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Mr. Hughes: That is a perfectly valid question, and I have some proposals to make. I always try to put my own suggestions on the table.

First, however, let me deal with two other troubled sectors. Junior hospital doctors are at risk. I attended a national forum in Bath the other day to talk to junior doctors who feel undervalued and under pressure. It is hard enough to get into medical school. If people come out feeling that the health service does not want them, they will go abroad or into employment in the private sector and our huge investment in the cream of the cream will be lost.

We need more training places, and the Secretary of State is alert to that, but we must also ensure that junior doctors do not believe that they will be abused by having to work too many hours. I do not want to repeat the debate about why the Government proposed a 65-hour limit when they say that they want a 56-hour limit, although it seems to me that something has gone badly wrong. We must correct the message by saying that that proposal has been withdrawn. Until they hear that that is so, junior doctors are right to believe that there is a risk that they will be asked legally to work more than 56 hours and up to 65.

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The third area in which something must be done is general practice. Turnberg said clearly that the number of GPs in London needed to be increased to match numbers in the rest of the country. As the hon. Member for Ilford, North (Ms Perham) may know, we have far fewer doctors per head of population than all other European Union countries, bar one. If we are to have a proper health service, we must have enough doctors.

I have suggested before how we might achieve the right number of health service staff, but I shall repeat my ideas. We could offer bursaries to people to work in the health service, as used to be done for people entering the services or signing on to work for ICI. We could offer a deal, helping people through training in return for several years of service. We could offer loyalty payments to those who stay in the health service rather than deserting for richer pastures.

The regrading proposals being considered by the Government would allow people to be graded at higher levels and paid more while still undertaking hands-on professional activity. We could offer incentives for returnees, not simply saying that they will not have to pay for training, but giving some additional half-year payment if they return for three to five years.

Finally, the Secretary of State was right to say that strategic provision of accommodation for health service workers in London would replace the lottery of being unable to find anywhere because a nurses' home has been abolished. I suggest that the Housing Corporation could be asked to provide, through a housing association, something that might provide corporate housing for the NHS across London. To be honest, some of the hospitals are so near each other that they do not each need their own staff accommodation; but sufficient provision in the right places is needed.

Finally, from the viewpoint of patients, I come to the issue of waiting lists. As the Secretary of State said, waiting lists have come down. However, waiting times have not. The number of people who wait more than 12 months is still in its thousands. Although there are now none waiting over 18 months--nor should there be, because it was a patients charter obligation that there should not be--when will we have a guarantee that no one will wait more than 12 months either between seeing his doctor and seeing his consultant or between seeing his consultant and being treated?

The regional figures for London are still bad news. I have the North and South Thames figures rather than the new London regional figures. Since Labour came to power, there has been a 77 per cent. increase in North Thames and a 112 per cent. increase in South Thames--up from 43,000 to 76,000 in North Thames and from 26,000 to 55,000 in South Thames--in those not seen by their consultant for 12 months or more after having been seen by their GP. In other words, the number of those waiting for a consultation has effectively doubled since Labour came to power. That is no good. It is no use telling a patient that the time between seeing the consultant and getting the operation has been reduced if the time the patient has to wait to see the consultant has doubled. Both waiting times must be considered together. Resources are required to tackle both at the same time.

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Cancelled operation numbers remain high--when people are told on the day or the day before that they cannot be admitted--and need to be tackled.

Mr. John Wilkinson (Ruislip-Northwood): Will the hon. Gentleman give way?

Mr. Hughes: I will not give way only because I am aware that the hon. Gentleman and others may wish to speak and because I have taken a couple of interventions.

The Secretary of State, rightly, introduced a review of beds and we applauded him for it. He tells me that work is being done and that he will return with proposals. Turnberg was clear in saying that we had no excess number of beds in London. We were pleased to hear that because the previous report suggested that there was. Yet, since the Government have come to power, we have lost 651 beds in acute, geriatric, learning disability and maternity provision. We have lost 16 maternity beds, six learning disability beds, 85 geriatric beds and 569 acute beds. As far as I am aware, only mental health beds have increased, by 116. If Turnberg said that we did not have enough beds, for a Labour Government two years later to deliver 651 fewer beds is not to solve the problem. I am prepared to wait a few months for the Secretary of State to come up with a considered view, but he will not honour any implied or expressed Labour party commitment to save the NHS if the Government do not provide the beds we need--not for those who are being dealt with as day-case patients, but for those who need them.

Mr. Clive Efford (Eltham): I should like some clarification of the figures. An extensive building programme is taking place which will result in an increase in the number of acute beds on those that currently exist. Are they included in the hon. Gentleman's figures?

