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Mr. Nicholas Winterton (Macclesfield): I have followed the hon. Gentleman's speech with interest, and consider that he has made some very good points. He has mentioned people walking or using a bicycle rather than driving. Will he say how that can be brought about? I hope that he will not suggest compulsion, or that people should be dictated to, as I think that setting an example is a more appropriate approach.

Earlier in his speech, the hon. Gentleman mentioned the tragic case of a friend who died of cancer within five or six weeks of diagnosis. I hope that he is not suggesting that that person would have been saved if he had been screened earlier and the disease identified sooner. It sounds to me that that was a case of terminal cancer, and it would be grossly unfair to lay his friend's death at the door of the national health service.

Mr. Hughes: The hon. Gentleman is very experienced in these matters, and is right to raise those points. I agree about the need to use example rather than compulsion, but I also think that there is a place for incentives. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) was deputy leader of Sutton council when it introduced

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an incentive to its work force to travel to work by bike rather than by car. That incentive was a travel allowance, and has become part of good practice. There are all sorts of other practical options, such as providing enough secure cycle racks for cycle users.

I do not blame the health service for the death of my friend. His name was Dave Clark: he was the editor of my local newspaper, and the Minister for Public Health, whose constituency includes Dulwich, knew him too. He died in Guy's hospital, which did a wonderful job on his behalf. However, although it is not possible to screen people at every moment throughout their lives, the chances of disease taking hold could be reduced if people checked their health more commonly, for instance by having their blood pressure checked at work regularly. My brother did not know that he suffered from high blood pressure. He had a stroke at work. It is not certain, but that stroke might have been prevented had there been a routine way of checking blood pressure at his workplace.

The second matter about which I want to speak is sexual health. One of the real challenges in London is to improve the sexual health of people, including young people, and to reduce unwanted and unintended teenage pregnancies. The health action zone in my part of the world has that specific intention, but there are worrying signs. The number of young women who become pregnant at a very early age is still very high, which indicates the need for proper sex education. Another worrying sign is the upturn in the incidence of HIV and similar conditions as a result of unsafe sexual practices.

In a capital city as cosmopolitan, varied and diverse as London, we must use public health promotion opportunities to tackle those problems head-on. Some people may find such methods of communication embarrassing, but more would find them effective.

Thirdly, the Turnberg committee was clear that London's mental health services are the highest of priorities. I welcome that clarity. The committee made two specific points in its recommendations. The first was that there must be minimum standards for mental health services, applicable across London. Those standards should cover maximum waits for appropriate residential care, the speed of response of community teams and the availability of 24-hour support services.

The Government have allocated some money for such services, but I hope that the Minister, when she replies to the debate, will say whether there is a target date by which facilities for people with mental health needs throughout the capital will be available on a 24-hour basis. Those people need to know that such a service does not close at 6 pm, but is available around the clock. There can be fatal consequences if such people are left to struggle on their own with their depression or with the pressures that they face.

The Turnberg committee also recommended that there must be intermediate care facilities with beds for recuperation, rehabilitation and respite care. For those who look after those who suffer mental illness, schizophrenia or depression, or for those who suffer it themselves, somewhere to go for a day or two can be necessary. People need to get away from the madding crowd to be able to recover in calmness. We need community beds as well as acute beds, the type of beds that many constituency hospitals used to have, but have been closed. I do not mean high-intensity or

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high-dependency beds; I mean low-dependency beds which give an opportunity to get away and to seek asylum--in the proper sense--from the pressures of the capital.

On resources, the hon. Member for Rutland and Melton rightly talked of the deficit in the health service at the beginning of this financial year. The Chief Secretary to the Treasury said about a year ago, when he was Minister of State, Department of Health, that there should be no deficit this year. Yet Redbridge and Waltham Forest health authority starts the year with a deficit of £1 million; East London and the City has a small one; Kensington, Chelsea and Westminster has a deficit of £750,000; Croydon has one of £3.5 million; and Kingston and Richmond one of £2.75 million. After two years of Labour Government, London's health authorities are still in significant deficit.

That means that, at the start of the year, money must be found out of the budget intended for front-line services. Among the trusts, University College has a deficit of £3.5 million; Chelsea and Westminster, £3 million; St. Mary's, Paddington, £6 million; and Richmond, Twickenham and Roehampton, £4 million. Trusts and health authorities cannot manage and reduce such great sums if the funding system provides no money from the Treasury to pay them off and no other additional resources.

Ms Karen Buck (Regent's Park and Kensington, North): The hon. Gentleman mentioned St. Mary's hospital, Paddington. The current deficit there was discovered some months after the general election, having been in the system for years without anyone knowing. One can ask how that happened. Undoubtedly pressure was applied before the election to ensure that the scale of deficit was not public knowledge.

Mr. Hughes: I do not dissent from the apparently valid first point. However, I hope that the hon. Lady will agree that, no matter how deficits come about, when it comes to running a trust and delivering services at a place as important as St. Mary's, a deficit of that size requires someone to come to the rescue; otherwise, the trust is left simply paying off the overdraft rather than paying nurses or carrying out care.

Turnberg recommended a review of resource allocation funding. The Government's annual report adds that the advisory committee has concluded its work and changed the relevant formula. The changes look good, although I am not able to say whether they are enough. It would be useful if annual reports set out the cash effect of the changes. Who wins and who loses? Whether for health, transport or local authorities, the formula is often the key. If the formula is wrong, the service suffers badly.

Can the Minister tell us whether the weighted capital has been adjusted to reflect the burden of mental health need in London following the Turnberg recommendation? Turnberg said that more money was needed. If that has not yet happened, when will it?

London is under huge staffing pressure. The report tells me neither how many staff we have nor how many vacancies there are. I know that there are many vacancies for nurses, doctors, midwives, health visitors, health professionals and hospital ancillary staff. We are also losing general practitioners. We do not have enough of

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them--many GPs are coming up to retirement age--and Turnberg recommended that something be done to recruit enough. London is short of dentists, and the report says nothing about what is being done to ensure access for everyone to an NHS dentist. We have lost many school nurses, and we do not have enough counsellors, an important part of the health service professional family.

Pay matters hugely. The hon. Member for Rutland and Melton rightly asked the question that I had asked the Health Secretary on Tuesday about NHS pay. It is no good the Health Secretary blaming the management of trusts and saying that they may receive their P45s if staff are not paid until September. Having announced the pay increase on 1 February, the Minister of State wrote to me on 4 May, saying:

If people were not told until 8 April that they could pay the money, it was not surprising that it was not in many pay packets by 30 April. The Government, not the trusts, gave that authority.

The Minister for Public Health might tell her colleague that, in addition to speedy action by trusts, the Government must press the buttons when pay awards are announced. Nurses have told me how disheartening it is to be told that they are valued and loved, but that no one is sufficiently bothered to make sure that they get the pay increases that they may desperately need.

Ms Linda Perham (Ilford, North): I have listened as the hon. Gentleman has outlined the problems associated with nurses' pay, dentists and doctors in trusts and health authorities, including my own Redbridge and Waltham Forest health authority. I am sure that he appreciates that the Government have put billions of pounds into the health service, so what solution does he offer to all the funding problems?

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