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It goes on to say:"it is claimed that 97 per cent. of patients at Whipps A and E have an `initial assessment' within five minutes, but this does not acknowledge that they then have to wait for a proper assessment to be carried out. That can take one hour."
Official Forest Healthcare trust figures relating to patients in each priority group seen by a doctor show that 78 per cent. of priority 1 patients are seen within two hours, 82 per cent. of priority 2 patients are seen within four hours, and 84 per cent. of priority 3 patients are seen within four hours. My CHC asks, "What of the patients who are not seen within those times--how long do they wait?" Even after being seen by a doctor, a patient may wait hours for further attention because of the pressure of work on the A and E Department.
Several hon. Members have referred to the London ambulance service. We all know that it descended into a shambles when the computer broke down. Many of us would blame the Government in their pressure to privatise the service. Whatever the situation, let us look at the current position. Mr. John James, who is responsible for the service, has written to me saying:
"Overall, the total cost of the emergency services has risen from £63.9 million in 1994-95 to £82.2 million in 1995-96, an increase of 28.6 per cent. However, because £4 million in 1994-95 was met from central funds in 1994-95, which were not made available in 1995-96, the overall increase in cost to DHAs was 37.2 per cent."
That means that district health authorities in London have had to find an extra £22.3 million from their hard-pressed budgets to pay for that London ambulance service shambles and to try to get the service back into order. That £22.3 million has been taken out of patient treatment in London, whereas the Government should have provided that money.
The hon. Member for Hendon, South (Mr. Marshall) talked about the £2 million for Edgware that has bought his vote tonight. A couple of million will come out of patient care in Edgware and in Hendon to pay for the London ambulance service. The money with which the hon. Gentleman has been bought off has been swallowed up very quickly. [Interruption.] That certainly is true. I have done a survey and I can show hon. Members the results.
The House of Commons Library presented for me figures that show that 83 hospitals in London have closed between 1979, when the Government were first elected, and March last year. On top of that, there have been a large number of accident and emergency unit closures. Many more are in the pipeline. All that has occurred without any publicly stated Government policy or anybody's policy on accident and emergency provision in London. Those closures are carrying on apace because trust managers regard them as the best way of further reducing acute beds in their areas. A and E closures are financially driven.
Our vote tonight is the last chance for London Members, particularly Conservative Members, to save the health service in London, particularly A and E provision in London. Even if some A and E units are not under threat now--and many of them are--the Government will come for hon. Members' accident and emergency units if they carry the day.
In the 1980s, the Government said--they have continued to try to use the phrase--that the health service was safe in their hands. There comes a time when that phrase must be proved, and we shall find out tonight. We
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shall discover whether the Conservatives can stand by it. Unless London Conservative Members show courage, as some who have spoken tonight have done, a significant proportion of the NHS in London will slip like sand through our fingers.8.45 pm
Mr. Roger Sims (Chislehurst): I have previously commended my right hon. Friend the Secretary of State for her courage in tackling the issue of London hospitals, and I do so again today. The amendment refers to the 20 or more reports that have recommended action that is clearly overdue. The action that was needed my right hon. Friend has initiated. To bring everything to a complete halt now, as the motion appears to demand--indeed, those were the words of the hon. Member for Hampstead and Highgate (Ms Jackson) a few minutes ago--seems to me to be unacceptable. If the Opposition thought that the wording of their motion would seduce me into supporting them, they have failed. Of course, these are matters in which, whatever decisions are taken, some people will be upset. Every hospital has a loyal following of local residents, patients, general practitioners, doctors and nurses at the hospital, and doctors and nurses who have trained there and perhaps have moved on. If we always bowed to all their wishes, there would never be any changes. But, if it is proposed to close a hospital or substantially to change its character, there must be a process of consultation. That, surely, is a moral obligation as well as a legal obligation. Consultation surely means listening to the views expressed and considering them, and not being averse to responding to reasoned arguments.
The Secretary of State and the Minister for Health have their advisers-- political advisers and medical professional advisers--but they should take account, too, of what may be different advice offered by others who are as well qualified professionally and of those who are as able, if not better able, to reflect the views of the communities affected, including, of course, local Members of Parliament. I fear that that is not always done. My right hon. Friend enjoys my admiration as a most able, enthusiastic and dedicated Secretary of State, but a Minister must also be a politician, and in politics one is more likely to get things done if one listens to what people have to say and tries to take them with one.
