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Mr. Deputy Speaker: Order. The hon. Gentleman is trying hard, but he is not being successful. He must stick to what is in the Bill, or I shall have to rule him out of order.
Mr. Livingstone: I made that point because the powers already exist, and I want them used in Brent, which, of all social services departments in Britain, has the most urgent need. I do not believe that any hon. Member would be other than horrified to discover that the constituents whom they represent had to suffer in such circumstances. How does one create such a complete air of neglect? The comparative studies that are now possible and the strengthening of the Audit Commission in social services must give it the ability to step in. Even if it cannot take control, it can at least draw attention through the new powers to areas were one borough council is performing dramatically worse than others.
As I mentioned in Committee, the question of reporting should have been in the Bill. I shall not repeat on Third Reading everything that I said about it in Committee, but this is a tremendous missed opportunity. I hope that the Bill will be strategically amended in the other place to strengthen the powers that will be given to the Minister. If it is, I hope that the Government will the accept the proposals, because what we have is not adequate.
My hon. Friend the Member for North-West Durham(Ms Armstrong) made it clear that we are not happy with what we heard from the Minister. If the Bill is amended in the other place, he will have the support of the House to use tougher powers to stop the abuse of the system of reporting on performance indicators. If cannot be right if those indicators are reported in such a way that nobody is interested in looking at them.
Who would produce an election address of just solid, turgid type? No one would read it. We have nice pictures of ourselves. We have pictures to illustrate local topics. We have graphics. If a council refuses to use those options and just produces dense acres of type, people will not plough through it.
Ms Armstrong:
I do not wish to detain the House for much longer, but hon. Members should be reminded that the Government were given an opportunity to clarify their wish to use the Audit Commission more effectively to secure probity and the delivery of high-quality services in local government.
The Bill deals with two fairly minor matters. It proposes that the social services inspectorate should be able to work with the Audit Commission to inspect whole social services departments, an important new power which I welcome. I have always considered it nonsense that no power to ensure both effectiveness and value for money is enshrined in legislation. I also welcome the
Government's recognition that the current regime for the publication of performance indicators does not meet its objectives. However, I still do not think that the Bill has got it right.
The Government have not faced up to the problems that local government has asked them to tackle. Myhon. Friend the Member for Brent, East (Mr. Livingstone) talked about Brent and, on Second Reading, my hon. Friend the Member for Holborn and St. Pancras(Mr. Dobson) spoke of the delay in solving Lambeth's problems, which was due partly to the fact that the auditor had not the necessary powers and partly to a lack of consistency. In Committee, we had a short debate about the importance of consistency among district auditors, and ways of ensuring that were suggested. I am sorry that the Government did not take the opportunity provided by some of our amendments.
On Second Reading, my hon. Friend the Member for Holborn and St. Pancras also mentioned Brent and Westminster. He pointed out that in those boroughs, as well as in Lambeth, the public could not feel confident about the way in which matters had been handled, and that the district auditor had continually been thwarted. It is our responsibility to ensure that government at every level is as open, honest and responsive to local people as the House can make it. I am sorry that the Government did not tackle that issue in the Bill.
Question put and agreed to.
Bill accordingly read the Third Time, and passed.
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Knapman.]
Mr. Hugh Dykes (Harrow, East):
I am grateful for the opportunity to speak on this topic. As I raised it in April last year, it may seem strange that I have raised it again tonight, but significant developments have taken place in the intervening time. I make no apology for bringing up the subject again, as there is still great public concern about the future of Edgware general hospital.
The issue must be examined again very meticulously: although it is a local issue, it impinges on all the services provided by the NHS in the neighbouring areas of north and north-west London, and, indeed--as some patients are referred from parts of greater London that are a long way away--on services north of the river generally.
I thank my hon. Friend the Under-Secretary of State for Health for his attendance. I hope that he will be able to reassure me. This has been a long campaign: it began when the last Secretary of State for Health made what we regarded locally as a tragic, unnecessary and unjustified decision to allow local agencies to proceed with the closure of the hospital's accident and emergency unit, and it continues in full force.
It is interesting to reflect on the panoply of local campaigns, which seek numerous objectives. I suppose that nothing is more important than the provision of health services--the services of hospitals, GPs and clinicians, and all the other facilities that are provided by a national health service in which we still take enormous pride. Health is one of the most crucial issues, especially for older people.
Experience suggests, however, that--logically and understandably--once a decision has been made, even local people who disagree passionately with that decision may drift away from their previous strong position. Although their arguments retain their validity, they may say, "There is nothing that we can do. The authorities are determined to go ahead, and we must accept their decision even if we still disagree with it."
