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11.13 am

Mr. Simon Hughes (Southwark, North and Bermondsey): I thank the hon. Member for Putney (Mr. Colman) for securing this debate, which is the first since the Government's announcement on the Turnberg proposals four months ago. On 3 February, I generally welcomed the report. It was also widely welcomed in the House and outside, as the hon. Gentleman said. It set out many good paths for the health service in London, and we can see that progress has been made.

First, I congratulate the Government on acting speedily on one of the recommendations, by accepting the logical proposal that London should have one strategic health

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authority. Many of us have argued that case for many years, and the Government have announced that it will be set up next year. Like the hon. Gentleman, I welcome that, but, as the Minister knows, I also believe that we should go further and make the Greater London authority, when it is set up, the strategic health authority for London. In all logic, that should be the case. I know that there are implications concerning what should be done in the rest of country, and that different management structures would be in place, but it would be far better if strategic planning were done by elected people rather than by people whom nobody knows or chooses.

Chapter 4 of the Turnberg report examined locality commissioning, and work is being done on that. I hope that the Minister will accept that there will be a problem if there is not a common set of boundaries with local government. There is a desire to have such common boundaries, within which locality groups fit, and for health authority and local authority boundaries gradually coming together. That would be common sense. However, there is a democratic deficit, and some people have a problem with the idea that developments in primary care will be led by practitioners, rather than by the public, who would make sure that practitioners did what the patients wanted.

The Secretary of State and I had an exchange yesterday on public involvement in health services. He was wrong to say that no party has ever proposed that there should be democratic management of the health service. My party believes that health and social services should be merged under local government control, and that the local authority should therefore also be the health commissioning body. The Government have not come that far, but they are moving in that direction.

The hon. Member for Putney rightly said that the Berlin wall in health care must be broken down. I ask the House and Ministers to accept that there will come a time when we merge health and social services commissioning, as in Northern Ireland. Those services deal with the same people at different stages in their treatment and need, and the illogicality of one service being a local government social services function and another being a separate health authority function does not work for the patient or the practitioner.

I hope that the Government will also seriously consider making more democratic the representation on trusts and health authorities, as well as evaluating the idea of health commissioning eventually being merged with local government. The Government are committed to reforming local government structures; let us not ignore health structures.

The Minister is well aware of the problems in primary care alluded to by Turnberg. In London, we face a severe prospective crisis in the number of doctors and GPs and, in some areas, of nurses and other practitioners. That is very worrying. Some areas of London have staff shortages of up to 20 per cent. By the end of the next five or 10 years, the health service must deal with these problems, particularly in the capital, where pressures are greater and travelling and housing are more expensive.

Ministers probably say privately to their colleagues over the road that they do not want Chancellors, including the present one, to insist on pay awards being staggered, as was done this year. Pay awards should not have been staggered this year. It has not helped; nurses were furious

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and other workers were unhappy. If the economy allows it, as it currently does, pay awards should be made in full to encourage people to come into nursing and the other professions in public services, such as medicine and therapies. I hope that the Minister will tell us--if not today, then soon--how he plans to deal with recruitment needs in London. If we do not meet those needs, we shall be unable to implement all the proposals made by Sir Leslie Turnberg and his colleagues.

On intermediate care, the health service is at an interesting stage. We now realise--as do the Government, and I commend them for it--that the community does not need only intensive care beds, high dependency beds or long-term beds, for respite care or convalescence, or to reduce blocking hospital beds. It needs a network of community hospitals in London, which we used to have. I do not blame this Government for closing them down. I should be interested to hear how the Government plan to respond to that need and open them up.

All areas of London should have a community hospital. To take a local example, I know that, when people, particularly the elderly, from the north of Southwark no longer need acute care, or need other care, they often cannot find it locally. They are cared for at home, if that is possible, or sent a long way from their community, where their partners, spouses, families and friends cannot easily visit if there is no public transport or they have no private transport. I hope that the need for a second tier of in-patient care in London, with and without nursing help, will be addressed.

Sir Leslie's report rightly concentrates on the needs of mental health care in London. Ministers understand the pressure, but the long-awaited paper on mental health has still not been published. It has been much delayed, and we keep being told that it is imminent. The Minister may make an announcement on that. The Under-Secretary of State, who is responsible for mental health matters, has promised to announce the Government's policy in this area.

My plea to the Government is that they ensure soon that London has the 24-hour services that Sir Leslie and his colleagues recommend. People's crisis needs can be greatly alleviated if there is somewhere they can go at any time. Mental health provision for people who are not in-patients is extremely under-resourced.

Some welcome announcements have been made about bed closures. Will the increase in the number of establishment beds in London be permanent? Yesterday's announcement referred to the new beds as beds to deal with the waiting list and waiting times problem. I welcome that, but will they be available next year and the year after? Turnberg said--thank goodness--that we could no longer afford any further closures of hospital beds in London. The NHS Confederation says that, between 1990 and 1996, the number of acute in-patient beds fell by 2,761, which is a hell of a lot of beds. It would be helpful if the Minister could tell us whether it is Government policy to have a particular number of beds and what that number is, and whether the new beds will be included in future projections.

The report considers that the sensible way in which to deal with the planned five parts of London is a separation of acute and elective care to ensure, among other things, that people's planned operations are not cancelled. If that

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can be achieved--it is the logic of the Bart's decision--it will be welcome. The two services should not be muddled.

The Minister would be surprised if I did not say something about the largest hospital trust in the country, Guy's and St. Thomas's. On or near his desk is a set of papers awaiting his decision about the final configuration of services. We must all try to ensure that no health service money is wasted. The Minister knows that, if we do what the trust proposes and move the paediatric department from Guy's to St. Thomas's, a new building will have to be built at a cost of about £50 million, and seven floors of a relatively new building at Guy's will be left clinically empty. The plan is to use them for administration, which is nonsense.

People in charge of the cardiac centre have told me that, at the same time, they do not have enough money to do their job properly. We must ensure that the money is used where the need is, which, I would argue, would require paediatric services to stay at Guy's without huge additional expenditure, and the cardiac centre to have the money it needs, rather than buildings to be built that are not needed.

I hope that the Minister will make people happy, will make the health service more effective and will use money more wisely by making the popular decision that Guy's shall have 400 to 500 beds and the elective care, while acute care is concentrated be on the St. Thomas's site.

The hon. Member for Putney was trying to ensure that Labour was not blamed for Tory decisions. In my part of London, we still believe that Labour should take its responsibility because it endorsed the Tory proposal to close accident and emergency services at Guy's. The Government cannot get out of their responsibility. That may not apply in the hon. Gentleman's part of London, but it was as much a Labour as a Tory decision to close our accident and emergency services. It was certainly not the platform on which the Labour party campaigned against me at the general election. People were told that Guy's would be saved on day one of a Labour Government. If that did not include saving the accident and emergency services, I do not know what they thought people believed they meant.

Yesterday, the Chancellor said that he would continue to be an iron Chancellor. The health service requires a Chancellor who understands its resource needs. Sir Leslie has said that the health service in London needs the resources to do the jobs that we all want it to do. Health ministers will make their case, but the proof of the effectiveness of the Government's health service pudding will be whether the Chancellor next month announces significant increases in resources for the health service in London and elsewhere. Without them, much of what is in this excellent report will not come to pass.

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