House of Commons Hansard Debates for 10 May 1995

Mrs. Beckett: In a not so sotto voce intervention, the hon. Lady asks what that has to do with London. I have pointed out to the hon. Lady and people like her that those problems do not only exist in London, although we are focusing on London's problems today, and that London cannot be sacrificed because every other area in the country will benefit; every area is experiencing the same difficulties. Against that background, what are the Secretary of State's proposals, particularly for London? She proposes to close world-famous hospitals, and to take even more beds out of use. Let us look at Guy's, because, apart from anything else, it illustrates the need to scrutinise all that the Secretary of State says today very carefully.

A few weeks ago, the Secretary of State said that Guy's accident and emergency department would not be closed for some years, that Philip Harris house would be used

"for most purposes for which it was intended"

and that Guy's would continue to

"provide a wide range of specialist and local hospital services." I am sure that many of those who heard that announcement thought that it meant that Guy's would be saved as they now know it. Answers to parliamentary questions that I have tabled show, however, that in-patient beds at Guy's will be cut from 702 to 112.

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The transfer of services to St. Thomas's will not apparently be possible without even more rebuild, expense and disruption to clinical services than was originally suggested. It will still leave empty eight floors of Guy's tower and all 11 floors of New Guy's house, both recently built and in clinical use. I understand that, even if all the developments required to replace at St. Thomas's facilities provided at Guy's were carried through, available space for clinical services would be less than existing space.

Estimates of the cost of that transfer are in excess of £200 million. Suggestions seem to be made that much of that money will come from private sources. Those who make that investment will no doubt expect a return, yet that investment is being made in large part to replace facilities that already exist. Despite what the Secretary of State said last month, it still appears that 18 state-of-the-art intensive care beds are among the facilities provided in Philip Harris house which will be lost. That is on top of the loss of up to 31 existing intensive care beds at Guy's, when everyone knows that there is intense pressure on such beds in London as a whole.

In many ways, that aspect of the proposals symbolises the Secretary of State's failure. When Philip Harris house is handed over, it will include 12 surgical and six medical intensive beds, which, according to contract, will have been equipped with all the most modern purpose-built facilities and equipment. Such beds are needed. Intensive care beds are under pressure everywhere in London, yet the Secretary of State intends to authorise the spending of millions of pounds of public money to rip out and destroy those facilities so that they can be replaced by something else. No matter what the blueprint is to which she is working, and no matter who the experts are who drew up the blueprint, however long ago it was, that makes absolutely no sense.

There is concern about the practical and financial impact of the proposals for Edgware hospital. The money allocated to build up Barnet hospital is, I understand, sufficient for the first third of redevelopment, but London Health Emergency estimates that the Barnet project needs to be at least two thirds completed before it will be practical even to consider going ahead with the proposals for Edgware. That is apart from the question of redeveloping and making changes in transport patterns in the region, to which Conservative Members have drawn attention.

My chief criticism of the Secretary of State is that a pattern runs through all the proposals and all the problems that the Government create. They anticipate the effect of the change that they have decided is desirable. They presume that what they expect will happen, and that the unexpected will either not arise or be insignificant. When the unexpected does happen, such as the increase in emergency admissions, they carry on regardless.

Sir John Gorst (Hendon, North): Surely the logic of the right hon. Lady's argument is not, as she has already stated, that there should be a pause or a review, but that the closures to which she has referred should be reversed completely and, in my view, for all time.

Mrs. Beckett: The hon. Gentleman will no doubt make his case and that of some of his hon. Friends, but unless the Secretary of State is made to realise the depth of

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concern about the whole range of her proposals, some irreversible changes will take place. It may or may not be in the area that affects the hon. Gentleman's constituency, or in the constituency of the right hon. Member for City of London and Westminster, South (Mr. Brooke), who represents Bart's, but irreversible change will take place. We believe that no such change should take place without review.

Mr. Duncan Smith: Will the right hon. Lady give way?

Mrs. Beckett: I cannot. I am sorry. I would have given way to the hon. Gentleman, but time is not on my side.

