| Previous Section | Home Page |
Column 793
6.8 pmMr. Brian Sedgemore (Hackney, South and Shoreditch): It is an enormous privilege to have heard the speech made by the right hon. Member for City of London and Westminster, South (Mr. Brooke). We have always held him in high esteem and today, for the first time for a long time, we had a reaffirmation of honour in the House of Commons. We can only salute and applaud the right hon. Gentleman for the grace with which he delivered his speech and for the difficulty with which he has made his decision, for the moment, about his conflicting loyalties. We all know that loyalty to party often conflicts with loyalty to constituents, conscience and principles. The right hon. Gentleman has told us that, for the moment, he believes that it is right that he should go along with his loyalty to his constituents, his conscience and his principles. We salute him. At the weekend, the Secretary of State called in some of the press and told them that she had a bundle of letters in support of her plans to close hospitals in London. I wonder how her bundle of letters compared in quantity to the 1 million people who signed a petition stating that Bart's should not be closed and to the 1 million people who signed a petition stating that Guy's should not be closed. I wonder how it compared in quality with the letters that Professor Lesley Rees, the dean of Bart's medical college, received from 344 heads of departments from 42 countries around the world and the 245 letters that he received from medical and scientific institutions from around the globe. I wonder how her little pile of letters compared with the shoal of letters--I have a copy of each one--that the Prime Minister received from top medical experts from around the world.
On the evidence of the correspondence that I have seen--I have looked through it all--the Secretary of State has been charged, indicted and found guilty by the public and by the medical establishment, not just in this country, but worldwide. It only remains for the House tonight to pass sentence and to seek retribution for what the Secretary of State has done.
Two weeks ago, the Prime Minister came to Hackney to praise Hackney council for its inner-city initiatives. He said that he wished there could be cross -party support for them and that Conservative boroughs as well as Labour boroughs could follow the example of Hackney. I was delighted to see him there and discussed some of the problems with him.
Hackney council said that it would work with anyone providing that it was in the interests of the council. It said that it would like some support from Conservative councillors on some of the steps that it wanted to take. Conservative councillors have voted for a motion that is an unequivocal indictment of the Secretary of State's proposal to close Bart's and the London chest hospital. They will be delighted with the decision of the right hon. Member for City of London and Westminster, South tonight. I think that they, like many other people, will be wondering anxiously about how other Conservative Members will respond to the debate.
Yesterday I visited Bart's to open an exhibition of paintings by patients in the Strauss ward--the only ward at Bart's that deals exclusively with those receiving treatment for mental illness. The exhibition took place in St. Bartholomew the Less, a beautiful church inside the hospital.
Column 794
The irony is that the Strauss ward was opened on Wednesday 25 May 1992 by Her Majesty the Queen. Members of the royal family, including the Queen, have all been instructed that they are no longer to pay visits to Bart's, for fear that the anger that already exists due to the impending closure will be made worse. I asked yesterday and I ask the House today: what sort of a society is it where the Queen can be told by second-rate politicians that she cannot go in to the world's oldest and best hospital, even to open new wards or to see and respect some of its past glories?Over lunch yesterday, I spoke to some of the consultants. I did not intend to stay for lunch, so none of the consultants were hand picked, and we had a general talk about what was going on. It was interesting that they all, without exception, said that they were angry and bemused. They said that, when challenged to produce a profit inside the internal market, they did precisely that. They said that, when asked to enter into a merger with the Royal London hospital, they did so in good faith and thought that it might work, only to be told shortly afterwards that it was not to be a merger, but the closure of St. Bartholomew's hospital. They accused the Secretary of State of bad faith and a lack of integrity.
The consultants used words similar to those that I heard the hon. Member for Hendon, North (Sir J. Gorst) use on television. They said that they thought that the Secretary of State did not listen and that some of her arguments were incomprehensible. Some of the consultants were ruder and said that they thought that the Secretary of State was unintelligent, was living in a fantasy world created by her civil servants and had lost all contact with reality.
