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Mr. Gareth R. Thomas (Harrow, West): The hon. Gentleman used the phrase "retrograde step". Does he accept, with the benefit of hindsight, that his failure to oppose the closure of the accident and emergency unit at Mount Vernon hospital when his party was in government was a retrograde step, and will he take this opportunity to apologise to his constituents--and, indeed, mine--for his failure in that regard?

Mr. Wilkinson: I have no reason to apologise. I initiated an Adjournment debate calling for the accident and emergency unit to be kept open at night when there were plans to close it at night. The then Minister--now my right hon. Friend the Member for North-West Hampshire (Sir G. Young)--acceded to my request, and the unit was kept open at night for a while; but the health professionals believed that its closure would constitute a better use of resources. They felt that it would be better to concentrate on A and E services at what they considered to be better-equipped hospitals, such as Watford general, Northwick Park and Hillingdon. Hon. Members are extremely rash if they arrogate to themselves a professional competence in matters of health service clinical judgment which are rightly in the domain of health service professionals.

I was not happy with the proposal. It went against the grain. Local people, however, were informed that the unit had to close; they were told that the cancer treatment service would be built up, and that that would become the hospital's specialist role--which indeed it has, to the credit of all concerned. I am arguing that organisational changes in the health service in London are putting at risk even the long-term future of the cancer centre.

The proposed changes are fundamental. Paragraph 4.34 of the consultation document proposes that


That is to happen at the beginning of the next financial year. The document continues:


    "inpatient services for non-acute medicine and care of the elderly, together with medical day care, medical outpatient services and the minor injuries service remain on the Mount Vernon Hospital site".

However, the next paragraph states:


    "from April 2001 the above inpatient services of non-acute medicine and care of the elderly, medical outpatients and minor injuries, plus other services, e. g. children's services, should transfer into the community hospital in the north of the borough".

In other words, there is a stay of execution. In the early part of the next century, Mount Vernon will be deprived of much of its bread-and-butter work.

Paragraph 4.37 states:


That is all very well, and a reasonable person would commend such proposals to make better use of skilled personnel; but, at the same time, it is proposed that

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Mount Vernon hospital--which currently forms a joint trust with Watford general--should merge with Hemel Hempstead and St. Albans NHS hospital trusts in Hertfordshire. That will complicate the cross-London boundary dimension of the health service still further.

The North Thames regional executive dealt with both the home counties north of London and London north of the Thames. That allowed co-ordination, which was thoroughly healthy--especially for hospitals such as Mount Vernon, which took patients from north of Greater London. How things will work under the new regional authorities has yet to be defined: I hope that the Minister will be able to explain.

I am particularly perturbed about the future of the burns and plastic surgery units on the Mount Vernon site. Those specialties are crucial to the underpinning of the cancer centre. The possibilities under consideration appear to be the resiting of the entire unit at Northwick Park hospital in Harrow, the resiting of the plastic surgery centre at Northwick Park--with the burns element going to Chelsea and Westminster hospital--and division of the work between Northwick Park and Chelsea and Westminster, with the burns element going to Chelsea and Westminster. I do not comprehend why those changes are proposed; I do not see how they will help to ensure the long-term future of Mount Vernon as a cancer centre.

The same applies to Hillingdon health authority's further proposals. According to paragraph 4.54 of last Friday's consultation document,


Again, there is only a stay of execution.

All in all, it would seem that the powers that be have it in for Mount Vernon hospital--God alone knows why. Mount Vernon is an outstanding institution. Most people who have been treated there, have visited the hospital or have the privilege of working there describe it as a centre of excellence. This death by a thousand cuts would be a tragedy.

I am convinced that my constituents, and those who benefit from the hospital's services, will fight for its future. They believe that it ought to be built up rather than run down, and that the fact that Her Majesty's Government--who have made such play of their commitment to the NHS, during their election campaign and since--should contemplate damaging a premier cancer centre beggars belief. I hope that wiser counsels will prevail.

11.47 am

Mr. Roger Casale (Wimbledon): I congratulate my hon. Friend the Member for Putney (Mr. Colman) on obtaining the debate. I know how hard he has worked to secure the future of Queen Mary's hospital, both before and since his election. I, too, campaigned, in my neighbouring constituency, to keep Queen Mary's accident and emergency unit open. We did not claim that

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it would automatically be restored if we were elected, but I venture to suggest that had my hon. Friend been the Member for Putney since 1992 rather than 1997, the situation at Queen Mary's might be very different.

The Tory Government left the new Labour Government an appalling legacy of underfunding and huge regional disparities in health care. However, we also have another inheritance: the Labour party set up the NHS, and initiated the principles and philosophy behind it, along with the commitment to rebuild it. If there was one reason why support for Labour was so strong in my constituency last May, it was the belief that Labour would rebuild the NHS.

Underfunding in London, including my area of south-west London, is a particular problem, as the Turnberg report makes clear. Some time ago, my health authority, Merton, Sutton and Wandsworth, produced a report called "The River Runs Dry". According to the health authority, that phrase


in the next financial year


    "without major reductions in staff and other costs of our providers."

Since the publication of that report, the Government have made additional resources available, and detailed negotiations to secure a bridging loan have taken place with the NHS regional executive.

I do not share the rosy view of the South Thames regional executive that is held by my hon. Friend the Member for Putney. I hope that proper funding arrangements for the Merton, Sutton and Wandsworth health authority can be secured. Difficult and acrimonious negotiations have been taking place. A local GP told me, "The deficit is being passed from the trusts to the health authority and back again. Nobody wants to be left with the deficit when the music stops."

If the Merton, Sutton and Wandsworth authority cannot get a bridging loan to cover the non-recurring part of its deficit, the consequences for my constituents will be severe. They will look to the Government, in responding to the Turnberg report, to address the specific problem of resource allocation in London. The NHS needs more resources nationally and more must flow to where they are needed most.

My constituents welcome, as does Turnberg, the Government's commitment to a review of the national distribution of funds for the health service. Page 26 of the Turnberg report suggests that that should be done


In the report "The River Runs Dry", Merton, Sutton and Wandsworth health authority states:


    "We have major concerns about aspects of the capitation formula. We spend the vast majority of our resources on what we would regard as high priority unavoidable need and the allocation that we receive does not appear to adequately reflect the needs of our population."

That assessment is consistent with Turnberg's findings for London as a whole. All is not well with London's health service, and the problems must be sorted out.

Coming to grips with the immensity of London's population and the diversity of health needs and life situations of Londoners will be no easy task. One could do worse than consult the list of special factors that are

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part of the everyday reality of health care in south-west London and which are cited in the Merton, Sutton and Wandsworth report. Do other areas spend the same amount on AIDS and HIV treatment and care, on serious mental illnesses, on people with learning disabilities and on mentally disordered offenders? Do other regions have the same diverse cultural mix, the same mobility and the same age profile of the population as London does? Does the present capitation formula adequately reflect those factors? My interpretation of Turnberg is that it does not.

If those factors had been taken into account in the Government's review of the formula, the health needs of my constituents would have been more truly reflected, the Merton, Sutton and Wandsworth deficit would be reduced or eliminated, and local health care resources would be increased.

There are some important proposals in the Turnberg report for cutting the cost of administration by the merger of South Thames and the North Thames regional health executives. In the short term, I am sure that the South Thames executive will ensure that my local authority gets the bridging loan that is needed. In the longer term, we must move away, as my authority wishes to do, from the continuing need for such transitional arrangements by making sure that the formula more truly reflects local health needs. We must also increase the share of national income that is spent on health.


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