My concerns, as the House will be aware, are with the proposals concerning Guy's and St. Thomas's hospitals. Let me make it clear that the issue is not about spending money on those hospitals in inner London as against expenditure further outside London or in the suburbs. Indeed, I shall want the Bromley hospital trust to be given adequate resources to enable it to develop a new hospital on the Farnborough hospital site. In this case, the issue is not about closing down complete sites, because both sites will remain open. It is certainly not a Guy's versus St. Thomas's contest. The issue is the need to obtain the best possible use of limited resources-- that is buildings, equipment and staff. It is, to quote the words of the Secretary of State in a letter that she wrote to the hon. Member for Southwark and Bermondsey (Mr. Hughes),
"to ensure the most efficient and clinically coherent balance of services between its sites" .
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On 29 March, when the consultation process was completed and the proposals were on the Secretary of State's desk awaiting a decision, I secured a Wednesday morning debate on Guy's hospital. I summarised the original and final proposals for the two hospitals and the consultation process. I spoke of the work of the Save Guy's Hospital Campaign, of which I am joint chairman. I outlined our concerns and raised a number of issues.A week later, the Secretary of State announced that she was confirming the proposals without modification. Of course I accept her word that what I and others said in the debate was read and considered, but I am sure that she will understand that some people have the impression that our words were completely ignored. Personally, I was surprised that no attempt was made to answer the points that were raised in the debate before the decision was announced. I have since had a letter from my right hon. Friend, but some of the issues remain unresolved.
It would be unreasonable of me to repeat the speech that I made on 29 March, even if time allowed, which it obviously does not, but the Government amendment invites me to call on the Government to ensure that their decisions on London hospital services are carried forward.
If I subscribed to that, I would be endorsing, among a number of other propositions, first, leaving the City of London and its 300,000 daily commuters--some of whom are my constituents--after 1998 without any accident and emergency facilities to deal with another Cannon street train crash or Bishopsgate bomb outrage; secondly, not using to the full Philip Harris house for the purposes for which it was designed and built at a cost of £154 million; thirdly, using Guy's for day surgery, elective surgery and minimally invasive therapy without any intensive care facility on the site; fourthly, the separation rather than the integration of out- patient and in-patient services for specialties such as renal, oncology, cardiology and ENT; and, fifthly, I would be endorsing the expenditure of £90 million on new building and refurbishment at St. Thomas's to accommodate the services moved from Guy's, while leaving some 19 floors or 35,000 sq m of unused space at Guy's.
I cannot in all conscience endorse such plans, so the House will understand why I shall not support the amendment which calls for their implementation.
8.52 pm
Mr. Andrew Mackinlay (Thurrock): I consider that London's hospitals are underfunded and I appreciate all the arguments advanced by hon. Members representing part of Middlesex and London in respect of the Edgware general hospital. Before I came to the House, I worked in Golders Green for 12 or 13 years and I empathise with local people who appreciate and want to keep the accident and emergency department open in Edgware. I shall return to that in a moment.
The motion refers to London's health service. Strictly speaking, there is no such thing: there are two regional health authorities. My area of Essex is part of the North Thames region and in the context of today's debate I would argue that it is part of London's health service.
I am unique inasmuch as I am the only Opposition Member representing Essex and the counties that skirt London or the M25 ring. I can legitimately claim to speak on behalf of those constituents who are not represented in
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the Chamber at the moment, except by the Government Whip, the hon. Member for Chelmsford (Mr. Burns), who has to remain silent. We listen to the Government's argument that the closures will provide additional resources for counties outside London, but that is not the experience of my constituents and those who live in areas surrounding London. Frankly, we do not believe the Government. [Interruption.] Somebody from a sedentary position said, "Rubbish," but my constituency of Thurrock endured the pain and anxiety of losing the accident and emergency department at Orsett hospital. Regrettably, only when the closure of the accident and emergency department at Edgware general is proposed, or hon. Members representing Westminster and the City are aggrieved, does the House pay attention to a crisis that is not peculiar to the old GLC area, the boundaries of which resulted from a decision made in the House of Lords at 2 am in 1963 and which do not represent "London" in the context of this debate. London is much wider, especially with regard to health provision.Conservative Members are aggravated by the political fallout that was demonstrated in stark terms last week. As we approach a general election, they want to distance themselves from the Government's policy of cuts in the national health service. They did not speak up when the accident and emergency department in my constituency was closed or when accident and emergency departments were closed elsewhere around the M25 ring.
