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5.28 pm

Mr. Clive Efford (Eltham): In deference to the hon. Member for Macclesfield (Mr. Winterton), who was not present for the speech of the hon. Member for Rutland

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and Melton (Mr. Duncan), I should like to read out a list of hospitals that have closed in the borough since 1979. The hon. Member for Rutland and Melton made a great deal of closures that were set in train by the previous Administration, but took place after the election of this Labour Government.

The British Hospital for Mothers and Babies was closed, as were the St. Nicholas hospital, the Eltham and Mottingham cottage hospital and the Brook hospital; and units dealing with the cardiothoracic and neurosciences specialties were both closed--all closed when the Conservatives were in government. The decision to close the Greenwich and District hospital was also taken at that time, and the decision to close Guy's hospital was announced just as a brand new building to house important research into cancer and other illnesses had been completed. We then had the discredited Tomlinson report, which recommended that we should lose acute beds because London was over-supplied. Tomlinson justified that recommendation on the basis that top-slicing money from acute services and investing it in primary care would lead to less demand on acute services in hospitals. However, when one devotes money to health areas where access is somewhat diminished, one begins to identify greater need for acute services and secondary and tertiary health care. It was a con to recommend that money be top-sliced from acute services and ploughed back into primary care before we had the opportunity to gauge the effects or the benefits, and it cost the people of London dearly.

That is the situation that the Labour Government inherited: the national health service was definitely under seige. I pay tribute to the staff of the national health service not just for the way in which they responded to the three recent bombings in London, but for their dedication to the health service while it was under seige. While claiming to protect the NHS, the previous Government were trying to dismantle it. It is only the dedication of the doctors and the nurses that held the NHS together so that a future Government could develop it as this Government are doing.

I welcome the initiatives that have been set in train. Primary care groups will bring decision making about local health services closer to the communities. I have argued and campaigned for that move for many years. I am a former chair of a social services committee and a former member of a community health council and a district health authority. I believe that we will see further improvements in planning and in the quality of health care when people from social services sit around the table with GPs, nurses and the lay people who use those services and devise local care strategies.

I totally opposed fundholding, and I remain concerned about the changing role of the GP in relation to patients. Prior to fundholding, GPs were patient advocates. Fundholding made them the gatekeepers of the resources. GPs had a vested interest in reducing access to resources in many instances. Primary care groups must guard against making GPs fund managers rather than planners and advocates on behalf of their communities. GPs will play an important role in leading community discussions as qualified professionals, in developing health care

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strategies and, at times, advocating additional resources rather than cuts. Primary care will need to develop in order to provide a wide range of services.

There is another important issue regarding waiting lists and the care of patients awaiting treatment in hospital. I would like to see more transparency in terms of performances in hospitals, particularly by consultants. I talked recently to a chief executive who described the disparity between the work rate of consultants in an NHS hospital and their work rates in private practice. He also expressed concerns about the relationships between local GPs and particular consultants, and how certain consultants are favoured when GPs make referrals.

The chief executive told me that trusts and providers must act as the gatekeepers for people who are referred to consultants because there is a clear relationship between the size of consultants' private practices and the size of their NHS waiting lists. I realise that that is a generalisation, and I would not suggest that it is true of every consultant. Frankly, however, some of them are behaving like spivs. They say to patients, "I cannot treat you in the next year, but if you cross my palm with silver, I will treat you a week next Tuesday." People on NHS waiting lists are forced to pay for treatment by consultants, and they often see in private practice the same consultant whom they would have waited to see in the national health service.

There should be more transparency on that matter. We have league tables in many areas of public service, so why not for individual consultants? They earn a great deal of money out of the national health service, and there should be performance statistics that not only detail how many operations they carry out within the NHS, but account for what they are doing in the private sector, so that we know their performance rates.

I was cited an example about eye operations. In the NHS, surgeons would perform five or six operations in a session, but, in the private sector, the same consultants would perform nine, 10 or 11 operations in the same time and, in addition, carry out pre-med duties and wheel the patients into the operating theatre to increase the throughput. Incentives must be offered so that such productivity is mirrored in the national health service.

I am aware that other hon. Members want to speak, so I shall be brief. We are about to elect a mayor for London. Someone with such a high profile in a capital city has a major role to play in public health campaigns to improve health and the understanding of health issues across the city.

