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5.51 pm

Mr. Mike Gapes (Ilford, South): It is always a great pleasure to follow the right hon. Member for Cities of London and Westminster (Mr. Brooke), who entertained us greatly when we were considering the Greater London Authority Bill. Today, he has raised some interesting issues. Although it is tempting to pursue some of them, I have a specific constituency interest to deal with.

First, however, I should like to raise one other issue for the Minister to address in her reply. As she will know, some months ago, I raised it also with my right hon. Friend the Chief Secretary to the Treasury.

What is being done to tap London's great resource of refugee doctors? My health authority--Redbridge and Waltham Forest health authority--and particularly Dr. Peter Elliott, who works for it, have introduced an innovative scheme to try to train in English and help gain accreditation for refugees with medical expertise or who have worked as the equivalent of general practitioners in hospitals in their own countries before being forced to flee to the United Kingdom. Currently, it is difficult for them to gain accreditation.

I hope that the British Medical Association and other authorities, with the Government's assistance--not only the Department of Health, but the Home Office will have to become involved--will facilitate the employment of refugee doctors, particularly in serving refugee communities where their linguistic skills and cultural understanding would be of great help.

I shall concentrate my remarks, however, on the specific issue that was dealt with at some length in the speeches of my colleagues and neighbours from Redbridge and Havering: the new hospital at Oldchurch, which was pushed for by Turnberg, and endorsed by the Secretary of State in accepting Turnberg's recommendations.

The Turnberg report was submitted to Ministers in November 1997, and the Secretary of State responded to it on 3 February 1998. On that date, I asked him for an

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assurance that development of the new hospital would not have a detrimental effect on the King George hospital--in Ilford, in my constituency--which is only about 3.5 to 4 miles from the proposed site of Oldchurch hospital.

The Secretary of State told me:

I very much welcomed that statement then, as I still do. However, some issues have not been resolved, and the Redbridge Health Care trust and the local community still have some concerns.

The King George hospital is relatively new. It was opened less than six years ago. In that time, the level of activity at the hospital has increased enormously. When it was built, it was planned that there would be 55,000 accident and emergency attendances a year. In 1998-99, there were 90,000. Elective work is double what was planned, and there has been a 49 per cent. increase in emergency work.

The hospital has also had a lot of new investment, with £7.5 million of further capital to develop essential departments and support in pathology, radiology, cardiology and sterilisation services, as well as a new computer linking system with information, advice and facilities for downloading tests for general practitioners. The hospital has put a great deal of effort into its relationships with local GPs. I am pleased to say that, in the past year, waiting lists have fallen by more than 30 per cent., which is, as they used to say in eastern Europe, over-achieving the target. The waiting list situation was not good, but there has been a significant improvement.

Three, four or five years ago, I was critical of my local hospital. At one point, I called for a public inquiry because I was getting so many complaints from constituents about how things were going at the hospital in 1994 and 1995. There has been a significant improvement at the hospital in recent years. I pay tribute to the staff--the nursing and medical staff and the ancillary staff--and to the management of the hospital for the improvement that they have brought about. I receive far fewer complaints about my local hospital than I did when I was first elected to Parliament seven years ago. Of course, there are still complaints, as there will always be with any hospital, and they have to be dealt with properly.

The trust has brought in new ways of working--day-case surgery, overnight day-case systems and opening the unit on Saturdays and Sundays--to deal with the problems. The hospital is now effective, very busy and very popular. It needs to continue the work that it is beginning to do so well. My hon. Friend the Member for Upminster (Mr. Darvill) pointed out how the final decision on Oldchurch was causing uncertainty. As well as affecting the people of Upminster, Hornchurch and Romford, that uncertainty causes problems for the King George hospital in Ilford. The new investment that our hospital needs will be affected by uncertainties and delays at the new hospital. The uncertainty surrounding Oldchurch is making long-term planning more difficult.

The greater co-ordination and discussion between Redbridge and Waltham Forest health authority and Barking and Havering health authority have been

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important developments. There have also been contacts and discussions between the trusts. I welcome that. It would be absurd if trusts competed with each other rather than working together to serve the interests of the local community and patients. Turnberg called for such co-operation and opportunities for collaboration. That is all to the good, but I reiterate my initial point about the importance of there being no uncertainty about the future of the King George hospital as the new hospital at Oldchurch is developed.