The Government assumed that the new computer system for the London ambulance service would work as planned and they pushed ahead with its implementation. Across the country, day case surgery increases and, as a result of technical change, there is increased throughput of patients, but either no allowance or insufficient allowance is made for the knock-on effects, for the fact that facilities to resolve the problems of people receiving day case surgery are all too often inadequate or non-existent, and for the fact that speedier discharge of in-patients means far greater pressure on wards as everyone still in hospital is at the peak of their need for care and attention.

Beds in psychiatric hospitals have been taken out of use in huge numbers. Over-ambitious anticipation of reduced levels of need has meant that even though the number of beds in the private sector has increased, there is still well above 100 per cent. occupancy in all too many cases. Psychiatrists despair that the facilities required to help them cope with those with a mental disorder no longer exist on a level to meet the need. What is true in all those areas of policy is especially true in spades of the funding of primary care in London. The Secretary of State's chief argument for the reduction in hospital beds is that the Government assume what almost nobody else now takes for granted--that investment in primary care will reduce the demand for hospital beds. In fact, there is a growing suspicion that by revealing unmet need, it will actually increase the demand. What no one doubts is that the public have lost confidence in this Government's handling of the NHS--something for which the Secretary of State blames everybody but herself. The public have lost confidence in the Government's competence, their good faith and their ability to listen.

One of the Secretary of State's colleagues recently spoke of her family's history in terms that, for me, evoked the 1914 war rather than the more recent conflict. Her colleague spoke of her in family tradition marching towards the gunfire. I thought that analogy to be more than a little misconceived. If there is a parallel with the experience of that conflict, it is that the Secretary of State, far from being a brave subaltern or even one of the poor bloody infantry marching towards the guns, is the general, safely back at headquarters ploughing on with a doomed strategy and refusing to take any notice of the fact that there is any alternative.

The right hon. Lady claims to have a mailbag full of correspondence supporting her proposed changes to London's health service. However, when we tabled a parliamentary question asking what percentage that was of the total correspondence that she received on the

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changes, I am afraid she told us that the figures were not available. It probably would not matter if they were, because I am beginning to think that the right hon. Lady's outstanding political characteristic is that she hears only what she wants to hear. Her ears are as closed to other voices as her mind is to other opinions. I know that many hon. Members in the House today do not support the policies that the Secretary of State is advocating and that if there were a free vote, she would be defeated. Those who do not support her proposals must weigh seriously whether they should support her in the Lobby tonight. She will take no heed--and I suspect that the Government will take no heed--of measured words of caution or of anxieties, no matter how deep, how sincere or how seriously expressed.

If the House wishes to send a message that even the Secretary of State cannot misinterpret or misunderstand, that message must be clear. It must be bold. It must be defeat.

4.57 pm

The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:

`noting that the problems of London's health service have been the subject of at least 20 reports in the last 80 years, all of which have come to broadly similar conclusions, believes that a better service for patients lies in implementing decisions and not a further review; commends the Government for its record in investing in modern hospitals, first class specialist centres and primary care and for its determination to take necessary decisions in the long term interest of the Capital's health service and the people of London; and calls on the Government to ensure that the decisions are now carefully carried forward taking due account of concerns that they should be properly paced so that patients continue to benefit from new and better services before old ones close.'.

This is a serious debate and a matter of great importance and consequence. It is a subject of, frequently, great conviction and of great emotion, not only for my hon. Friends but, I accept, for Opposition Members and for those whom we serve in constituencies throughout the land. I believe that our task is to achieve a health service worthy of our capital city for the next century.

"To argue merely for the status quo is a grave disservice to the future well being of the health service in London."

The right hon. Member for Derby, South (Mrs. Beckett) will recognise--or at least she should recognise--those words not as my words, but as those of her immediate predecessor.

Sadly, as the right hon. Lady's speech today has shown, the Labour party has gone downhill since then. What is remarkable about the so-called new party is how it has scuttled away from the sound consensus on the need for change in London's national health service. The right hon. Lady's moratorium is a cop-out. Dithering in Opposition shows why her party would be a disaster in Government. This debate is a cynical and opportunistic piece of parliamentary gamesmanship, and once again shows beyond doubt that Labour will always put party politics before the nation's interests.

