relevance to tackling domestic violence through the national curriculum, through their programmes of sex education, and, in the wider curriculum, through their programmes of personal, social and health education.

The Government believe that the response to domestic violence needs to involve action on several fronts, directed towards ensuring that the perpetrators are brought to justice, that victims receive the emotional and practical support they require, and that steps are taken, through education and community initiatives, towards prevention in the long term. We believe that effective action requires the commitment and involvement of all local agencies, working together to develop local preventive strategies, and to provide help and support to women suffering from domestic violence. In order to co-ordinate an effective and concerted Government response to domestic violence, interdepartmental groups were set up at both official and ministerial level in 1993. The groups set about taking forward the Government's reply to the 1993 Home Affairs Select Committee report on domestic violence.

The official group has met four times to discuss the key areas of raising public awareness, improving the way in which agencies can respond to those suffering from domestic violence, and refuge provision. I shall talk more about some of those issues later. Proposals for increasing public awareness and inter-agency co-operation were endorsed by the ministerial group on domestic violence. Both the official and ministerial groups are due to meet again to examine a range of issues, such as improving the collection of statistics on domestic violence, and the nature and extent of refuge provision. Because of the hidden nature of domestic violence, it is especially difficult to get an exact idea of how many cases exist.

Of course, to prevent crimes of violence within the home in this and future generations, there is a need to change attitudes and behaviour. It is also clear that effective action extends beyond the criminal justice system. Towards that end, the Government recently funded a domestic violence awareness publicity campaign made up of several strands of action to help those suffering abuse.

The campaign, which took place last autumn, used the slogan, "Domestic Violence--Don't Stand For It", and focused on the criminality of domestic violence and the right of all people to live their lives free of fear and abuse. The message communicated was that domestic violence is first and foremost a crime that should not and will not be tolerated. That message was directed at the victims of domestic violence as well as the perpetrators, to help them realise that they will be taken seriously and that they should seek the help and assistance that is available.

The campaign was a large one, consisting of 500,000 guidance leaflets and 100,000 indoor posters, which were distributed to voluntary and statutory agencies. A taped version of the guidance leaflet was also produced for the blind and visually handicapped. A short public information film called "Don't Stand For It" was shown

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across 350 cinemas for a period of six weeks, and is estimated to have reached an audience of 1 million viewers.

The materials used in the campaign all gave details of a telephone helpline. Briefing packs were also prepared for the media, to encourage them to run complementary articles and features. I am grateful to my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) for drawing attention to the effort that the Government put into that campaign.

To have an idea of the pay-off, we should have to ask Sir Paul Condon, for example, and he would confirm that, in every division in the Metropolitan police, there is a domestic violence unit, and there has been a large increase in the number of people coming forward to report violence. That is good in itself, but of course the downside is that Sir Paul's figures for violence in the metropolitan area will increase this year. However, we must understand clearly that the good side of those figures is the fact that women are coming forward to report violence that existed before but was not reported. As well as getting victims to seek the help they need, we are also encouraging them to work with the criminal justice system to apprehend the perpetrators of these crimes. A number of initiatives have been undertaken to create an effective response to domestic violence, which will engender the confidence needed in victims to come forward.

Victims are often afraid to come forward in case they will be subjected to further threats and violence. If we are to succeed in combatting domestic violence, we must give victims the confidence to break their silence and help end their personal suffering. Those who intimidate witnesses can currently be charged with the common law offence of attempting to pervert the course of justice. The Criminal Justice and Public Order Act 1994 contains a new offence of intimidating a witness, juror or someone assisting the police. This is designed to deter would-be intimidators, and to make it easier to prosecute those who do intimidate.

The new offence, which came into force on 3 February this year, will remove the requirement of the existing offence to prove that the intimidation was intended to pervert the course of justice. Under the new offence, offenders could be convicted simply on the basis that they intimidated a person whom they knew to be a witness. There are already a number of practical measures in place to protect witnesses from intimidation. For instance, witness addresses are removed as a matter of course from copies of statements passed to the defence. The Royal Commission on Criminal Justice, which reported in 1993, made a number of recommendations designed further to increase support and protection for witnesses.