I remember when the hon. Member for Hendon, North said movingly on television that there was an important thing called a political process, in which one had to take note of people's fears, people's aspirations and--a phrase that I particularly remember--even people's prejudices. I do not believe that the 2 million people who have signed the petition are all prejudiced, but even if they were, it would be extraordinary for a Secretary of State to say, "You 2 million people have had your say, now listen to the experts. I am going to get on with it and take the advice of my civil servants." That does not seem to be the way to conduct politics seriously. The right hon. Member for City of London and Westminster, South spoke about the haemorrhaging of the centre of excellence at St. Bartholomew's hospital and of the staff that were leaving. The dean of the medical college yesterday faxed me some updated figures. I am afraid that they are even slightly worse than the right hon. Gentleman said. I have the fax and the names--obviously, I will not read out the names.
The figures show that seven professors and six senior lecturers have already been lost and are going to such places as Sheffield, Manchester, Oxford, University college hospital and the Royal Free hospital. They also show that four professors, three senior lecturers and a recorder are at risk.
Some people may say that the figures amount to only 20 people and there are hundreds of people carrying out research at Bart's, but it is important to remember that each senior figure who goes will take a clutch of research workers with him or her. Those research workers do not just carry out abstract medical research; they help with
Column 795
the provision of clinical services at Bart's. They have been helping, not only at Bart's, but at the Homerton and the Queen Elizabeth hospital for children in Hackney.One does not need to be super intelligent to realise that the Homerton could seriously suffer in the future because it is no longer linked to a teaching hospital. It does not have the links that it should have with the Royal London hospital and St. Bartholomew's hospital. We need to consider medicine in east London in the context of the Royal London hospital, St. Bartholomew's hospital, the Homerton hospital and, probably, hospitals in Newham, and come up with a sensible solution and sensible amalgamations. There is no need for war between St. Bartholomew's hospital and the Royal London hospital.
A few weeks ago the Secretary of State said that the ethos of Bart's could be transferred to the Royal London. From a sedentary position my hon. Friend the Member for Bolsover (Mr. Skinner), who was here at the time, asked how the bloody hell we could transfer an ethos. I phoned up the Department of Health and was told that it could be bottled and transported. I was told that the extract of Bart's would be issued in bottles to each of the patients moved to the Royal London hospital.
Mr. Deputy Speaker (Mr. Michael Morris): Order.I call Sir Nicholas Scott.
6.18 pm
Sir Nicholas Scott (Chelsea): Hanging in my office in the Norman Shaw North building is a cartoon that was given to me in 1987. It was drawn by that marvellous cartoonist, Marc. It shows two Back Benchers--I think that my hon. Friends would probably recognise them--and one is saying to the other:
"I used to have this nightmare that she'd made me Minister for Northern Ireland, but lately it's been Minister of Health". I do not think that many of us in the House envy my right hon. Friend the Secretary of State and her team of Ministers some of the difficult decisions that they are having to face as they try to ensure that constituency Members of Parliament and existing institutions are properly looked after while at the same time ensuring that we have a health service for London that is up to date as new developments and new techniques are introduced into the health care of our capital city. They have a difficult job, but we too have a difficult job. I ask my right hon. and hon. Friends to understand how difficult that job sometimes is when, as my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) said, marvellous institutions with long histories are too easily challenged and face extinction.
We look at the arguments and the statistics in the Tomlinson report. We refer to a report by Professor Jarman, which challenges many of those ideas and statistics. We listen to my right hon. Friend the Secretary of State and to my hon. Friend the Minister on the "Today" programme, with a soothing and, I am sure, accurate flow of statistics to challenge some of the arguments that are being put against them. We then look at the Evening Standard and the claims of the community health councils. It is difficult for us, as constituency Members of Parliament, to see where the real value in the arguments lies.
Column 796
I know that my right hon. Friend wants to get it right not just for today's London but for tomorrow's London, and that gives her several difficult considerations.Sometimes, too little notice is taken of a number of factors other than the existing population and the existing needs of the population of central London. The population of central London does not consist entirely of those who have a residence in central London. We have a huge additional daytime population whose needs must be met by many hospitals in the city centre. We also have a considerable number of overseas residents, visitors and tourists who might need attention by our health service. Many visitors come to this country specifically to take advantage of the excellent health service in central London, and they bring with them other economic advantages to the centre of London.
