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but recent tragedies in London and the south -east have shown that there are dangerously few intensive care beds.One of the saddest aspects of the debate is to go, as I did recently, to Phillip Harris house to see the newly installed provision for intensive care beds. It was explained to me that all that provision is to be ripped out and smashed to pieces, even after it has been paid for, because the Government are no longer willing to provide the revenue funding. That is a shame. It is an act of vandalism, and should be resisted by the House.
The Secretary of State for Wales said:
"Make sure there are enough general medical and surgical beds." That is what our motion says, so I invite him, at least, to vote for it tonight.
The Secretary of State for Wales said:
"I suspect it is a myth that it is cheaper to close the older hospital and do everything in a new large one."
My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) made the same argument. He may not often be found on the same side as the Secretary of State for Wales, but he made the same argument when he said that the transfer of services from the Bart's site to the Royal London hospital is by no means a move that will save money, let alone do anything else.
The Save Guy's Campaign commissioned a report by independent consultants, which showed that a retention of an accident and emergency unit and in- patient services at Guy's was financially viable. Those arguments deserve consideration and, dare I say it, reconsideration.
The motion does not demand--as the Labour party would ideally like it to-- reconsideration by an independent organisation. It asks only for reconsideration by the Secretary of State for Health. It asks her to think again.
The Secretary of State for Wales, who may be the next Secretary of State for Health, said:
"The local hospital remains a cherished institution." Of course, he was speaking for Wales, but he might have been speaking for Edgware as well. He said:
"I am asking the health authorities to slow down their passion for reorganising. It must go at a pace people accept."
He is certainly not the only Conservative Member of Parliament to have said that recently. He also said, referring to reorganisation: "It must be based on health arguments, not financial considerations."
The hon. Member for Hendon, North (Sir J. Gorst) said:
"human beings, not balance sheets, come first."
That remark found a cheer from the Opposition, at least. I urge the House to listen carefully to what was said tonight by Conservative Members as well as Labour Members, worried for their constituents. This is the last chance for health provision in London. The Opposition's motion deserves the support of the whole House in the Division tonight.
9.42 pm
The Minister for Health (Mr. Gerald Malone): Never has there been a more unlikely suitor of Conservative Members than the hon. Member for Newcastle upon Tyne, East (Mr. Brown). It was an astonishing performance, in which he admitted that he had not even been able to table the motion that he wanted to.
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I wonder who stopped him. Is it yet another story of a split between the hon. Gentleman and the right hon. Member for Derby, South (Mrs. Beckett)?Mr. Nicholas Brown: It is self-restraint.
Mr. Malone: Doubtless, when he takes over, we shall see the end of all that, shall we not?
Mr. David Hinchliffe (Wakefield): When my hon. Friend takes over?
Mr. Malone: From his right hon. Friend the Member for Derby, South.
I thought that in this, the fourth debate about health in London in which I have spoken as Minister of State, we might have heard something positive from the right hon. Member for Derby, South or from the hon. Member for Newcastle upon Tyne, East. However, I agreed entirely with my right hon. and learned Friend the Member for Putney (Mr. Mellor) when he said that there was no policy; that we had heard nothing in the debate about what the Labour party would do. On four successive occasions, health in London has been debated and we have heard nothing positive. That point was reiterated by my hon. Friend the Member for Croydon, North-East (Mr. Congdon).
Today's debate gave the Opposition the opportunity to fill in the blank pages of their policy. They could have told the House what they would do about London's health service. They could have told it, and Londoners, about their plans to improve primary care and prepare hospitals in London for the 21st century. We heard nothing about that. The Opposition could have made commitments to validate their charge, perhaps, that the Government have got it wrong.
With any charge from any responsible Opposition that the Government have got it wrong comes an important corollary: they must have an argument about what they would do to put it right. I thought that if we did not hear it from the right hon. Member for Derby, South, we might hear it from her hon. Friend the Member for Newcastle upon Tyne, East, but we heard nothing.
