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12.5 pm

Mr. Alan Duncan (Rutland and Melton): The hon. Member for Harrow, East (Mr. McNulty) kindly referred to this as my first attempt to reply at the Dispatch Box, and indeed it is. It is a great pleasure at last to be dealing with doctors rather than spin doctors.

The hon. Member for Putney (Mr. Colman) has done the House a service in raising this topic for debate. It is a matter of great importance and, of course, of legitimate constituency interest to him. However, he suffered something of a memory lapse when he said that Queen Mary's hospital would enjoy a different future. Indeed it will, but it is very different from the future that his party promised in the run-up to the general election.

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The Conservative health team will endeavour at all stages to be constructive. As we approach the 50th anniversary of the NHS, our mission is to help to develop and to improve it. It may be fertile territory for political combat, but our side will never join battle at the expense of the NHS. This issue requires mature attention. A capital city is a complicated area for health provision. The issue is politically charged, but where there is rapid medical progress, where there are demographic and infrastructure changes, where there is deterioration in buildings and development pressure around them, there is a need from time to time for a fundamental review, which is exactly what we did with the Tomlinson report and, for rather different reasons, what the Government are doing with the Turnberg report.

It is sad that the response to Tomlinson when we were in government was not mature. The then Opposition did not attempt to improve the health service. It was low party politics. The result was that the present Government became boxed in, which is why the Turnberg report was necessary in the first place. It was designed as something behind which the Government could hide. Perhaps the most cynical would say that it was designed as a convenient dustbin for their pre-election promises. It was not about saving hospitals: it was about saving the Minister's face. It is no thanks to the Government that Sir Leslie Turnberg managed to convert his task into such a useful exercise. His starting point was that primary care in the capital matters. I think that we all share that view and recognise that the debate principally centres on hospitals.

The Government came to office with a pledge to review London's health service. They came with a certain amount of pre-election baggage because they had promised an enormous amount to local communities. They played on the fears about the future of local hospitals; many of those who voted Labour believed that a Labour Government would save those hospitals, just as Labour had promised, only to find that they are now severely disappointed.

Ms Margaret Hodge (Barking): Is the hon. Gentleman suggesting that it was a mature decision by the previous Government to close Bart's, and that it is part of the pre-election baggage of this Government to ensure that it remains open as a facility for Londoners?

Mr. Duncan: I will come in a moment to the deceit that the Government have shown on the issue of Bart's and the promises that they made in the run-up to the election which have not been met.

In opposition, the Labour party complained that London had too few hospital beds. One function of the Turnberg report was to allow the Government to claim that London now had about the right number of hospital beds. That was the first step towards their current programme of closures and cuts. The paltry number of extra beds announced the other day by the Secretary of State does not make up the 200 that the Government have slashed from our plans for the new Royal London hospital.

As the hon. Member for Barking (Ms Hodge) has suggested, the Government needed to be able to claim that they had saved Bart's. Turnberg has given them an excellent public relations formula for doing so, despite the

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fact that Bart's is now closed as a district general hospital for the local community--a fundamental element of the campaign to save Bart's.

Mr. McNulty: Will the hon. Gentleman tell us exactly when he will start being mature and constructive?

Mr. Duncan: The hon. Gentleman should perhaps listen to the facts and feel ashamed that the Government he supports have betrayed so many of the promises which, no doubt, helped him get elected.

A raft of promises were made to the people of Edgware and Roehampton, and the Turnberg report has been able help here, too--offering a convenient way of removing accident and emergency facilities from local people.

I should like to ask the Minister certain specific questions which it is his duty to answer. The Turnberg report recommends the downgrading of Queen Charlotte's hospital, with Hammersmith taking on most of the extra work load. We are concerned, as is Turnberg, about the clinical base of Hammersmith hospital. If it is to be able to handle the extra work caused by the transfer of Queen Charlotte hospital's facilities, significant investment in Hammersmith will be needed, and there are concerns about the suitability of the Hammersmith site for such work. May I have an assurance from the Minister on his plans for investing in Hammersmith?

I should like the Minister to explain how the interim period before such investment occurs will be handled. What plans does he have for increased co-ordination with Queen Charlotte's hospital and Charing Cross hospital? How will the financial base for the hospital be managed? Those are important questions which I hope he will answer.

The Secretary of State was proud to have saved Bart's. He admitted as much in the original debate on Turnberg, when he said that one of his principal reasons for commissioning the report was to avoid the history books recording that it was he who closed that ancient hospital. That was noble of him, but Bart's, in the way he promised, has not been saved. Bart's has been closed as a district general hospital for local people. It will no longer serve the community. To its traditional patient base, Bart's no longer exists.

