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7.58 pmMs Glenda Jackson (Hampstead and Highgate): The hon. Member for Surbiton (Mr. Tracey) suggested that his constituents wish to be treated near where they live. That is also true for people who live in inner and outer London boroughs. They, too, wish to be treated near where they live.
I pay tribute to the hon. Member for Hendon, North (Sir J. Gorst), who was an example to every Member of the House in the way in which he defended so honestly and openly the interests of his constituents and, I thought, even more, the interests of some of his most vulnerable constituents.
That is true for all of us, because we are attempting to defend people who, in many instances, are suffering from illnesses that they do not understand or are recovering from accidents which, by their very nature, came upon them when they were unprepared. To exacerbate those people's concerns by possibly making them travel for treatment to an area that they do not know, which makes it difficult for relatives to visit them to offer comfort as they recover, acts against the basic tenets of medicine and health care.
The hon. Member for Broxbourne (Mrs. Roe), in her guise as Chairman of the Select Committee on Health, gave us a comprehensive list of the London hospitals that she intends to visit and listed the witnesses from whom the Select Committee intends to take evidence. I hope that the Select Committee will also find time to take evidence from a constituent who earlier today submitted a green card asking to meet me. When I went out to Central Lobby, she told me of her grave concern about the outcome of the debate. She works in the cancer department at Bart's hospital and I am afraid that I could not reassure her that the outcome of the debate would be that Bart's will continue to flourish and to serve people as it has done for 800 years. She is a dedicated worker in the national health service and she told me that what is happening within the NHS in London is "a disgrace", to use her words. She cited instances where people suffering from cancer have had to wait more than four weeks even for an appointment, let alone any kind of treatment.
I regret that my hon. Friend the Member for Islington, North (Mr. Corbyn) is not in his place, as he made a salient point about the availability of health care, which impacts on all hon. Members who represent inner London constituencies. He said that there is obviously a need for primary health care in London, but an equal need for hospital health care. He argued that the health care provided for millions of Londoners at accident and emergency departments should continue to be offered until primary health care facilities are up and running.
As he said, it is not an either-or situation. Undoubtedly, it could end up as a neither-nor one, because many people in London--possibly hundreds of thousands--are not registered with any general practitioner. They look to the A and E departments of their local hospitals for treatment. If those departments are closed, some of the most vulnerable people in London will be left without any health care at all.
Various figures have been bandied today about the actual population of London. Some Conservative Members have argued that, since 1979, which seems to be a watershed for some of them, the London population has fallen. The hon. Member for Kensington (Mr.
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Fishburn) made a valid point, however, when he said that the population of London is not just made up of those who are residents, but includes the vast influx every morning of those who work in our capital city. They, too, require health care and health services when they are in what could be deemed the city of London, even though they live outside it.In the past few years, there has also been a great influx of people looking for work and for homes in London. In many cases they appear on no register or census. My constituency seems to have an increasing population of homeless men. In many cases their homelessness has been exacerbated by problems occasioned by drug and alcohol misuse. It is extremely difficult for them to obtain any kind of medical treatment unless they register with a GP. In many cases pride, foolish though it may be, prevents them from doing so. They can, however, use the facilities that are provided by A and E units.
My central concern undoubtedly rests with the hospitals in my constituency, the Royal Free and the Whittington. We hear about restructuring day by day- -on occasions, it seems like hour by hour--including the closure of Bart's and the possible closure of the A and E department at Edgware. If such facilities are lost, the hospitals in my constituency will be expected to take up the slack. They will be expected to be able to provide services for the sick and those involved in accidents.