There are two other factors that we should bear in mind when we look at the pattern of health provision in central London. I understand the first factor, because the Department in which I recently served shared some of the burden of it with the Department of Health. I refer to the policy of care in the community--perfectly proper and perfectly understandable. There is no doubt at all in my mind that a significant number of those who have been released from institutional care and put into community care packages need from time to time to go into mainstream hospitals in central London because of a deterioration in their condition. Perhaps there is no other place to which they can turn to be properly looked after. We should not ignore the possibility of terrorism as we look at the need for hospitals in central London. I am not talking about Northern Ireland and its influence on this side of the water, which we have had to endure for many years. However, bearing in mind what happened in Oklahoma and the growing number of organisations that seem to believe that they can turn to terrorism to publicise and achieve their ends, we must take account of that trend as we consider proper health care provision in our major cities, particularly in London. The second factor that all Members of Parliament in central London can regard with pride, and for which we must fight to ensure its continuity, is that London maintains its widely recognised reputation throughout the world as a centre for health excellence. We must not lose that. I know that my right hon. Friend wants to keep that reputation and, indeed, to enhance it, and it should be a major factor in our consideration. We should consider not only the existing population who need such services in central London, but those from across the world who come to take advantage of them.
I have three major hospitals in my constituency. One is the Chelsea and Westminster hospital--a new, flourishing, expensive hospital. Whether in today's terms that hospital would ever have been built is not for me to say, but it exists and it is performing extremely well. It is still not used to absolute capacity. It has an excellent contract with the Kensington, Chelsea and Westminster health agency. I believe that it has a glittering future.
Since that hospital opened in early 1993, the number of in-patients and day -patients has steadily increased by more than 15 per cent. in each of the two years that the hospital has been open. Attendances at the accident and emergency department have increased from fewer than 40,000 in the first year to more than 60,000 this year. I recently paid a visit to that A and E unit, and I speak very strongly in support of the service that it provides.
Column 797
That hospital has also introduced something that exists elsewhere--I hope that the practice will steadily increase--and that is a rota of general practitioners serving in the A and E department in the evenings. They are able to cope with the less serious visitors to the department, just as GPs would in their own surgeries. We should encourage that development in our hospitals.The Royal Marsden hospital is also in my constituency. On 21 April, my hon. Friend the Minister was asked whether he had had any meetings about the closure of the Royal Marsden hospital and whether he had any plans for its closure and he answered none to both questions. I hope that I can count on him to continue to use that precise and brief answer to subsequent questions. There is no doubt that the Royal Marsden is a fine institution with a glittering reputation for high-quality research, and it deserves to flourish in future. The third major hospital in my constituency is the Royal Brompton. My hon. Friend the Minister knows that board members of the Royal Brompton hospital have invited companies to meet them with a proposition to introduce a new ambulatory care centre without beds, to be known as the Royal Brompton clinic, which might be developed using the private finance initiative that the Government recently introduced. The private sector has shown great interest in that proposition. We have the chance, in Sydney street in my constituency, to have a new day clinic for respiratory and heart cases, along the lines of the Mayo clinic in the United States of America, and not costing a penny to the Exchequer but provided by private finance. It would be a tremendous addition to the quality of health care in central London.
I very much hope that my right hon. Friend the Secretary of State and her team of Ministers will be able to overcome any objections that may be encountered elsewhere in the Government in order to bring that imaginative scheme to a proper conclusion.
My right hon. Friend has shown great political courage in the way in which she has tackled her job. She needs, too, clear judgment about the future needs of London against the background that I have sought to describe in this brief speech. In the months and years ahead, that will be a difficult task for her, but I wish her well. 6.27 pm
Mr. Jim Dowd (Lewisham, West): The right hon. Members for City of London and Westminster, South (Mr. Brooke) and for Chelsea (Sir N. Scott) have injected the reasonable and measured tone that such debates sometimes lack. It is a shame that, on occasions, our debates are reduced almost to cliche and stereotyping. The idea that this debate is an argument about London versus the rest of the country is not only inaccurate but fraudulent, and those who peddle it do so to try to obscure what is happening in London.
As my right hon. Friend the Member for Derby, South (Mrs. Beckett) said, the debate is of much greater significance; it is about the shape, nature and purpose of the national health service after the market reforms. What is happening in London hospitals today is only because they have been at the sharp end of those reforms, and it will ripple into other parts of the country before long.
The allocation of resources to health will always be difficult for any Government. I speak as somebody who was a member of the area health authority for Lambeth,
Column 798
Lewisham and Southwark from 1976, and who became a member of the district health authority for Lewisham and north Southwark, which succeeded it.I and my colleagues on that authority spent many of those 16 years ensuring that we got the best value for money. Many of our decisions were extremely difficult. Sometimes we were comparing apples with oranges, but decisions had to be taken in the best interests of the people in the area.