It is time to make it clear that the Government are cutting hospital provision for many people in London and elsewhere. I heard all the arguments advanced by the hon. Member for Hendon, South (Mr. Marshall) excusing why he would not support the Opposition motion tonight but would sustain the Government. They involve palliatives and promises that extra facilities will be provided as compensation for losing A and E departments. They are not worth the paper they are written on.
I should say, as a lesson for other hon. Members who are considering supporting the Government, that when our accident and emergency department was closed in Thurrock, we were assured that the rest of Orsett hospital would be maintained. They were solemn and binding undertakings, but a few months ago it became clear from a leak that they intended to close the whole hospital.
My constituents and others joined in a massive campaign to retain Orsett hospital, or what was left of it. We succeeded, but we do not believe that that will the prevent faceless men and women who run our health authorities and the trust from again trying to close totally our Orsett hospital.
I use my constituency as an example of what could happen elsewhere. It is in the fastest growing area of south-east England outside London--the Thames gateway--yet the madness of Government policy and their lack of planning led to an attempt to close our hospital. My constituents now have to travel to Basildon to get hospital care, which has put an inordinate extra burden on Basildon and other hospitals. My hon. Friend the Member for Barking (Ms Hodge) described how Oldchurch hospital would close and put extra demands on Harold Wood hospital. Since my local accident and emergency department closed, my constituents are putting extra demands on Harold Wood hospital, because that is one of
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the places where they are taken by bus or ambulance to receive accident and emergency and other treatment. It is foolish that this policy should be allowed to continue.The motion calls for a halt and a major review. That is prudent. It would be appropriate to encompass in any review everything in an area wider than the old GLC area--everything around the M25 ring--as we are as vulnerable to the cuts as elsewhere.
There has been some commendation of the few Conservative Members who have said that they will not support the Government tonight. I join in that, but there is a danger of going over the top and implying that the hon. Member for Hendon, North (Sir J. Gorst) is equivalent to the Archangel Gabriel. I give him full marks but where has he been all this time? He is faced with the closure of an accident and emergency department on his own doorstep now, but he would not have dreamed of supporting me in defending the A and E department at Orsett. I do not suppose that he knows where Orsett is to be found.
If Conservative Members generally are concerned about the thrust of Government policies, they must support the Opposition motion so that the Government will pause and rethink the totality of the policies on which they are now embarking. I do not know whether it was implied or said by an Opposition Member on radio this morning that this is not a party political matter. If so, I dissociate myself from that remark because it is party political. In the months leading to the next general election, I shall unashamedly point the prosecutor's finger at Conservative Members who do not join us in the Lobby tonight. They are all the same and they are all to blame by acquiescing through their silence in a rundown and haemorrhaging of the NHS in and around London. It is time to spell that out without ambiguity.
I cannot find words to describe the lasting resentment among my constituents at the Government's deceit and betrayal over hospital care. I include in that the people of Basildon, whom our loss at Orsett also affects. My constituents now have to be sent to Basildon hospital and endure inordinately long waits on trolleys and in the casualty department. In addition, many of my constituents are taken not only to Harold Wood hospital but across the River Thames to Kent, such is the absurd lack of planning.
I welcome being able, perhaps for the first time, to muscle in on something that is wrongly described as a "London debate": it goes much wider. It affects people in Harlow, Basildon, Thurrock, Gravesham, Dartford, Slough and other constituencies around the London area, which are not being properly represented in the House, and whose national health service is not being championed by Conservative Members.
9.2 pm
Mr. Hartley Booth (Finchley): It is a pleasure to follow the hon. Member for Thurrock (Mr. Mackinlay) who, as usual, was robust in his remarks, and on this occasion robustly wrong.
The debate has been characterised by a mirage of the past, suggesting that the health service in London was always better then--a sort of never never land of wondrous results. In fact, we are dealing with the same problem that has existed for hundreds of years.
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Liverpool Street and Broad Street railway stations are built on the foundations of a medieval hospital that was well known at the time. Some people might think that it would have been better if it had been kept as a hospital. A retired doctor from St. Thomas's reminded me that 30 years ago patients were left on the floor in a crisis. Only in 1968 was the first accident and emergency consultant in the country appointed. Today, such consultants can be found everywhere. We have been improving, and we should put that fact on the scales tonight.The Opposition motion criticises the closure of accident and emergency facilities in London, while the Government motion stands for new and better services and says that the Government will take due account of concerns. I hope so. I do not accept that the description "closure of . . . facilities" is apt, accurate, balanced or fair in respect of Barnet. A new hospital costing £61 million is being built, and we are promised that a new casualty unit will be kept open in Edgware. However, I shall be making some demands of my right hon. and hon. Friends on the Front Bench.