In addition, health care in south-west London was a significant pre-election battleground for the Government. The people of Roehampton--who the hon. Member for Putney conveniently seems to have forgotten--were given specific assurances by their Labour candidates, and they must feel disillusioned that they put their trust in them. The decision in effect to close Queen Mary's hospital, with the removal of its accident and emergency facilities, has broken Labour's pre-election promise to keep that institution open.

Mr. Colman: I see this as a personal attack on me. Will the hon. Gentleman confirm that the decisions to close the acute surgery service and other acute services and to downgrade the accident and emergency department were taken in the November before the general election and were acted on on 1 April, all fools' day, one month before the election?

Mr. Duncan: All Labour candidates who had an interest in the hospital--and in the party's campaign

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nationally--led the country to believe that such a decision would be reversed. That has not happened, and it is that deceit which I find so contemptible.

The Turnberg reforms have many merits. There are questions that I hope the Minister will answer, but it is difficult to trust the Government on something like this in the climate in which they are running the NHS today. People should be aware that, when the Government say that they have increased funding, they have not. There is £940 million less going to the health service than would have been the case had the Conservative party returned to office. Waiting lists have gone up by 137,000.

What in Sir Leslie Turnberg's proposals will suffer as a result of the Minister's panic and efforts to restore waiting lists to the levels that the Government inherited from us? I have high hopes for health care in London, but little confidence that the Government will deliver. They are spending less, closing more and making people wait longer. In that context, it is unlikely that the Turnberg proposals will deliver the health care that we all expect.

12.15 pm

The Minister of State, Department of Health (Mr. Alan Milburn): I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing this debate. This debate is extremely important, not just for his constituents and for him, but for the House as a whole--and particularly for hon. Members representing London constituencies.

The Government share my hon. Friend's aim of ensuring that Londoners in all parts of this capital city have access to the highest-quality health care possible--not just in hospitals, but through primary care and community health services.

For the first time in decades--thanks to Sir Leslie Turnberg and his team, and the Government's adoption of all the recommendations--there is now a clear agenda for health, health services and social care in London. As my right hon. Friend the Secretary of State said when announcing the Government's acceptance of the Turnberg report on 3 February, the time for action on London's health service has arrived.

Sir Leslie Turnberg's team did a remarkable job, and I pay tribute to him and them. The comments of the hon. Member for Rutland and Melton (Mr. Duncan) were astonishing. He must be the only person in this building--he is probably the only person in London--who supported the Tomlinson report, which found no favour with the public, politicians and, most important, with the people who work in the NHS in this city. As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said, there has been universal praise for the way in which the review was carried out, and there has been broad agreement on the diagnosis of the problems.

The recommendations not only tackled major strategic concerns--to which the hon. Member for Rutland and Melton referred--but dealt in a hard-headed way with extremely difficult operational issues. As the hon. Member for Ruislip-Northwood (Mr. Wilkinson) reminded us, those issues do not go away. Change is endemic in the NHS. Turnberg, and the Government's acceptance of the report's recommendations, does not put

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a halt to change in the NHS; it is the start of a 10-year modernisation programme for the NHS in London and its environment.

Watford and the surrounding hospitals are the subject of consultation. We will bear in mind what the hon. Member for Ruislip-Northwood said and ensure that, when the final decisions are taken, they will be in the best interests of patients in his constituency and others served by those hospitals.

We are at the start of the programme which will see London's health service getting better step by step, year by year. It is important that we make it clear from the outset that there is much on which to build. We often concentrate in these debates on things that are wrong, and there is much that is wrong in London's health service. However, there is a great deal of which to be proud as well--great hospitals at the cutting edge of medicine, science, teaching and research, high-quality local hospitals, GP surgeries and more. There are also formidable challenges for London's NHS. The best services in the land sit cheek by jowl with some of the worst.

Turnberg reversed the absurd Tomlinson position that London was over-bedded compared with the rest of the country. The Government seek to build on that important recognition. The hon. Member for Southwark, North and Bermondsey asked whether the commitment to improving waiting lists was continuing. I remind him that Turnberg called for more detailed work on ensuring that we have the right number of beds. That work is being done, and the evaluation is continuing. We will have to ensure that we have the right resources, staff and bed numbers to ensure that we get waiting lists down--we want to do that not only this year, but in subsequent years.

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