Let me sum up the Government's case briefly. It is in three parts. First, clinical excellence is very important for London's hospitals. That means bringing specialist services together. It means, of course, that some hospitals have to change and, indeed, that some have to close. There was consensus on that under the reign of the right hon. Lady's predecessor, but that seems to have disappeared. Other hospitals--for example, Edgware, which has been quite rightly mentioned frequently in the debate--will have to change in character to community hospitals, delivering care closer to patients than they were able to do before. That change is in the interests of the community.
It is extremely important to meet the challenges of technological change, as well as those associated with increasing day care, earlier discharge and the falling number of referrals from outside London--not just from outer London to inner London hospitals, but from the home counties and the rest of the country.
Mr. David Wilshire (Spelthorne): Has my hon. Friend had the chance to study the letter that I sent to him from my health authority? It explained that the rapidly accelerating switch to treating people locally meant that, last year, North West Surrey health authority had to
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encourage my local GPs and local consultants to persuade their patients to go to central London rather than be treated locally, to use up contract money. I must tell my hon. Friend that my constituents want to be treated locally, not bundled off to central London to help to keep other hospitals viable.Mr. Malone: I have read the letter that my hon. Friend sent me. He made a valid point, which will be echoed by many hon. Members. It is important that London meets the challenge of changing referrals. It is essential to ensure that funds that are allocated to health authorities in London go on patient care and are not swallowed by high-cost institutions.
The investment that the Government have made in primary care for London-- £210 million in recent years--is second to none and is transforming the face of primary care in the city and bringing new facilities on stream on a day-to-day basis.
The hon. Member for Southwark and Bermondsey (Mr. Hughes) asked the fundamental question: is London being overfunded? If he looks at the weighted capitation basis of funding, he will see that it is overresourced by £91 million. That does not take into account top-sliced funding that goes towards transitional payments to maintain institutions. That overfunding is not the main argument, because the hon. Gentleman and other hon. Members who clearly have constituency interests in the city should ask themselves whether they want to see the resources that are given to their health authorities, which are meant to be spent on patient care, absorbed by institutions that are not run on an efficient basis. I suggest that, in their constituency interests, that should not be so.
My right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) asked specifically about consideration of the York report. I can tell him that it was given proper consideration. The Treasury has scrutinised the business case and it said that the case for a single-site solution seems robust and well founded in contrast to what was put forward.
My right hon. and learned Friend the Member for Putney made a number of valid points about the difficulty of the detail. I agree that the detail is difficult. That is what the Opposition find difficult to understand. Until now, they have all gone with the policy for change and argued that change is essential, but when we get down to the agenda of change, they disappear over the horizon without an idea to bring to bear on the argument.
My right hon. and learned Friend the Member for Putney asked about the role of the purchasing authority with regard to the hospital in his constituency. The health authority is still to be persuaded about that case, but I have no doubt that my right hon. and learned Friend will follow up the representations that he has already made to me, and that he will continue to press the authority very firmly about that matter.
My right hon. Friend the Member for Chelsea (Sir N. Scott) raised an important point about the Royal Brompton hospital. My Department and the Royal Brompton are currently looking at various development possibilities and I know that my right hon. Friend continues to make strong representations on the hospital's behalf. My hon. Friend the Member for Surbiton (Mr. Tracey) emphasised the technological advances that have
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been made in health care. It is important that we recognise technology changes and build hospitals for the 21st century; we must not be left behind.I now come to the comments of my right hon. Friend the Member for Brent, North (Sir R. Boyson) and my hon. Friends the Members for Hendon, North (Sir J. Gorst) and for Harrow, East (Mr. Dykes). They have clear constituency concerns, and I must admit quite frankly that I cannot meet all the points that they raised. However, I ask them to bear in mind the fact that Edgware hospital will not close, as has been suggested in the popular press. I know that they recognise that fact.