Camden and Islington health authority has been told by the Department of Health that, in the next five years, it must look to a reduction of £25 million in its budget. I have asked the Secretary of State directly where the money will come from to expand facilities, as will be necessary, at the Royal Free and at the Whittington and to pay for the additional staff, but answer comes there none. I add my voice to those of other hon. Members who have urged the Secretary of State to call a halt to the seemingly mindless rush to change existing health care provision in London. As my hon. Friend the Member for Barking (Ms Hodge) has already said, we are talking about the treatment of patients--individual human beings. It is their needs that we attempt to serve through the NHS in London. I regret that the Secretary of State is not in her place. Surely she can take on board what constituency Members from London hear day in and day out, not only from our constituents but from people who are daily at the sharp end of NHS delivery in London. They all say that there is something wrong with that service provision. Day in and day out, we hear that the NHS in London is under inhuman pressure and that, in many cases, it is beyond the point of restitution and is suffering from internal decay. We are told that it is failing to do that which it was set up to deliver and to which those people who have dedicated their lives to working in it are still committed: to make the ill well and to ease the suffering of those who, for whatever reason, are particularly vulnerable.
I urge the Secretary of State to listen. She has been asked by hon. Members on both sides of the House to listen to the people who know best--not just the patients who use the health service, but most definitely those people who provide that service.
8.7 pm
Mr. Robert G. Hughes (Harrow, West): The hon. Member for Hampstead and Highgate (Ms Jackson) said that the health service was failing generally, but such
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characterisation is a great insult to the people who work in it. That has never been my experience of the health service when either I or my family have used it.In the seven or so years in which I have been a Member of Parliament, I have seen improvements in NHS provision in my constituency. There are still some problems, which were highlighted today by the Opposition, but they have not offered us a shred of evidence that they have a policy to deal with those problems. One must warn the Labour party that shroud waving did it a disservice at the previous general election--it partly cost it that election--and that shroud waving does not win it any votes.
As we were told that this debate is a non-party political occasion--
Mr. Hughes: Yes, that is what we were told on the radio by the Opposition, who said that the debate was about the health service. Presumably that is why the leader of the Labour party did a photo-call at Bart's this morning and why the right hon. Member for Derby, South (Mrs. Beckett) made such a highly political speech. I therefore thought that I would look back at the last debate on the health service when the Labour Government were in power.
On 15 March 1979, there was a debate in the House during which it was revealed that 600 hospitals were dealing only with emergencies, nine had closed completely and 5,500 beds were out of action. That did not cause cries of alarm at the time because that was an improvement on the situation when the House had last debated the subject the previous November. That is what the Labour party did to the health service when it was in government-- it closed hospitals, reduced nurses' pay and cancelled the hospital building programme. Labour party members have no standing in this debate.
I came to the debate wondering on what evidence my right hon. Friend the Secretary of State had based her plans to allow the closure of the accident and emergency department at Edgware. The subject has been covered disgracefully by the Evening Standard and by other media outlets. I heard a journalist on London News Radio say, "Doubtless the Secretary of State will provide an argument for the closure, if there is one." That is a disgraceful way to approach the debate.
I tabled a question to my right hon. Friend asking for the scientific evidence upon which she had based her decision. I put that evidence before the right hon. Member for Derby, South and my questions clearly caught her on the hop. The fact that she had not examined the scientific evidence proved the emptiness of her arguments. I think that that is a disgraceful performance by a leading Labour party spokesperson.
The review of that evidence is available in the Library of the House of Commons--it is not hidden away--so the right hon. Lady and her colleagues may examine it if they can be bothered. It talks about the relationship between the size of accident and emergency departments and clinical outcomes. If we are talking about providing the best possible health service, we must talk about clinical outcomes. What happens when people use the accident and emergency facilities? All the evidence suggests that
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more lives will be saved in the future when the changes are implemented. I put that point to the right hon. Lady, but she did not seem to understand it.In 1992, the North West Thames task force suggested that accident and emergency departments with fewer than 50,000 new patients per year did not have the necessary throughput for cost-effective care. It said that departments should have the capacity to deal with at least 50,000 new attendances per year as smaller departments are unable to employ experienced staff at night and at weekends. I argue that this matter does not revolve around financial considerations; we must examine what happens when A and E departments are concentrated in one area.
The results of a survey carried out in Orange county in the United States indicated a severe reduction in the number of deaths judged preventable. Labour Members may read about it in the "Archives of Surgery"--which I think is rather more authentic than Labour party briefing notes read by Labour Members. [Interruption.] Labour Members should listen to this, because it is important for their constituents as well as my own.