Courts should make greater use of their existing powers, to enable statements of witnesses other than the defendant to be read out where the witness is afraid to give oral evidence. The recommendation has been drawn to the attention of all serving judges, and will be used in judicial training seminars. Witnesses who do not wish to have their addresses read out in court--as is the normal practice--should be allowed to hand them in to court or

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be able to use accommodation addresses, with the leave of the court. Courts have the discretion to allow the information to be withheld.

In cases where the victim fears for his or her personal safety because a defendant is about to be released on bail or following a successful appeal, particular care will be taken. Departments are considering what further steps can be taken on a multi-agency basis to assist victims and witnesses who fear for their personal safety or that of their families.

Police policy on domestic violence is important, and is based on the premise that assaults within private relationships are no less criminally serious than violence which takes place between strangers out in the street. In July 1990, guidance was issued to the police in England, Wales and Scotland to ensure a quick and effective response to domestic violence, taking into account the overriding needs of the victim. Similar guidance was issued in Northern Ireland in 1991. All police forces now have a force policy on domestic violence. The policies emphasise the overriding duty to protect victims and children from further attack, the need to treat domestic violence as seriously as any other form of violence, the use and value of powers of arrest, the dangers of seeking reconciliation between assailant and victim, and the importance of keeping records to monitor the policy in practice.

Forces throughout the UK were also encouraged to set up dedicated domestic violence units or to appoint officers to deal specifically with domestic violence cases and to liaise with other agencies working in the field.

The Crown Prosecution Service treats cases of domestic violence seriously. It has also examined its procedures in order to ensure an effective response. In 1993, it updated and published its comprehensive guide issued to staff for dealing with domestic violence cases, and that procedure is again under review and will shortly be updated. The CPS recognises and endorses the principle that violence in a domestic background is not a factor which reduces the seriousness of the offending.

The CPS does not act directly on behalf of individual victims or represent them in court in the criminal proceedings, because it has to take decisions reflecting the overall public interest, rather than the particular interests of any one person. Nevertheless, Crown prosecutors always think very carefully about the interests of the victim, which are important, when deciding where the public interest lies.

A vital matter in ensuring that the victims of crime have the necessary confidence in the criminal justice system is the sentencing process. Effective penalties also act as a deterrent to potential offenders. The sentencing decisions of the courts have the capacity to inspire or dilute that confidence. For domestic violence to be seen to be tackled vigorously by the criminal justice system, it is essential that sentencing decisions are based on the premise that assaults within private relationships are no less serious than violence between strangers.

We are committed to ensuring that the courts have the powers to sentence offenders appropriately. As with other types of crime, custody is appropriate in the most serious cases. The Criminal Justice Act 1991 enables courts to impose a longer sentence upon a violent or sexual offender than is justified by the seriousness of the offence, if such a sentence is necessary to protect the public from harm.

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The Government have also given their support to the increase of the maximum penalty for attempted rape to life imprisonment, and of that for indecent assault on a woman to 10 years. In 1991, the House of Lords confirmed an earlier ruling by the Court of Appeal that rape within marriage was unlawful. That ruling is particularly important in enabling the courts to deal with cases of domestic violence, where such cases occur, with the severity they deserve.

Every effort is being made to ensure that the best use is made of facilities available to accommodate the needs of victims who give evidence in court, particularly in cases of domestic violence where there has been violence or abuse which may have left the witness feeling intimidated or in a vulnerable state. The courts charter, published in November 1992, recognised the needs of potential witnesses who may be apprehensive about appearing in court. The Crown court witness service also plays an important role in supporting the victims of domestic violence. It provides information, advice and emotional support to witnesses attending the Crown court. The civil law has a vital role to play in providing those suffering from domestic violence with an effective legal avenue of protection and redress. The Government have recently introduced the Family Homes and Domestic Violence Bill, which is currently receiving detailed consideration by the Special Public Bills Committee in another place. The Bill replaces the piecemeal remedies available under the current statutory framework with a single, consistent set of remedies which will be available to all courts with family jurisdiction. Two types of orders will be available--non- molestation orders prohibiting particular behaviour or molestation generally; and occupation orders with a variety of possible terms, either declaratory or regulatory. Those could, for example, define occupation rights in the home, including the exclusion of the respondent from it and, where appropriate, an area around it. The orders will be available to a wide range of people within a loosely defined domestic or family relationship. At present, only current spouses and cohabitants can apply for remedies. Under the new Bill, that will be extended to cover former spouses, former cohabitants, certain relatives, others who live or have lived in the same household, parents of a child or in relation to any child, persons who have had parental responsibility for that child, and parties to the same family proceedings.