Edgware hospital is being kept open, and there is a list of improvements for the new area trauma centre to be built at Barnet General hospital, costing £1.5 million. It will offer a major treatment room with greater availability of specialist piped medical gases, decontamination showers and a sound attenuating examination room. The "physical specs", as they are called, state that the centre will be 250 per cent. larger than the present A and E department. There will be an operating theatre for major trauma, diagnostic imaging and a pneumatic tube system--all costing an arm and a leg in more senses than one.
I asked an orthopaedic surgeon at Barnet General for his thoughts on the centre. He welcomed it. He had possibly wanted a new hospital situated midway between the two existing hospitals, but he is grateful and delighted that there will be a new hospital in Barnet--not least because he currently has to travel between Edgware and Barnet in rush hours and in crisis situations. I shall refer to transport later, if there is time. At present that consultant has to cover two hospitals.
Do we want to retain the A and E department on the same basis as at present, as suggested by my hon. Friend the Member for Hendon, North (Sir J. Gorst), whom I deeply respect? No--we want to improve on that situation. Are we against all change? Of course not. At present, there is an orthopaedic consultant only at Barnet General and none at Edgware, and there is no maternity department at Barnet. That cannot be left as it is. There must be change.
Safety is paramount, as was mentioned by my hon. Friend the Member for Harrow, West (Mr. Hughes). The Royal College of Surgeons states that 25 per cent. of all deaths in A and E departments are avoidable. I could not have deaths on my conscience, so I must speak out tonight to say that such deaths are avoidable if we have the improved A and E departments that our new hospitals and constituents deserve. We must satisfy the public's fears.
How do we do that? I have been fighting for better transport links across the A1, which is a huge physical barrier. I am grateful to my right hon. Friend the Secretary
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of State for saying that she will bear that in mind. We shall be watching for such improvements. We certainly do not want people dying en route to hospital.I hope that the Edgware injury clinic--the new casualty department, as the chairman of the local NHS trust calls it--will not only have 80 per cent. of current casualties, but that it will be supported by general practitioners, not just nurses or paramedics. We need better transport links and I am glad that we have improved community medicine, to which my hon. Friend the Member for Hendon, South (Mr. Marshall) referred. On behalf of the people of Barnet and Finchley, many of whom cross the A1 to Edgware, although many more go to Barnet, I thank the Government for the new hospital that we are getting. It would be niggardly not to be grateful for it. We shall keep Ministers to the four promises that we have heard today. We shall be watching. We ask what Labour, whose debate this is, would be doing. Would it reverse the decision over Bart's? Would it reverse the decision to give us a new hospital in Barnet? Would it keep Edgware open? Answer comes there none. The Labour party is vacuous in the absence of real answers to difficult questions in this area. Literature has been quoted to us this evening by my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke). I will quote Shakespeare: the Labour party is
"full of sound and fury,
Signifying nothing."
9.11 pm
Mr. Clive Soley (Hammersmith): I offer my apologies to the House for having missed the first part of the debate. I am Chairman of the Select Committee on Northern Ireland, which has been taking evidence this afternoon.
I want to speak, if only briefly, on a number of matters. First, I wish to make a point which I suspect may have been made before, so I shall therefore make it briefly: the fundamental problem with the Tomlinson report was that it did not take into account the impact of outer London on inner London. One of the powers and strengths of Professor Jarman's report was that it recognised that inner London could not be treated as though there were some dividing fence between inner and outer London. Once that artificial fence is taken away, the problem in London is seen to be not so simple as Professor Tomlinson's report made out. That is why things have gone badly wrong.
My second point, and one of the prime reasons why the Secretary of State is in such serious trouble, is that the main problem in the health service-- one which has to some extent been there since the 1974 management changes, but dramatically more so in recent years--is the lack of an effective method of consultation. As a Conservative Member said, people felt that consultation was not working. That is certainly my experience in west London. The feeling is that things happen without a strategy. I acknowledge that the Secretary of State has said that she wants a strategy for health care in London, but the various community groups, including the community health councils and others who should be taken into the confidence of the hospital management structures, do not feel that they know what is happening or why.