In one of today's newspapers, the Secretary of State apparently attacks me for not supporting the Government's investment in the improvements to Lewisham hospital, among others. That was another piece of shorthand. Over the years, I was deeply involved in what became phase 2 at Lewisham and phase 3 at Guy's.
Philip Harris house has already been mentioned this evening. I am pleased with what has been achieved. My major concern, and the reason why I am speaking this evening, is that so much of that achievement is being put at risk. The improvements at Lewisham are welcome, but they have not achieved the objective of providing a service adequate to the needs of the area.
When the proposals for the future of Guy's and St. Thomas's were put out for consultation by the current health authority, the majority of responses outside the area immediately surrounding Guy's hospital were from people in my constituency who overwhelmingly used Lewisham and King's. That is because those people know that Lewisham and King's cannot cope at the moment, let alone if the accident and emergency department at Guy's were to the close.
In 1976, when I started on the health authority, there were about 16 hospitals in Lambeth, Lewisham and Southwark. Today there are four. Anybody who says the idea of change is new and needs to be faced now is misleading himself. Change in the provision of health care in London has been a fact of life, certainly since the formation of the national health service.
Many of those hospital closures were bitterly contested at the time. The decision to close Sydenham children's hospital had the capacity to be extremely emotional. I supported the closure of that hospital for a number of reasons, not least of which was how the process was approached. Ultimately, the authority and the clinicians convinced people in the area that a better service could be provided elsewhere--at Lewisham hospital. It was only with some reluctance that the people in the area agreed to the closure of Sydenham children's hospital, and subsequently moved to Lewisham hospital, which is doing very well.
That element of consent is totally lacking in the issues before us this evening. What has been most clear in the process post-Tomlinson is that change has been pushed forward almost with a life of its own. Theoretically, the people of London were consulted, in so far as they were given the opportunity to write letters to the Secretary of State and their local health authorities, but there is a widespread feeling that the consultation was a sham, and that nothing they said, except at the very periphery, was taken into account, and their views had no impact on the decisions that were taken. The issues that we are discussing this evening involve public confidence as well as health care provision.
Column 799
The timetable for Tomlinson was set four or five years ago. A great deal of contrary authoritative information has emerged as the process has unfolded, and there is some doubt as to whether Tomlinson has achieved its objective. For example, since 1992, bed closures across the country have reached some 3,000, and 45 per cent. or more than 1, 300 were in London alone. That shows how rapidly health care provision-- certainly acute provision--has changed in London. Mention has been made of the Jarman report, the work of the King's Fund and others.It is not reasonable, particularly in the case of Guy's, though the same case can be made for other hospitals, that no alternatives have been produced. The "Save Guy's Campaign"--I pay tribute to the hon. Members for Southwark and Bermondsey (Mr. Hughes) and for Chislehurst (Mr. Sims), and to my hon. Friend the Member for Dulwich (Ms Jowell), who have done so much work for that campaign--got KPMG Peat Marwick to carry out an extensive and detailed analysis of the options available under two or three site configurations, in concert with Guy's, St. Thomas's, University and King's College hospitals. Nobody said that it was the perfect blueprint, but those proposals made it clear that there was room for a reasoned and informed debate to decide on an alternative to the current proposals.
Hon. Members on both sides of the House are concerned about the proposals for accident and emergency provision at various hospitals, because the accident and emergency department is the heart of a hospital. All experience shows that, once the casualty department is closed, before the decline of the rest of the hospital is simply a matter of time. It is sometimes accelerated and sometimes delayed, but it is inevitable. That is why the accident and emergency unit at Guy's is critical for people in south-east London who have been at the forefront of change in acute provision in London.
A perfectly reasonable argument has unfolded over the years for the rationalisation of specialties. The arguments are far more technical, although the assessment of their benefit is easier to calculate than that for accident and emergency provision. The rationalisation of specialties will always cause dispute, but there is more broad agreement, certainly in the light of technical and technological developments, about how developments should unfold. Accident and emergency provision is an entirely different matter, as that is how people define their local hospitals.