Sir John Gorst rose --

Hon. Members: Give way. [Interruption.]

Madam Deputy Speaker: Order. I wish to hear the Secretary of State. Does she wish to give way?

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Mrs. Bottomley: In a minute.

Governments must rise above such tactics. Our task is to take the necessary decisions that the national interest demands. There are no instant answers or scratch-card solutions. It is not a question of a bit more money here or a review there. Those are smoke-screens thrown up by the Labour party to disguise the real questions at the heart of the debate.

Do we want London to continue to enjoy an outstanding national and international reputation for service, teaching and research, or are we to submit to a second-class service? Do we want Londoners to have the most modern and advanced hospitals, or is it more important to preserve every building and site even when they are outdated and ill suited to today's needs? Do we want to bring general practitioners and community health services up to the standards of the best, or is the current patchwork a price worth paying to maintain the hospitals status quo?

These issues have been debated endlessly:

"For 30 years, reports have been written and schemes put forward for improving medical care and teaching . . . Everyone who has studied the problems accepts that specialist services are duplicated, too few patients live near the sites in inner London and those in outer London are deprived. Everyone agrees that the first priority is to improve primary care and help GPs."

Those were not my words but those of Lord Annan, a distinguished former vice-chancellor of London university. Lord Annan speaks for many.

I pay tribute to the many doctors, nurses, scientists, academics, commentators, the independent specialty review members, the research team members and the patient groups who have prepared and argued the case for change. They believe that the time has come for the Government to stand firm in London's interests. They speak with a powerful and authoritative voice which we all must hear. They believe that we must build for the future, rather than remain fossilised in the past.

It is not just the distinguished academics and eminent doctors who have been calling for change. Those closest to patients know that the services in London are not good enough. We must address change to make sure that we have a capital health service for the people of tomorrow.

Sir John Gorst: I wish to refer to a point that my right hon. Friend made earlier in her speech, when she described the tabling of this debate as opportunism by the Opposition. May I inform her that I sought from the Leader of the House an opportunity for such a debate and remind her that I wish to register my vote against these proposals?

Mrs. Bottomley: I accept my hon. Friend's constituency interest, and I shall say more about the situation in Edgware and Barnet later in my speech.

The Labour party knows full well that, if it ever pretends to be a party of government, addressing change in London is necessary. Many Labour Members are seeing phenomenal and unprecedented investments in their constituencies as we build hospitals near to where people live. For them, today's debate is a piece of outright cynicism and opportunism. I repeat those words strongly.

Mrs. Beckett: Will the Secretary of State give way?

Mrs. Bottomley: No, wait. [Interruption.]

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Madam Deputy Speaker: Order. The House knows full well that is up to a Minister or any Member who has the Floor to decide whether to give way or not.

Mrs. Bottomley rose --

Mr. Andrew Faulds (Warley, East): On a point of order, Madam Deputy Speaker. Whatever gibberish the Secretary of State wishes to propound today, should she not be called to order? Is there not a long-established tradition in the House--I have been in the House longer than the Secretary of State--that when the leading speaker from the Opposition gets up, the Secretary of State sits down?

Madam Deputy Speaker: Order. The hon. Gentleman may have been here for a long time, but he has still not grasped the point.

Mrs. Bottomley: I shall give way to the right hon. Member for Derby, South in a moment, but I want to get on a little further in my speech first.

There are difficulties and problems, and it is well understood that hon. Members feel close to their constituents and the institutions which have served them over many years. It is inevitable that when we are faced with such complex and fundamental change, great sensitivity is necessary in handling the delivery of that change. But the difficulties and the problems make the case for change even stronger.

The stories and accounts that we have heard of the difficulties in hospitals are precisely because there are many separate units instead of larger units, which are better managed and which co-operate better in handling the ebbs and flows of health care more effectively. Report after report makes the point that we must deliver a health service which is right for the future, and not a service that was right for the past.

