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Mr. Letwin: Will the Minister give way?

Mr. Howarth: No I shall not give way--it is very late.

The position is clear: there will be occasions when referendums are appropriate, and occasions when they are not. They cannot create unity where no unity exists, and they cannot change the fact that Parliament is a sovereign body. However, they provide a unique way of consulting the people on specific issues, particularly on policies that are important in particular countries or parts of the country. That is why the Government committed themselves to holding a number of referendums. The electorate endorsed that principle and elected this Government, and we have carried out those promises.

We have had a useful debate, but we should be clear that referendums have a place and will not always be used in every circumstance. They will be used where appropriate.

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Turnberg Health Proposals

10.59 am

Mr. Tony Colman (Putney): The Labour party welcomed the Turnberg proposals in February this year. As I could not ask questions of the Secretary of State following his statement in the House, I will concentrate the bulk of my comments on the effects of the proposals on my constituency. Some of my hon. Friends have said that they will touch on the report's wider implications and what has happened since February. The report was widely welcomed, not least in Putney, whose residents suffered years of cuts in services and uncertainty, particularly in the provision of hospital services.

May I make a declaration of interest? Since 1966, my family and I have been treated at Queen Mary's hospital, Roehampton, my local hospital. I have fought for its retention almost all my adult life. My predecessor also fought for it, but in the last two years of the Tory Government, Queen Mary's suffered severe cuts. Under the Tories, and before I became the Member for Putney, the hospital lost acute surgery, paediatrics, orthopaedics, maternity services--my sons were among the last to be born there--gynaecology and obstetrics. Also before the last election, the accident and emergency department was downgraded. Those cuts totally undermined the viability of the burns and plastics unit remaining on site.

I state those facts because the local Conservatives have been reinventing history in the recent local elections. It is worth reminding the House that those cuts in services were not opposed by my predecessor or by the local Conservative council at the time. It is only since the general election that the Conservatives have done a U-turn, conveniently forgetting that they made the cuts themselves. The cuts were not opposed by the Conservative nominees on the community health council, with the honourable exception of the late councillor, Duncan Hawkins.

The doctors and nurses at Queen Mary's hospital, Roehampton have coped brilliantly and have performed miracles over the past year to cope with those Tory cuts. The Turnberg report gave a vision for a new, secure Queen Mary's hospital--a secure community hospital for the 21st century. I shall devote the remainder of my speech to the future of Queen Mary's and how it has fulfilled that vision in implementing the Turnberg proposals.

More than 90 per cent. of the services previously provided on the site will continue into the next millennium. The transfer of the remaining acute services to neighbouring hospitals is proceeding to plan and the new wards at Kingston hospital will be available in August. However, the out-patient services, which form the vast bulk of the services available to my constituents, will be immeasurably strengthened and improved by a new, integrated care centre offering rapid diagnosis and treatment, out-patient and clinic services in ENT, gastroenterology, elderly care, dermatology, gynaecology--including ante-natal, post-natal and assisted conception--neurology, oral and orthodontics, ophthalmology, orthopaedic and fractures, paediatrics, pain control, plastics, rheumatology, urology and HIV-AIDS, haematology, and a beta-cell diabetes service.

Some 200 in-patient beds will cover rehabilitation and respite care, mental health and elderly continuing care. Day units will continue, including the Bryceson-White

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unit for elderly people, the mental health resource centre and the Bader rehabilitation unit. The nationally renowned skin bank will remain.

I could go on with a laundry list of all the services available at the new Queen Mary's, but suffice it to say that it is a substantial hospital. I thank the Minister for his rapid and positive response to the referral of the proposals from Wandsworth community health council this year. I am grateful for his support for the rapid diagnostic centre, the minor injuries unit, the day surgery up to level 9 under local anaesthetic, and primarily for his support for the financing of brand new hospital buildings through the private finance initiative under a successful business case. A project manager has been appointed; the business case is being worked on and should go to the Minister this autumn. We all hope that building will commence within the next three years. In the meantime, the hospital will continue to use the existing buildings that have served the area well for so long.

The number of acute beds moving from Queen Mary's is 172 but, as I said, more than 200 non-acute beds will remain; 137 replacement beds will open at Kingston, 34 will open at St. George's, 12 will open at Chelsea and Westminster, and two will open at West Middlesex. Those new beds reflect the range of choices that the people of Putney should have. I obtained those figures before yesterday afternoon's announcement of additional beds for London.

The movement of the burns and plastics unit will be accompanied by an identical number of beds in its new location. The new wards that will be available at Kingston in the autumn are of the portakabin type, and it is important that capital is made available for permanent buildings at Kingston and elsewhere. It is also important that the once-an-hour bus service between the two hospitals becomes a half-hourly service. Kingston out-patient services are becoming overcrowded. With shorter waiting lists at Queen Mary's hospital, local health care experts should perhaps look at transferring all out-patients to Queen Mary's hospital from Kingston, thereby releasing space for the required permanent acute care facilities at Kingston.

