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Mr. Stephen Dorrell (Charnwood): I am pleased that the right hon. Gentleman is now making the position clear on the election pledge to a health review in London. Why has he chosen to announce the review on a Friday, when most hon. Members are in their constituencies? Is not it completely absurd for a statement of such significance to be made on a day when the great majority of hon. Members have planned to be away from the House, looking after the affairs of their constituents? Is it because the right hon. Gentleman recognises that it is yet another review of London's health care which, frankly, is the very last thing that the national health service in London needs?
The truth is that the right hon. Gentleman recognises that this is a cheap election gimmick that is best put out of its misery as quickly as possible. [Interruption.] The right hon. Gentleman is likely to be put out of his misery pretty quickly. How is it possible to take seriously a review that will follow the Tomlinson process, which took four years, carried out a detailed examination, by specialty, of the health care provision in each hospital across London and conducted a detailed review of the implications of service provision for research, medical education and the development of primary health care? How is it possible for all of that now to be dispatched in four months, including holidays? It simply is not credible. It is the thinnest veneer that the House has been presented with in a very long time.
How can we take seriously a review that the right hon. Gentleman said only last month, from the Dispatch Box, would be charged with looking at the same evidence that
Tomlinson looked at, applying the same disciplines that Tomlinson applied, yet would be debarred from reaching the same conclusion as that independent review? How independent is a review that is told that it cannot reach a specific conclusion which was the considered conclusion of the previous review?
Is not the true purpose of the review revealed in the list of hospitals that the right hon. Gentleman announced in his statement? He promised that there would be a particular review of Bart's, Queen Mary's' Roehampton and Harold Wood and Oldchurch hospitals. The House may wonder what those hospitals have in common--it is the fact that they have been the subject of public excitement by Labour Members. The House will notice that absent from the list is Edgware hospital, yet during the general election campaign, the Labour shadow Secretary of State for Health gave a specific commitment to a review of the service changes planned for that hospital. Why are the Government now reneging on that specific commitment?
Why are the major changes for Guy's and St. Thomas's--which will be of concern to the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), the Liberal Democrat health spokesman--not the specific subject of review by the panel? What will be the major changes? What will be the panel's specific role in the current reorganisation of London's medical schools? Does the Secretary of State envisage proposals being made to alter the current process of change in those schools?
If the panel is to focus on issues of particular public concern, will it focus on the reorganisation of accident and emergency provision in London, which has been under way for several years? The right hon. Gentleman will be aware of the Audit Commission report that recommended that accident and emergency provision should be concentrated in departments with more than 50,000 attendances a year. Do Ministers agree with that recommendation, or do they have a different view? Will the panel examine that recommendation, and will it make recommendations on future accident and emergency provision in London?
What assumptions will the panel be told to make about resources for London's NHS? Is the Secretary of State aware of long-standing evidence of the imbalance in available resources between inner London's health service and the health service on the London ring? Are Ministers committed to continue correcting that imbalance, or will they explain to communities on the London ring that resources available for their health care will continue to be less generous than those available in inner London?
What assumptions will the panel make about charges for NHS services in London? What assumptions will it make about charges for general practitioner services, and what assumptions will it make about charges for hospital services? Does the Secretary of State think that charges within the NHS will be a means of squaring the circle of all the commitments that he has made?
The truth is that the review fools absolutely no one, and it will merely delay until the autumn the day on which the Secretary of State will have to make real decisions about the future shape of London's health service. He will
then not be able to prevaricate any longer. He will have to earn his salary and start making the decisions that are his and his alone to make.
Mr. Dobson:
That was a regular rigamarole of insults against a very distinguished group of people--who, at my request, have undertaken to conduct an independent review of health services in London. They believe that the task can be accomplished under the tight timetable that we have established. We have discussed with panel members their terms of reference, their method of working and the timetable under which they will operate. They will do their best, and I do not think that the former Secretary of State's string of insults will accomplish anything.
The former Secretary of State said that we have made the announcement today because all hon. Members are in their far-flung constituencies. The announcement is about London, however, and there are very few far-flung constituencies in London. Moreover, a substantial number of my hon. Friends representing London constituencies are in the Chamber. He may call the announcement a "cheap election gimmick", but we call it keeping our promises. We will keep all our election promises.
Mr. James Clappison (Hertsmere):
What about Edgware?
Mr. Dobson:
The former Secretary of State referred to the Tomlinson report. All I can say is that I want a report that commands if not the approval, at least the respect of everyone concerned. That certainly cannot be said of the Tomlinson report, which was ripped to shreds by Professor Jarman, who is a member of our independent panel.
The reason why I listed specifically four hospitals is that they are currently directly threatened with closure because of the activities of the right hon. Gentleman and his predecessors. It is therefore necessary to review specifically those hospitals, although all other hospital closures and proposals for change will be covered in the review.
Mr. Clappison:
What about Edgware?
Mr. Dobson:
The former Secretary of State asked me to give a specific commitment about medical schools. I can tell him--
Mr. Clappison:
What about Edgware?
Mr. Dobson:
Apparently someone wants to get somewhere on the Northern line. The hon. Member for Hertsmere (Mr. Clappison) would be able to get there quicker if the previous Conservative Government had not prevented ABB getting the new rolling stock rolling.
The former Secretary of State asked me about the review of medical schools. Under the panel's terms of reference, it will advise on how best to maintain the pre-eminent role of medical education and research in the capital. He also asked about A and E departments. It may be that all types of official bodies have said that they are satisfied with provision of accident, emergency and
ambulance services in London. From the experiences that I and my hon. Friends have had over the years in talking to people, however, we know that there is a great deal of concern among Londoners about the adequacy of accident, emergency and ambulance services. We therefore want our independent panel to review the proposals.
I have dealt with all the sensible points made by the former Secretary of State--so far as he made any sensible points. We have established a highly reputable, widely respected and independent advisory panel that will review the future of health care in London, from the point of view of Londoners who need those services. If he is not satisfied with that, I am sorry for him.
Mr. Peter Brooke (Cities of London and Westminster):
The House will recall the notice in a maternity hospital ward that said, "The first three minutes of your life can be the most dangerous," under which someone had written, "And the last three can be pretty dodgy, too." In that context, four months in the history of a hospital that is nearly 900 years old are but a hiccup in history. I welcome what the Secretary of State has just said.
Given that, in the past 20 years, the resource allocation working party formula--which was introduced under the Labour party and sustained by the Conservative party--has been responsible for the movement of considerable NHS resources out of London, will the Secretary of State tell us--at a time when anything is thinkable in the NHS--that he will not rule out extra resources, should the panel determine that they are necessary?
Mr. Dobson:
I thank the right hon. Gentleman for his characteristically generous welcome for what I said. As we have made clear, we are conducting a comprehensive spending review of every aspect of the activities of the NHS. I can make no promises before the outcome of that review, although I realise that, over the years, there have been significant pressures on London. As the right hon. Gentleman said, those pressures are the result, over a long period, of the policies of successive Governments.
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