Edgware hospital will remain as a community hospital that will deliver patient care to the community. It will provide a minor accident treatment service, which will cater for approximately 50 per cent. of those who use the current accident and emergency service. Some £60 million will be invested in the hospital in Brent in order to turn it into a first-class facility.
Sir John Gorst: So that I may be absolutely certain that I will enter the correct Division Lobby this evening, I ask my hon. Friend to leave aside the palliatives, sedatives and tranquillisers that have been dressed up as concessions and, even at this 11th hour, to give an undertaking that the accident and emergency department at Edgware hospital will remain open.
Mr. Malone: I cannot give that undertaking, because it would be the wrong thing to do. The Government will put in place new, worthwhile facilities, and I hope that hon. Members in the area will be able to reassure their constituents about service provision. If my hon. Friend were to visit some minor units that have been established already--for example, the St. Charles's hospital minor injuries unit that was referred to in the debate--he would find that they are first-class facilities that could meet the needs of his constituents extremely well. [Interruption.] I hear an intervention from a sedentary position that no one believes me. I do not ask Labour Members to believe what I say; they should go and see for themselves what those units, which are close to the community, can provide. They are excellently run and they have zero waiting times. They are first- class facilities.
Mr. Dykes: Even if the Minister cannot give that concession to my hon. Friend the Member for Hendon, North (Sir J. Gorst), can he not at least postpone the closure of the A and E unit at Edgware hospital and confirm that there will be additional ambulance provision pending further examination of the whole question?
Mr. Malone: My hon. Friend knows about the additional ambulance provision that has been promised already. I cannot promise any further delay or postponement of the closure of the A and E unit at Edgware hospital. However, I emphasise the pledge that my right hon. Friend the Secretary of State has given, that we will put in place equivalent, if not better, facilities that will soon be up and running. That is not merely a pledge from Ministers or from the health authorities; buildings of bricks and mortar will be occupied by doctors and nurses who will run the facilities in a proper way. I hope that my hon. Friend will accept my assurance.
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I come to the remarks of my hon. Friend the Member for Broxbourne (Mrs. Roe), who is Chairman of the Select Committee on Health. She referred to the way in which the Committee scrutinises the Government's policies. That scrutiny is very welcome and I know that my right hon. Friend, fresh from this debate, is looking forward to appearing before the Select Committee tomorrow.The hon. Member for Islington, North (Mr. Corbyn) talked about London waiting figures. May I say to the whole House that there has been a tremendous achievement on waiting figures in London? In the 12 months up to March 1995, the number of people who had been waiting for more than one year fell by 26.3 per cent. That is an enormous achievement. I do not know why Opposition Members who claim to support the health service denigrate it when it makes such achievements, and try to cast it down.
I tell the hon. Member for Newcastle upon Tyne, East that the health service in London is not as good as in other parts of the country because we have got to get London's health service into the same shape as the health service in other parts of the country. It is the Opposition motion that stands exactly in the way of that. The hon. Member for Newham, South (Mr. Spearing) made an interesting speech. He gave a historical analysis of what has happened in health, with which I do not quite agree. He harked back to the good old days before 1990, when he said that there was a consensus on health policy. I remember being in the House between 1983 and 1987. To echo the words of my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler), if that was consensus before 1990, God help us if war had broken out, because the truth is that the Opposition have attempted to thwart every attempt made by the Government since 1979 to reform the health service and make it more efficient.
The hon. Member for Woolwich (Mr. Austin-Walker) talked about resources and said that we would have to be extremely careful not to take away care provision before we had provided other facilities. That is right, and it was one of the pledges that my right hon. Friend the Secretary of State gave the House; I am pleased to reiterate it in my winding-up speech.
My hon. Friend the Member for Hendon, South (Mr. Marshall) welcomed the primary care initiative. [Interruption.]