Where there has been violence or threatened violence, the court will be required to attach a power of arrest to an order unless the applicant or relevant child would be adequately protected without it. That will reinforce the

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ability of the police to assist in preventing the escalation of violence and the intimidation of the victim. The changes represent not only a clarification of the existing law, but also a strengthening of the civil remedies available for domestic violence. As I stated earlier, truly effective action against domestic violence requires the commitment and involvement of local agencies working in concert to develop local preventative strategies and to provide help and support to the victims. The ministerial group on domestic violence has approved proposals for an inter-agency circular on domestic violence, which will be issued shortly to a wide range of statutory and voluntary agencies. It will set out the Government's approach to the issue, and encourage all local agencies to co-ordinate their responses to domestic violence.

No one agency can meet the needs of those who experience domestic violence. Recent developments, involving co-operation between the police, local authorities and voluntary agencies, have highlighted the importance of inter-agency work as potentially a more effective way of addressing domestic violence.

In particular, the establishment of a local domestic violence forum-- whereby representatives from a range of services in both the statutory and voluntary sectors come together at the local level to provide the necessary services and support of the local community--represents one model through which to focus inter-agency efforts to improve support and services for women experiencing domestic violence, and also for co-ordinating resources for men to stop using violence.

The Home Office programme development unit is currently funding several innovative projects, looking at the potential of treatment programmes for offenders. The aim of the experimental approaches being taken is to find out what approaches are the most effective in tackling domestic violence.

Research and evaluation are important. That evaluation is taking place in the court-ordered Change and Lothian treatment programmes--that is the Dobash report. The results of the evaluation are currently being considered, and will provide much-needed information on the efficacy of treatment programmes for men who are violent.

The range of measures being taken forward by the Government to tackle domestic violence, which I have outlined, reaffirms our commitment to effectively responding to this most distressing of crimes.

Mr. Deputy Speaker (Mr. Michael Morris): Order. We now move to the debate on the future of Guy's hospital.

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Guy's Hospital

11.30 am

Mr. Roger Sims (Chislehurst): Thirteen months ago, the Secretary of State for Health announced, in the context of the Tomlinson report, her strategic direction in respect of the future disposition of services on the two sites owned by the Guy's and St. Thomas's Hospital trust. The trust subsequently made its proposals, which have been considered by the local health commission and the regional health authority and now sit on the Secretary of State's desk awaiting a decision. In making that decision, she will be advised by my hon. Friend the Minister for Health, to whom I am grateful for attending this debate to listen to what I and others have to say before finalising his views.

Discussions on how services should be rationalised between the two hospitals predated the report of the Tomlinson inquiry, which considered the provision of medical services in London as a whole. Unfortunately, the administrative and clinical staff of the two hospitals had difficulties in reaching a consensus. I give credit to the Secretary of State for at least seeking to grasp the nettle in making a statement on 10 February 1994, in which she said:

"We therefore intend to ask the trust to pursue proposals that, over time, will concentrate acute and specialist hospital services at the St. Thomas's site."--[ Official Report , 10 February 1994; Vol. 237, c. 460.]

She went on to propose that Guy's should be used almost exclusively for teaching and research.

The reaction to her announcement was immediate: from consultants, some of whom were my constituents; from people living in the vicinity of Guy's; and from patients and ex-patients of the hospital, some of whom were also my constituents. Following that, the hon. Member for Southwark and Bermondsey (Mr. Hughes), in whose constituency Guy's hospital lies, called together a group of interested people, formed the Save Guy's Hospital campaign, and invited the hon. Member for Dulwich (Ms Jowell) and me to join him as co- chairmen.

The campaign management group consists of doctors, nurses, patients' representatives, a solicitor, trade unionists and others, of all political persuasions and of none, united in their concern about the hospital. May I record my respect for the work of the hon. Member for Southwark and Bermondsey, who has, primus inter pares of the chairmen, conducted the affairs of a disparate group with considerable diligence and diplomacy, enabling its members to work well together?

