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Dr. Tonge: I am a little confused by the hon. Gentleman's argument. He seems to be saying that because Mount Vernon is a big cancer hospital--I will not dispute his claim that it is the biggest in the south-east, although the Royal Marsden might also make that claim--
Mr. Wilkinson: On a single site.
Dr. Tonge: That is as may be. He is arguing that the burns unit must be at Mount Vernon because it is a very big cancer hospital. Cancer is hundreds of diseases, but I can think of only a very small number of them that involve plastic surgery as a consequence. I cannot see the connection.
Mr. Wilkinson: Obviously, I defer to the hon. Lady's medical expertise, but, undoubtedly, both the cancer specialists and the plastic surgeons at Mount Vernon all agree that, time and again, reconstructive work following cancer surgery requires plastic surgery. It is just as fundamental as that. Although I do not belittle the hon. Lady's expertise, taking the burns and plastics unit away from Mount Vernon would undoubtedly diminish the scope of treatments available to assist cancer therapy.
Mr. Gareth R. Thomas: I share the hon. Gentleman's view that the intervention of the hon. Member for Richmond Park (Dr. Tonge) was not particularly helpful to those of us who are campaigning for the future of Mount Vernon hospital, but does he accept that the loss of its accident and emergency unit in 1996, against which I argued at the time, has already diminished its status and made it much more difficult for those of us who are fighting to secure its future, as has been put to me by many of my constituents?
Mr. Wilkinson: Of course the hon. Gentleman is right. I remember making a speech in this place 20 years ago in which I argued that the accident and emergency unit at Mount Vernon should be kept open at night. The then junior Health Minister, now the shadow Leader of the House, my right hon. Friend the Member for North-West Hampshire (Sir G. Young), agreed that it could and should be. A few years ago, however, health professionals argued that it was not appropriate to maintain such a facility, that there should be fewer, better-equipped A and E units in
the country and that, in the interests of our constituents, we should accede to the proposed transfer. Against our better judgment, we went along with so-called professional opinion and, as the hon. Gentleman makes clear, the transfer diminished the range and scope of services at the hospital to the detriment of its longer-term potential. I accept entirely what he says.
As for the Hemel Hempstead hospital, it is interesting to note what West Hertfordshire health authority has suggested for its reorganisation of facilities. This is germane to the modernisation of health services in London. Mount Vernon is in a joint trust with Watford general, which is of course in Hertfordshire, so the West Hertfordshire hospital reorganisation programme has a direct impact on Mount Vernon, which straddles the Greater London and Hertfordshire border.
The West Hertfordshire review has hypothesised about, ultimately, a new PFI hospital on a green-field site somewhere in the west of the county. It has not specified where, but, if it were to be built, both Watford general and Hemel Hempstead would probably close. Furthermore, it has laid claim to the new hospital as the location for Mount Vernon's burns and plastics unit. The plot becomes even more complicated because the South West Hertfordshire community health council has officially refused to accept the health authority's proposals, and adjudication rests with the Secretary of State.
I must also mention the work of the Cleft Lip and Palate Association, which is another charity in a particularly important field of medicine for young children. The surgery involved is similar to plastic surgery. The association has always understood the merits of Mount Vernon's work and supported it. I went to its annual general meeting at the hospital only last week.
There is still doubt about the long-term future of Harefield hospital. The Government have conducted a review of cardiothoracic facilities in west London, and the options before us are that things should stay as they are, which would mean that Harefield, which is part of a joint trust with Royal Brompton, would continue in its present form, as I and all my constituents want; that its facilities should be transferred to the Royal Brompton; or that both hospitals' facilities should be combined in a new hospital in the Paddington basin.
Three or four weeks ago, I went to a meeting of the Harefield transplant club, which consists of patients who have had heart transplants and who meet for mutual support. They met at the hospital, as they always do. They were insistent on the merits of Harefield. The hospital is located in open country, in the green belt. It is an ideal location for a heart hospital and it has helicopter facilities, which assist heart transplantation. The work of the heart science centre has already been referred to in the debate. Those in the transplant club pointed out that, although after a heart transplant one is all wired up to machines, it is easy to walk about at Harefield and to go out into the garden. It would be nonsense to try to do that in the busy streets of London. I wrote to the Secretary of State, asking him to see a delegation of the Hamsters, led by me. I am still awaiting his reply.
Mr. Keith Darvill (Upminster):
I welcome the fact that the debate is being held just two years after the general election which delivered an undeniable mandate to this Government to concentrate on the priorities of education and health. Today's debate provides an opportunity to review achievements, discuss progress on the recommendations of the Turnberg report and raise the health concerns that we all have. The debate helps us all to develop our understanding of the Londonwide health issues. More importantly, it will help us to improve care for those who need it in London and to make progress in areas that have not been addressed adequately in our great capital city.
London has lagged behind other United Kingdom and European cities in its lack of a strong citywide approach to health. In preparing for the debate, I have had cause to refer to the public health report, to which the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) referred and which I commend to the House. The report is entitled "The Health of Londoners" and is prepared by the Health of Londoners project. It states:
The creation of the Greater London Authority--the Bill had its Third Reading last night--with an elected mayor for London and a single London office of the NHS executive provides unparalleled opportunities for the health and well-being of Londoners to be given the long overdue attention they deserve.
