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Mr. Davey: I spoke to the chief executive of Kingston hospital today to clarify what he seeks from the region for his A and E department. He is suggesting several options, including renovation, but also including new build. It will be for the region to decide, but the business case has not been withdrawn; several options are being suggested and are now being properly costed. I think that the hon. Gentleman would agree that that is the proper business approach to making that important investment at Kingston hospital.

Mr. Colman: I thank the hon. Gentleman for that additional information and I am sure that he would agree that the site needs an immediate improvement this autumn. I would be concerned by any delay.

My third point about the situation in Kingston is the fact that many of the nurses on the acute wards who were transferred in April 1997 subsequently left, for a variety of reasons, but among the key ones was the unavailability of creche facilities. A bid is being made for a new 48-place day nursery on the Kingston site and I ask the Minister to support it. Another problem in the transfer of the nurses was the move from an inner-London weighting area to an outer-London weighting area. Everything must be done to ensure that nurses do not leave. It is not acceptable to recruit from the Philippines, however good those nurses are, because nurses who have previously worked at Queen Mary's cannot transfer, because of the lack of creche facilities or the diminution in their salaries for moving all of three miles.

My fourth point is the need to ensure that communication links between Kingston hospital and the Queen Mary's hospital sites are improved. At the moment, those links hardly exist and they are crucial to ensuring the development of the rapid diagnostic unit. Further communication links are needed between the two primary care groups that operate from the Queen Mary's site--the Richmond PCG, headed by Dr. Ian Johnson, and the Putney Roehampton PCG, under Dr. Sarah North--to ensure a joined-up national health service in south-west London.

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I also endorse the bid from the chairman of the Richmond PCG, Dr. Ian Johnson, for GP beds on a site at Queen Mary's. Additionally, I endorse the work by the Pathfinder Trust on additional mental health beds as part of the new community hospital at Queen Mary's.

I especially wish to endorse the thrust of the Turnberg report about taking a local and regional approach. The report talked of a health service for London governed by a single bureaucracy, in order to leave behind the North and South Thames regions, but it also mentioned five sectors that would result in a sub-regional approach. I also endorse the South West London community trust, which came into being in the past month by bringing together the Richmond, Twickenham and Roehampton trust, the Wandsworth community health trust and the Merton and Sutton community trust. The new trust will minimise bureaucracy, and I especially endorse the work of Dr. Liz Nelson, the outgoing chair of the Richmond, Twickenham and Roehampton trust and the new chair of the south-west London community trust, and of Lucy Hadfield, the new chief executive. As part of the move to sectoralisation, I hope to see Merton, Sutton and Wandsworth health authority and the Kingston and Richmond health authority coming together, so that we have the primary care groups on a constituency level and a more over-arching approach on a sub-regional basis to deal with contracting.

The Turnberg report clearly stated in its criticism of the previous Government's delivery of health care services for south-west London that there was a need for a clear, unambiguous commitment to fulfil a credible plan. I have described such a plan today. The previous Government left health care in south-west London floundering: this Government, in modernising London's health service, have a clear vision that is being realised.

2.34 pm

Mr. Simon Hughes (Southwark, North and Bermondsey): Like the Secretary of State and the hon. Member for Rutland and Melton (Mr. Duncan), I wish to begin by paying tribute to the health service in London for its prompt, skilled and dedicated work in recent weeks. The excellent and timely work of the ambulance service and the paramedics was followed by the skill and commitment shown by people who worked for hours and hours in operating theatres to try to save the lives of those who had been attacked by the deranged, and to try to ensure that their horrific injuries were minimised and the violation of their integrity as human beings was reduced. The work continues, because people are still in intensive care battling for their lives, and it is a tribute to the best principles of the health service. Those staff do huge credit to their professions.

Hon. Members present for the debate are almost entirely Londoners, because we are exempt from the democratic activities that affect the rest of the country. I said almost entirely, because the hon. Member for Rutland and Melton is a notable exception. There are elections in his part of the world, but there are no Tory candidates.

Mr. Duncan: Forward planning.

