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Mr. Paul Burstow (Sutton and Cheam): I should like to start by picking up on the comment made by the hon. Member for Upminster (Mr. Darvill) that there is still a long way to go in modernising and improving London's health service. I wanted to speak in the debate to highlight a few concerns that have been drawn to my attention in my constituency or that my constituents have raised with me in correspondence.

I should like also to touch on a comment made by the hon. Member for Hornchurch (Mr. Cryer). I should deal with that now, as I believe that he is about to leave the Chamber. He made a very important reference to Professor Millard's report and work on hospital discharge arrangements for elderly people. In that work, Professor Millard--who is a constituent of mine--has highlighted the fact that too many of our senior citizens are being discharged from hospital straight into residential care, whereas proper investment in rehabilitation services would have avoided the need for them to go into such care. We have to ensure that more work is done on the issue, to ensure that independence is promoted and that people may continue to live for longer in their own homes.

Professor Millard's work in targeting that issue complements very well the work of the royal commission on long-term care. I hope that the Government will soon be publishing their conclusions and recommendations on how to address that issue. We are growing impatient to hear how they will address it, and particularly look forward to reading the guidance, which is soon to be issued, on discharge planning. I hope that the Minister will be able to deal with the issue in her reply. I was also grateful to the hon. Member for Hornchurch for mentioning the issue, as it reminded me of that research.

I should like also to deal with the merger, in my area, of the St. Helier NHS trust with the Epsom Health Care NHS trust. Although Epsom is outside the Greater London NHS region, by dint of its merger with the St. Helier trust, it will be covered by the London region. I should like to address a number of issues that have arisen from the merger.

The first issue is the concern expressed--not least by the community health councils covering the new trust--that, at the end of its life, the Epsom trust, which no longer exists, had on its balance sheet a £2.7 million deficit, and that that deficit will be inherited by the new trust. The new trust has conceded that there are substantial cost pressures on its new budget, and that those pressures will impact on its ability to operate. Not the least of the pressures are those arising from the pay award, from the European working time directive and from year 2000 problems.

The deficit issue, and how it is handled, is a particular concern for me and my colleagues in the local community health councils. We are fearful that it will lead to "service reconfiguration"--which, too often, is a terrible euphemism for cuts--so that the new trust's budget may be realigned with the money that the health authority and the Government feel that the trust needs to deliver health care services.

Mr. Casale: It is understandable that the community health council, which is also the CHC for my area, will have some concerns about the merger of the St. Helier and

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Epsom trusts, but my understanding is that it has broadly endorsed the merger. Does the hon. Gentleman generally endorse it? Does he--as he has mentioned thepotential £2.7 million deficit--also welcome the £3 million that the Government have made available for the St. Helier accident and emergency service in his constituency?

Mr. Burstow: Perhaps I should first clear up the matter of where St. Helier hospital is located. It is in the constituency of my hon. Friend the Member for Carshalton and Wallington (Mr. Brake)--who is unable to be here today, but shares a continuing interest and concern, as do the hon. Gentleman and I, about the provision of services at the hospital.

The hon. Member for Wimbledon (Mr. Casale) was right in saying that the community health council, with caveats, indicated its support for the merger. I, too, have been a supporter of the merger--not least because of the need to reach critical mass in being accredited by royal colleges, and all of the consequences that flow from that, so that the hospital is viable and able to operate. I also welcome the long-overdue, but much-needed investment in our A and E department, so that it is able to address the issues, especially at winter crisis time, that seem to have become an element of the way in which the health service operates. However, Epsom CHC is also concerned to ensure investment in the A and E department to secure the long-term future of Epsom hospital. Anything that the Minister can say about that would be greatly appreciated.

Both CHCs have real concerns about service reconfiguration--or cuts. I hope that Ministers will give further consideration to that today. I hope at least that the new London region will do all that it can, together with the two health authorities that cover the new trust, to ensure a soft landing in managing to bring the budget into line with the resources that will be made available to the trust over the coming years.

The problems in the local health economy in my area and in the constituency of the hon. Member for Wimbledon are exacerbated by the deficits that the health authority has had to grapple with over recent years. A recovery plan is in place to bring that budget into line with the Government's target for health authority spending. I dislike the language of targets and recovery plans, because it disguises the way in which budgets are being reduced. That will make it more difficult for the new trust to bed down in the way that many of us, including the people who rely on the services, would like.