There are still concerns among the local community, many of which may be unjustified, but uncertainty may lead to difficulties in future. The argument does not relate to money, egos or competition between trusts. Anyone with any knowledge of the medical profession and the way in which hospitals work will know that any institution requires a certain level of achievement to make it fully viable in terms of the number of junior doctors who are attracted to work there and the number of specialisms that it offers. Increasingly, clinical services are being developed whereby hospitals require a certain volume of patients to maintain the quality of work--doctors need to do a certain number of a particular type of operation in order to keep their hands in.

My worry, which is widely shared, is that a consultant-driven approach may be at variance with community need. We need to get the balance right. It is not just a matter of resources; there must be a balance within the service so that hospitals are viable and attractive. We do not want any one hospital to act as a magnet for the best consultants and people with career aspirations so that other hospitals are regarded as declining backwaters or as failures.

As we develop new facilities, we need to recognise the needs of the existing ones. That view is widely shared by hon. Members on both sides of the House, but it needs reiterating.

Strategic planning and co-operation are very important. As the constituency Member for the King George hospital, let me say that it is vital that elective surgery is not moved away, that the new hospital at Oldchurch fulfils the requirements of its community, and that the two hospitals work together in partnership, as that will be important for the future. The new development must not compromise the future viability of the existing hospital. I am confident that it will not, but my constituents in Ilford want that assurance.

6.3 pm

Mr. Edward Davey (Kingston and Surbiton): I start by associating myself with the remarks of my hon. Friend the Member for Richmond Park (Dr. Tonge). With her experience of more than 30 years spent working in the health service, she analysed the problems that we have in south-west London, and particularly at Kingston hospital, very well.

I am also grateful to the hon. Member for Putney (Mr. Colman), who is no longer in his place. He referred to the problems at Kingston hospital and gave it his full support. Many of his constituents use it; it is a vital service for them, as it is for my constituents. I am particularly delighted that the hon. Gentleman has become convinced of the need for new investment in the accident and emergency department. However, I do not share his belief that the health authorities of Merton, Sutton and

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Wandsworth should merge with Kingston and Richmond. That view was not mentioned in the Turnberg report; nor was it shared by those in the local health authority whom I met.

As time is short, I shall limit my remarks on the wider modernisation agenda, save to focus on one or two technological developments in my constituency. Agora Healthcare, a local software firm--I should say for the record that I have no financial or other interests in that company--is working with a local GP practice and the Kingston hospital to see how they can use information technology to integrate primary and secondary health care to reduce waiting lists. That is a technological development in which the Government ought to be interested.

The company is running a pilot project in a local GP's practice, sending digital photographs of dermatological conditions on-line to the consultants at Kingston hospital to see if they can speed up the process and improve the medical outcomes. By the company's calculations, if the project--which is proving its efficacy--were to be rolled out across the country, it would immediately hit the Government's reduction targets for waiting lists. I commend the pilot to the Minister.

Technological solutions would help in the structural changes in south-west London. My hon. Friend the Member for Richmond Park mentioned the problem of clinical records being lost, and we are concerned about that in the secondary sector. Some consultants saw a patient at the old Queen Mary's site at Roehampton and again later at Kingston. There is a need to improve communication between the two sites and to make sure that the records can be easily accessed from both. That would improve the attractiveness of Kingston hospital as a place to work, as well as a place to be treated.

My hon. Friend the Member for Richmond Park rightly referred to the problems of staff shortages at Kingston hospital. The closure of Queen Mary's has made it worse. I wish to praise the staff of Kingston hospital, who have been working flat out because of the pressure--pressure which is over and above the national pressure about which we have heard today.

The transition from Queen Mary's has been difficult. Turnberg referred to the need for local health managers to have a credible plan for the transition. In an Adjournment debate last spring, I warned about the need for that plan to ensure that we did not suffer huge bed shortages during the summer and autumn of 1998. I am pleased to say that, following those warnings and work with the Government, the bed shortage did not occur. The Roehampton wing was put up on time at the Kingston hospital site, which was good.

There have been problems in the transition, not so much with buildings, as with staff shortages. Despite the best efforts of management, a lot of the staff did not transfer from the Queen Mary's site to Kingston--as the hon. Member for Putney mentioned--partly because of the London salary weightings and the lack of creche facilities at Kingston. However, they were also fed up with and demoralised by the way in which Queen Mary's had been run down over a number of years. They felt that the last change was the straw that broke the camel's back, and they were not prepared to go along with it. Many

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patients and much of the health demand transferred to Kingston, but Kingston did not get a lot of the staff. That has exacerbated the staff shortages locally, and there is still a major hangover from the change.