Mr. Hughes: If that is forward planning by the Tory party, it must really be in difficulties. The hon. Gentleman is a welcome exception, but the rest of us are here because the Government's business managers wisely scheduled

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this debate today. We welcome it, as we welcomed the Turnberg report. Sir Leslie and his colleagues did a good job and we are grateful to the Government for commissioning the report and for taking from it the guidelines for London's health service.

I welcome also the Government's agreement on the preparation and publication of progress reports on the health service in London. We have now seen the first of those reports and I hope that we have regular, annual reports. Those reports should not only address the Turnberg report and its recommendations--and examine how each is being implemented--but give us the statistics for the previous year, this year and the next year, so that we can make comparisons of simple matters, such as bed and staff numbers. I guess that the House will debate only one more such report, before the matter is handed over to the Greater London Authority, which will properly wish to consider the strategic plans for the health service in London.

Another useful background document, which has not been expressly mentioned so far in the debate, has been published since the last debate on London health. The Health of Londoners Project's report, on the public health of London, was compiled by all the health authorities and it is a valuable document from which much useful information can be gleaned. I commend those who worked on the document, especially the public health directors of the London health authorities, many of whom are eminent in their own right.

All our debates about what the NHS should do must be predicated on the actual state of health of Londoners. The public health document contains various facts about that which confirm how unequal our society is and how severe some of its health problems are. For example, the document reveals that one third of London's secondary school pupils are eligible for free school meals. That is a hugely high figure for the end of the 20th century. According to definitions that I did not devise, the number of London people living in poverty rose from 14 per cent. in 1983 to 24 per cent. in 1992. Some people are in a worse financial and social position than a decade ago.

As the Secretary of State noted, indicators of homelessness, of domestic violence, of the numbers of people out of work, of those claiming income support, and of the numbers of families in which no one is in work and 324,000 children belong to such families--all show the social context of the work of the NHS in London. People must have the best opportunity to achieve the best health. We can begin to understand the pressures when we discover that two thirds of the asylum seekers and refugees who come to Britain come to London.

The Government, and their predecessor, rightly tried to define public health priorities. Three of those priorities relate to premature deaths, and are hugely important in London. Those priorities are to reduce the number of deaths from cancer; to reduce the number of deaths from heart disease, strokes and related diseases, which in large part are activity-related; and to reduce the numbers of suicides, and therefore the incidence of the mental illness that leads to suicide.

Although cancer mortality rates for people under 65 are falling, in Greater London and elsewhere, my experience is that huge numbers die from cancer in London who,

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with early detection and treatment, would have survived. A friend of mine died in that way last year, five or six weeks after first diagnosis. He left a teenage son, and his is one of the tragedies that all hon. Members would want to prevent.

Such problems are not outside our control. Politicians with the right social policies can resolve them. I hope that we are united in our determination to ensure that people's chances of surviving are improved. That is a bigger task in London than anywhere else in Britain. I pay tribute to the Government for having that commitment. I shall support them and work with them to deliver on it, although I shall also have a go at them when I think that they have got targets or priorities wrong, or when they do not deliver as they should. However, I hope that all hon. Members share the same goals and motivation.

I hope that Ministers will consult members of the Opposition parties--perhaps outside the House--to agree the figures and indicators used in annual reports. That would ensure a common basis for information. Debates such as this are often bedevilled by the political manipulation of statistics. Independently audited statistics--for example, about waiting lists, and so on--would ensure that we do not have to argue about their accuracy.

Three elements in the national targets require continued effort. The first is general health. We can reduce the number of people who become ill from circulatory diseases by reducing accidents, improving public transport and cutting air pollution. Above all, society should encourage people to exercise, walk and cycle, rather than be increasingly less active as they grow older.

Obesity and inactivity are bad for health, but increasingly evident. That is why it is important to try to cut out unnecessary car journeys, to encourage people to take their children to school on foot, and so on. If children are encouraged to walk or cycle to school, or if adults are encouraged to get to work on foot, or by bicycle or public transport, where possible, there is a direct effect on their chances of living longer. Such incentives, if got right, can lead to a huge reduction in death or illness rates.


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