Two other concerns arise from the merger. The first is that the two hospitals are several miles apart and the public transport between them is very poor. The local CHC in my constituency undertook some research and found that it would take about four hours to travel by public transport from St. Helier hospital to Epsom hospital and the journey would cost up to £7. As the services of the two hospitals are brought together and economies of scale are achieved, there will be concerns that people will have to make the journey to secure the treatment that they need. My hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) rightly referred earlier to the work that my local authority has done with the local health service to promote better bus services. I am keen that my local authority and the local health service should

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undertake the necessary work now to establish good public transport links between the hospitals to make the trust a reality in the local transport infrastructure.

The second issue is that the trust straddles two NHS regions and two health authorities. The London region will take the lead in overseeing the new trust, but there are concerns among those who represent the interests of patients that the trust may not do so well out of that arrangement, particularly in the Epsom and Surrey area. Anything that the Minister has to say about how the London region will deal with a trust that is not part of its area would be helpful.

I had an opportunity just two weeks ago to lead a deputation of the two local community health councils to see Baroness Hayman. She was very constructive in our dialogue and I was grateful for the meeting. As a result, several messages have been sent back to the trust and the health authority. We look forward to a good on-going relationship between the CHCs and the new trust.

There are two other issues to which I wish to refer arising from my mailbag and representations that I have received from constituents: chiropody services and multiple sclerosis. I regularly attend meetings of the Sutton seniors forum, which recently received a presentation on the joint investment plan being drawn up by the local social services department and the health authority on issues related to ageing and services for elderly people. A well-resourced chiropody service is a key to promoting independence, particularly among elderly people, and unlocking resources that would otherwise be used in acute services and other parts of the care system. The pressures for cost savings are undermining the service, increasing waiting times and restricting the nature of the service that is provided to my constituents and others. Those false economies result in greater costs in the local health and social care economy in my area and in other parts of London.

The need to improve and extend foot care services was not referred to specifically in the Turnberg report, but community health care services were referred to in detail. Although I strongly welcome the merger of the Merton and Sutton Community NHS trust with a number of others to create a new south-west London trust and some of the economies in management costs that should arise from that, I am concerned that the merger may lead to a loss of focus on local situations, not just at borough level, but at individual level. It is essential that the reorganisation of the management structures of health services does not result in the loss of the local connection and focus on delivering appropriate care and treatment. Investment in foot care services must not be overlooked in my constituency or more widely in London. I hope that the Minister will be able to say something about that.

I was fortunate to have an Adjournment debate on MS in February, so I shall not talk about it for too long today. The treatment of MS should be about more than just prescribing beta interferon. It must be set in the broader context of neurological services. A survey last year by the Association of Quality in Healthcare found that 46 per cent. of health authorities did not have service plans or adequate information on which to base plans for tailoring services for those who suffer from MS--rehabilitation services, continence care and many others.

There are only 400 neurologists in the country--the same number as in the city of Boston--and just 58 specialist nurses. At present, 95 per cent. of patients with

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neurological conditions such as Parkinson's disease, Alzheimer's and MS are cared for by their GP, not through neurological services. Such degenerative conditions all too often lead to costs falling on social care, when health care would be more appropriate.

The MS drug therapy that we hear about all too often, with debates in this place about rationing, is not the be-all and end-all. However, since 1995, NHS guidance on relapsing and remitting MS has encouraged prescribing beta interferon in the context of advice from neurologists. In too many cases, even when neurologists advise and recommend its prescription, it is not made available. Constituents have written to me to express concern about long waits.

Two weeks ago, the NHS regions were given new guidance on beta interferon that they were about to issue, but it was not issued. I understand that it would have cast doubt on the prescribing of beta interferon, particularly for secondary progressive forms of the condition. During my February Adjournment debate and during Health questions in April, Ministers declared their intention to refer beta interferon to the National Institute for Clinical Excellence. Why was it necessary to issue new guidance when NICE is being set up to give the Government proper advice?

NICE's work on beta interferon is only part of the picture. We need a national neurological services framework. Will the Minister be able to tell us when such work might be undertaken, so that all the issues can be brought together and dealt with systematically?

I have brought these issues to the attention of the House because they are of concern to my constituents and many others in London and have been highlighted in my correspondence. We value and welcome the progress that the Government are making in some areas, particularly some of the additional resources for A and E, but, as others have said, there is still a long way to go to secure the NHS services that we all want.

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