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Mr. Colman: Does my hon. Friend agree that one of Merton, Sutton and Wandsworth health authority's major problems is underfunding of the treatment of mentally disordered offenders, and that that underfunding amounts to almost £7 million a year? That dates back to the previous Government because I understand that those costs were moved from the Home Office to the Department of Health, and that the issue has never been properly dealt with. Given the importance of Springfield hospital, which is within the Merton, Sutton and Wandsworth health authority--

Mr. Deputy Speaker (Mr. Michael Lord): Order.

Mr. Colman --that matter should be addressed.

Mr. Deputy Speaker: Order. When I rise the hon. Gentleman should sit down immediately.

Mr. Colman: I apologise, Mr. Deputy Speaker.

Mr. Deputy Speaker: The hon. Gentleman has already made a speech and he is starting to make another one.

Mr. Casale: I understand that the non-recurring deficit is down to about £5 million. The £7 million to which my hon. Friend refers, if properly reflected in the formula, would solve the immediate funding crisis. I have cited some other pressing underfunding issues, but the one to which my hon. Friend refers would in itself deal with the health authority's current problems.

However, it is not just a question of more money for the NHS, although, of course, more for London and especially south-west London is crucial. As the Turnberg report makes clear, we must also involve and consult local people in deciding how that money is spent. As Turnberg puts it, the problem is not whether the public should be involved but how they should be involved.

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The report is rightly critical of old-fashioned and out-moded methods such as public meetings, circulars and so on. It criticises the NHS Executive guidance on public consultation, which, as Turnberg says, needs to be urgently reviewed. Some of the suggestions in the report, such as focus groups and citizen juries, will be familiar to students of modern-day consultation techniques, but consulting the public is a difficult and many-sided job, and deciding how best to do it is difficult. I congratulate the local health authority on setting up a series of regular meetings with hon. Members in my area. They have been valuable, and, as Turnberg acknowledges, the community health councils also play an important local role.

Local civic forums and health forums, and consultations with voluntary and community groups also have a role to play, but the overall question of how genuinely to involve the public remains difficult, given the immensity and diversity of London's population. Moreover, a sustained effort is needed if consultation is to be effective.

My community health council and the health authority produce excellent leaflets from time to time, but, after one or two issues, they peter out. When there is a funding crisis, the flow of information dries up because there is no money to pay for consultation materials. Just when maximum consultation is needed, there is silence followed by cuts in services.

I congratulate the Government on opening the meetings of health authorities and trusts to the public. With the help of my local community health trust, I have obtained the dates of public meetings and, in the coming months, I plan to distribute a list to all interested parties for wide circulation in my constituency. However, we must go further, by having lists of such meetings posted in GPs' surgeries. Perhaps every surgery should have a television set, which could also show films and videos to inform local people. We must grapple with this difficult subject of consultation, so that we can formulate a coherent, sustainable and effective strategy for consultation of local people. It will be a daunting task. The Turnberg report gives pointers, but we need to go further.

Mr. Gareth R. Thomas: The report states that a positive communication strategy is necessary to facilitate pan-London debates on the capital's health service. Does my hon. Friend agree that the excellent result in the recent London referendum augurs well for such a debate under the auspices of a Greater London authority? Does he further agree that one of the reasons for so much under-investment in London's health service is precisely because London has not had a voice?

Mr. Casale: I agree. Londoners are not as aware as they should be of regional disparities in health care. Although the authority may not have a direct role in the expert provision of health care, it should give Londoners a greater say in the shaping of local health care. The Greater London authority will be valuable, as will the London civic forum, in informing Londoners about the key issues of strategic health care in the capital. Involving local people will be the first hurdle that we must surmount, and it is part of the wider consultation strategy on health services in which those bodies will play a vital role.

Local commissioning groups are mentioned in the Turnberg report and they are beginning to take shape in my constituency in line with the White Paper proposals.

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There is a potential cluster of important primary health care trusts in my constituency. At its heart is the Nelson hospital which can be a hub for the services and a future high-quality community hospital. I am working on that with the full co-operation of the St. Helier trust and I should also like to involve the Government and my constituents in that process. I was delighted by the recent visit to my constituency of the Minister's PPS, my hon. Friend the Member for Salford (Ms Blears), to discuss how we can proceed.

