House of Commons Hansard Debates for 19 Apr 1995

Mr. Campbell-Savours: May I draw my hon. Friend's attention to a letter from the dean of the medical sciences building at the University of Toronto? It is a letter to the Prime Minister dated 7 January 1993. He says:

"St. Bartholomew's has a reputation for academic excellence in clinical care, medical education and research which is recognised around the world. My most direct knowledge of St. Bartholomew's concerns Gastroenterology in particular. St. Bartholomew's has been an acknowledged leader in Gastroenterology for more than 100 years. Currently, its clinicians, scholars and scientists in the Academic Department of Paediatric Gastroenterology are recognised world-wide. These facilities represent a resource to London, to Britain and to the international academic medical community."

That was from a Mr. C. A. Ottoway MD PhD FRCP, of the medical sciences building at the University of Toronto. I understand that he is the dean of the department. So my hon. Friend has an example. I have many examples in this book.

Mr. Sedgemore: My hon. Friend is privileged to have letters which I do not have. I have heard of that particular

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dean. He is of international renown. When he says that in gastroenterology St. Bartholomew's has a department of world excellence, I am inclined to believe him.

The point that my hon. Friend has to make, and I have to make in order to persuade the House, is as follows. My hon. Friend has dealt with one area. The fact that St. Bartholomew's is recognised internationally as excellent by someone whom we can respect does not mean that it is excellent across the board. How does one prove that an institution is world class? That is the onus on me in this debate. How can I prove to the House that here we have a world-class academic institution which is excellent across the board? Normally, one could not do it.

If we ask people at St. Bartholomew's hospital what they are like, they will tell us that they are brilliant. Of course they will. If we ask people at Corpus Christi college what they are like, they will tell us that they are brilliant. If we are to prove it, we must find external proof across the board.

Mr. Campbell-Savours: Perhaps I can give my hon. Friend yet another quotation that is equally valid. It comes from an institution in Amsterdam- -the Academisch medisch centrum. I do not speak Dutch so I cannot pronounce it right. It says:

"Worldwide and certainly in Europe the significance and the fundamental contributions of St. Bartholomew's Hospital are unanimously recognised. For many decades the hospital has been a leading institute in many areas of gastroenterology. The contributions towards medicine and medical care of many of its distinguished physicians and surgeons in the past and in the present have been of immense importance in many areas of gastroenterology. I would like particularly to refer to all the recent work with respect to diarrhoeal diseases and to various infectious diseases. But there are many other areas in gastroenterology where St. Bartholomew's has excelled."

There are letters from all over the world in this document and they spell out and emphasise the important contribution that that medical college makes in those areas.

Mr. Sedgemore: I am grateful to my hon. Friend, who is making an important contribution. If he has many such letters, I hope that he will catch your eye later in the debate, Mr. Deputy Speaker. Perhaps he will be able to cover more of the spread than gastroenterology and immunology.

Mr. Skinner: That still does not prove it.

Mr. Sedgemore: By accident, I can prove that St. Bartholomew's is a global institution, a jewel in the crown and something that any civilisation would be silly to destroy. I shall not prove it in relation to the hospital, as we have had many debates on that, but I think that I can do so as regards the medical college. It is up to right hon. and hon. Members to decide whether they think that I have proved it.

The Tomlinson report contained two recommendations on St. Bartholomew's hospital. One was to close it and the other to merge its medical college with the Royal London medical college, which is what we are discussing. I think that the report referred to that being done in relation to the Queen Mary and Westfield. Those announcements sparked off a frisson throughout the medical world and the globe.

People did not sit back and say that it was something that was happening to some minor hospital somewhere in Britain--well, not somewhere in Britain but in the

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constituency of my right hon. Friend the Member for Bethnal Green and Stepney and the heart of London, our capital city. They did not say, "It has nothing to do with us." They wrote about it. What is the quality of the people who wrote? What was the scale of the coverage and the depth of their feelings? I shall not quote whole letters, as my hon. Friend the Member for Workington did.

Mr. Campbell-Savours: It was only a part of the letter.

Mr. Sedgemore: Then it had even more power.

St. Bartholomew's has released to me 344 letters from 48 countries, which were sent to Professor Lesley Rees, the dean of the medical college. To be absolutely fair, some referred to the hospital, but most referred to the medical college and said its resources should not be split up or merged and that it should not disappear as it was one of the world's great institutions. If it works, why muck it around? That is the gravamen that my right hon. Friend the Member for Bethnal Green and Stepney must answer.