In this case, however, that has not happened: if anything, feelings are stronger than they were before. That is a remarkable phenomenon, which I cannot recall observing before in many years of becoming involved in local issues. The passions aroused by this unwise decision are still extremely powerful, and the mass campaign continues--supported by most local politicians, both councillors and Members of Parliament. That must be borne in mind; but it is even more important to bear in mind the tangible underlying reasons why the proposed closure is a mistake.
It was in that spirit that, along with other hon. Members from all parties, I tabled an early-day motion on22 January. The composition of those who signed the motion reflected approximately the percentage of referrals from constituencies in the area surrounding the hospital. The motion asked the Department of Health and the Ministers concerned to ask Barnet district health authority and the other bodies involved, including the Wellhouse trust itself, to look at the matter again.
In early November, in the House of Lords, my noble Friend Baroness Cumberlege--speaking on behalf of the Secretary of State--repeated emphatically that, in a
process of extensive and thorough consultation, Barnet health authority and the Wellhouse trust had consistently sought to involve the public in their deliberations through a series of public meetings and the distribution of leaflets and articles in the local press. My noble Friend went on to say that the Secretary of State would not be reversing decisions made by his predecessor.
I can understand that. That is the normal basis on which a new Secretary of State takes over a portfolio, which will include all the adjustments that have been made in hospital policy. Conservative Members need no lectures from the Labour party, which many years ago, when it was in government, either closed or savagely cut some60 hospital units per annum.
It is normal, and natural, for Secretaries of State to say, "I cannot go back on the decisions of my predecessor." Officials present the position in those terms when the new Secretary of State takes over. Dossiers are examined, but there is no suggestion of reconsidering closure proposals. That is understandable, but I nevertheless feel that a fundamental mistake has been made in this instance. Given the importance of the issue to local people, I hope that my hon. Friend the Minister will listen to the details sympathetically.
I was grateful for the opportunity to raise the matter in the lengthy Adjournment debate that took place on5 April. Once again, tonight's debate has begun before the time when public business normally ends in the Chamber. Let me reassure you, Mr. Deputy Speaker: that does not mean that I shall speak at excessive length. I believe that my hon. Friend the Minister has an engagement, and I shall be speaking at a dinner if I manage to arrive on time.
In the previous debate on the Audit (Miscellaneous Provisions) Bill, the hon. Member for Brent, East(Mr. Livingstone) was, for various reasons, obsessed with the state of Brent council. With even more justification, I am obsessed with the future of Edgware general hospital, although, I hasten to add, it is on the other side of the road shared equally between myself and my hon. Friend the Member for Hendon, North (Sir J. Gorst).
I remind my hon. Friend the Minister of a number of important considerations that, once again, point powerfully to an unusual and demanding position that can irritate any Government, Ministers and officials who, once they have reached a decision, believe that they cannot go back on it. In this case, there are reasons for reconsidering the matter carefully.
I reiterate what I said on 5 April during the previous Adjournment debate. When the accident and emergency facilities at the Royal National orthopaedic hospital in Stanmore were closed about 12 years ago, it was reiterated repeatedly by the local agencies--the Minister will recall that there was a different structure then--and by Government spokesmen--and I can give chapter and verse on this any time the Minister cares to ask for it--that the local public did not need to be concerned about that, because the A and E facilities at Edgware general, which was just down the road, would take care of any substitution.
That important factor persuaded a number of local people reluctantly but gradually to accept the closure of the Royal National orthopaedic hospital's A and E unit--
a successful unit, and one close to the M1 motorway. That closure was also a mistake, but it happened a long time ago, and we cannot go back on it.
In that Adjournment debate, if I may quote without taxing the House's patience, I said:
the main district general hospital in the middle of my constituency, and located alongside the town centre--
There has been no significant reassurance by anyone that I care to recall--unless the Minister can disabuse me tonight--that that would not be so. The local public are extremely worried about that.
The hospital's A and E services are needed as much as the Barnet hospital must be expanded. Because it is in another region, I shall deliberately refrain from commenting too much in detail on Barnet hospital and its build-up, which I also welcome. No doubt there will be some referrals from my constituency to that hospital, although obviously not many. That would be welcomed by the local public, but it does not negate or reduce the primary requirement for Edgware general to remain a major multi-department medical facility in its own right, and not to be truncated drastically and tragically by closing its most important section--the accident and emergency facilities.
There is no reassurance so far on that point. It remains to be seen what the Government and others responsible for the decision will say in detail about these matters. Traffic congestion is one of the main issues that will arise again and again when these matters are considered.