As my hon. Friend the Member for Richmond Park said, the management of Kingston hospital went over to the Philippines to recruit, and they recruited some excellent nurses. However, it seems absurd that they had to go to the other side of the world to find staff to work in the health service in south-west London. That raises wider issues of pay and training; and there is a feeling that, at Kingston hospital, the transition was not supported as much as it should have been.

Locally, some GPs have not felt that, in the first year of the transition, they could refer patients to Kingston hospital whom they previously referred to Queen Mary's. The statistics show that the transfer of patients has not been as large as was expected prior to the closure of Queen Mary's. That is purely to do with the staff shortages. GPs tell me that, once enough staff are in place and the investment has been made in the space, they will start referring their patients to Kingston.

Investment is urgently needed in Kingston hospital. Comparing the year before the closure of Queen Mary's, 1996-97, with the year 1998-99--the services were transferred from April 1997--we find a massive increase in the work load at Kingston hospital, with 15 per cent. more people attending accident and emergency, a 60 per cent. increase in in-patients and a 71 per cent. increase in emergency in-patient cases. That has created huge pressure, and it is vital that the management should be backed up in the effort to tackle it.

The hon. Member for Putney was right. The investment in the accident and emergency department is crucial. The Secretary of State said that £100 million was available for small improvements in London. Investing in accident and emergency at Kingston would be not only a small improvement for my constituency, but a major improvement for the whole area. I hope that the Government will give their backing to the hospital's long-term future.

There are many good developments in the health service in south-west London. The primary care groups have taken off well in Kingston and I wish them well. Many local people have been involved in campaigns to improve local GP practices and medical sites in New Malden, Surbiton and Chessington, for example. I pay tribute to Chessington councillors who, working with developers, have ensured that land is available for a new medical centre there and that the developers will provide a subsidy to link it to Kingston hospital with new public transport services.

Kingston and Richmond health authority has had below average funding increases for some time. The national average cash increase for the next financial year is 6.6 per cent., but in Kingston and Richmond it is 5.5 per cent. In real terms, the national average is 4.4 per cent., but Kingston and Richmond is getting only 2.9 per cent. Local health managers are concerned that, if that trend continues, they will be really stretched.

The Secretary of State rightly said that the Government should direct resources to where they are most needed--the Government are right to tackle inequality in health care--but sometimes Ministers, not only in the Department of Health, but in other Departments such as

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the Department of the Environment, Transport and the Regions, look at a place such as Kingston and dismiss its needs because it is leafy.

If Ministers came to Kingston and travelled around the constituency, they would see that many parts are not leafy at all. There are pockets of severe deprivation. Norbiton ward, for example, is one of the poorest in the whole of London. Poverty exists in the royal borough. We have below average wages for London. If resources are to be allocated to redress inequality, I hope that Ministers will consider not only the macro-picture but some of the micro-measures.

Some of the statistics that are often used do not give a fair reflection of the poverty in constituencies such as mine. The measure of free school meals is an example. Because the previous Conservative council ended the hot meals service in schools, many mothers on income support whose children would otherwise have a free meal no longer claim their entitlement, because they do not want their children to have a cold meal.

I am concerned about the suggestion by the hon. Member for Putney that Kingston and Richmond health authority could merge with Merton, Sutton and Wandsworth. I urge Ministers not to go down that road, not only for the reason so eloquently expressed by my hon. Friend the Member for Richmond Park--that it would mean another management upheaval, another bureaucratic change--but because it would create a mega-bureaucracy, thus reducing both the flexibility of the management of local health services and the focus on the health needs of the communities that my hon. Friend and I represent.

Such a merger would prevent managers from focusing on the real priorities in Merton, Sutton and Wandsworth, as well as in Kingston and Surbiton. The hon. Member for Wimbledon (Mr. Casale) talked about the merger between the Pathfinder mental health trust and the Sutton mental health trust, but I think that that was a retrograde step for the mentally ill people who were using the Sutton services. They had much more in common with the Kingston and Richmond services, in terms both of those who were delivering the services and of the types of need. That emphasises my point that pushing together bureaucracies does not necessarily achieve a focus on the needs of local communities.

There is much more that I could say, but I am conscious of the fact that several Labour Members want to speak, so I shall finish by saying that, although a lot of what the Government are doing for health in London is welcome, I hope that the Minister will forgive me if my judgment and praise are reserved until we hear the decision about investment in Kingston hospital. That investment is much needed, and it cannot come too soon.

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