Sir Sydney Chapman (Chipping Barnet): I reassure the hon. Gentleman that we have one thing in common: both our sons were born in Queen Mary's hospital. However, I am not sure what the hon. Gentleman is trying to convey to the House. He has listed new services and said that many of the services have been moved to other hospitals around Putney. Is that not precisely what is necessary to give rationality to our health service? The hon. Gentleman complained about Tory cuts at Roehampton, but have any of those services been restored on-site? If not, is he not saying that the Labour Government are continuing the previous Government's policies of rationalising the NHS?

Mr. Colman: Clearly, the hon. Gentleman does not realise that, once services are moved off-site, doctors, nurses and facilities are also moved. That has happened. If he suggests that the Tory cuts can easily be reversed, he should go to his local hospital and ask how transferred services can be brought back.

Sir Sydney Chapman: The hon. Gentleman asks me to understand that point; it is a pity that some of his hon.

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Friends did not make that point when Edgware hospital was closed. They gave the impression that the accident and emergency department at Edgware could be reopened.

Mr. Colman: I am sure that my hon. Friend the Member for Brent, North (Mr. Gardiner) will make his point adequately if he is able to attend this debate. I must make it clear that what happened at Edgware and Queen Mary's happened under the Tory Government, and they were responsible for those changes.

The transfer of acute beds from Queen Mary's to Kingston created a balance, but it is important that, as soon as practicable after the transfer of those acute beds, the transfer of beds from Putney hospital should take place. There must not be a gap when Queen Mary's hospital is not used to its full capacity. Following that transfer, I look forward to new health care facilities in a public-private partnership with the local council, housing associations and the private sector, ensuring that Putney hospital continues to be a health care facility for the people of Putney. I further endorse the use of accommodation at Putney hospital by students of the Roehampton institute, a university that has a number of proposals on how it can work in partnership with the hospital across the road.

There is an urgent need to train general practitioners and hospital staff in management issues, particularly in the development of primary care groups and trusts. That could dovetail well with the Roehampton institute's plans for the expansion of health care subjects.

As I said, Queen Mary's continues to have the world famous Bader rehabilitation unit for amputees, with associated prosthetics and orthotics manufacturing workshops, and wheelchair manufacture and service. The workshops have been provided by two private companies--RSL and Steepers--which, in the past few days, have merged. I am pleased to tell the House that I have received assurances from Stephen Horam, the finance director of RSL, that there will be no reduction of the continued operational work force of more than 500, and Roehampton will continue, through the public-private partnership of the NHS and those companies, as a world centre for prosthetics and orthotics.

I welcome the White Paper on the future of the health service, particularly because of the way in which it backs up the principles outlined in the Turnberg report. I especially welcome the encouragement of trust mergers, and I look forward to a reconfiguration of trusts in south-west London, potentially based on the Queen Mary's site. A dialogue has now opened in south-west London between trusts, health authorities, GPs, local authorities and local communities. That dialogue must continue and seek ways in which to achieve a more holistic approach to community services in particular. With the development of larger hospital trusts, there must follow the development of a larger critical mass for community services, to provide an appropriate balance.

The next five years should bring much larger trusts, in terms of geography and service provision. Their roles will include co-ordinating and providing health promotion services, professional development of nurses and other clinical staff, provision of specialist managerial advice and support and, of course, the efficient running of comprehensive primary and community health services.

Queen Mary's and other hospitals like it in London have a key role to play in providing a more local and accessible service for their communities, while seeking

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ways in which to achieve greater flexibility in developing partnerships in care, and shaping local health services to meet the future needs of local people.

On a contentious note, as a former local authority leader, I feel that health authorities should be replaced by joint commissioning by primary care groups and local councils. The Berlin wall could then finally be removed from health care. Local health authorities, forced as they were under the Tories continually to cut back services, often did so in ways unacceptable to local residents--as is the case with Queen Mary's, as fully described in the Turnberg report. It is important to realise that local councils have been managing care in the community for the past six years with considerable success, and with at least 85 per cent. of services purchased from the not-for-profit or profit sectors. That has worked. Local councils should replace local health authorities in London.

I also welcome a single London-wide health authority, as recommended by the Turnberg report, but I hope that on the back of successful trials of local council purchasing of health care, the Greater London authority could take over that London-wide role. I realise that that may take time.

In the meantime, I pay tribute to the work of Sir William Wells, chairman of the South Thames regional health authority until its demise next year. He has done a huge amount in the past five months to ensure that the Turnberg proposals have been put into action in the South Thames region. I wish him well in his new role outside London.

Queen Mary's hospital has been through a difficult period over the past three years, but the time since February has been managed well. The new chief executive, Veronica Cotterill, has led her staff well into a secure future. I pay tribute to Dr. Elizabeth Nelson, the new chair of the Richmond, Twickenham and Roehampton trust, who has done so much to lead from the front and who has plans way beyond those that I have mentioned today. Finally, I pay particular tribute to Mrs. Alex Elliott, chair of the Queen Mary's League of Friends, who is sitting in the Gallery. She represents the most important people--the Queen Mary's community. She spoke last Sunday about an exciting new future for Queen Mary's and the friends' plans to support it. She has been brilliant.

After Turnberg, Queen Mary's has a different future. In the 50th year of the NHS, Queen Mary's future has been not only secured, but strengthened as a model of how the national health service can adapt itself to reflect new patterns of health care, while serving local residents in the most appropriate way for the 21st century.

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