Mrs. Beckett: The Secretary of State has repeated today what she has said repeatedly in the past few days on radio and television. She has said that there is something cynical and opportunistic about the Opposition tabling the debate. As her hon. Friend the Member for Hendon, North (Sir. J. Gorst) reminded her, we called on the Secretary of State to provide a debate during which the House could thoroughly assess and thrash out the consequences of the proposals. We have called on her to do that many times in the past, and it is a demand that she has consistently refused.

If the Secretary of State thinks that it is not the purpose of Members of this House or members of Her Majesty's Opposition to provide an opportunity for proposals of this magnitude to be assessed, debated and discussed by people of different points of view, she does not belong in the House at all. That is what we are here for.

Mrs. Bottomley: I totally accept that the Labour party is the natural party of opposition. It constantly criticises and interprets developments in a cynical fashion, but never has any constructive proposals. Those of us who are now seeing the third health spokesman for the Labour party are still waiting for a policy from any of them. "A moratorium", "out to consultation" and "another review" is what we hear. The Labour party does not want to offend anybody, and it never says yes or no. That is always the way forward for the Labour party.

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The right hon. Member for Derby, South responded to an intervention from my hon. Friend the Member for Hendon, North in that way--she said neither yes or no. The Labour party will say anything to try to achieve power ruthlessly and cynically.

Several hon. Members rose --

Mrs. Bottomley: I intend to proceed.

Dame Elaine Kellett-Bowman: Will my right hon. Friend give way?

Mrs. Bottomley: In a moment.

The change must be handled sensitively and it must be properly paced, but there is no serious challenge to the direction of travel. "Go carefully," we are told, "but do not go back".

I give my hon. Friends, Members of the House and London patients a strong assurance that there can be no going back. The issue now is not the policy, but the implementation of the policy.

It is the duty of the health service to carry out the decisions with skill, tact and perseverance if the benefits to London and the rest of the country are to come through. I have just written to the chairmen of the two Thames regions to stress precisely that message. Those chairmen, and the health authority and trust chairmen involved, will be held to account for carrying the policies through. They must explain, listen, lead and reassure staff and public alike that the changes will bring tangible and important benefits to patients. That is a message that they welcome. They are committed to working for the future, and not clinging to the past.

Dame Elaine Kellett-Bowman: My right hon. Friend will have noticed that the right hon. Member for Derby, South (Mrs. Beckett) said that if there were a free vote tonight we would not vote in support of the proposals. Should not the right hon. Lady give a free vote to Opposition Members to see how her northern Labour Members vote? They do not want more money for London, but more money for the provinces.

Mrs. Bottomley: As ever, my hon. Friend is acute on matters of health policy.

Sir Teddy Taylor (Southend, East): While I fully understand the views of local Members of Parliament, will the Secretary of State confirm that the over-concentration of hospitals and spending in central London inevitably mean that other areas in the region are seriously and consistently under-funded? Would it comfort the Secretary of State to know that many of us have a great deal of admiration for her courage in facing up to an issue that has been neglected for years, but only contempt for the Opposition, who pretend that the problem does not exist?

Mrs. Bottomley: I thank my hon. Friend. He represents a constituency where, in the past, constituents routinely travelled to London for care that they now receive at home. It is time to have a better balance of service and funding. London has long had many specialty hospitals, which are duplicated and fragmented and do not deliver the care that we expect for the future. We seek to achieve a balance within London and the home counties.

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The result of the changes will be more modern local hospitals that are better geared to meeting the needs of Londoners today and tomorrow. For example, in Greenwich a new hospital--the Queen Elizabeth--will be available to NHS patients from August, bringing services from two other hospitals on to a better site. Neuro-sciences will transfer from the Brook to King's. Close links with the internationally respected Institute of Psychiatry will establish a truly world-class centre of excellence.

Hon. Members will know how strongly I believe that our job is to maintain not only national but international excellence in this country's research and teaching. The Brook hospital will close as it is old, cramped and ill- suited to modern health care. Incidentally, it has no "e" on the end, as the Opposition wrote in their original motion.