In a one-year experience, trauma care in Orange county California, where patients were taken to the closest hospital, was evaluated and compared with San Francisco county where all trauma victims were brought to a single, centrally-located trauma centre. The survey concluded that
"73 per cent. of the non-CNS deaths in Orange County might have been prevented if the patients had been taken directly to a trauma centre".
That idea is not restricted to the United States; nor is it anything new. The hon. Member for Barking (Ms Hodge) suggested that the measures were being rushed through. It was first suggested in 1961 that there could be an advantage in changing the accident and emergency arrangements. That suggestion has been ignored many times since then by many Secretaries of State and I pay enormous tribute to my right hon. Friend for having the political strength and courage to carry through the reforms.
Residents in Edgware will be no more than five or six miles from an A and E department. I appreciate the traffic problems in that part of London and I will turn to that issue in a moment. Some £60 million is being invested to upgrade the Barnet general hospital.
A scare story has been circulated in my constituency that that will put extra pressure on the Northwick Park hospital. That sounds reasonable on the face of it, but it is not true. As was said earlier in the debate, 30 new beds have been opened at Northwick Park hospital this year and it is planned to open another 60 beds next year. Admissions through the accident and emergency department currently total 13,000 and it will have the capacity to deal with 16, 500 admissions in April 1997--the date of the proposed changes at Edgware hospital.
In addition, Northwick Park hospital will employ more staff and the hospital is about to engage a second consultant in the accident and emergency department so that it has the expertise to enable it to realise the scientific evidence which indicates that large, well-staffed A and E departments will save lives.
I agree with the remarks by my hon. Friend the Member for Surbiton (Mr. Tracey) about the lamentable record of the London ambulance service. The Pinner ambulance
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station in my constituency answers only 60 per cent. of calls within 14 minutes. Anyone who is familiar with the Harrow and Pinner area knows why that is so--the ambulances are concentrated on what must have been a very good site for that area many years ago, but it is no longer suitable. We need to disperse those ambulances. We need to implement some of the radical changes--I must explain it in shorthand because my time is brief--adopted by the Northumbria ambulance service.It has made enormous improvements and I am sure that the hon. Member for Newcastle upon Tyne, East (Mr. Brown) would confirm that fact. It has a first-class ambulance service, which is measurably the best in the country. If it is good enough for Northumbria, it is certainly good enough for London. I hope that the ambulance service will introduce radical changes and use the extra money wisely. The service would benefit from employing paramedics on motor bikes who would get medical assistance and equipment to accident victims quickly.
8.17 pm
Mr. Stephen Timms (Newham, North-East): Six months ago, when we last debated the health service in London, I raised concerns about the future shape of community health services in east London. At that time deep anxiety was expressed about the proposal to have a single trust-run community health service for Newham, Tower Hamlets, Hackney and the City. I was delighted when the Government announced at the beginning of December that there would be three separate trusts, and I welcomed the Government's response to the points that were made during the debate.
We were anxious that there should be separate trusts in order to expose how much money was being spent in each of the three areas. Our suspicions about funding disparities were confirmed when advertisements for senior positions in each of the new trusts were published. The published budget for Newham per head of population was less than half of that for the rest of the area. That fact highlights the issue of health service funding in London upon which I shall concentrate my remarks this evening.
The Government's amendment to the Labour party's motion on the Order Paper
"commends the Government for its record in investing in . . . the long-term interest of . . . the people of London;"
That choice of words betrays a complacency which rings very hollow all over London. There is growing and compelling evidence, including work commissioned by the Government, that areas such as Newham are deeply under- resourced and yet are still being cut back further in the allocation of national resources.
Two weeks ago the King's Fund published a report, called for by the former Government chief medical officer, entitled, "Tackling Inequalities in Health". The report's conclusions were forthright and unequivocal. It says:
"People who live in disadvantaged circumstances have more illnesses, greater distress, more disability and shorter lives than those who are more affluent."