I have carried out a fairly unusual analysis of those documents across a wide range of the spectrum. After hon. Members have heard it, if they do not think that it adds up to a global institution that can stand on its own, they should speak and we can carry on the argument.

I spent several days undertaking this new type of summary of the way in which one analyses such things. First, I asked what countries the letters came from, did they cover a wide spectrum of the globe and were they from important or unimportant people.

Mr. Skinner: What do you mean--important or unimportant?

Mr. Sedgemore: I mean, did they have academic excellence upon which the House could rely or were they people writing odd letters and saying--

Mr. Skinner: I do not like elitism.

Mr. Sedgemore: My hon. Friend is quite right. Elitism is favouritism. We are talking about academic excellence and in that sense, when it comes to preserving institutions of academic excellence, in one definition of the word I am an old-fashioned conservative. I hope that that will give Conservative Members some comfort. I am trying to behave responsibly in this debate. The spread of countries from which letters have been sent is extraordinary. It includes Argentina, Australia, Austria, Belgium, Brazil, Canada--17 letters--Cyprus, Czechoslovakia, Denmark, Finland, France, Germany, Ghana, Greece, Hong Kong, Hungary, India, Ireland, Israel, Italy, the West Indies, the United States--97

letters--Switzerland, Sweden, Spain, South Africa, Singapore, Saudi Arabia, Russia, Romania, Portugal, Poland, Oman, Norway, New Zealand, the Netherlands, Malta, Malaysia, Malawi, Kuwait and Japan. Anyone can see that some countries are missing and that some 70 or 80 countries in the world are not represented, but basically that list represents the whole of the advanced medical world, which has sent letters. Is it not worth the House taking notice of them? I have looked at the number of letters that came from distinguished universities, which I know from my experience and reading have academic experience in the medical world that is worth noting. The following

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universities sent letters of support and said that this is a global institution and we would be foolish to let its human and property assets dissipate.

Mr. Campbell-Savours: Has my hon. Friend seen correspondence supporting the merger from any of those countries?

Mr. Sedgemore: My hon. Friend raises a good point and the short answer is no, I have seen not a single letter in support of the merger.

Mr. Shore: I have seen no letters against the merger.

Mr. Sedgemore: That is because my right hon. Friend has not been doing the talking and delving that I have been doing inside St Bartholomew's hospital in the past fortnight. One then gets a different story, but that is a point for later on.

The distinguished universities concerned are, in Australia: Monash university; the University of Adelaide; the University of New South Wales; the University of Queensland; the University of Tasmania; the University of Western Australia; and the Walter and Eliza Hall Institute of Medical Research, Melbourne, which is almost a university. They all said that this is a world-class institution and we should not break it up or let it go.

From Brazil, we received letters of support from the University of San Paulo. From Canada, we had letters of support from McGill university; McMaster university; the Tom Baker cancer centre, Calgary; University hospital, London, Ontario; the University of British Columbia; the University of Toronto; the University of Vancouver; and the University of Western Ontario--all the great universities of Canada. From Finland, we had letters of support from the University of Helsinki and the University of Turku.

Mr. Campbell-Savours: In the light of that overwhelming body of opinion worldwide that has written to the Prime Minister, the hospital or whoever in support of retaining the existing college structure, is it not odd that the Minister is unwilling to come to the Dispatch Box to answer a simple question: if it is the will of Parliament that this Bill does not proceed, is it right for the college authorities to proceed on the basis that they can use the royal prerogative? Is it not odd that, given the overwhelming weight of support, Ministers stand aside and not reflect publicly on those matters?

Mr. Skinner : They are arrogant.

Mr. Sedgemore: As my hon. Friend says from a sedentary position, they are arrogant. The arrogance of 17 years of one-party rule is destroying our national health service, but I shall concentrate on the Bill before us.

Mrs. Clwyd: Does my hon. Friend agree that it seems entirely inconsistent with Government policy when, at the same time as they are trying to promote the City of London as a financial centre in the world, we have reactions from all over the world to the dismantling of a great medical institution? Can we imagine our competitors in Frankfurt or Paris doing something similar while trying to attract wealth and jobs to their city?

Mr. Sedgemore: My hon. Friend makes a point that the City of London realises only too well is perfectly valid. One cannot imagine any other country breaking up a medical institution of this character. The chairman of

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the policy and resources committee of the City of London corporation, who is obviously a Conservative--Mr. Michael Cassidy--wrote only a week ago about the disaster that is befalling the City of London.

