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Mr. Steen: I think that we agree about PPG3. The only snag is, when will it happen?

Mr. Raynsford: As the hon. Gentleman knows, the procedure in respect of issuing planning policy guidance is that the document must be issued first for a period of consultation. We are considering the responses to PPG3, and we shall make a more definitive statement in the relatively near future. However, PPG3 is a material consideration already, as a draft document, and authorities may have regard to it in considering appropriate planning matters. Once the process of issuing new planning guidance starts, that becomes an influence on future planning decisions, so the impact of PPG3 policies, which the hon. Gentleman welcomes, should already be starting to be felt.

Mr. James Gray (North Wiltshire): I presume that the Minister will wait to hear the outcome of the consideration by the Select Committee on the Environment, Transport and Regional Affairs of PPG3 before he comes out with the final version.

Mr. Raynsford: The hon. Gentleman, who is a member of the Select Committee, is well aware that we consider Select Committee reports very carefully. We do not always agree with everything that they say--he would not expect that--but we will look carefully at the Committee's conclusions.

Mr. Steen: Assuming that PPG3 comes into effect, whether or not it reproduces the original consultation document, the implication is that local district councils--planning authorities--will be able to refuse planning consent on green-field sites. If they do not have a city in their district, can they point to the neighbouring town and tell the developer, "Develop there"? What happens if the developer who wants to develop on the green-field site in the district council area appeals to the Secretary of State? Will the Secretary of State be able to turn down the appeal, pointing to PPG3 and saying, "Look in the city next door"?

Mr. Raynsford: The hon. Gentleman will be aware that, under the plan-led system, we are seeking to encourage an approach in which sites are identified in advance--in which there is a more proactive approach to planning--so that developers are encouraged to consider appropriate sites. As I shall mention, the national land use database is designed to make it easier to identify brown-field sites in urban areas for development.

However, the hon. Gentleman must accept--as we all do--that, even if we achieve the 60 per cent. target, a certain proportion of development will continue to take place in non-urban areas. Indeed, there is a need, for the vitality of rural areas, for some development to take place in many of those areas, to provide employment and

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opportunities for people who must live there. A balance must be maintained. We cannot have a mechanistic approach which automatically refuses any green-field development. The purpose of the sequential approach that we are adopting is to steer development towards brown-field areas wherever possible.

I mentioned the national land use database. The hon. Member for Totnes highlighted the lack of knowledge about the extent of vacant urban land. We must have a better understanding of where the land is and where it is available. The national land use database published its first results on 20 May. I find it slightly shocking that that is the first effort of its kind to identify such land. Obviously, it must be developed. Although we only have the initial findings at the moment, it is a step in the right direction and will help us to pursue our policies.

In all these initiatives we are attacking the causes of urban decline and people's tendency to look for alternatives to urban sites for development. We want to reinvigorate cities and encourage people to return to and develop in cities. If we can reverse the decline--if we can make our urban centres more vibrant, exciting and pleasant places in which to work, live, and play--we shall have gone a long way to protect the countryside from unreasonable pressures for development.

I stress, therefore, that the Government are not only focusing on urban areas. We shall publish a rural White Paper to express our concerns for the countryside and the need for appropriate policies relating to rural areas.

My hon. Friend the Member for Stroud (Mr. Drew) made several very pertinent comments. He has taken a serious interest in the subject of development in both urban and rural settings and the inter-relationship between the two, which is rarely the subject of the careful thought of which he gave us the benefit this morning. From his perspective, the inter-relationship between urban and rural areas is hugely important.

The hon. Member for Sheffield, Hallam (Mr. Allan) spoke about the benefits of city life and the need for more diverse tenure patterns and for more diverse mixed developments in city centres. I wholeheartedly concur with him. We believe that a greater diversity in tenure patterns and a mixture of residential, commercial and retail activities in city centres helps to keep vibrancy and avoid their going dead at night, which was often the problem of mono-tenure or mono-activity cities where all the business closed in the evening, people left and the areas were often very unwelcoming and sometimes crime-ridden. Bringing people back to live in the city centre can help to create greater security and vitality. There is an enormous amount to be said for that.

The hon. Member for Witney raised several issues, including that of fiscal instruments. The task force did make several recommendations on fiscal instruments, which the Government will want to consider carefully before replying. As he knows, final decisions on taxation are a matter for the Chancellor of the Exchequer, but it was always thus, even under Conservative Governments. I have no doubt that the Chancellor of the Exchequer will want to respond on several of those issues in due course.

The future is about harnessing growth to promote a better quality of urban living and to bring back life to the hearts of our towns and cities. Achieving an urban renaissance goes hand in hand with relieving pressure on the countryside. The task force's report is a challenge to

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the Government, public agencies, the private sector, local neighbourhoods and individuals. We must all play a part in ensuring that cities and towns become places where we are proud to live and to work. We need to think positively and work across all sectors to make an urban renaissance a reality. This is not a short-term programme--it is about long-term sustainable development.

The task force's report sets out the task before us. It has already started a major public debate about the quality of life in our towns and cities. The Government will continue to work in taking up that challenge.