Mr. Harry Greenway (Ealing, North): My right hon. Friend will know of my concerns for the national health service in London, which I have frequently discussed with her. The hon. Member for Newham, South (Mr. Spearing) and I have often raised the issue of the London ambulance service. Is she aware that this morning I called an ambulance for a lady who collapsed before my eyes? It arrived within seven minutes and the lady was in hospital and being properly treated shortly afterwards. Will that be the future pattern for London? Is my right hon. Friend also aware that, just a few years ago, Labour-controlled Ealing council put £500,000 on the rates of Ealing hospital and other medical or hospital institutions in Ealing, so much did they care about the health service for my constituents- -

Madam Deputy Speaker: Order. I have already said that interventions must be brief.

Mrs. Bottomley: My hon. Friend is right about the significant developments in the London ambulance service, which for many years has been a troubled and unsatisfactory service. We now see extremely encouraging progress: better manning and staffing arrangements, clearer leadership and, above all, a better service for the people of London, including my hon. Friend's constituents.

Ms Glenda Jackson (Hampstead and Highgate): The Secretary of State will know that last year one of my constituents suffered third-degree burns to 40 per cent. of his body on a Sunday. He had to be taken to hospital in a fire engine because no ambulance was available in north-west London. When I drew that case to the attention of the Secretary of State, the letter that I received in reply led me to believe that new ambulances would be provided for that part of London. A subsequent letter has told me that the proposal to cut the ambulance service within my constituency from its present complement of eight ambulances to two is a step forward. I do not regard that as an advance and nor do my constituents.

Mrs. Bottomley: I shall look into the hon. Lady's case. I can inform her, however, that 180 new vehicles are being provided for the London ambulance service and there is a formidable programme of investment. We have long sought better management and leadership of the London ambulance service, which is one of the few

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services left that has not gained trust status. It is old-style NHS, not the NHS that we have been so keen to put in place.

As well as the changes that I have described, many other hospitals are being strengthened and improved. I challenge the Opposition to admit that their constituents often see the benefits. The hon. Member for Hampstead and Highgate (Ms Jackson) is all too keen to criticise, but we rarely hear about the improvements taking place at the Royal Free hospital or the extra investment. The hon. Member for Islington, North (Mr. Corbyn) never mentions the £2 million spent on his accident and emergency service.

Mr. Jeremy Corbyn (Islington, North): Will the Secretary of State explain why there was no elective surgery in the Whittington hospital between December and April this year? Why are 3,000 people waiting for operational appointments at the Whittington hospital when she has managed to spend so much money on improving health care in Islington by closing Bart's and the Royal Northern hospitals?

Mrs. Bottomley: Time and again, the Opposition fail to appreciate why it is so necessary to introduce change in London. Waiting times are coming down, but we need larger and better balanced units, A and E services which deliver a high quality of care, and investment in primary care. That is exactly what we are delivering.

Although we hear from the hon. Member for Dulwich (Ms Jowell) about Guy's, she never mentions what is happening at King's--the new neuro-sciences unit, liver unit and magnificent day surgery unit, and the £8 million going into the A and E services. Nor do we hear from the Opposition that by tackling the problems in London we can better help hospitals outside London, which so many of my hon. Friends are concerned about.

Sir George Gardiner (Reigate): Before my right hon. Friend leaves the subject of constituency interests and loyalties, is she aware of the great irritation felt by many patients outside London at the assumption that any serious case must be treated at a London hospital? She will be aware of all the new regional specialist centres that have been founded in recent years. Will she undertake not to seek to pacify pressure groups from London at the expense of funding for the new centres of excellence throughout the country?

Mrs. Bottomley: My hon. Friend is exactly right. What we need is a national health service which serves patients' interests but does not have its agenda dictated by the patterns of the past.

I wonder whether the hon. Member for Plymouth, Devonport (Mr. Jamieson) will speak on behalf of his constituents. Does he still want them to travel 200 miles from Plymouth to the London Chest hospital for their heart operations, or will he have the courage to admit that the changes in London will deliver a new cardiac unit in Plymouth?

The person who deserves a prize for the ultimate cynicism is the right hon. Member for Derby, South. Did we hear a word from her about the £10 million for the Derbyshire Royal infirmary? Of course not. It is the height of hypocrisy for the right hon. Lady to criticise changes in London when similar concentrations of

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specialist services are taking place in her constituency along with the development of community services, and her constituents are seeing the benefits.