We have had representations from the Aristotolean university at Thessaloniki and Athens university in Greece, the university of Budapest in Hungary, the University of Esfahan in Iran, University college, Cork, Ireland, the Chaim Sheba medical centre at Tel Aviv university in Israel, the University of La Sapienza, Rome, and the universities of Bologna, Florence, Genoa, Milan, Modena, Naples Padova, Pavia, Siena, Trieste and Turin in Italy, Kyoto university in Japan, Kuwait university, the University of Malta medical school, the Academische Ziekenhuis in Groningen, Academische Ziekenhuis in Utrecht, the Catholic university in Nijmegen, Erasmus university in Rotterdam, and the University of Amsterdam. That is virtually the whole of the Netherlands, which has a reputation in medical science. We have had representations from the universities of Auckland and of Otago in New Zealand, the University of Oslo in Norway, the universities of Lisbon and of Porto in Portugal, the Moscow state university, and the M. V. Lomonosov Moscow university.

Mr. Campbell-Savours: Who wants to change the present position?

Mr. Sedgemore: Apparently, nobody in the whole world wants to, apart from whipped Conservative Members and my right hon. Friend the Member for Bethnal Green and Stepney.

We have had representations from the University of Ljubljana in Slovenia, the universities of Natal and of Stellenbosch in South Africa, the universities of Barcelona, of Madrid and of Santiago de Compostela in Spain, the universities of Gothenburg, of Lund, of Umea and of Uppsala in Sweden, the Centre Hospitalier Universitaire Vaudois, Lausanne, Ho pital Cantonal Universitaire de Geneve and University hospital, Zurich.

We have had representations from the Albert Einstein college of medicine, New York, the American Cancer Society, Columbia university, Cornell university, Georgetown university, Harvard university, Indiana university, Iowa state university, the Johns Hopkins medical school--one of the greatest medical schools that the world has ever known and ever will known- -Loyola university in Chicago, the universities of Stanford in California, Alabama--

Mr.Campbell-Savours: What are they all saying?

Mr. Sedgemore: I shall come to that.

We have received representations from the universities in Arizona, California, Detroit, Florida, Kentucky, Maryland, Miami, Mississippi, Nebraska, Pennsylvania, South Carolina, South Florida, Southern California, Tennessee, Texas, Vermont, Virginia Washington, North Carolina and St. Louis. [Laughter.]

Hon. Members are laughing, but those are 114 of the world's most prestigious universities with medical schools. One or two of them may have written letters that are over the top. They may have done it out of kindness, but one cannot get 114 of the world's top medical colleges to say, "Keep this medical college as it is, linked to its

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hospital, and let this global jewel get on with its business." I do not know how my right hon. Friend the Member for Bethnal Green and Stepney will answer that. That is the geographical spread. My hon. Friend the Member for Workington mentioned

gastroenterology. I said that it was all right to mention that but that plenty of other medical sciences existed. How does the spread go in those letters? It goes throughout the medical sciences. Bart's is being described as a megacentre of academic research and of doctors' teaching and training in the following areas: anatomy, basic science, cardiology, cardiothoracic surgery, clinical biochemistry, clinical pharmacology, dermatology, diabetes, endocrinology, gynaecology, gastroenterology, haematology, human nutrition, AIDS, medical education, medical informatics, medical oncology, metabolism, microbiology, molecular genetics, nephrology, neurology, nuclear medicine, obstetrics, orthopaedic surgery, pathology, paediatrics, paediatric endocrinology, paediatric gastroendocrinology, paediatric oncology, pharmacology, physiology, preventive medicine, psychiatry, radiology, reproductive physiology, surgery, transplant surgery and urology.

That is just about every medical discipline that we know about. Representatives of all those disciplines say that Bart's is magnificent; it is wonderful; it works; keep it; leave it alone. Why have we come here to destroy it?

I shall not read long letters, but I should like to read a few small excerpts. Hon. Members may judge the quality of the people who have written them in relation to the hospital.

Professor Bela Halasz from Hungary wrote:

"I was shocked . . . I was startled . . . Its scientists are leading members of important international organizations . . . In my opinion it would be a very great loss, if they"

were dispersed. He knows what he is talking about. Perhaps my right hon. Friend the Member for Bethnal Green and Stepney knows him. On basic science, Professor Guido Pozza from Italy wrote: "It is my strong opinion that such a decision will bring about a great loss for biomedical research in U.K . . . I do really hope that St. Bart's shall not end its activity."