It should not surprise anyone that poverty, deprivation and social exclusion are the main features affecting health in the capital, as elsewhere. Although inner London seems to fare worst on many, but not all health indicators, the problems associated with poverty and social exclusion are distributed throughout the capital, even in the most affluent areas.
The hon. Member for Southwark, North and Bermondsey referred to a number of points raised in the report, and I want to add one or two important statistics for the record. A total of 940,000 adults in London--17 per cent.--receive income support and 750,000 receive housing benefit. Forty per cent. of the population live in electoral wards that are among the most deprived 10 per cent. of all wards in the country. There are many more statistics that demonstrate the extent of deprivation in London. Such deprivation leads to health inequality and premature death. The report states that the chances of dying before reaching 65 are almost twice as high in the
most deprived areas of London as in the least deprived. That shows that the gap between rich and poor is increasing.
Those statistics were produced at about the time of the 1997 election and illustrate the circumstances that pertained during the Conservative Government. It is clear that, notwithstanding the protestations and assurances from the two Conservative Prime Ministers between 1979 and 1997 and the Health Ministers during those years, the health service was not safe in their hands. It is one of the main reasons for Conservative failure at the ballot box and why there are more Labour Members than Conservative Members in this Parliament.
In stark contrast, my right hon. and hon. Friends in the Department of Health have set about the task of modernising our health service with zeal. Hon. Members will be aware that there is no shortage of reading material and reports on health in London. The most important reference point and the base for this debate is the strategic review of the health service in London, prepared by Sir Leslie Turnberg.
In his letter to my right hon. Friend the Secretary of State dated 18 November, which is when he presented his report, Sir Leslie Turnberg said:
It is important that the decision is made as soon as possible because there is a need to invest in a modern hospital for a modern health service and because of the circumstances of this case. A healthy partnership has been developing between the local authority, the health trust, the community health council, GPs and the five Members of Parliament representing the area covered by the area health authority. Many other decisions are waiting on the decision about the hospital. Community provision, GPs and primary care areas are all awaiting the decision which is, in many ways, the last part of a detailed jigsaw. There are firm reasons why the decision should be made as soon as possible.
The previous Government began to address primary care issues following the Tomlinson report in 1992. In many ways that was too little, too late. The London initiative zone programme badly underestimated the extent to which the previous Government failed in their first 10 years in office. At the time of the Turnberg report, LIZ investment was estimated to have been £265 million. Ultimately, the programme is estimated to have invested £402 million.
Page 33 of the Turnberg report states:
In 1997, in my area, only 8 per cent. of the 124 GP premises in the Barking and Havering health authority were above required minimum standards. I therefore welcome the information provided in the Department of Health's progress report. On page 9, it describes the 73 major schemes that--a year after publication of the Turnberg report--have been completed. Nevertheless, much more has to be done, particularly in my health authority--which the Department's report states is benefiting from four major schemes. However, those schemes go only some of the way towards achieving the minimum standards described in the Turnberg report.
I enthusiastically support primary care groups, which are another major development. A primary care group has been established on the boundary of my own constituency, enabling me to work with doctors who are enthusiastic about the group's work. I congratulate Dr. Haider and Dr. Anthony, who are the group's co-chairmen and are working with the local community in a true partnership. I have attended one or two of their meetings, at which--I am able to report to Ministers--enthusiasm for the group's work was expressed.
People at the group have been telling me that they want to be left alone to get on with creating stability after all the reforms. Nevertheless, I am sure that primary care groups will deliver the rewards that we expect from them.
I believe that primary care groups will have a big influence in addressing some of the issues raised in the LIZ review. I was particularly interested in the review's comments on people attending accident and emergency units. At the North Middlesex hospital, for example, 67 per cent. of patients
"It is time for the health of Londoners to be put fully on the map."
That statement is right and that is what is being delivered by the Government.
"We found a health service under pressure. Services across the whole spectrum of care, from those in the community and primary care to those in hospitals, were sorely stretched. Although the impact of these pressures was most keenly felt in the care of elderly people and those with mental illness, others were not immune from the failures to meet an acceptable standard of service . . . Furthermore, there is evidence to suggest that the pressures are increasing. Despite all this, healthcare workers are doing the best they can and we found examples of good practice, even in areas of severe pressure."
The report makes a number of recommendations, which the Government have accepted. I want to refer to two. First, there is the position of Oldchurch hospital, which has been referred to today by my hon. Friends the Members for Romford (Mrs. Gordon) and for Hornchurch (Mr. Cryer). The report recommends that there should be a new Oldchurch hospital, covering the whole of the Barking and Havering health area. I was pleased to hear the Secretary of State say today that it was one of the areas awaiting prioritisation.
"Despite considerable investment in primary care services in the last few years, services lag woefully behind those in the remainder of the country--the number of practices below recommended standards remains high, too many premises remain poor, single-handed practices represent a larger proportion than elsewhere, recruitment is difficult and the total number of GPs has fallen slightly in the face of a rise across the rest of England."
That is the state of London's health service, at a time when London's population, for the first time in decades, is increasing.
"suggested that their reason for attending was because their GP surgery was not open."
The report also states that the London ambulance service was
"the primary carer for 85 per cent. of patients carried",
and that, overall, London ambulance service
"crews assessed that 13 per cent. of their calls were to patients who should have been dealt with by their own GP."
The statistics demonstrate the extent to which primary care groups, GPs and primary carers generally may help us to make better use of our resources.
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