Mr. Hugh Dykes (Harrow, East): My right hon. Friend is right to say that Conservative Members do not need advice from the Labour party. When it was last in government, some 60 hospitals a year were wholly or significantly closed down. Does my right hon. Friend appreciate the difference in the complex arguments between central and outer London hospitals and the severe crisis that Edgware General hospital in outer London faces? If its A and E unit is closed down, Barnet General hospital and Northwick Park hospital will be too far away for ambulances to get there in time. Her suggestion of two additional ambulances is insufficient and inadequate. Will she respond to those arguments for Edgware General hospital?

Mrs. Bottomley: My hon. Friend will understand that I have already said that I hope to say more about Edgware General hospital later. I shall refer specifically to the matters that he has mentioned, but he is absolutely right about the Labour party.

The right hon. Member for Derby, South may be an endangered species, as one of the few members of her party to have served in government, but she appears to have forgotten that Government's record, in which I am not surprised that she takes little pride. Sixty hospitals closed in every year that Labour were in office. They cut nurses' pay and cut--

Mrs. Beckett: The Secretary of State has now said two things in an attack on me. The first I find extraordinary. She says that I do not welcome investment in my constituency; of course I do. But why-- [Interruption.] I simply add that, when the Derbyshire Royal infirmary, to which she referred, was contacted, it asked where the £10 million was, but we shall not go into that.

I do not know why the Secretary of State should suppose that, because there has been investment in hospitals in my constituency, I should be indifferent to the problems that she is causing in London. That is a peculiar attitude to express.

Secondly, it is untrue that 60 hospitals a year closed under the most recent Labour Government. The figures show that 128 hospitals were built in five years under the most recent Labour Government, compared with 21 under the present Government.

Mrs. Bottomley: We can clarify the figures further at a later time. [Hon. Members:-- "Oh."] Sixty hospitals closed-- [Interruption.] The hospital closure programme of the most recent Labour Government is the least of their record. What about a party that cut nurses' pay, cut doctors' pay and cut national health service spending for the only time in its history? That is what the right hon. Lady--

Mrs. Beckett: Will the Secretary of State give way?

Mrs. Bottomley: No, I have given way quite enough. [Hon. Members: -- "Give way."] No, I will not.

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That is what the right hon. Lady described a moment ago as exercising political judgment. Those of us who worked in the health service at that time remember what that political judgment was like: it was painful for staff and patients, and none of us wish it to be repeated.

Mr. Nigel Spearing (Newham, South): It is being repeated.

Mrs. Bottomley: That is interesting. The hon. Gentleman said that it is being repeated, but it was a strange use of language because there has been an enormous advance in nurses' and doctors' pay, there has been an improvement in training and, most important, we have opened--not closed, but opened--a new hospital development, on average, every week that we have been in government.

Mr. Jacques Arnold (Gravesham): Would my right hon. Friend note that we in north-west Kent, which goes for many of the home counties, resent the fact that so many of our constituents have to travel at great inconvenience all the way into central London for treatment, where added on-costs of 40 per cent. apply? That is because resources have always been concentrated on central London. If my right hon. Friend presses on and releases resources to improve the type of centres to which my hon. Friend the Member for Reigate (Sir G. Gardiner) referred, and Darenth Park hospital in my constituency, she will have support for putting health care where people actually live.

Mrs. Bottomley: I share my hon. Friend's opinions, but it is important that the specialty services which remain in London--the tertiary services--should become even greater centres of excellence. The dilemma is that, as fewer patients come to London, for all the understandable reasons, because of the massive building programme that we have established throughout the home counties, when they do come to London they will expect a level of care and a quality of expertise that is among the absolute best. Only by bringing those specialty services together shall we achieve that excellence. That is what the specialty review said. That is what the academics and the researchers said time and again. That is the reason why we have received such strong support for those proposals from the leaders of the profession, especially those who mind about excellence, not only for the present century, but for the century ahead.

Mr. Simon Hughes (Southwark and Bermondsey): Will the Secretary of State give way?

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