Madam Speaker: Order. The House should settle down and hear the last minutes of the Minister's winding-up speech. The House is much too noisy. Too many meetings are taking place.
Mr. Malone: I am glad that my hon. Friend the Member for Hendon, South welcomed that initiative. I assure him that the pledge to continue to improve the London ambulance service will be honoured. The right hon. Member for Derby, South made much in her remarks about the NHS building programme. I have to tell her, on behalf of my right hon. Friend the Secretary of State, that my right hon. Friend stated that there had been one new building programme a week in the five years to March 1994. I have to apologise on behalf of my right hon. Friend, because she misled the House. That would have led to a total of 260 building programmes over that period. There were, in fact, 375 building schemes, each costing over a million pounds, completed
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in an NHS programme worth over £1 billion nationally. Since 1979, the Government have put £22.5 billion into NHS building programmes. What we get from the Opposition is impresario politics. Today, as the right hon. Member for Derby, South was speaking, we saw that the soundbites were taken by the Leader of the Opposition as he appeared in Bart's hospital. I have a question that everybody in Bart's hospital would like to ask the Opposition. If they take the political credit for appearing to save Bart's hospital, are they prepared to stand up at the Dispatch Box today, tonight, at this moment, and say that they would save Bart's hospital?Mr. Nicholas Brown: The Minister will find out in the Lobby in three minutes' time.
Mr. Malone: The hon. Gentleman gave no policy commitment or anything of that sort. There never has been from the Labour party. At the core of this debate is the point about hospitals.
"There is a tendency in some quarters to defend the very small hospital on the ground of its localism and intimacy . . . but everybody knows today that if a hospital is to be efficient it must provide a number of specialised services. Although I am not myself a devotee of bigness for bigness sake, I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one."--[ Official Report , 30 April 1946; Vol. 422, c. 44.]
I wonder whether the Opposition agree with that. They probably do not. That is from the speech of Aneurin Bevan in moving the Second Reading of the National Health Service Bill on 30 April 1946. The Opposition have resiled from what was promised then. They have no policies. Bevan took on the challenges, which the Opposition are not prepared to do. That is why the House should reject the Opposition's motion.
Question put, That the original words stand part of the Question: --
The House divided: Ayes 308, Noes 320.
Division No. 144] [9.59 pm
AYES
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Abbott, Ms DianeAdams, Mrs Irene
Ainger, Nick
Ainsworth, Robert (Coventry NE)
Allen, Graham
Alton, David
Anderson, Donald (Swansea E)
Anderson, Ms Janet (Ros'dale)
Armstrong, Hilary
Ashdown, Rt Hon Paddy
Ashton, Joe
Austin-Walker, John
Banks, Tony (Newham NW)
Barnes, Harry
Barron, Kevin
Battle, John
Bayley, Hugh
Beckett, Rt Hon Margaret
Beith, Rt Hon A J
Bell, Stuart
Benn, Rt Hon Tony
Bennett, Andrew F
Benton, Joe
Bermingham, Gerald
Berry, Roger
Betts, Clive
Blair, Rt Hon Tony
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Blunkett, DavidBoateng, Paul
Boyes, Roland
Bradley, Keith
Bray, Dr Jeremy
Brooke, Rt Hon Peter
Brown, Gordon (Dunfermline E)
Brown, N (N'c'tle upon Tyne E)
Bruce, Malcolm (Gordon)
Burden, Richard
Byers, Stephen
Caborn, Richard
Callaghan, Jim
Campbell, Mrs Anne (C'bridge)
Campbell, Menzies (Fife NE)
Campbell, Ronnie (Blyth V)
Campbell-Savours, D N
Canavan, Dennis
Cann, Jamie
Carlile, Alexander (Montgomery)
Chidgey, David
Chisholm, Malcolm
Church, Judith
Clapham, Michael
Clark, Dr David (South Shields)
Clarke, Eric (Midlothian)
Clarke, Tom (Monklands W)
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