Mr. Hughes: I quoted from parliamentary answers to me about the number of beds when the Government came to office and at the last date when that number was recorded. Obviously, the figures do not include beds that do not exist yet. I accept that there is a building programme and that more beds will be provided, but that is no consolation to a patient who needs a bed now. Therefore, my question is: how are we dealing with the current shortage and when will we make up the shortage, let alone have the additional beds that we need?

On the provision of in-patient services, not only do we need more beds generally, but we specifically need staffed beds for mental health--another Turnberg recommendation--and to ensure that we get the reorganisation of services right. Some of such improvements will be brought about by the new planned Greenwich hospital in the hon. Gentleman's part of the world.

One of Turnberg's proposals is that no A and E department should treat more than 100,000 admissions, based on a report by Professor Browse. Turnberg went on to say:

There may be different views about who did what to the health service in terms of A and E provision, but--the Minister, more than anybody, will be aware of this--

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the Government's decision to confirm the proposals of the last Government, which they need not have implemented, to close the A and E department at Guy's was probably the most unpopular decision that the Labour party has ever made for my constituents. Certainly, it has meant that the Labour party is viewed with much less credibility in my part of the world. Given that the decision has now been made, which clearly my constituents, including Labour councillor colleagues, and I opposed, what is the procedure for making sure that the alternative facilities at St. Thomas's can cope? I have seen nothing to suggest that there will not be more than the upper limit recommended of 100,000 admissions a year having to be treated at St. Thomas's, however good the staff are. We cannot take a gamble on other hospitals being able to pick up the pieces when, for example, we close the A and E department at Guy's.

I shall conclude with a list of proposals. First, for those who are mentally ill and who have a history of violence to themselves or others, please may we have a named professional responsible for co-ordinating their care? In so many cases, the health service, social services, housing department or local authority have all been doing their own thing. Somebody must take responsibility for those people.

Mr. Nicholas Winterton: Is that compulsory?

Mr. Hughes: It is not, but, where a person has such a history and convictions, somebody needs to be held to account to ensure that that person lives in a place where he does not disrupt the neighbourhood, where he has the drugs and takes them if necessary, where if he needs to be readmitted, he will be readmitted, and where if an order needs to be served on him, it will be served. Far too many, although not huge numbers, of such people are wandering around and, regularly, some people are killed and others are threatened and injured by them. I hope that the Government can agree to that straightforward proposal.

Secondly, may we have a system in place so that, if people are troubled by the advice or service given by a GP, they have a right to a second opinion from somebody who might be designated a GP consultant in their area? Many of my constituents have been unhappy with their GP. It is difficult to change one's GP and it often takes a long time to do so. A patient may not want to change his GP, but may just want a second opinion.

Thirdly, may we have a similar system for in-patients? Over the years, a stream of constituents have said that they felt uncomfortable and did not feel that their relative was being treated properly. In every hospital, at every hour of the day, there should be somebody on duty, possibly not employed by the health service, to whom in-patients, friends or relatives can go with their complaint or concern. That person should not be directly involved in the care of the patient. A complaint system that does nothing for six months makes people angry, impatient and frustrated. It may also come too late. A system that deals with complaints there and then would be far more responsive.

Fourthly, may we have a regular review of transport services to and from hospitals? In Sutton and surrounding areas, the local authority linked up with the health authority and the trust to make sure that the buses ran from where people lived and shopped to the hospital at

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the appropriate times. It is no good buses stopping at 6 pm. They need to run during visiting hours in the evening and at the weekends, so that people have access to the hospitals. Fifthly, can we concentrate on improving the waiting areas of many of our hospitals? They are grimness exemplified. A lick of paint and a little money would improve them.

In conclusion, there are lots of big issues coming down the tracks. There are questions about whether London will be prepared for the millennium, and about ensuring that we have primary care groups coterminous and working with local authorities. Our views, however, are these: as soon as possible, there should be a democratic regional tier for the health service in London and we hope that London regional government will be given that responsibility; as soon as possible, there should be a merger between health and social services to reduce management, improve co-ordination and the delivery of services; and all the parts of the health service should be brought together, so that the range of services--from self-medication to NHS Direct, the local chemist, the clinic, the surgery and the hospital--are seen to be part of a family of services to be drawn on, depending on the acuteness of one's need.

However, there must a real growth in the resources allocated to our health service--a growth in the share of the gross domestic product devoted to it--so that we can reach the same levels of care as comparable countries. Without that growth, we shall always struggle. There must be a real growth in the number of staff, who can be paid for from the growth in investment, and a real growth in accountability. We probably have the best health service in the world, but it could be very much better. The people of our capital city want that, and they are asking for it urgently.

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