The general feeling about consultation is that a paper is published, people are asked for their views, which they give, but at the end of the day the rubber stamp comes
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down reinforcing the original proposal without people's views and comments being taken into account in any effective way. Consequently, there is much anger and lack of understanding when decisions about hospitals' futures are made. A simple but dramatic example occurred in west London when the new Chelsea and Westminster hospital was built, massively over cost--more than £200 million. In retrospect, that was an incredible decision. Had it been made by a local authority, it would probably have led to councillors being surcharged.The Secretary of State was then faced with the unenviable decision whether to close Charing Cross hospital or Hammersmith hospital. Charing Cross hospital was only 20 years old, but Hammersmith hospital is the world's premier postgraduate medical school with an immense reputation in Britain and overseas. Eventually, the right decision was made and the two hospitals were merged into one trust. However, that still leaves the question of what is to happen to the three large hospitals in west London. It is not that there is over-provision; rather there is under-provision in certain key areas. I receive the same sort of letters as other hon. Members about the lack of bed space and the lack of time for operations.
The closure of an accident and emergency department in effect means the closure of the hospital. That is why there is such
concern--certainly in west London and, I suspect, elsewhere--that the purchasing authority, which in my case is the Hammersmith, Hounslow and Ealing authority, will choose to buy from only one hospital, perhaps Charing Cross, leaving Hammersmith, which has had less investment in its accident and emergency department, more vulnerable. If we get into the ball game in which the purchaser decides which accident and emergency department survives, in the long run the purchasers will make the decisions about which hospitals survive. That is not the most sensible way to proceed.
I suspect that psychiatric patients have not been discussed in any great depth today. In my area and, indeed, throughout the capital, the provision of beds for such patients is a major problem. Care in the community is clearly a good policy, which we all endorse--provided that the community facilities are there; if they are not, the policy becomes a disaster. In that event, there is no care in the community. There have been some horrendous cases in recent years.
The provision of housing, hostels and follow-up nursing care is vital, and the lack of psychiatric beds poses a major problem to the safety of patients and, indeed, the public at large. Some of the patients are very disturbed; some, though not all, are offenders. We should bear in mind that the regional secure units also feed into the system of care in the community. There is a human problem for the individuals concerned, but a drastic problem for the health service and the general public.
Let me say this to the Secretary of State: for heaven's sake start looking at a management system which is so secretive that people feel--rightly, in my view--that they do not know who is making the decisions, how those decisions are being made or how they themselves can have any impact on those decisions. The problem with the NHS, in this context, is that it is paid for by the taxpayer but the taxpayer knows virtually nothing about what is being proposed and how the money is to be spent. We need to think long and hard about the sort of management
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structure that is necessary in the health service to deliver an efficient health care system combined with accountability to the public.Finally, I do not think that we shall have the morale in the health service that we ought to have until we provide a proper pay structure for nurses, midwives and other key groups who currently feel battered and undervalued.
9.16 pm
Mr. Hugh Dykes (Harrow, East): Thank you for calling me at this late stage, Mr. Deputy Speaker. I appreciate it very much. Having launched an Adjournment debate on 5 April which lasted much longer than usual, and having made a long speech on that occasion, I do not resent the fact that others have spoken earlier than me today, and I am glad that the Chair made those selections.
It behoves me to say--as did my right hon. Friend the Member for Brent, North (Sir R. Boyson)--that I shall not be able to support the Government tonight after what I have heard so far. I am extremely disappointed that the Secretary of State was unable to make any significant concessions to alter the drastic position in which we find ourselves.
For geographical reasons, my hon. Friend the Member for Hendon, North (Sir J. Gorst) and I--with the permission, approval and support of our other colleagues--have led, for over a year, the great campaign to save the accident and emergency unit of Edgware general hospital from closure. The closure is proposed by the district health authority, and supported by the regional health authority. We continue to think that a grave mistake.
The position is not the same as that of the old central London hospitals-- although I wish them well, and do not want them to be closed, either. This vital unit in an outer London borough is heavily used, efficient and popular; as my hon. Friend the Member for Hendon, North has said on many occasions, it is also part of a much-loved social institution. It is on the Edgware road, on the border between my constituency and that of my hon. Friend. If it is closed, the journey to Barnet, the Royal Free hospital in Hampstead or the Northwick Park hospital will be too long in congested traffic. The Northwick Park hospital, incidentally, is the most important district general hospital in my area and the constituencies of Brent, North and Harrow, West. I wish it and its future development well; that does not contradict what I am saying about Edgware general hospital.