We need to take more action in schools. I know that we have started that process, but we need to give young people more practical education about the simple facts that we all should learn in our day-to-day lives. I refer to matters such as the storage and cross-contamination of food and the treatment of minor illnesses. The technology and information exist to allow people to take better care of themselves, and young people are certainly capable of accessing that knowledge. If people understand more about their ailments, fewer demands might be placed on the health service.

My local health authority is trying to organise an international conference on health care issues, and its endeavours have the support of the Department of Health. As the authority is responsible for the Greenwich area, it will not surprise anyone that the event will be called the

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millennium conference. It is designed to increase young people's awareness of health issues across the world, so that they will return to their communities and become advocates for better health care. It will also be an opportunity for young people to learn from one another about the issues that confront communities across the globe.

One of the issues that we need to address in future, of which I know the Government are aware, is the provision of better health information. Knowledge can help to reduce the demands made on the national health service because people are then able to take better care of themselves and one another, and within that process, emphasis must be placed on educating young people.

5.40 pm

Mr. Peter Brooke (Cities of London and Westminster): I normally have the pleasure of listening to the hon. Member for Eltham (Mr. Efford) speaking about his experience as a taxi driver, so it is a very great pleasure to hear him on another subject on which he is just as fluent.

I congratulate the Government on providing this debate today. I am not one of nature's great modernisers, although I would not go so far as the Scottish judge who said that change for the better was a contradiction in terms. Such days as this, which are dies non for the larger House because of the constituency imperatives on a polling day that take Members away from here, afford so great, if so narrow an opportunity that I have a practical suggestion to make to the Modernisation Committee.

Since these days are likely to be given to geographical subjects--because some Members are away from the House--I hope that there might be a virtue in reserving them further ahead than the usual fortnight's notice, so that Members know that the debate is coming up. Today's subject is complex, as the great weight of King's Fund reports that gather on one's shelves testify. It is a problem not just to accumulate the data, but as, I fear, one or two speeches have demonstrated, to organise, distil and refine such data. If we have more time to prepare, the debate would be even better than this one.

My constituency references will be brief, but like the dodo in "Alice in Wonderland" there is a prize-giving aspect to the occasion. I shall not seek to match the Secretary of State's encomium on the recent emergencies, which he gave eloquently and wholly appositely. His praise was intensely well warranted and, in turn, a tribute to the well-rehearsed preparation of various national health service institutions.

On a longer-term basis, in 1998, we had in the Kensington, Chelsea and Westminster health authority much the lowest proportion of patients waiting for 12 months or longer of the 16 London health authorities. On the other hand, in 1997, it had the second largest proportion of single-practitioner general practices, at 56 per cent. It was thought that that figure would fall following the closure of Westminster hospital, but, if it has, it remains high and an inner-city phenomenon.

At the other end of my constituency, 11 per cent. of the 564 most deprived electoral wards in England and Wales are in the East London and The City health authority. In that context, it was warming that the Turnberg report singled out the health authority's communication strategy for special and particular praise. I am personally proud

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that Sir Brian Jarman, who is historically linked to St. Mary's, co-produced the Turnberg report and has done such path-finding work on bed use, should be professor of primary health care at Imperial College school of medicine.

Apart from the dodo's prize giving, I must say a word about Bart's, on which there was a mini-clash between my hon. Friend the Member for Rutland and Melton (Mr. Duncan) and the Secretary of State during the opening overs of the debate. I am personally delighted not only at the Secretary of State's decision following the Turnberg report, but at the fact that he is riding herd on the dispositions of Bart's through the appointment of external arbiters.

The papers of yesterday's board meeting of the Royal Hospitals trust give pointers to why there continues to be local concern, to which my hon. Friend the Member for Rutland and Melton made reference. The outline business case for the new hospital at the Royal London and the redevelopment of Bart's was due to receive approval at yesterday's meeting, only to be delayed by further guidance from the regional office on the development of cancer services at Bart's. There is to be an intensive programme of work over the next few weeks to define which services are required in a centre of excellence at Bart's. I could not possibly complain about that, but the path of true love in east London does not seem to have run entirely smoothly.

Bart's leads me more smoothly to the configuration of medical schools in Greater London. Labour Members tend to be critical--I remark neutrally--in what they say about what happened in the NHS in Greater London during the first 18 of the past 20 years. In that process, they omit to pay credit to the reorganisation of London medical schools in the university of London. I should, incidentally, declare an interest as a member of the council of that university. The Flowers and Swinnerton-Dyer reports, early in my time in the House, may seem to belong to another age to those who came into the House in 1997, but they are worth revisiting to realise the scale of the revolution that has since been carried through.

