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Mr. Roger Casale (Wimbledon): I welcome the opportunity to comment on the Government's plans for modernising the health service in London. I should like to report to the House and to the Minister the progress that is being made in my constituency and in Merton, Sutton and Wandsworth health authority to rebuild the national health service in south-west London and equip it to meet the health challenges and demands of the 21st century. That is happening in the context of wide-reaching demographic change, but in the knowledge that the Government are committed to giving the British people the health services that they need and deserve.

We inherited from the Tory Government a health service that was underfunded and demoralised, fragmented and inefficient and in which competition for scarce resources between different parts and sectors of the health service threatened to undermine the core values, principles and ethos of what was a truly national service and the envy of the world. In just two years, the new Labour Government have put in place a framework for massive year-on-year funding increases, a strategy for tackling health inequalities and a vision for the future of our health service based on modern forms of organisation and a new culture of partnership and consultation to identify and meet health needs.

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In London, the Government moved swiftly to set up a strategic review of the health service under Professor Sir Leslie Turnberg. I welcomed that decision and the report when it was published and debated last year. The shortcomings of the health service that we inherited from the previous Government were perhaps no more starkly in evidence than in London. A comprehensive review of health service provision from its very foundations was a strategic priority for London and for the national health service.

Alongside the commitment to increase funding--£21 billion over the next three years--the Government's commitment to implementing in full the recommendations of the Turnberg report stands as a further milestone along the road to rebuilding our health service. My local health authority area has felt the impact of those commitments immediately and will continue to benefit from a Labour Government delivering on their promises for many years to come.

London has suffered from a funding formula that has not truly reflected its health needs. Following a delegation last year to the former Minister of State, Department of Health, the right hon. Member for Darlington (Mr. Milburn)--now the Chief Secretary to the Treasury--which I led and in which the hon. Member for Sutton and Cheam (Mr. Burstow) and my hon. Friends the Members for Putney (Mr. Colman), for Battersea (Mr. Linton), for Tooting (Mr. Cox) and for Mitcham and Morden (Siobhain McDonagh) participated, I am delighted that there will be a freeze on further changes to the existing formula to review key factors such as the age profile and ethnic composition of London's population. I understand that the freeze will continue until 2001, when the working group will report.

The establishment of a Londonwide regional health executive is also a major step forward. Indeed, without it, it is difficult to see how a strategic approach to dealing with Londoners' health needs would be possible. However, I welcome the new regional health executive for the efficiency savings that will now be made by cutting down administrative costs--savings that will be reinvested in the health service in London to reduce waiting lists further and deliver improved front-line patient care.

Organisational change is also taking place at the sub-regional level in south-west London, and I endorse the merger of the Epsom and St. Helier trusts and the appointment of Jennifer Denning as the new chair. Similarly, I am pleased to endorse the community trust merger to which my hon. Friend the Member for Putney referred and the appointment of Dr. Liz Nelson as chair. The new trust will not be coterminous with the health authority area, but I support it because the inclusion of the Richmond trust will provide the critical mass necessary to make Queen Mary's hospital, Roehampton viable as a community hospital and also because of the strategic advantage of such a merger in the context of providing a quality health service for south London.

Most of all, however, I should like to take the opportunity to thank the Minister for the extra resources that have been made available to my local health authority over and above what was due to us through the national resource allocation on the existing formula. London--and especially south-west London--had been so starved of resources by the previous Government that one of the first

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reports that I was given to read by my local health authority after my election in 1997 was entitled "The River Runs Dry".

This year's budget for Merton, Sutton and Wandsworth health authority represents a cash increase of 6.3 per cent. and a real-terms increase of 3.8 per cent. In addition, the Government have provided £3 million to improve and enlarge the accident and emergency department at St. Helier and £2 million to cope with winter pressures. As a result of those and other changes, the burden of financial deficit across the local health economy has been reduced from £25 million in 1997-98 to £3.4 million for 1999-2000. The reduction in waiting lists at St. George's and St. Helier and across Merton, Sutton and Wandsworth health authority area has exceeded the Government's target by 4.3 per cent.