I am disappointed. During the last minutes of the debate, the Minister has the chance to make the additional concessions that we would require to support the Government tonight. I would not have any pleasure in supporting a Labour motion. I cannot remember the previous occasion when I did that. That is not the job of a Government-supporting Member.
I strongly support all the Government's policies, but we need extra movement, an extra concession and extra realism from Ministers. They should not respond only to the medical bureaucrats in their Department, whose easier solutions are to combine units to try to save accounting costs at the margin. Everyone can do that. It is not a particularly difficult exercise, despite the obvious
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complexities, but for the sake of all our constituents--the human beings in our constituency--we want the hospital to be saved. If the A and E department goes, the hospital dies. That is an obvious reality. Everyone knows that. Every medical expert knows that. If the Minister could make extra concessions saying that closure would not take place by the target date, that further time would be given for consideration, and that the Government were not humiliated or embarrassed by having second thoughts on an unwise proposal, I could reconsider my position. From what has been said so far, I doubt whether that will happen, but this is the last opportunity for the Government to say, "Yes, we have listened not only to the people, but to our own Members of Parliament." 9.20 pmMr. David Congdon (Croydon, North-East): This is our fourth debate on London's health in the past 13 months. That shows the level of interest in and concern about the future of health care in London. One of the most depressing things about today's debate has been the unwillingness of Opposition Members to face up to the difficult challenges involved in taking decisions on health care in London. We have had a bit of a pretence that London is not over-resourced in terms of teaching hospitals and specialist facilities, but the facts stand for themselves. In 1993-94, average spending per capita in inner London was £565 per person compared with the national average of £370 per person. That shows that London is over-resourced. In saying that, I recognise that today pressures exist on beds in London. That is why I have urged, and am pleased to urge again, caution on the pace of change in London. Many changes are occurring at the same time. We have care in the community and the internal market. All those issues must be taken into account.
In listening to the debate, especially in relation to Edgware general, Barnet, Bart's, St. Thomas's and Guy's hospitals, I am struck by the need for us to redefine what we mean by accident and emergency services. People who are injured in a major road accident, who suffer a severe stroke or cardiac arrest or who need intensive care, do not care which hospital an ambulance takes them to, so long as they receive first-class treatment. Frankly, they do not want to be taken to a third-rate A and E department where no consultant is on duty, where perhaps a junior has worked for only a few months, and where their chances of surviving are slight. We need to distinguish firmly between what I would define as major trauma centres and minor injuries departments.
My plea to my right hon. Friend the Secretary of State would be this: we need to be clear what we are talking about when discussing minor injuries departments. I should like them to be open 24 hours a day with a general practitioner on duty. It is rightly said that one of the problems in London is that the people of inner London use their hospital rather than their GP surgeries. That is partly because of poor primary care. We will not change that and, in a sense, I am not sure that it really matters, so long as those people receive the care they need. That
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is why local provision of minor injuries units could go a long way to allaying public concern about the closure of major A and E departments.My only other main point, because I know that time is short tonight, relates to Bart's and the Royal London hospital. I have no axe to grind in relation to whether Bart's stays open or closes, but I have a concern, which I have expressed before, about the capital costs involved in relocating to the Royal London, which in gross terms amount to about £240 million. Given the comparatively small scale of the saving involved--£30 million a year--I am concerned about whether that represents good value for money, especially bearing in mind the fact that the dual-site option would achieve roughly half the savings at a small capital cost.
We all know the extent to which capital costs can be underestimated and revenue savings overestimated. I urge my right hon. Friend to ensure that the figures for Bart's and the Royal London are subjected to close scrutiny. As an outer London Member who for many years has been pressing for major capital investment at the local Mayday hospital, and who now knows the large sums that will be invested in the facilities at the Royal London, I must question whether that is the best value for money. We need rigorously to assess whether the single-site option is always better than the dual-site option. I have no reservation in supporting the general direction of the changes proposed by my right hon. Friend the Secretary of State. She has taken courageous decisions, and she deserves our support. 9.25 pm
Mr. Nicholas Brown (Newcastle upon Tyne, East): My hon. Friends the Members for Hampstead and Highgate (Ms Jackson) and for Newham, South (Mr. Spearing) echoed many of the speeches made during the debate when they asked the Government to think again. Whatever can be said for the Government's position as it has been represented tonight, it cannot possibly be said that it commands public support. The petition to save Guy's hospital has been signed by more than 1 million people. Three mayors from three separate boroughs, one Labour, two Tory--at least, that was the roll call at the time--visited the Under-Secretary of State to discuss the Department's plans for the Edgware hospital. They represented 700,000 residents in north-west London. They were bluntly dismissed, told that the decision had already been made and that the time for negotiations had passed. The right hon. Member for Brent, North (Sir R. Boyson) expressed concern about that, as well he might. Some 183 local councillors have expressed their opinion on the Government's plan to close Edgware hospital. Only one has said that he supports the Government's position; the others do not.