It is the 50th anniversary of the NHS, which should be allowed at least to voice a wish list of what it wants for its birthday. For my constituency, I should like to see not only a start made on improving services at Nelson hospital, making it the hub of new services, linking it with the new primary care trusts, but a review of the capitation formula and more resources nationwide for the health service, so that my constituents and those throughout London receive the health services that they certainly deserve and desperately need.

11.59 am

Mr. Tony McNulty (Harrow, East): I wish to make just three quick points under the auspices of this debate. I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing the debate. As has been said, it is much needed.

The three quick points that I want to make are, first, that I think I sit somewhere between those who suggest that we should have directly elected borough health representatives and those who suggest that the Greater London authority should fulfil the role. I said on Second and, I think, Third Reading of the Greater London Authority (Referendum) Bill that it was crucial that the Greater London authority had a key scrutiny role at least in relation to strategic provision for London's health. I still adhere to that view and hope that that comes out when we get to the legislation, but I agree that it should have a strategic role rather than a specific Londonwide commissioning role.

Secondly, it is interesting that the hon. Member for Chipping Barnet (Sir S. Chapman), who mentioned me carte blanche, I suppose, with other north-west London Labour Members in relation to Edgware, has now gone. It is touching that he is now suddenly involved and concerned about Edgware's accident and emergency department. I was a key figure in the campaign for that department for four years and can say happily, hand on heart, that we saw the hon. Gentleman precisely zero times throughout that campaign.

Guilty men were involved in that campaign, but happily we have seen their demise as Conservative Members of Parliament. They are Messrs Gorst and Dykes, who--I choose my words extremely carefully--have lied through their teeth to the public in the past year about some silly bit of paper that they had by way of a promise from the then Secretary of State for Health, the right hon. Member for Charnwood (Mr. Dorrell), about the A and E department remaining open.

The only honest person--again, I choose my words carefully--in the whole process in the then Government was the right hon. Member for Charnwood, who said in June 1996 that the A and E department was closing and

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that he would do all that he could to ensure that it closed long before the general election ensued. He stuck to his promise and, on April fools' day 1997, the department was closed beyond redemption in terms of buildings, legal contracts and assorted other tendering processes. Therefore, we will take no lessons from the now absent hon. Member for Chipping Barnet or from any other Conservative Member--the hon. Member for Rutland and Melton (Mr. Duncan) should please rub the bit about Edgware out of his debut speech from the Dispatch Box.

The third point concerns specialisms, one particular sector on which Turnberg does not really touch; it was not in the brief, which is fine. I have the great pleasure of having the Royal National Orthopaedic Hospital NHS trust slap bang in the middle of my constituency. It carries out orthopaedic work of international repute, which is beyond any challenge. The hospital is a fairly substantial one and carries out a major specialism.

The hospital has been waiting for the best part of 15 or 20 years for the regional health authority to secure its future on the current Stanmore site. The latest bureaucratic nicety from the authority is a musculo-skeletal review, which will determine whether that orthopaedic provision will be available on the Stanmore site, or otherwise. There will be serious ramifications and knock-on effects for surrounding local hospitals throughout north-west London if the future of the Royal National Orthopaedic is not secured.

Happily, the Minister of State, Department of Health, my hon. Friend the Member for Darlington (Mr. Milburn), has agreed to meet me and other north-west London Members to try to resolve the situation. For such a significant national treasure in the NHS still to be floundering after 15 or 20 years with its future not secured is wrong; that situation must come to an end at the earliest possible time. If it does not, and it lingers on and on, the hospital will fail. It will fail ultimately to attract key international personnel, who happily come to it for some work experience and training, and it will fail to attract the brightest national brains in terms of orthopaedic provision and musculo-skeletal work.

I hope that the Minister of State--not necessarily in his winding-up speech, but subsequently, when we meet--will tell us that the position of the Royal National Orthopaedic is assured. I know that His Royal Highness the Duke of Gloucester, who opened a significant scanner on the site yesterday and had the pleasure of visiting a ward there that was named after his father, would endorse the proposals. Everyone in north-west London would. I hope that that proposal, which is, I accept, a non-Turnberg proposal, is addressed sooner rather than later, for the betterment of health provision.


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