As Turnberg says, 70 per cent. of all research and development expenditure allocated to medical schools by the NHS executive goes to the London schools and 42 per cent. of all medical undergraduates in England are trained in London. He also points out that there can be disadvantages for local services in such a concentration of academic excellence in medical schools.

Other colleagues have no doubt had representations from medical students about the creation of a new medical school nationally. I am making inquiries privately of the Department for Education and Employment and the Department of Health. I am in no way making a bid for another London school, but, were there to be one nationally, it would relieve strain on the London schools. Any light that the Minister can shed on that when replying to the debate will be welcome.

I hope that the London rationalisation will continue. I can remember a conversation at Bart's 22 years ago when the Bart's element at the occasion thought that Greater London could manage with, for example, three centres of excellence in neurosciences. The fact that Turnberg reports on 11 centres in neurosciences being reduced to six is an index of how far we may still have to go.

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The Secretary of State alluded to the link between poverty and deprivation and the quality of health and advanced a claim that the Government were addressing the poverty and deprivation in the interests of good health. Looking round the Chamber, I cannot recall immediately whether anybody else present today was present for a recent interesting statistical analysis given by the Economic and Social Research Council in Room W1 off Westminster Hall on the link between poverty and health. Health was measured by morbidity, whether average or below or above.

Broadly speaking, the ESRC had one table for the 1980s--the tables were calculated by current constituencies--and another for the 1990s to date. My constituency and that of my parliamentary neighbour, the hon. Member for Regent's Park and Kensington, North (Ms Buck), who I see in her place, came in the top 50 poorest out of the 659 by household indices of poverty. The hon. Lady's constituency came high in the list for ill health in both decades and tables. Interestingly, my constituency, which is an inner-city seat--perhaps the ultimate inner-city seat--has jumped from being in the top 100 illest in the 1980s to being in the top half for good health in the 1990s. That was so sharp an improvement that I drew it to the attention of the ESRC, which is separately conducting an investigation.

One contributory reason I have suggested to the ESRC is the arrival of asylum seekers. At the time of Turnberg, 85 per cent. of those granted refugee status had settled in London, with the majority in inner London, and there were 100,000 in London who were either refugees or awaiting confirmation of refugee status, with still larger numbers today. Those refugees are likely to be poor but, on average, they are likely to be younger than the general population they have entered.

I mention that study in the context of the Secretary of State's claim because the ESRC was not so sanguine as the Secretary of State today that the Government were concentrating resources in the poorest constituencies. As a veteran reader of the Black report, which came out at about the time I first came into the House, I was agreeably surprised when the ESRC, when making its presentation, was comparatively warm about the way in which the Conservative Government, by comparison, had targeted resources in that context.

In the same spirit, I want to talk about measurement, accounting and economic inputs. I well remember how few accountants British Telecommunications had when it was a corporation in the public sector. The national health services's accounting was similarly primitive when I first came into the House--incidentally, under a Labour Government--and, as I have said previously, that cost my constituents severely. The resource allocation working party--RAWP--was taking money out of London and the accounting system was rewarding us slowly, and less than adequately, for services that hospitals in inner London rendered to non-London residents in expensive operations where payments were calculated on the basis of average rather than actual cost. I hope that that situation has improved latterly and that the Minister can now sleep at night over the accuracy and fairness of the accounting.

I am, however, concerned about what the Turnberg report said about under-enumeration for the capitation formula; and I can personally believe in that concern.

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Over and above the homeless, the mentally ill and the refugees--all of whom Turnberg deals with--in my constituency mail, proportionally, I receive two letters from residents in my constituency who are not electors for every five that I receive from those who are electors. That suggests to me that there may well be under-enumeration.

Although the Secretary of State, at the beginning of the debate, sailed serenely through the brush on low pay, I shall remark anecdotally--as an occasional out-patient at a teaching hospital, where I see a specialist of high reputation, at his clinic--that the paperwork of appointments is a nightmare for both of us. I am booked for one date; hear nothing further; then am told that I have missed another date; then discover that the date I had originally been given is one on which the specialist is on holiday.

I make no complaint about that at all. I am not seeking special treatment. It is a very good way of finding out what one's constituents themselves have to experience. The specialist puts it down to what the NHS is able to afford to pay clerical assistants. However, it is not conduct that commands respect, and it must be economically inefficient for the consultant, for his patients and for the NHS as a whole.

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