The more I became involved with the group, the more I became convinced that the information on which the Secretary of State's decision was based was inaccurate and inadequate. My personal concerns--other hon. Members will no doubt express their worries--stemmed from three aspects.

First, the accident and emergency service at Guy's is currently much used by local people; other hon. Members will certainly wish to refer to that dimension. In addition, however, there is a commuter population of some 300,000 people who work each day in the City. Inevitably, among them accidents, emergencies and illnesses occur daily, not to mention the possibility of large-scale incidents such as the Cannon street rail crash or terrorist outrages, both of which the City has experienced in recent years. With the Barts service now closed, it is essential that the City has an easily accessible A and E department.

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Secondly, Guy's has a number of important specialist services such as oncology, cardiac, renal, neurology, ophthalmology, and ear, nose and throat, to which thousands of patients throughout south-east London--indeed, south-east England as a whole--are referred by their GPs. For them, Guy's is extremely conveniently placed in terms of public transport, as it is literally on the doorstep of London Bridge station and the bus station. Ease of access is important for patients, but equally so for relatives who wish to visit. No other hospital --certainly not St. Thomas's--is as easily accessible. Thirdly, earlier plans for developing Guy's included the construction of Philip Harris house, partly funded from charitable sources. It was planned, designed and built to house the specialist services to which I referred, equipped with the latest technology, and has just been completed at a cost of £154 million. It is incomprehensible that it should not be used for the purposes for which it was intended.

May I make it clear that, while the Save Guy's Hospital campaign's purpose has been and continues to be to retain Guy's as a viable hospital, it is in no sense antagonistic towards St. Thomas's? The issue is the most cost- effective allocation of resources between the sites and the distribution of services between the hospitals, which will provide the greatest benefit to patients.

The campaign group examined in detail the facts and figures pertaining to both hospitals and the implications of the Secretary of State's instruction. To assist in that analysis, it commissioned KPMG, which produced a thorough report incorporating alternative proposals, which were clinically coherent, carefully costed and involved less capital expenditure. The campaign group drew on that report in submitting its observations and alternative proposals to the hospital trust.

In due course, the hospital trust issued its proposals, which were to close Guy's A and E; to bring together most of the specialist clinical departments on the St. Thomas's site; to develop a centre at Guy's for day surgery and day treatment; and to bring together the medical and dental schools and King's college on the Guy's site. What the trust effectively proposed, therefore, was to close the A and E department at Guy's altogether and gradually transfer most specialties to St. Thomas's while producing at the Guy's site a centre for what was described as "planned surgery", which would be without any back-up facilities such as intensive care--a proposition that much clinical opinion believes to be unsafe. By implication, the trust rejected the KPMG plans and the campaign's variation on them, although it did not argue them in detail.

Those proposals then went to the Lambeth, Southwark and Lewisham health commission, which clearly considered the objections that had been made to it. It effectively decided that the proposals should be implemented, but over a period of five to seven years rather than four. Its recommendation was that the A and E department should be kept open until 31 December 1998 and should not be closed until the expansion plans for the King's, Lewisham and St. Thomas's hospital site were in place, until the London ambulance service was meeting acceptable standards and until the programme to improve primary and community care services in Bermondsey, Rotherhithe and north Southwark had been implemented.

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It recommended that plans to bring together most of the services currently on the two sites on to the St. Thomas's site should proceed, as should developing day surgery at Guy's, but that such implementation should be spread over a period of up to seven years and that the trust should be provided with additional funds to facilitate that.

When those recommendations were passed to the South Regional health authority, it did little more than endorse them. In a letter to some of my hon. Friends, the Minister says that it did so "after detailed consideration", but I question that assertion. The members of the authority were given only a brief summary of the consultation process and its outcome and, in his report to the authority, the regional director advised members that

"no credible alternative plans were put forward during consultation".

The KPMG plans may well be susceptible to criticism, but to dismiss them by implication as "incredible" was surely grossly irresponsible. It is worth pointing out that members of the authority were not given an opportunity to study them until the last minute.