On cardiology, Professor Sean Blake of Dublin wrote:

"It seems to me that this would be a tremendous tragedy." Dr. Richard Hauer from the Netherlands wrote:

"It was with astonishment . . . deepest support to attempts to avert this highly undesirable development."

Professor Wellens of the Netherlands wrote:

"many new developments in the diagnosis and management of cardiac arrhythmias have come from colleagues working in St. Bartholomew's Hospital . . . St. Bartholomew's Hospital is academically very much alive."

Mr. Campbell-Savours: Will my hon. Friend give way?

Mr. Sedgemore: May I just develop this point? I am looking at the clock and I want to give other Members a chance to speak. On cardiac surgery:

"I am astonished . . . a beacon, a lighthouse and a guide to, not only the Londoner, but also, to the people of the United Kingdom and the world at large . . . the fate of such a perennial institution, cannot be determined by an ephemeral . . . body"--

I assume that that is a reference to Parliament--

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"this national treasure"

wrote Professor Gerard Guiraudon of Canada.

On clinical biochemistry, Professor Jarob of Germany said: "This tells a lot about successful and excellent education going on not only in Dr Galton's department but also in the whole institution. So I am sure the closure of this tradition-rich famous institute would be an irreparable error . . . I feel strongly about my conviction".

On clinical neurophysiology, Anna Maria Seppalainen of Finland wrote:

"St. Bartholomew's has often exercised interdisciplinary approach . . . This type of approach is severely endangered if the facilities and specialists should be dispersed in various locations." On clinical pharmacology:

"several highly respected physicians and surgeons from Bart's have, over the years, contributed to continuing education at the Academy as Distinguished Academicians . . . There is thus a longstanding academic and professional link between Bart's and the medical community of Singapore . . . it would be a disastrous mistake to close the Hospital."

That is Professor Vernon M. Oh from the national university of Singapore.

On endocrinology, Professor Luiz Cesar Povoa of Brazil wrote: "As a member of the executive Committee of the International Society of Endocrinology I can testify to the high concept of this institution and its contribution to the Endocrinology not only in England, but in the whole World. So, it seems, I repeat, incredible . . . England is respected in the world by its capacity in maintaining tradition, developing new sophisticated techniques and training in a high level"

"Human Resources. Undoubtedly, St. Bartholomew's Hospital is a symbol of this statement."

On gynaecology, Professor Masterson at the university of Florida in the United States of America, who is one of the great experts in his field, wrote:

"surprise and dismay . . . one of only six training centres approved by the Royal College of Obstetricians and Gynaecologists for clinical and fellowship training in Gynaecological Oncology." Dr. Holmesley of North Carolina in the United States of America is another respected expert. He said that the

"most critical loss would be an active training programme in Gynaecological Oncology".

That is roughly the same statement that I have just read out from the other source.

In the sphere of haematology, Professor Sherrill Slichter from Washington, America, said to Professor Lesley Rees, Dean of St. Bartholomew's medical college:

"Your department and institution are well recognised as examples of the best in medical education and scientific excellence . . . I would consider it both a personal and professional loss to the haematologic community if your department was no longer in existence."

On the subject of immunology and AIDS, the Ruprecht-Karls university in Heidelberg, Germany states that there are

"alarming reports . . . the work of St. Bartholomew's is highly respected in the international transplant community . . . ranks among the best institutions worldwide."

Professor Jonathan Mann from the Harvard school of public health, another major university, said:

"Beyond the clinical and academic excellence associated with St. Bartholomew's, I have had the opportunity to observe the high level of international collaboration which the facility and its senior staff, such as Professor Anthony Pinching, have manifested. Professor

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Pinching has been a major figure in AIDS research and in global thinking about HIV/AIDS . . . a major concern would emerge should St. Bartholomew's cease to exist."

Anthony Pinching came from St Mary's--he is one of the people whose work with the Government stopped the onslaught and spread of AIDS in this country. If his department were to be ripped up, we would all pay a terrible price, but, apparently, that may be on the cards. In the sphere of medicine, Professor Casanueva of Spain said: "for Endocrinology, your hospital is the most important and leading unit in Europe . . . prevent this absurd measure." Mr. Michael Thorner said:

"the current policy appears to be precipitous and poorly thought out . . . Bart's not only serves its patient base, but it is an important centre for teaching of medical students, as a postdoctoral training institution and as a centre for medical research." The evidence goes on and on. I think that I am beginning to prove my point.