The hospitals in south-east London, including Guy's, cannot cope with the current demand. Speaking to a friend, I asked after his mother, who is one of my constituents in Sydenham. He informed me that she had been very ill with pneumonia, and that at one stage her GP wanted to admit her to Lewisham hospital. He said that had there been a bed available, she would have been admitted.
When I asked him what he meant by that, he said that, when they had asked for a bed at Lewisham, Hither Green or Guy's, no beds were available, so she stayed at home. Fortunately, she is better now, but those decisions cause not only distress to the individuals concerned but untold distress, inconvenience and worry to their families when they are given medical advice that they should be admitted to hospital but they cannot get in.
Column 800
I was interested to hear the Secretary of State further refine the delay in announcing the closure of Guy's. She has now given a date before which it will not be closed. That is another tactical retreat, which will enable her to come back and steal the show by announcing a date 20 years on from that, and by then we might have dealt with many of the issues relating to Guy's. The announcement of the delay in itself shows how overwhelming pressure has been against the proposals of the trust.The trusts are unresponsive, and the performance of the London ambulance service remains a source of considerable concern to all of us in London. Sadly, the figures are deteriorating, after a marginal improvement.
The Secretary of State's decisions are virtually irreversible, but the motion provides an opportunity to think against before it is too late for the people of London and the NHS they prize.
6.37 pm
Mr. David Mellor (Putney): It is a pleasure to follow the speech of the hon. Member for Lewisham (Mr. Dowd), who was extensively involved in the health service. I agree with a number of the points he made about health services in London that were refreshingly free of the partisan camp that so often disfigures such occasions. There has been a measured quality to the debate that might not have been anticipated, given some of its pre- publicity.
One of the reasons that impelled me to speak was my anger at the campaign of vilification that has been mounted against my right hon. Friend the Secretary of State in recent weeks. It is inevitable in the extremely difficult waters in which she has to fish.
As one of those who took on the job of Minister of Health not long after the cartoon to which my right hon. Friend the Member for Chelsea (Sir N. Scott) referred, I can assure him that, of all the posts I occupied in 11 years in government, health was far and away the most stressful and difficult. The Archangel Gabriel himself would have difficulty emerging in pristine condition from occupying that post.
It was a genuine pleasure to be in the House to hear the exceptionally eloquent and stylish speech of my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke). The fact that he takes the view that he does is a sign of how difficult is the task of my right hon. Friend the Secretary of State. All of us who care about the health service in London will be concerned about some things that are happening, and all have reservations about some of the detail of the proposals. However, overall there is no doubt that that which my right hon. Friend is doing needs in some part--probably the greater part--to be done. It cannot be ignored or avoided by anybody who wants to discharge effectively the office of Secretary of State for Health with any distinction, particularly in the eye of history. I hope that it will be possible to conduct debates without trying personally to vilify the holder of an office merely because that individual cannot shrink from taking difficult decisions.
I need not rehearse the justifications for Government policies. London is no longer the place to which patients from all over the country must come for a range of specialist treatment. It should be a matter of pride that, under this Government, we have for the first time a truly
Column 801
national health service. One can have a heart transplant at the Freeman hospital in Newcastle, and St. James's hospital in Leeds is a European leader in liver surgery. Nobody is far from a modern hospital that can fulfil almost all their needs.Whether we like it or not, the transformation of some central London hospitals from great centres of excellence offering services to a substantial part of the nation to district general hospitals was always going to be difficult and painful. That does not mean that some of the decisions and detail should not be examined, and I cannot quarrel with a number of the points made on behalf of Guy's and Bart's. It is clear that London could not go on the way it was. The right hon. Member for Derby, South (Mrs. Beckett) has left the Chamber. It would have helped if at some point in her speech she had recognised that the process of reducing the number of hospital beds in London began under the last Labour Government, which established the London Health Planning Consortium--although it reported in the first 12 months of this Government.
My hon. Friend the Member for Reading, East (Sir G. Vaughan), who was Minister of State for Health at the time, will remember that the consortium recommended 6,200 bed reductions overall, amounting to 20 to 25 per cent. of central London's bed stock. If, by some miracle, Labour had won the 1979 general election, presumably it would have embarked on much the same course, because it set in hand the first substantive report.
I longed--in the course of a speech that lasted half an hour and seemed much longer--for the right hon. Member for Derby, South to say what Labour, which we are now meant to see as a credible and serious party of government, would do to deal with London's health service. It is deplorable that we were treated to an opportunistic assault on the Government, merely for being the people who must run the health service.