There is no diminution in the force of the local campaign--I emphasise that. I am not at all reassured by any statements so far from the Wellhouse trust, London ambulance service representatives, other people involved and Department spokesmen. There has been no significant tangible reassurance about the provision of the necessary ambulance services that would take care of additional journeys to the other units instead of Edgware general. That is a glaring gap in the range of information that is needed to reassure the local public as the campaign forges ahead, trying to persuade the Government to change their mind on this important issue.
I referred to that matter last June, when there was a further development in the local campaign. There was an enormous expansion in public anger and resentment that the authorities would in no way reconsider the decision. As I mentioned in that Adjournment debate and elsewhere, the local public consultations, including those of the regional health authority, were extremely inadequate and people did not feel that their points were listened to with care and responded to in any way. They were brushed aside--that is the glaring truth of this sad saga.
After a further stage in the campaign, when a number of meetings took place, I suggested In my June statement:
The campaign is of the whole of the people, and has nothing to do with political parties in that direct detail.
The statement continues:
In that campaign, local politicians should aim to achieve the central objective of persuading the Government to change their mind on the A and E facility, not seek to score points off each other or indulge in gesture politics, which will not save the accident and emergency facilities.
In that spirit, there were various questions from me and hon. Members in the summer months, seeking to get the Government to persuade Barnet health authority to change its recommendation and to reconsider these matters, as it could within its own powers, but we did not succeed, as is well known.
Autumn came. After continued campaigning, there was still no significant response from the Department to, for example, my question in a letter to the Secretary of State for Health on 21 July about traffic congestion and the excessive time needed for ambulance journeys Northwick Park hospital even with the blue light operating. Some informal tests have been done of those journey times, which were disturbingly long.
I again show to the Minister the local map produced by the Canons Park residents association campaign in its newsletter, an effective document. It produced a series of articles about the issue, continuously, up to the latest editions, showing again how congested the area around the Edgware general hospital is, how relatively uncongested the area around Barnet general hospital is, and the difficulty of those various journey times.
In July last year, the Prime Minister was kind enough to reply to my letter to him. I thought it was right to make some of these points to No. 10 Downing street. At the end of his letter, he confirmed that it was necessary to retain "significant" hospital services at Edgware. He did not go into detail--rightly, he left that to the Department and to his colleagues--but it is what "significant" means that is of major concern.
All the medical experts that I have talked to say in some detail say that, if we excise anything other than just the marginal A and E services in a modern A and E unit such as that at Edgware hospital, we inevitably undermine the provision of services in that hospital and its ultimate rationale. We could turn it into a sort of bucket hospital--if that is the right phrase, without alarming people excessively--that just starts running down.
I am sad to say that there are a few examples of the running down of facilities already as people psychologically start preparing for the ominous moment in May 1997, the scheduled date for the closure of this significant facility. They are starting to think of it as a much truncated unit offering a limited range of services.
There is still time, however, for all this to be reconsidered, without anyone being humiliated into a drastic climbdown or a change that is beyond all reasonable expectations. It would be absurd for anyone to expect the Government to say that they are completely reversing a decision that was taken after, I presume they would suggest, considerable thought, but it is the way in which the issue is reconsidered to try and achieve the right solution for the modern A and E facility that we still want at Edgware hospital in 1997 and beyond that is important.
That is the key to what the Government can suggest to Barnet health authority and the Wellhouse Trust on how they should handle the matter and reconsider. None the less, I am aware of the absolute need to support the new managers of Wellhouse trust and not to humiliate or embarrass them, or to make them think that their role is being betrayed by a change that goes beyond their expectations for the detailed range of services that the modern hospital will offer.
I acknowledge that Barnet, with its expanded, modern, high-technology facilities, is vital, especially for people in the northern part of that borough. Again, I shall deliberately refrain from annoying my colleagues, if they read my words in Hansard, by commenting too much on what is happening outside my borough of Harrow.
Of course, Northwick Park hospital is central to our requirements in Harrow town centre. It also serves Brent, and takes patient referrals from as far as away as Ealing and beyond. However, Edgware general is in the middle of all those areas, and it should still be a significant major hospital for them, rather than being reduced, as it might be, to a low-facility unit.
The campaign continues. I pay tribute to the enormous power and effect of the Hands Off Our Hospitals campaign, and to all the people who have organised it. They have not given up; they have not reduced their activity and efforts. I shall bring to the Minister's attention information that we received recently through the campaign supporters' newsletter. There will be a campaign consultative meeting on 22 February, and another major rally, to engage the attention of all of the public in that area again, on 19 March, right in the heart of the Edgware general hospital area.