It continues:
"During the 1980s social divisions accelerated at a rate not matched for such a sustained period by any other rich industrialised country. Not surprisingly, the impact that this increase has had on health is now beginning to emerge. Death rates in some of the most
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disadvantaged areas in Britain not only worsened in relative terms between 1981 and 1991 . . . but among some age groups, such as young men, the death rates actually rose."That cannot be accepted as just an unfortunate fact of life. It must be addressed by those responsible for the health service. The King's Fund report also says:
"The injustice could be prevented but it will require political will. The situation could be substantially improved if the political will existed to recognise that tackling inequalities in health is a fundamental requirement to social justice for all citizens. The question is: can British policy makers rise to the challenge?" We cannot afford to ignore that challenge. The spiral of poor health and under-achievement cannot be allowed to continue. The social and economic costs as well as the moral responsibility will be borne by us all.
In October, the Centre for Health Economics at the University of York reported to the Government on the distribution of health resources. Its findings were unambiguous. It said:
"The current formula (introduced in the early 1990s) has resulted in a shift of resources away from the poorer and sicker areas." The York report produced a new capitation formula which would yield a significant shift of resources to the inner cities.
Tragically, the Government's response has been to water down that report and we are now told that in my area of east London we are to lose out even further when the Government's adaptation of the formula is fully in place. We will lose out by £14 million in a budget of £322 million. The pattern is the same elsewhere in inner London. It is a travesty of the York report's recommendations and the figures show that the Government are moving in the opposite direction to that recommended by the York team.
There is a crisis in the health service in London. Departing general practitioners cannot be replaced. In our accident and emergency unit at Newham general hospital, only seven of 11 vacant posts could be filled in the last recruitment round. The work load for many health workers is far greater than would be tolerated in more prosperous areas. There is a shortage of children's nurses, and orthopaedic wards have to rely on agency staff.
I want to raise deep concerns about what has happened to the funding that has been earmarked for primary care improvements in east London. The Secretary of State made a great deal about the need to redirect resources into primary care. We all welcome improvements in primary care and there is no doubt that, by one means or another, the Government have made some funds available. What has become of that money? Where are the improvements that it is supposed to bring? I have with me an astonishing document. It is the latest district audit management letter on the City and East London family health services authority--the body that is charged with the responsibility for overseeing the primary care improvements that the Government have promised in east London. Those improvements are, without doubt, desperately needed. The document talks about the affairs of the authority and it says:
"there have been clear failures to recognise that there are legal limits on the powers of the FHSA . . . there have been instances where officers have maintained unofficial bank accounts in respect of FHSA funds . . . little regard was given to recommendations at audit for improving the management and financial affairs of the authority."
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Those serious allegations are documented in the report, which goes on to conclude that"such failures have resulted in the consequent loss of scarce resources to health services in the area."
The document tells us that significant sums of money have been wasted.
I am aware that there have been personnel changes at that FHSA, but it has shown itself wholly unable to oversee the capital projects that the Government have required it to deliver and which the Government have promised to the people of east London.
The Star Lane medical centre in the constituency of my hon. Friend the Member for Newham, South (Mr. Spearing) was allocated a grant of £1.9 million in the first year of the London implementation zone programme. Three years later there is no sign of a single brick being laid. I have tabled a parliamentary question asking where that money now resides.
This morning I received a letter from the Newham GP forum which says:
"We are at the bottom of a major recruitment crisis as well as suffering from rock bottom morale."
The root of the problem is a catalogue of projects involving GP premises which have gone catastrophically wrong. The letter lists five of them. About one project it says that, because of his experiences with the FHSA, the doctor
"is on the verge of a nervous breakdown and bankruptcy." It says about another project:
"Despite this length of time and commitment no clear path has been agreed as to how these premises can be developed any further." That "commitment" involved a dentist putting in £150,000 of his own money.
About the next project the letter says:
"there is a strong possibility that recently started building works will be stopped before completion because"
the doctor's bank has
"advised him that he has too much negative equity."
Another doctor secured a promise of £700,000 towards the cost of the premises from the London Docklands development corporation, subject to the work being started by 1 July this year. The letter states:
"there is no likelihood of any building works commencing before the deadline and as a result the whole project may have to be shelved."
