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Mr. Dobson: It was 50 per cent., not 100 per cent., before.

Mr. Horam: Exactly--it was 50 per cent., but it has now gone down to 40 per cent., which is a deterioration of 10 per cent. under the Labour Government. Because of simple incompetence, the situation has deteriorated since Labour got into power. The story is the same in the London police service, and we now have fewer police in London. The fact is that, since Labour got into power, things have got worse in accident and emergency units, on waiting lists and in the ambulance service.

As London Members of Parliament, we all know how important primary care is and how dependent on it we are. Hon. Members on both sides will admit that the Conservative Government did a great deal to improve the quality and quantity of primary care in London. We disagree on the question of GP fundholding, but the right way to deal with what the Government perceive to be the problems arising from GP fundholding--that it may, in certain circumstances, increase the number of tiers in the health service or affect the way in which patients whose GPs are not fundholders are treated--is to make every GP a fundholder, not to level down and create large collectives that lead to increased bureaucracy. The

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£150 million that the Government have spent creating that extra bureaucracy would have been far better spent on the front line of GP fundholding in London.

If we are honest, we have to acknowledge that there is much wrong in the health service in London. Some worthwhile things are happening, but the Government can only say of many of them that they were inherited from the Conservatives. The Labour Government inherited NHS Direct--a very good thing which we were working on before the general election. They inherited the private finance initiative--as has been pointed out, 31 of the 35 new hospitals being built are financed through the PFI.

The Labour Government have reaped where the Conservatives sowed--they had no ideas about the health service when they were in opposition, and they have none now. All too many of their ideas were started by the Conservatives and inherited by Labour, and there are fundamental problems that the Government are not tackling--they cannot even manage within existing constraints without displaying the sort of incompetence seen in Bromley last December. The only possible thing to say to someone who is ill is, "Do not be poor, do not be old, do not need expensive drugs, and do not live in London."

6.48 pm

The Minister for Public Health (Ms Tessa Jowell): That is one of the more extraordinary speeches that we have heard from the Opposition Benches--perhaps it was caused by a bout of pre-election fever afflicting the hon. Member for Orpington (Mr. Horam).

Let me try to get back to the purpose of the debate, which is to give us an opportunity to set out the ways in which the Government have been setting about the process of modernising the national health service in London. Modernisation is about rebuilding the national health service: integrating health and social care, driving up standards of care, making the NHS more accessible, tackling health inequality and tackling the root causes of ill health.

We need to do that because London is a capital divided--a city of great extremes containing some of the richest and some of the poorest parts of the country. In my own inner-London constituency, one can pass from one area into another where life expectancy is up to eight years less, simply by crossing two roads, so short is the walk from affluence to poverty. The City--the financial centre of Europe--deals with billions of pounds every day. However, Newham in the east end of London, is the second most-deprived local authority in Britain. In fact, 13 of the poorest local authority areas in the country are in London.

London has more high earners earning £750 a week or more and more low earners earning £100 a week or less than anywhere else in the country. London is a city of contrasts. Inequality is the overarching theme that we considered in tackling London's health. That is why my right hon. Friend the Secretary of State commissioned the report by Sir Donald Acheson on inequality in health. That is why a centrepiece of our forthcoming health White Paper will be detailing the way in which we will meet our aim of improving the health of the poorest people in London and the rest of the country faster than we improve the health of the population overall. That will not be easy.

The chances of dying before the age of 75 are almost twice as high in some areas of east and south London--such as Newham, Tower Hamlets, Southwark and

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Lambeth--as in the least-deprived parts of the capital, such as the City of London, Bromley and Kingston upon Thames. Infant mortality rates in inner-city London are some of the worst in Europe. Even some of the healthiest parts of London have higher infant mortality rates than the worst parts of Stockholm.

Those facts tell their own story. Hon. Members will be aware of other risk factors--for example, London has some of the lowest rates of immunisation and screening take-up. Those factors dictate our course of action in improving the health of Londoners, which is the purpose of modernising London's health service. My hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) and several of my other hon. Friends referred to the importance of investing in primary care, particularly in order to reduce the number of isolated, single-handed practices. We must also address the problem of unequal access to care and the extent to which, for too many people, access does not necessarily match the need for care.

Modernisation means tackling those issues. As my right hon. Friend the Secretary of State set out, we are doing that by establishing health action zones, education action zones and sure start--which has been given the go-ahead in Camden, Haringey and Southwark, with much more of London to be covered in later announcements. They are the practical ways in which we will begin to remove the obstacles to the improved delivery of health care and improved health for Londoners.

If we look back at the previous Government's record, we will see that nothing crystallises their folly more than what they did to London's hospitals--particularly their mad claim, which proved to be disastrously wrong, that London had too many acute beds. The Turnberg report compared the situation in London with that in the rest of the country and concluded that London did not have more beds than it needed. We are determined that the number of beds should be based on a rational assessment of need, which is why, last September, my right hon. Friend the Secretary of State announced a national bed inquiry to ensure that in London, as well as the rest of the country, the national health service is equipped with the resources and beds to meet the demands of patient care.

Mr. Wilkinson: Will the right hon. Lady give way?

Ms Jowell: No. I am very short of time and I have cut short the winding-up speech so that I can respond to the debate.

This debate is an opportunity to report on progress in implementing the Turnberg recommendations, all of which we accepted, which will take 10 years. The report calls for action and investment in primary care, mental health, intermediate care and community services. In the judgment of the Turnberg panel, none of those services was up to the standard that the people of London had a right to expect. My hon. Friends the Members for Eltham (Mr. Efford), for Upminster (Mr. Darvill) and for Wimbledon (Mr. Casale) all expressed concerns about that.

I say to the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), who asked about action on delayed discharge, that we shall consult in the summer on guidance for the approach to that problem, so that we can take practical measures to tackle it.

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The Turnberg panel did a remarkable job and we are grateful to it. However, we must be clear that putting those recommendations into practice will take the next 10 years.

Modernisation of capital investment in London is critical. At least 50 primary care premises will be improved this year, benefiting around 100,000 patients. In the biggest hospital building programme in London, £1.2 billion will be spent on new and improved modern hospitals. My hon. Friends the Members for Hornchurch (Mr. Cryer), for Ilford, South (Mr. Gapes), for Upminster and for Romford (Mrs. Gordon) referred to the Oldchurch hospital, which is being considered by Ministers.

Modernisation schemes are planned or under way at 32 of London's accident and emergency departments, and improvements include new ventilators, cardiac monitors and anaesthetic units at the Royal Free hospital, a new X-ray room at Kingston hospital and an admissions ward at Epsom general. Whipps Cross hospital, which had problems last winter, had some of the most rundown facilities, and the trust is to be allocated £695,000 from the capital modernisation fund to enable it to make improvements in the flow of patients through the accident and emergency department by redesigning ambulance arrivals and resuscitation areas.

Several hon. Members expressed concern about the London ambulance service. Of course we share their concern about its performance. The service's problems have been exacerbated by absenteeism and staff shortages, but it is responding to more calls than ever. The London regional office will be working closely with the London ambulance service to ensure that its standards are those that have been promised.

We have made fantastic progress in tackling waiting lists. To hear the Opposition try to rewrite the facts is, frankly, extraordinary. The creation of a Greater London Authority and a mayor for London gives us the opportunity to charge the mayor with the major responsibility of safeguarding Londoners' health.

We have heard the usual litany from the Opposition today--they have talked down the national health service and its sustainability. They are a party in desperate search of a policy.

It being Seven o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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