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Mr. Peter Brooke (Cities of London and Westminster): I am most grateful to the Secretary of State for giving way, not least because the Middlesex hospital is on the border that separates my constituency and his, and because some of my constituents were among the patients treated. I should like to add my commendation and tribute to those volunteers from hospitals that were not in the front line who spontaneously came in to see whether they could help.

Mr. Dobson: I certainly join the right hon. Gentleman--my good neighbour--in paying tribute to those from other parts of the health service who came forward to volunteer their help. The right hon. Gentleman accompanied my right hon. Friend the Home Secretary on a visit to the UCH Middlesex hospital, which I know was much appreciated.

The NHS in London provides health care for 7 million people who live in London, 1 million who come to work in London and 25 million tourists and other visitors. The service has a hard task. Up to now, that task has not been made any easier by the rundown state of many hospital and other NHS buildings, by disproportionate cuts in beds in London, by the unreliable nature of much vital plant and equipment and by the absence of a Londonwide NHS organisation charged with planning and delivering

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London's health and health care as a whole. We need to modernise London's health service, and that is what we are doing.

The population served by the NHS in London is very mixed. Some people and some neighbourhoods are prosperous and healthy. Others are quite the reverse. In some parts of London, unemployment, low pay, poor housing, crime and disorder, and environmental pollution combine to undermine the living standards and health of hundreds of thousands of local people. The Government's policies are intended to reduce gross inequalities in health, partly by improving health care in the most deprived areas and partly by making those areas and the people who live in them less deprived in the first place.

At the general election, we promised Londoners action on both aspects. We are keeping those promises. Within seven weeks of taking office, I set up the Turnberg review to provide an independent report on what the NHS in London needed. Within seven months, I was able to publish the Turnberg report and announce that the Government had accepted every one of its recommendations. They covered primary care; community health services; mental health services; general, specialist and teaching hospitals; emergency services; and teaching, research and development. All of them aim to improve the treatment and care of patients.

We have got on with making the improvements that are needed. Work is under way on building schemes worth more than £400 million, including new hospitals in Bromley and Greenwich and additional modern hospital buildings at Guy's and St. Thomas's, Central Middlesex, Hammersmith and Queen Charlotte's, Barnet and Homerton hospitals. National priority has been given for a further £350 million to be invested in a modern new hospital at UCH, and major modern developments at King's College, St. George's and West Middlesex University hospitals.

Subject to national prioritisation, further investment of more than £500 million is planned, including new hospitals at Oldchurch and the Royal London, and substantial modernisation at Bart's, St. Mary's at Paddington basin, Queen Mary's at Roehampton, Newham and Whittington. All over London, smaller modernisation schemes have been completed, are under way or will be under way shortly. More than £300 million will be invested in these smaller-scale improvements and modernisations over the next three years. More than £100 million is planned for this year.

London is a major centre of medical research, and we intend to keep it that way because it is good for Britain's reputation as a world leader in medical science and also good for patients. An excellent example of the role of research and development in improving health care delivery is the improvement in mortality of children with meningococcal septicaemia over the past five years in the children's intensive care unit at St. Mary's hospital, Paddington. By centralising critically ill children from the south of England in a single unit that can undertake research into the disease and assess new forms of treatment, greatly improved mortality has been achieved. St. Mary's has 5 per cent. mortality for children suffering the sudden shock associated with meningitis, the lowest rate reported anywhere in the world. That is an important example of the benefits of combining research and service on relatively rare diseases.

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The Turnberg report recommended that we review specialist services in west London, and we have made progress. A west London partnership forum chaired by Lord Newton of Braintree, a former Tory Cabinet Minister, was established last summer to advance that work.

We want local people to receive accessible top quality treatment and care. We also want Imperial College medical school and its NHS partners in west London--especially the Royal Brompton, Harefield, Hammersmith, St. Mary's, Chelsea and Westminster, and Charing Cross hospitals--to maintain and enhance their national and international reputations in medical education, medical research and the development of new, improved, science-based treatment and care.

The leading clinicians in the area have been involved in formulating this new approach. I welcome this imaginative and long-term approach to the problems and opportunities of the area and look forward to receiving further details in due course.

We will not allow the development of these long-term plans to interfere with immediate developments in both services and research in west London. As I have personally told Sir Magdi Yacoub, there will be no planning blight. I am therefore pleased to announce that, over the next three years, we will be investing up to £2 million of NHS resources in a new heart sciences research centre at Harefield hospital. We hope shortly to approve similar investment in a new patient services centre at Harefield and in the Fulham wing at the Brompton hospital.