Further much-needed and important organisational changes are also going ahead at the initiative of local health decision makers and with the support and active involvement of the Government. In respect of mental health care, for example, Sutton and Pathfinder mental health services are to merge and Pathfinder has now received approval to redevelop its provision on the Tooting site. One site will now provide in-patient adult services for all Merton residents and a women-only area will be part of the new development. Most important, six primary care groups are now in place across the health authority and chief executives have been appointed to each.

The Nelson primary care group in my constituency, jointly chaired by Dr. Howard Freeman and Dr. Martyn Wake, is already playing a key strategic role in shaping the way in which health services will be delivered in our local community in future. Together with the St. Helier trust, the health authority and other local stakeholders, the Nelson primary care group is developing exciting new plans for a new community hospital on the site of the Nelson hospital in Wimbledon. The project will eventually house the Nelson primary care group and give local commissioning GPs a central role in the delivery of consultant-led services on site, relieving the strain on the large district hospitals and providing locally based services to the community in the heart of the community and, thanks to the community health council and the Wimbledon Civic Forum's health forum, in partnership with the local community.

New developments are also expected with regard to the future of the Atkinson Morley's hospital in my constituency and I thank the Minister for his intervention last year to ensure that the paediatric neurosurgery unit currently based at the Atkinson Morley's hospital will move with the rest of the neurosurgery department to the new PFI-led neurosurgery and cardiac unit at St. George's hospital in 2002.

For all the false sentimentality expressed by the hon. Member for Rutland and Melton (Mr. Duncan) about health service buildings, it is important to remember that Labour is more interested in the level of service. Atkinson Morley's services are not being broken up or reduced; they will be moved in their entirety to more modern buildings at St. George's, and I support that move.

I close my remarks by referring to what may be the most difficult and challenging task facing the Government in their drive to raise standards of health care across

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London: the need to bring about a cultural shift in the way in which the health service operates as the NHS moves to centre stage as the key public institution in our joined-up approach to creating a fairer, stronger and more equitable society. "Partnership" and "consultation" are the key words. They are easy to say--we all know what they mean--but more difficult to put into practice. How many of us know how to do that effectively?

Historically, the whole ethos of the NHS rests on co-operation and partnership to take forward a common endeavour in the public interest--caring for the nation's health--but that ethos was systematically eroded by a generation of Tory Governments and it will require not just good faith and good words, but hard work, organisation and perhaps further statutory duties to consult in order to reverse the decline. For example, consultants will have to learn to work more committedly in partnership with doctors if community hospitals and primary care groups are to deliver their full potential contribution to public health. It will not be enough to knock down the Berlin wall between social services and health services; many bridges will need to be built if we are to achieve a seamless service as planned.

Throughout the process, clear performance criteria must be laid down. Those criteria must be public and they must be publicly monitored. Above all, local communities and patient groups must have a stronger voice in the framing of health improvement plans and the shaping of local health strategies generally. Such an approach will help to deliver quality and equality in the health service by rooting out substandard performance and by identifying best practice and spreading it around.

The Wimbledon Civic Forum, which I established in my constituency and which I chair, brings together local residents and community groups to discuss issues of common concern with key decision makers. It is a valuable additional channel for communication and consultation in that regard.

The Wimbledon Civic Forum's health forum, under the chairmanship of Mr. Albert Johnson--together with the local community health council, under Dr. Lea McDonald--is leading the consultation on service provision at the new Nelson community hospital. The health forum has also held meetings with the chief executive of the health authority and the head of social services of Merton council to discuss the authority's health improvement plan, its strategy on mental health care and the authority's relationship with local community and social services. I ask the Minister to encourage such initiatives as a valuable way of helping to promote a cultural change in the way in which all our public services operate, as much of our success in modernising the NHS in London will depend on bringing that cultural change about.

In conclusion, our future in Merton, Sutton and Wandsworth is now vastly better secured as a direct result of the Government's response to Turnberg, the comprehensive spending review and the additional benefits delivered by the Government over and above these two, such as NHS Direct, walk-in centres and many others. I assure Ministers that, in my constituency and in south-west London, we support and are working to implement the changes that they are seeking to bring about across the country as a whole.

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4.41 pm

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