The letter adds that if that happens the doctor has decided to leave his practice, and Newham.
That is a catalogue of appalling mismanagement. Far from improving primary health care in east London, it is literally wrecking it. Those charged with delivering the improvements have been wholly incapable of doing so. I call on the Secretary of State to make an urgent and thorough investigation of what has happened to the London implementation zone funding for east London, because I am increasingly worried that terrible damage has been done.
8.27 pm
Mr. John Marshall (Hendon, South): I have been amazed by some of the speeches in the debate. When my right hon. Friend the Secretary of State was speaking, some hon. Members from outside London were suggesting that the health service in London was somehow overfunded. I do not believe that that is true. For example, there is a 23 per cent. shortfall in psychiatric
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beds in London. One has only to look at the performance of the London ambulance service, which, by common consent, is the worst in the country. If one looks also at the difficulties that sometimes affect the supply of intensive care beds in London, one recognises why people in London do not believe that the health service is overfunded.For colleagues from outside London to talk as if the health service in London is overfunded does a disservice to the debate, because it is not true. It was true in the 1970s when the then Labour Government instituted the resource allocation working party formula, which affected resources in London in the late 1970s and throughout the 1980s. Now those resources have been removed. It is wrong for people to recycle the speaking notes that they have used for the past 20 years and assume that they are still accurate. I know that in politics it is a great temptation to do that, but we should not seek to follow it.
I heard one comment about Edgware, which suggested that the hon. Member concerned probably did not know either its geographical location or even how to spell it. He suggested that it might be in central London.
When the Secretary of State announced in a written answer that she had approved the closure of Edgware accident and emergency department, I subsequently made a number of points. I said that she was proposing a system of primary health care whereby most of the extra £15 million would be spent after the Edgware accident and emergency department was closed, which seemed unacceptable.
I am pleased to say that this afternoon the Secretary of State has come to the House and agreed to spend an additional £2 million--as I understand it, £1 million this year and £1 million next year-- mainly in the western part of the London borough of Barnet, which includes a significant amount of my constituency. Obviously, it is difficult to be too beastly to a Secretary of State who has this afternoon given some money to my constituency.
However, I have a number of questions that I want to ask about the other four issues that I have raised with the Secretary of State. The first involves the London ambulance service. We are told that there will be two additional ambulance crews in the Edgware district. We are told that the London ambulance service will continue to be monitored against the patients charter standards. If the London ambulance service fails to meet those patients charter standards--
Dr. Ian Twinn (Edmonton): If it continues to fail to meet them.
Mr. Marshall: As my hon. Friend says, if it continues to fail to meet those patients charter standards, what will the Secretary of State do? Will further additional resources be put into Edgware? Will there be a radical reorganisation of the London ambulance service, or what?
I have raised the issue of transport links with the Secretary of State on a number of occasions. This afternoon she said that she was setting up a working party--50 per cent. of that working party is sitting on the Government Front Bench and the other 50 per cent. is to come from the Department of Transport.
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Transport links between Edgware and Barnet are particularly poor. During the Easter recess, my hon. Friend the Member for Chipping Barnet (Mr. Chapman) and I were due to meet the chairman of the Wellhouse trust at Barnet. We arrived on time at 2 pm. The chairman arrived at 2.15 pm and said that the trouble was that transport links between Edgware and Barnet were not what they should be. I understand that my hon. Friend the Member for Finchley (Mr. Booth) had a similar experience and was kept waiting even longer. The chairman was not trying to be discourteous or to prove a point, but the point was very well made. I am glad that the Secretary of State is setting up a working party.We have a right to know when that working party will report. Will it report to the House? How will we hear what it decides? If it recommends significant expenditure, it might be open to the Secretary of State to reopen the issue of the closure of the accident and emergency department at Edgware because, if a lot of money is to be spent on roads, further questions must be asked.