Work is continuing on the plans to build a new hospital at the Royal London in Whitechapel and transform Bart's into a major specialist cardiac and cancer centre. The distribution of cardiac services between the two sites has been sorted out with the help of Sir Terence English, and I hope to be able to announce the same about cancer services fairly shortly.

In the meantime, children's services have been successfully transferred from Queen Elizabeth's Hackney to the Royal London site, and the centre was opened on 28 October 1998 by Her Majesty the Queen. That was a big boost for the Royal London and demonstrated the commitment of both staff and management, who maintained a top-quality children's service while first meticulously planning the move and then doing the actual moving.

In the meantime, work to complete the Homerton hospital is well under way. The new A and E unit opened last December, the new children's and out-patients' departments will open next month and the work will be completed in May next year. Plans for extra modern acute services at Newham general have been approved.

The east end has also benefited from the extra £9.6 million which went with being designated a health action zone which is concentrating on children, young people and mental health. One programme covers refugees in the area, many of whom are suffering from post-traumatic stress. Other deprived areas in London designated as health action zones are Lambeth, Southwark and Lewisham, Camden and Islington, and Brent. All are helping reduce health inequalities by targeting special help on the most deprived groups in the most deprived areas.

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Since the publication of the Turnberg report, which emphasised the need to improve primary care, altogether 73 new or improved GP premises have been opened in London in the past year, and many more are to come. As a result, the proportion of substandard primary care premises in London has fallen from nearly one half to less than one third.

As in the rest of the country, primary care groups have been established in every part of London. The 66 PCGs bring together for the first time local GPs, nurses, people from social services and lay members--all working to improve the standard of primary care, commission improved services from local hospitals and identify and tackle local causes of ill health--all this in place of the previous Government's divisive internal market, which set doctor against doctor and hospital against hospital.

It will take time before all the benefits of this approach begin to work through, but let me give the House a few examples of how London PCGs are improving treatment and care for their patients.

The Harrow PCG is extending physiotherapy and dietetics services across the PCG, and developing and extending a community leg ulcer clinic which has transformed the treatment of leg ulcers in the area. The Bexley PCG is maintaining and extending physiotherapy, dermatology and chiropody services, and extending rheumatology outreach clinics PCG-wide. The Newham PCG is retaining and extending counselling, dietetics and physiotherapy across all the practices in its area.

Their work will tie in with the health improvement programmes which every health authority now has to draw up to identify and tackle the health and health care needs of their area. It is a modern, across-the-board approach which, again, is possible only because, under the new Government, all parts of the NHS are working together in place of the obligation to compete placed on them by the previous Government.

As recommended by Turnberg, we have increased investment in mental health services and improved co-ordination between the NHS, councils and voluntary agencies, not only in London but throughout the whole country. Last December, I announced a £700 million strategy to deliver safe and modern mental health services. That money is being invested in providing enhanced rapid response teams, more 24-hour staffed beds and more continuing care in the community. In London this year, health and social services will receive about £37 million extra for mental health services.

As recommended by Turnberg, work has begun on developing a Londonwide mental health strategy, drawing on the opportunities provided by new information technology. Part of that has been called by the people operating it a virtual institute in mental health research and development; it is a technological link, bringing together people in London who are doing research into mental health to provide better solutions for patients.

The movement of people and patients in London is very complex. It does not reflect the official, artificial boundaries of health authorities and trusts; that is why a Londonwide office makes so much more sense than the previous arrangements, whereby responsibility for London was divided between two regions, both of which

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also had responsibilities outside London. Therefore, to a quicker timetable than that envisaged by Turnberg, I have established a Londonwide regional office. The upheaval involved was kept to a minimum by good management, and the staff appear to have taken to their new role like ducks to water. Their work has been given a new purpose and dynamism. They will not be expected merely to formulate plans in consultation with the rest of the NHS in London; they will be expected to see to it that the plans are implemented.

The change has brought together health and social care programmes Londonwide, so that they can better work together to promote better and more effective working between the NHS and local social services in every part of London. That is crucial in raising the quality of service offered to elderly or disabled people and people with learning difficulties--for example, by playing a part in helping to improve the joint work among the NHS, local councils and voluntary organisations. That is already paying dividends. All over London, new arrangements are being made to help to look after patients better at home, so that elderly people do not have to go into hospital unnecessarily for want of proper care at home. Patients who have completed their hospital treatment can be discharged in the sure and certain knowledge that, between the local health and social services, there will be someone to look after them properly.


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