Today, we have had the promise of a minor injuries unit at the earliest possible date. What sort of promise is that? Why was not it promised for the earliest possible date before today's debate? As my hon. Friend the Member for Barking (Ms Hodge) pointed out, such a promise is a con; it is nothing of any substance.
Some 1,244 people responded to the consultation on the Government's plans for Bart's--88 per cent. opposed the Government's plans. More than 1,000 people attended the health care crisis in London conference, which was organised by the National Health Service Support
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Federation last February. The conference unanimously adopted a resolution demanding an immediate halt to the shutdown of accident and emergency departments, to bed reductions and to hospital closures--a call that has been echoed by Labour Members throughout the debate.The right hon. and learned Member for Putney (Mr. Mellor), no doubt unintentionally, made our point for us. While defending the broad thrust of Government policy, he also said that he has fought hard for local provision in his constituency. We can understand him saying that, so why cannot he allow his parliamentary colleagues the same right to fight for Edgware and the service that it provides to their constituents? My hon. Friend the Member for Thurrock (Mr. Mackinlay) pointed to the hypocrisy of some Conservative Members who support the thrust of Government policy, but defend provision in their own areas while not supporting other Members of Parliament, including Labour Members, who are trying to defend similar facilities in their constituencies.
Much has been said in the debate about political courage. My hon. Friend the Member for Leyton (Mr. Cohen) referred to the political courage of those Conservative Members who will not support the Government in the Lobby tonight. That takes courage, and I applaud them for that.
The political courage of the Secretary of State for Health has also been mentioned. I am all in favour of political courage, but not when it is providing the motivation to do the wrong thing. As has been said frequently in the debates which we have had on these topics, the Tomlinson report, on which the Government's decisions are founded, is fatally flawed. Tomlinson got it wrong. My hon. Friend the Member for Islington, North (Mr. Corbyn) said that the claim that London is over-bedded is inaccurate. London is not over-bedded. We are all grateful to Professor Jarman for the work that he has conducted which has shown that London is not over-bedded, but may well be under-bedded.
The hon. Member for Southend, East (Sir T. Taylor) talked about the over- provision of resources for London, but that is not true. It used to be believed, as the hon. Member for Southwark and Bermondsey (Mr. Hughes) pointed out, that London got 20 per cent. of the funding for only 15 per cent. of the population. However, the figures which the Department of Health publish include the costs for London allowance and for teaching facilities, and when allowance in the calculations is made for those additional costs, the funding and the population figures are broadly in line.
It was believed when Tomlinson reported that somehow primary care provision --I shall have more to say about this later--would reduce the demand for hospital services. It is my view that that is a false premise. By increasing the number of people who see a GP, the rate of diagnosis will be increased, and this will increase the number of referrals to London's hospitals.
Tomlinson believed that the location of casualty services was unimportant, but a number of hon Members--not least some Conservatives--have said that they do not accept that point of view. The closer a seriously injured person is to a casualty department, the more likely that he will be saved. Clinicians talk about the golden hour, which is vital. Certainly, a patient's chances are substantially diminished if the method of
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treating him is to put him on a helicopter and fly him up to Leeds. The right hon. Member for Brent, North (Sir R. Boyson) made that point rather well.My hon. Friend the Member for Hampstead and Highgate (Ms Jackson) said that it was a mistake to assume that the two London regions can perform like an average English region. London is in many ways a special case. It has a large transient population, high levels of social deprivation and poverty, more mental illness, a lower than average provision for personal social services, and poor provision for the long-term care for the elderly. That puts extra pressure on accident and emergency units, and to some extent it is right to say that accident and emergency units are being used as a substitute for GP provision and good primary care.