I also looked at one of the major medical institutions of the world--the equivalent of a medical college in Britain. I looked at what 10 people from that one major institution had said to see whether, across the board, I could get a favourable result. I looked for the reaction of the Harvard medical school, one of the greatest medical centres that the world has ever known. Ten professors were asked what they thought.

Professor Goyal from the department of medicine of Harvard medical school said that he felt "great astonishment" and that

"the adverse effects of its closing will be felt in the medical community throughout the world."

Professor Walker of the department of paediatrics said that he was "absolutely overwhelmed" and that it was

"outrageous . . . that the government should wish to close such a wonderful example of what British medicine has contributed to the world of medicine, medical research and to the quality of care of patients."

Professor Mannick of the department of surgery at the Harvard medical school said:

"I find this shocking in the extreme . . . St. Bartholomew's is a source of inspiration for academic physicians and surgeons throughout the world."

All the other professors say exactly the same.

Professor Nichols of the department of gynaecology and reproductive oncology said that he felt "astonishment and sadness". He said: "This centre of international communication in medicine has earned the respect of colleagues throughout the world . . . It is so easy to dismantle that which took professionals generations to develop, but the negative consequences for the women of the world will be those with which we must all live for a very long time." We can look at the letters in another way. I do not think that anyone has ever done this kind of analysis in support of an institution in this country. Ostensibly, we have a lot of letters which make academic medical points. However, we wish to highlight the strength of the emotions involved. How strong is the emotional tie with St. Bartholomew's? There is a negative emotional response to the idea of closing the hospital and merging the medical college and I have picked out some of the words which show the depth of that feeling.

I have analysed the letters and the principal words used again and again include: "shocked", "dismayed", "astonished", "disbelief", "deepest concern", "saddened", "surprise", "amazement", "appalled", "distressed",

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"horrified", "stunned", "devastating", "overwhelmed", "disturbing", "inconceivable", "incredible", "unthinkable", "astounded", "apprehension", "speechless", "horrible", "alarmed" and "You must be kidding".

The other side of the coin is how Bart's Smithfield is viewed around the globe. Some of the words used in the letters are: "unequalled", "pre- eminent", "world renowned", "venerable", "irreplaceable institution", "true legend", "wonderful unparalled example", "landmark without peers", "international role model", "pillar", "a beacon", "jewel", "a lighthouse", "shining light", "admiration", "envy", "a guide", "prestigious", "scientific strength", "innovative", "dynamic", "unique", "resource benefit of mankind", "incredible traditions", "highest distinction and renown", "top-flight", "great citadel", "magnificent", "dedication to excellence", "second to none", "superb reputation" and "national treasure". That is how people from abroad view the institution. If the great medics of this country were to meet the top 25 endocrinologists, cardiologists, physiologists or experts in any field--this exercise is not connected with the letters--would anyone from Bart's be in the room? Would anyone from Bart's stand as an example of that institution's international quality?

If one entered a room containing the world's top 25

endocrinologists, one would find Professor Michael Besser, professor of medicine at Bart's. Every endocrinologist in the world would recognise him. I do not wish to embarrass him, but Professor Besser is as close as one will ever get to a genius. He is not only a professor of medicine but also a chief executive following the publication of the Tomlinson report. He fought an heroic battle to save St. Bartholomew's hospital.

He would be recognised as the professor of medicine and the chairman of the department of medicine at Bart's. His department of endocrinology received a commendation in the 1992 research assessment exercise. He is a world leader in endocrinology and he has been a visiting professor to universities and medical establishments in Canada, China, Hong Kong, Italy, Malta and the United States of America. He was recently elected senior vice president and senior censor of the Royal College of Physicians.

He is currently chairman of the working party on hormone replacement therapy. He has served on the editorial board of the Journal of Endocrinology and the Journal of Neuroendocrinology and he is currently a member of the editorial board of clinics in endocrinology and metabolism. He could stand among the world's top 25 endocrinologists and people would look up to him. He also performs another function which is not quite as important--he is in charge of the case of my hon. Friend the Member for Workington when my hon. Friend is a patient at St. Bartholomew's hospital. That is the kind of genius and department that I am asking the House to fight to preserve, and not to let slide away into oblivion with the closure of the hospital. Once the department has gone, we will not get it back. Professor James Malpas would be recognised in that room. He is currently the senior physician at St. Bartholomew's hospital, and he is a world authority on childhood cancer. He is president of the Association of Cancer Physicians. The department that he heads has an international reputation, from both the clinical and

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