If one day--contrary to our wishes and expectations--the right hon. Member for Derby, South became Secretary of State for Health, the idea that people would be cheering her through the streets six months after she had taken office is ludicrous--the right hon. Lady, in her innermost thoughts, must realise how deeply ludicrous.
It is also ludicrous for the Labour party to imagine for one moment that it can get away, in the run-up to a general election, with making low-road points about the Government. The Opposition must say what they intend. They made that mistake before. They are unaccustomed to answering substantive points, and fall apart in the run-up to an election. In their private thoughts--although they would not admit this--they must be only too aware that that is the likely fate that could still overtake them, however full of optimism they are at the moment.
I will turn to one or two points of substance. I made it clear that I accept that my right hon. Friend the Secretary of State must take the steps she has, but it is inevitable that there will be resentment on these Benches and everywhere else if it appears that the health service that was subject to the major reforms introduced by my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) are still being run according to the principles of a group of faceless people at different tiers, making decisions of fundamental importance as to which institutions remain open and which do not.
Column 802
I was there at the formation of the policy, and it was always my understanding that the aim of the reforms was to empower patients and their doctors, and that the new mechanisms were to be responsive to their choices. The whole purpose of self-governing hospital trusts was to allow hospitals to respond in a much freer way to patients than before and to offer services whose popularity or otherwise would make it possible, with cash following the patient, for institutions to succeed or fail.A number of us find it difficult that a number of manifestly successful institutions can nevertheless be challenged by what appears to be a return to the old-style dirigiste principles that I hoped had gone out of the window with the advent of the reforms. I say that in relation to Queen Mary's University hospital, Roehampton. I am grateful to my right hon. Friend and to the predecessor to my hon. Friend the Member for Winchester (Mr. Malone) for determining last year that the threat to which Queen Mary's was subject should be lifted.
Mr. Sedgemore: Now we understand.
Mr. Mellor: I shall fight for the hospital in my constituency, as the hon. Gentleman fights for his. If I do so more successfully than the hon. Gentleman, he can draw his own conclusions.
Of the four hospitals in south-west London that were under scrutiny, Queen Mary's University was the hospital that doctors and patients regarded most highly. That was a reason for promoting its cause, and that cause was successful.
The problem for the health service is that there are too many cooks stirring this particular broth. I particularly draw to the attention of my hon. Friend the Minister the role of purchasing authorities. At present, Queen Mary's hopes to pioneer a new way of making hospitals more responsive to community needs through the rapid diagnostic centre, for which the region has already made £2 million funding available for the coming year. However, Kingston and Richmond health authority is now intervening and holding a pistol at the head of Queen Mary's, saying that, unless it is prepared to announce plans for closer co-operation with Kingston hospital, the investment cannot proceed.
It is the role of purchasing authorities not to usurp such functions, but to facilitate the choices that doctors and their patients make. If I walked down Putney high street today, none of my constituents would be able to identify one member of those health authorities. The Government would get the blame if things went wrong.
As my right hon. Friend and her colleagues have found, trip wires are set for them by people who are grinding their own axes and who hold no responsibility for maintaining public confidence in the health service or for ensuring that a manageable pace of change is promoted. Against that background, it is extremely important that processes go forward with a recognition that there are political elements in this that are too important to be left to the experts.
Column 803
6.48 pmMr. John Austin-Walker (Woolwich): It is timely to remind the Minister of the comments of the hon. Member for Hendon, North (Sir J. Gorst) on 5 April, when he asked the Secretary of State:
"Does my right hon. Friend accept that democratic politics is about delivering to people what the majority want, and not about telling the majority of people what they should have?"
He said:
"she is doing the wrong thing, in the wrong way, at the wrong time and in the wrong place."--[ Official Report , 5 April 1995; Vol. 257, c. 1738.]
The hon. Gentleman was referring to the problems relating to Edgware general hospital, but the same applies to other Greater London hospitals, such as Oldchurch and Greenwich district. When I visited Edgware, I was struck by the lobby outside. Those people were not the usual rent-a-crowd lobby that one might have expected outside a hospital proposed for closure. I was handed a leaflet by a constituent of the right hon. Member for Brent, North (Sir R. Boyson), who I believe was also a member of his party, relating to Edgware. It said:
"Five CHCs agree with the people, all the local MPs agree with the people, the GPs agree with the people. Those who want to close Edgware have no friends."