I understand the temptations for Ministers, bureaucrats and officials. If I were in their position, I should probably feel the same, and hope that attrition would account for the campaign, and that there would be a diminution in the intensity of feeling. But that is not happening. I must emphasise that to the Minister as strongly as I can. People want those significant facilities to remain. They want much more than the suggested replacement--that is, the minor accident treatment service now officially proposed by Wellhouse.
The consultations that the trust management said would be undertaken do not seem to have added up to much yet, although my colleagues and I have been offered several meetings. I do not decry that in any way, but I am not sure the trust is doing what it should for the local public.
There was an arresting headline in the local press recently. I hope that I am not showing too many exhibits tonight, Mr. Deputy Speaker, as if we were in a court of law, but we are dealing with a vital issue for the local population, and I am grateful for your indulgence.I should be happy to let the Minister have a copy of the1 February edition of the Edgware and Mill Hill Times, whose headline is "Closure plans may be illegal".
I have been dealing with many other matters this week, so I have not had the chance to find out whether that charge has been refuted, from whatever quarter, so I quote it subject to those inevitable reservations. Underneath that startling headline is another: "CHC threatens legal action over lack of consultation on Edgware General". The article says:
that is, the accident and emergency facility--
Much more follows, and what the newspaper says must be of significant concern to the Department of Health when it considers what would be the only drastic reduction or elimination of a major facility in a significant NHS hospital on the outer London fringes. That, among other reasons, is why we feel so steamed up about it.
One reason why I have deliberately raised the subject now is that there are now rumours of possible second thoughts from the Department of Health, and of a possible reconsideration of some aspects. The Wellhouse trust management may be trying to engage the attention and sympathy of local GPs, by holding various consultations to try to find possible ways through the problems.
Provided that the present A and E facilities are to be retained in their basic and major form, any suggestion would be considered fairly and fully by the patient representatives, by the representatives and spokesmen of the Hands Off Our Hospitals campaign, by the local parliamentary representatives, by local councillors and by the many thousands of other local people involved.
It is now for the Government to take on board the serious fact that the campaign will not go away. The campaign has no narrow political axe to grind; it represents literal common-sense reality, and what the local public feel, aided by their medical advisors and by a range of powerful voices from GPs, surgeons and consultants, all of which say that the decision must be reconsidered.
A basic mistake was made. The profound consultation necessary was lacking. There was an unwillingness--possibly inadvertent but, unfortunately, probably deliberate--on the part of the regional health authority and the district health authority to consider the many and voluminous representations of local protestors.
Those people were not simply indulging in the normal knee-jerk reaction, without any consideration of the details, when medical facilities are threatened. The very location of the hospital provides the main reason for the continuing concern. There is an overriding need for the Government to think again and to work out how they can accommodate the demands from Members of Parliament and from the local public.
The campaign will not go away. It will continue. If the Secretary of State and his ministerial colleagues can give us comfort and say that the services will be maintained, the public will be reassured, even if there are to be some changes. I am speaking theoretically, because I do not want to raise the subject of change deliberately.
For obvious reasons, I refrain from making any specific suggestions tonight. But even if the main high-technology equipment is to be located at Barnet--one can understand the investment priorities of its new programme--none the less, despite that small reduction at the margin, the whole range of existing A and E facilities could be maintained.
There must be a way forward, a way in which the Government can meet the demands of the local public. If not, the campaign, the agitation--I use that word in a
respectful sense--and the massive force of the combined voice of the people will continue, and I shall give it my full support all the way, as is my duty as a Member of Parliament.
8.12 pm
"I am worried about all aspects of the closure proposal. That is why others and I will be fighting hard and relentlessly to persuade the Government to change their mind. I am especially concerned about traffic congestion. It is an extremely congested area. If people are obliged to go to Barnet, Northwick Park"--
"or the Royal Free Hospitals, their journeys will take a great deal of time."--[Official Report, 5 April 1995; Vol. 257, c. 1792.]
"we have to stick together to try and persuade the Department of Health to change its mind. This is a gigantic task. We should be firmly united, not seeking narrow Party advantage."
8 Feb 1996 : Column 547
"It needs to be a sober campaign not an historical and emotional one."
"Barnet's patient watchdog has accused health chiefs of acting illegally over plans to close Casualty"--
8 Feb 1996 : Column 549
"and has warned it could take the matter to the courts.
Barnet Community Health Council . . . believes that Barnet Health Authority . . . is breaking the law by obstructing it in its duty to be consulted over health care changes."
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