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Dr. Lynne Jones (Birmingham, Selly Oak): My hon. Friend is right to refer to the climate of mistrust that has developed in Birmingham whenever we consider proposals for the reconfiguration of our health services. That is largely because people feel that change is finance driven to make savings and cut hospital resources. If we are to overcome that mistrust, it is essential that the health authority brings people along with its plans. Because of the perception that private finance is the only way to get capital resources into the health services, only schemes for which private finance is obtainable will be promoted, rather than schemes that are genuinely needed. That problem must be addressed if we are to get confidence in Birmingham--

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. The intervention is far too long.

Mr. Burden: My hon. Friend makes an important point. The debate around private finance will go on.

It is important for my hon. Friend the Minister to hear what I am about to say, and for it to be heard outside the Chamber. The climate of mistrust is understandable, as my hon. Friend and I have acknowledged. As the debate continues, people must listen to what is being said, whether by the health authority, the trusts or the other stakeholders, rather than the worst possible construction immediately being put on every document and submission. That results in trench warfare that sends all the wrong messages to Government and does not move the health debate forward in Birmingham.

My hon. Friend the Member for Selly Oak has adopted a highly constructive and positive view of health services in the city and has worked on that for a long time. My other hon. Friends in the Birmingham group of Labour Members have also done so. It is important that, as a city, we get ourselves together, work out what we want and go for it. If we do that, I am sure that we will get support from the Government.

1.15 pm

The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng): I congratulate my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) on securing time to debate this very important subject. In a health authority area that encompasses seven acute trusts, two community trusts and two mental health trusts, and spends over £500 million annually on health services, it is critical that the long-term strategy for those services is robust. My hon. Friend's interest in the matter and his contribution over a number of years enormously assist us in taking forward the health interests of Birmingham constructively, as does the involvement of several of my other hon. Friends from Birmingham in the debate.

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It is important to note that the debate--the tenor of which we got this afternoon--and the discussion are far from over. The conclusion of Birmingham health authority's recent public consultation on 2 March was an important starting point in developing a long-term strategy. The term "starting point" is probably a misnomer, because, as my hon. Friend mentioned and as anyone who takes an interest in the matter will know, there is a lively history of such reviews in Birmingham.

We must make sure that we do not end up with a bungled or botched job. That characterised the activities of the previous Government in relation to the health service in Birmingham. We must move to a sustainable and sustaining settlement of the outstanding issues.

A previous plan developed in the late 1980s, entitled "Building a Healthy Birmingham", failed because of the sheer scale of the capital investment that was required and its tendency to exclude primary care. It required an investment of £550 million, mainly for acute services, and a significant increase in acute beds. The previous Government's obsession with the market, the introduction of capital charges and the way in which health care was developed meant that the scale of the investment required became unsustainable.

My hon. Friend graphically described the need to invest in Birmingham, not least in a respect dear to this Government--the importance of ensuring that we tackle the scourge of breast cancer in a way that does not add to the suffering and pressures of those experiencing this condition. There is a need for more investment and to take forward proposals capable of commanding the support of the entire community.

The debate in Birmingham is taking place against a background of what my hon. Friend described as mistrust and suspicion, but we must look at the positive aspects. The relocation of the cramped and rundown Birmingham Children's hospital to the site of the former Birmingham general hospital--which will be completed in May 1998, and forms an investment of some £30 million--is good news and will deliver health gains.

There have been achievements in terms of the reprovisioning of the existing single-specialty hospitals on to acute hospital sites, where they would have all the clinical and support service back-up needed for modern health care. This has taken place after public consultation and--excluding the Royal Orthopaedic hospital, where special considerations applied--has been achieved with success.

The newly merged health authority in Birmingham must ensure that momentum is not lost, and it will ensure that steady development, year on year, keeps pace with the changing NHS. Birmingham health authority held a series of stakeholder conferences in June and July last year, each one based in the catchment area of one of the cities for main acute trusts. The contribution from those conferences formed part of the strategic planning which culminated in the consultation document.

The document sets out a number of choices, each reflecting an aspect of health care and looking at the effects of social deprivation on health. My hon. Friend is right to draw attention to Birmingham's specific problems. We have seen a positive change in the

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introduction of the needs element of the weighted capitation formula. Birmingham was the eighth highest gainer in the country and is now within 0.03 per cent. of its weighted capitation target.

My hon. Friend referred to the problems associated with providing high-quality primary care and the reliance on single GP practices and aging GPs, and the retirement which inevitably follows. Those will require careful managing. Inevitably, that must take place within the key principles laid down in the White Paper. The emphasis is very much on partnership.

The days in which the NHS was bedevilled by the obsession with competition and the market, which characterised the previous Government, are over. The emphasis in the new NHS is on co-operation and collaboration. That is good news. We want to maximise care for patients and shift the focus on to the quality of care, so that excellence is guaranteed to those patients.

Ms Gisela Stuart (Birmingham, Edgbaston): Will the Minister take account of the lack of GP recruitment within Birmingham? Simply saying that that "needs careful management" may not be adequate, given the tremendous need in some parts of the city--particularly around the city hospital.

Mr. Boateng: My hon. Friend speaks with authority on these issues, and she is right to draw the attention of those with responsibility for recruitment in Birmingham to the need to ensure that the requirements she has highlighted are taken on board.

In responding to the needs of the times, we must look at a number of models for primary care and the possible creation of ambulatory care and diagnostic centres. We must examine acute assessment, emergency admissions and intermediate care facilities for rehabilitation. The consultation document addresses those issues, which are important--particularly to the care of the elderly. We want to make sure that the lives of elderly people in Birmingham are improved in terms of their capacity to contribute actively to the community.

Dr. Lynne Jones: On rehabilitation services, there is a worry in Birmingham that the use of nursing homes and other facilities for care which was previously provided in hospital could lead us down a slippery slope towards charging. Will my hon. Friend assure us that the Government will reject that approach?

Mr. Boateng: I am anxious to make sure that we have a mixed market. We must recognise the contributions of the voluntary and private sectors, and we need to make sure that managers are innovative and prepared to look at new ways of delivering rehabilitation and recuperation. I strongly urge Birmingham health authority and the local authority to think boldly and imaginatively. They must work together to meet the needs of this vulnerable section of our society.

We have issued guidance to the health authorities as part and parcel of the White Paper principles and how we intend to implement our proposals. The integrated programme of action that we set out in "The New NHS" and those elements of the Green Paper "Our Healthier Nation" is where early progress needs to be made. That is the background against which decisions will be made about health care in Birmingham.

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My hon. Friends will understand that it is not my place, or that of any other member of the ministerial team, to comment on the health authority's specific proposals. There may come a time when that is necessary, but it is not now. The Government expect all strategic plans to take forward the interest of patients and health and social care, and to take into account the principles outlined in the White Paper. We want to make sure that we work together in a way that puts the patient at the heart of all that we do. The primary care groups and their development are important, and we must make sure that the local authority and the health authority work ever closer together.

On a recent visit to Birmingham Heartlands, I was enormously impressed at the way in which the NHS and the local authority are working together, and the real contribution that is made by social workers and clinical professionals alike. It is in that spirit of co-operation and collaboration that we will best serve the interests of all the people of Birmingham.

I am grateful to hon. Members who have contributed to the debate, and to my hon. Friend the Member for Northfield for taking the lead in bringing this important matter to the attention of the House.


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