The Secretary of State and the Minister for Health seem incapable of listening to any advice from any source with any contact with the service that is being delivered.
One comment that has been made to me in relation to Edgware, which has also been made in relation to the Brook, Greenwich district and the move of Oldchurch to Harold Wood, concerns the beds that will be lost in the process. I am continually told by the Secretary of State and the Minister that the new proposals take into account the changes in practice, developments and techniques, the increase in day surgery and the shorter stay in hospital, and that that is why there may be a bed loss.
That might have some credence if there were spare beds at the moment. But in all those hospitals, not only are there no spare beds, but bed occupancy is higher than the Minister recommends as a reasonable level and it is achieved by the use of trolleys and beds in corridors.
Hon. Members who have been patients awaiting an operation will appreciate that, no matter how routine an operation is for the hospital, for the patient it is a traumatic experience. To have to psych oneself up and prepare for the trauma of an operation only to be told on the day of or the day before the operation that no bed is available is not the kind of hospital service that people in London deserve or expect.
The Secretary of State referred in her opening remarks to the Brook hospital and neurosurgery. She says that she wants to locate neurosurgery services close to an institute of academic excellence, close to the Institute of Psychiatry at the Maudsley. Why does she not talk to the neurosurgeons at the Brook hospital and throughout London who question the rationale of locating neurosurgery with a psychiatric unit?
No one denies that some patients who need neurosurgery may at some stage require some psychiatric services. But neurosurgery should be accessible to patients and located close to a major trauma centre. The hon. Member for Gravesham (Mr. Arnold) spoke about
Column 804
taking services out of central London to the areas that they serve. I remind the Minister that the Brook neurosurgery service and the Brook cardiothoracic service serve the people of south-east London and north-west Kent. To move those services to Guy's, St. Thomas's and King's, further into central London, makes no sense at all to the people of Gravesham, Chislehurst or Old Bexley and Sidcup. It is not just Labour Members who have made such representations. The right hon. Member for Old Bexley and Sidcup (Sir E. Heath), the Father of the House, has called for a meeting with the Secretary of State to discuss the Brook neurosurgery services. Those services should move with the rest of the Brook hospital services into the new Queen Elizabeth military hospital. But if they were to go to Queen Mary's, Sidcup, I would not complain, because at least they would be located in a key area serving the sub-region.Dermatology services do not receive a great deal of publicity, and people do not think that they are particularly important, but they are one of the most heavily used medical specialties. We have talked about the loss of beds. London has seen 70 per cent. of dermatology beds disappear. The dermatologists do not argue that all those beds need to be maintained. They accept that there can be some rationalisation of beds and their location in centres of excellence. But with the disappearance of those beds has gone 60 per cent. of the dedicated dermatology nurses who would be required to provide the services in out-patient clinics and in the community. Why were the dermatology services not the subject of a specialty review and why was there no input from the London dermatology planning group in any of the Minister's considerations? Those matters need to be considered.
The Minister will know that the Select Committee has considered the London ambulance service. I do not want to speak at great length about that, but I say simply that it is on the record that almost every person who gave evidence to the Select Committee said that the drastic reduction in accident and emergency units in London had been a contributory factor to the problems of the London ambulance service.
People talk about the response times of the London ambulance service improving, for which, at the end of the day, the Minister is responsible, but in the key area of the rapid response time there has been virtually no improvement during the past two years since the Minister has taken up the matter.
The right hon. Member for Chelsea (Sir N. Scott) referred to psychiatric services. I agree with all the points that he made. We have heard about over-occupancy of beds in London. Nowhere is that more apparent than in the area of psychiatry. My local hospital is talking about bed occupancy rates of 120 per cent. We have heard of patients from Sidcup having to be flown to Leeds for acute services. In psychiatry, it is not uncommon for patients from Greenwich and Woolwich to have to go as far afield as Oxford or Woking on a regular basis. A consultant psychiatrist has said that it is not uncommon for patients to have to wait some 36 hours to be placed and for telephone calls to have to be made to up to 35 different hospitals. That does not imply a pattern of over-provision in London.