The regional director said that the commission's proposal is "responsive to the concerns raised and proposes a timescale which acknowledges local or public anxieties".

I hope that the Minister and the Secretary of State will similarly acknowledge those anxieties, which were reflected in the response to the consultation process.

Sir John Gorst (Hendon, North): Will my hon. Friend advise the House on one specific matter? Guy's has, to my knowledge, a reputation for being a centre of excellence, mainly because of its pioneering work in many fields--research, development and so on. Is such history and experience transferable from one hospital on the Guy's site to St. Thomas's, or is there likely to be any loss in the process?

Mr. Sims: I suppose that in theory anything is transferable, but surely there must be some loss of quality and of personnel if one starts shifting well-established centres from one site to another.

Sir John Gorst: Has that been considered?

Mr. Sims: It was certainly considered by the campaign group. I hope that it is being considered by the Minister and the Secretary of State.

I was referring to the consultation process. In the course of it, a petition raised by the campaign attracted many more than 1 million signatures and was presented to the House a few weeks ago; another, in similar terms, organised by Unison, bore 30,000 names. In addition, 350 individual letters were written objecting to the plans, compared with 23 in support, and 3,000 standard letters of objection were submitted.

Nowhere in the documents is reference made to the reaction from overseas, where there are many doctors who trained as students or postgraduates at Guy's. Earlier this week, I handed the Prime Minister a folder containing 184 letters from distinguished clinicians throughout the world expressing alarm and astonishment at the implication of the closure proposals.

I have not sought the debate to suggest to the Secretary of State or the Minister that the recommendations should be rejected in toto and that we return to square one, but I invite him to recognise their considerable implications and to modify them substantially.

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Is it logical, having accepted that the A and E department at Guy's cannot be closed in the next year or two, to say that it is to be closed at the end of 1998? If it is unsafe to close it now, surely it is unwise to specify that it will close in less than four years' time. It is not difficult to visualise the blighting effect that that will have on A and E and on other services, which will begin to decline, will lose members from the expert clinical teams there and find recruitment of the best people impossible. Surely it would be sensible simply to say that the A and E department will remain open and work normally and that its future will be reviewed in a few years' time in the light of circumstances then

prevailing--circumstances that cannot, at the moment, possibly be foreseen.

How can concentrating specialties on the St. Thomas's site, at an estimated cost for additional building of £54 million, be justified when Phillip Harris house, already completed at a cost of £154 million and incorporating the latest medical technology for renal, oncology, cardiac and neurology services, is not to be used to the full? Incidentally, if it is not so used, the future of the £25 million charity money donated for the building is, to put it no higher, uncertain.

The proposal is even more difficult to justify now that we know that the United medical and dental school and King's college London will not need all the space allocated to them at Guy's. Surely the space use needs to be re-assessed. What is needed is to devise a technically and clinically coherent and cost-effective solution that would provide specialist services on both sites but with minimal duplication.

The status quo, to coin a phrase, is not an option. Change is inevitable-- indeed, essential--but it must be realistic, it must be orderly and it must ensure that the best possible use is made of the two sites, of the existing buildings and of limited financial resources in the interests of those for whom the two hospitals, and indeed the national health service, primarily exist--patients. I earnestly plead with my hon. Friend the Minister to consider most carefully all that I have said and the words of those who follow me before reaching any conclusions on these difficult and important issues. I thank him for the time and energy that I know he has already devoted to them.

Several hon. Members rose --

Mr. Deputy Speaker: Order. It is clear that many hon. Members wish to speak, so I make a plea for relatively short speeches.

11.45 am

Mr. Simon Hughes (Southwark and Bermondsey): I am grateful for the opportunity to speak and I am grateful to the hon. Member for Chislehurst (Mr. Sims) for requesting, and securing, a debate. I do not want the debate to sound like a mutual support society, but I thank the hon. Gentleman for all that he has done and for the clear way in which he made the case. Colleagues on the Opposition Benches have been equally clear and supportive in arguing not from rhetoric or from general proposition but about the case.

I know that, since the Minister took over his job, he has been diligent. He has visited the hospital; he kindly invited me to be with him. He has briefed himself about the position, and we are entirely happy that he is doing

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