My hon. Friend the Member for Hammersmith (Mr. Soley) made the point very well that Tomlinson misunderstood the relationship between inner and outer London. Tomlinson believed that patients from outer London do not make significant use of inner London hospitals. That is just wrong. Recent research carried out by the King's Fund shows that, of the 500,000 in- patients treated in inner London, 150,000 came from outer London and from other parts of the country. My hon. Friend the Member for Lewisham, West (Mr. Dowd) made reference to the service which Guy's hospital provides to his constituents. When calculating the level of hospital provision in the capital, the Tomlinson report did not make a distinction between different types of hospital bed; it should have done. There is an important distinction between surgical beds, which are mostly used for elective cases, and medical beds, which are mostly used for emergency cases. The broad-brush proposal to close some 4,200 beds ignores the complexity of maintaining sufficient medical beds for urgent cases. If that were not understood at the time, we are informed every week of the outcome of that misunderstanding by the local press, who have yet another incident to draw to our attention.
The Tomlinson report referred several times to transitional funding. It was regarded as necessary to facilitate hospital closures and the development of primary and community services. The report did not cost those programmes and the Government provided no new money for them.
My hon. Friend the Member for Newham, North-East (Mr. Timms) spoke of a spiral of poor health and under- achievement, and referred to the recent King's Fund report. That is of enormous importance for the whole country, but it has specific and special relevance to inner London, so it is right that we should look at primary care provision in London.
The Secretary of State is fond of quoting specialist
experts--usually employed in her own Department--who support her point of view. Professor David London of the Royal College of Physicians said:
"London, like other big cities, needed a degree of
rationalisation and that was always going to be painful. But it needed to be thought out. Money should have been put into it to ease the change, instead of being the cash-saving exercise it now appears to be."
The hon. Member for Surbiton (Mr. Tracey) spoke about improvements in primary care. My hon. Friend the Member for Woolwich (Mr. Austin-Walker) made the sensible point that it is neither fair nor right to get rid of hospital beds before enhanced primary care provision is put in place.
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Between 1984 and 1992, the number of general practitioners per head of the population increased by 10 per cent. in England, but that was not so in London. Over the same period in inner London, there was a 2 per cent. decrease and only a 2 per cent. increase in outer London. Yet, not surprisingly, London has the highest percentage of waiting lists of a year or more. The Secretary of State made much of the fact that the figures are coming down, but she should have said that London still has the highest figures and the lowest reduction in waiting lists from December 1994. London has fewer family health centres per thousand of population than Newcastle, Leeds, Birmingham, Liverpool, Manchester or Bristol. It thus has a specific primary care problem, which the Government have not yet resolved.It is no secret that we hope to encourage Conservative Members to support us in the Lobby tonight. The House should be treated to some advice, which I hope it will respect because it was commissioned by the Government. It comes from the chief executives of the inner London health authorities whom the Government appointed. In their recent report, they say:
"On the basis of the evidence presented to us there are reasons for anxiety about the ability of the system to cope with a further round of bed closures."
Yet assuredly, if our motion is defeated tonight, the system will have to cope with a further round of bed closures. They say: "Some hospitals were found to be operating at 100 per cent. occupancy much of the time, and an average of 90-95 per cent. was common . . . generally speaking an average level of 85 per cent. occupancy is to be preferred."
So the hospitals are working at capacity. They said:
"The overall conclusion is that London's acute hospitals are operating under very considerable pressure."
I have not quoted those comments to make a party political point. We all have a duty to represent our constituents in this place and, as we consider how to vote tonight, we should consider those points, which come not from me but from the chief executives of the London health authorities. Every hon. Member would do well to bear them in mind.
Mr. Alan Lettin of the Royal College of Surgeons, speaking for health care professionals, says:
"Consultants feel the facilities are inadequate for the service we are expected to provide. We did warn the Government. The basis on which the cuts have been made was the King's Fund report, which has now been discredited.
What consultants would say to the Government is: `We never believed your figures because there are too many patients waiting for beds, emergencies and for routine surgery.'"
My hon. Friend the Member for Barking echoed that point. If I am to encourage Conservative Members to support us in the Lobbies tonight, perhaps I should quote from someone whom I know that they all respect--the Secretary of State for Wales. In a speech on 4 April 1995, he said:
"I do not wish to see bed reductions while waiting lists are still quite long"--
but waiting lists in London have just reached an all-time high of almost 180,000. He said:
"Make sure there are enough intensive care beds"--
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