We are told that the minor accident unit at Edgware will be opened as soon as possible--it will be opened in 1996 rather than 1997. That is of benefit, in that it will be up and running before any closure takes place. We have been told in a letter from the Secretary of State that there could be a general practitioner presence in the minor accident unit, which is currently expected to be solely a nurse-based unit. We should like to see that possibility fleshed out. We should like to know how likely it is that the unit will have a GP presence rather than just a nurse presence. That is an important question that must be answered, as the matter will clearly be of concern to us over a considerable period.
Everyone who knows me well knows that the past few weeks have been particularly painful. I think that even the Government Whips Office would accept that I am normally a loyal Government supporter. I have rebelled only twice: once over the social security reforms in 1988--
Dame Elaine Kellett-Bowman: Twice?
Mr. Marshall: I should remind my hon. Friend that the Government changed their mind within 10 days of my rebellion, so I was right. I rebelled for a second time in 1989 over the Football Spectators Bill and again I was right as the Government tore up the Bill, so I shall not take any lessons from my hon. Friend about when I should and should not rebel. I accept that, in the role that I have held for some time of parliamentary private secretary to one of the most decent and nicest men, I have had obligations.
I hope that never again will announcements about Edgware hospital be made by way of written replies on the day before Adjournment debates on the future of that hospital. Such a procedure was discourteous to my hon. Friend the Member for Harrow, East (Mr. Dykes), who instituted the debate.
I believe that this will not be the end of the saga and I suspect that it will be revisited from time to time. This evening, in view of what the Secretary of State announced earlier, I am minded to support the Government. But before my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) gets too broad a grin on her face, I should tell her that if her grin becomes much broader, I certainly will not support them.
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8.36 pmMr. Harry Cohen (Leyton): There is an enormous amount of public anxiety and anger at the consequences of the mishandling of the national health service in London. Some of the blame is put at the door of the managers, but most of it is laid at the door of the Secretary of State for Health and the Government.
I pay tribute to the few hon. Members who have spoken out and stood up to be counted tonight. They made eloquent speeches, fighting for their constituents and for London hospitals. They made a good point when they said that the Secretary of State refuses to listen to the concern of Londoners and refuses to acknowledge the reality of what is going on in the health service. I shall give some examples of the realities.
Casualty Watch recently published a report stating that it carried out 11 spot checks in London hospitals between April 1994 and February 1995. It found that more than 170 people had been waiting more than five hours on trolleys in those London hospitals and that most of those who were waiting were elderly. It even found one woman of 101 years old who had been kept waiting for six hours at Queen Mary's university hospital in Roehampton in January this year. I have taken up the issue. In late February, I complained that my hospital of Whipps Cross had a shortage of hospital beds and a shortage of trolleys. That shortage meant that patients were left on the ambulance trolleys that had brought them, thus tying up 10 ambulances that would be needed in an emergency. The chief executive of the Forest Healthcare trust said that the hospital was overwhelmed.
Waltham Forest community health council has just published a report giving examples of the crisis in the district. It stated that one woman who had a burst appendix was a priority 1 patient; she had a four-hour wait to see the doctor. She was in great pain and had to wait a total of seven and three quarter hours before she was found a bed. Another woman with a priority 2 illness was finally treated after a nine-and-a-half hour wait. An elderly woman with diabetes who had recently had a triple bypass operation was seen briefly by a doctor after half an hour, but she was then left on a trolley for seven and a half hours without any food or drink.
Another case involved an elderly disabled woman who had a nine-hour wait for a bed. Three months later, she went back to the accident and emergency unit with pleurisy. On that occasion, she waited 12 hours on a trolley for a bed, which eventually was not available, and she was sent home.
Those are just four examples in a recent report from my local community health council. It points out that Whipps Cross has one of the busiest casualty departments in the country, with more than 80, 000 patients. The number of patients has increased by 3,000 in the past three months because of the closure of Bart's accident and emergency department and the knock-on effects of that; there has also been the staff shortage that was mentioned by my hon. Friend the Member for Newham, South (Mr. Spearing).
The CHC takes apart the official patients charter, to which the Government keep referring, to say how wonderful things are. It says that the
"official patients charter statistics disguise the major problems patients face when using A and E services."
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