Column 805
I want finally to say a word about the Tomlinson-Jarman debate. Tomlinson was considering acute services in inner London, not the totality of health services across London. I do not think that anyone, certainly not Professor Tomlinson, would dispute the figures that have now been put forward on the totality of care in London by Professor Jarman. In the conclusion of his article in the British Medical Journal , Professor Jarman says:"It is clear that neither hospital use by London residents, nor the availability of hospital beds, nor considerations of relative efficiency provide a case for a reduction of the total bed capacity in London . . . It is important that any changes should be considered in the context of London's transport system and the particular problems in primary care and social services, relatively longer hospital waiting lists, below average availability of places in residential homes, and the increasing pressure on available hospital beds."
That is why so many Conservative Members are so concerned. We all accept that there is a need for change in London, but the pace of change and the kind of change that is being proposed are wrong. With regard to the Government's assumption about the improper use of resources, we all accept that primary care in London is underdeveloped, but the secondary care should not be taken away before the improvements in primary care are put in place.
6.57 pm
Sir Rhodes Boyson (Brent, North): The proposals for Edgware hospital have probably given rise to the greatest cause for concern in my constituency in the 21 years that I have represented it. People in London have a certain expectation of their hospitals. They are used to having specialist hospitals--such as Bart's and Guy's--in the centre, with a spread of friendly little hospitals around. That is why they feel so strongly about Edgware hospital.
We all accept that there must be reorganisation. We all accept that experts must be consulted. But I do not believe in the rule of experts. Experts can change their minds. It was the experts who ruined education in Britain with the discovery method and comprehensivisation, from the shackles of which the Labour party is now freeing itself.
What worries me about my right hon. Friend the Secretary of State, for whom I have obvious respect, is that she spends so much time talking about the experts rather than the people at the bottom of the pile who know what it is like in their area. The same applies to the size of schools and hospitals. Schools have now returned to their previous sizes. I have always said that in 10 years' time the present fashion will change, and change will be necessary.
Consultation has been mentioned. There has been no real consultation with the man and woman in the street, although various semi-quango committees have given their opinions. Perhaps ordinary people should have written letters, gathered in the streets or marched. In any event, the lack of consultation with them has made the position more difficult.
I have been re-reading some of what has been said about elective dictatorship. A Parliament is elected for five years; a large number of us are members of the Government, and a certain number are parliamentary private secretaries. They are all very good people; I am surrounded by them, so I am living dangerously. The Executive, however, has taken over Parliament, and it has
Column 806
become more difficult to ask whether the system is working and whether it is possible to do things in a certain way.Between 1986 and 1990, Edgware's accident and emergency department was rebuilt; three years later, its future was threatened and it began to be run down. It seems that, if we live long enough, we are bound to be in fashion at some point.
Leadership means convincing our constituents that we are acting in accordance with their best interests. I accept that that is difficult when it comes to the health service. Last week, the mayors of our three boroughs came to the House. They were seen not by the Secretary of State or the Minister of State, but by the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville). Bolton must be a good place; certainly the football has not been too bad this year. What the mayors reported to the council, however, did not make the council feel very confident that its views had been properly represented. Some higher contact would have been useful. Another problem is travel. It takes 45 minutes to travel from Edgware to Northwick Park on the 83 bus, and it costs 80p; it costs about £1.20 to travel to Barnet, and the journey can take up to an hour and a quarter. By that time, a person could be dead. As for ambulances, we do not know when they will arrive--and how fast they can move through the street: in many instances, they can move no faster than a bus. If an ambulance is stuck behind a bus for 10 minutes, there may be another two fatalities in that time. A letter that I received this week from a rabbi in my constituency shows the level of concern. He wrote that the closure of Edgware general hospital would
"not only put at risk the lives of my own members, but also of all the residents of Brent . . . I therefore earnestly request that you make known our concerns at the highest levels. It seems totally criminal that the Government is determined to effect their policies, without any regard for the welfare of the population."
That is the feeling not just of the rabbi and his congregation, but of many people in the area. If we are to get things right, a good deal of public relations and change will be necessary in Edgware and elsewhere. I hope that the Department will see to that in the morning, and will consider what we can do in Edgware to set people's minds at rest.
In the current circumstances, I cannot support the Government tonight. It gives me no pleasure to say that, but we are debating a major issue, and I speak on behalf of my constituents. I hope that there will be further discussions in the long term, which will reassure both them and me.
7.4 pm
| Next Section
| Home Page |