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St. Vincent's Hospital, Middlesex

12.30 pm

Mr. John Wilkinson (Ruislip-Northwood): I am grateful for the opportunity to raise the subject of the future of St. Vincent's hospital, Eastcote, Middlesex.The hospital lies in an ideally peaceful location--at about the highest point in my constituency--on Haste hill, on the edge of Ruislip woods nature reserve. From the windows of one of its sadly now-unoccupied wards, one can look down across the broad sweep of Middlesex towards London airport at Heathrow.

St. Vincent's has been in this perfect setting for some 75 years. It is a religious medical charity, registration No. 1014889, and a company limited by guarantee, No. 2721809, under the auspices of the Sisters of Charity of the order of St. Vincent de Paul. Their tradition of devoted, selfless care of patients has been St. Vincent's enduring characteristic to this day, and that tradition is maintained by the admirable clinicians and staff who work there.

That is exemplified by the inspiringly radiant photograph and the warm tribute to three St. Vincent matrons in the May 1999 newsletter of the hospital's dedicated league of friends. The newsletter says:

I pay tribute to Jacquie Scott and all those under her who are driving the process of change forward and seeking to ensure a long-term viable future for the hospital. The newsletter continued:

    "Sister Angela and Sister Carmel have guided St. Vincent's through many great changes in both the world around them, and in the services provided by the hospital. Jacquie Scott, who, in keeping with the times, has the title of Director of Nursing rather than Matron, has also been appointed Head of the Hospital, and she will undoubtedly be guiding the hospital through many more changes in the coming years.

    Sister Angela is at last retiring to her native Lanarkshire, where we wish her well, while Sister Carmel will continue to be available to us, as she resides in the Sisters' home at the hospital and is now able to devote her time to pastoral care. So, although Sister Angela's departure undoubtedly marks the end of an era, it is all part of the continuous process of evolution of the service that our hospital provides, under the care of the Sisters of Charity of St. Vincent de Paul."

It is instructive to give a brief outline of the hospital's history. At the turn of the century, Archbishop Bourne, who later became Cardinal Bourne, set up a home for 25 boys, mostly victims of tuberculosis and polio. Without this home, their chances on the streets of London--as hopeless incurables and social outcasts--were slim.

In 1906, the fate of the home and the children was in jeopardy through lack of funds, as the Archbishop failed to obtain financial support. The future looked bleak until, in 1907, an old coaching house was found in Clapham, and the Sisters of Charity of St. Vincent de Paul agreed to take over its running. This was founded as the St. Vincent's home for crippled boys.

Three years later, Mr. McCrae Aitken, a surgeon, visited the home and treated 19 of the children. As a result of his skill, 12 were earning their own living within three

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years. The work expanded and, in 1912, the home moved to Eastcote, Pinner, and became known as the Eastcote cripples home. That is its present location. An operating theatre was built and a physiotherapy department added in 1923.

In 1923, St. Vincent's adopted the name of St Vincent's orthopaedic hospital, becoming only the second orthopaedic hospital to be opened in this country. In 1925, a ward of 20 beds was opened for girls, and this was followed by yet another ward in 1930, which accommodated a further 25 patients. St. Vincent's continued to treat children and it was only during the second world war--when it had to care for casualties--that it first began to admit adult patients as part of the emergency medical service.

In the post-war period, the hospital's orthopaedic work has, until recently, continued on a major scale, although, as I will explain, it has had to be phased out to a large degree. The hospital has had a high reputation and was always immensely appreciated by the local community, which has selflessly supported the hospital's summer fetes and other activities and has recently helped to finance the opening of a shop on the site.

The range of services provided by the hospital includes work on joint replacements, care of the young chronically disabled and treating patients with severe multiple sclerosis and those who have had strokes or brain injuries. In 1996, the name was changed to St. Vincent's hospital to reflect the fact that orthopaedic surgical work was being phased out and to demonstrate that the hospital had a wider role as a community hospital.

Following a joint fund-raising appeal by the hospital and the Alzheimer's Disease Society, a specialist unit day centre for Alzheimer's patients called the Templeton centre was opened in 1997. The Holding Hands appeal did a wonderful job, and the Templeton day centre--named after its inspired promoter, Hazel Templeton--has as its object to provide high-quality care for those with dementia and to provide assistance and facilities on the site for their carers.

In 1998, a change of Government policy insisted that NHS patients should be treated in NHS hospitals where possible, and not in so-called private hospitals. Although St. Vincent's is a wholly charitable institution, it was considered a non-NHS hospital, and that led to the decision to phase out orthopaedic surgery.

The board and management at St. Vincent's agreed to continue serving the community, and that work continued in its current community hospital role. It is worth looking at the circular issued on 3 September 1997 from the NHS headquarters in Leeds and, in particular, paragraph 17--which, paradoxically, comes under the heading, "Ensuring Fairness." The paragraph said:

This is an extraordinary ideological predilection to support NHS hospitals, regardless of local circumstances and the cost-effectiveness of other institutions such as St. Vincent's, which is a wholly charitable hospital whose profit--when there is one--is always ploughed back into the care of patients.

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With the demise of the internal market, change and adaptation have been uppermost in health care planning, and never more so than at St. Vincent's hospital recently, which has had to adapt drastically and fast.

GP fundholding ended this March and was replaced by primary care groups on 1 April. Both systems were set up to arrange health services for all local residents. They were intended to work with the providers of local health services to ensure that local people receive the best possible treatment and care, but, in the transition from fundholding to the new PCG approach, St. Vincent's suffered and, whereas once there was a thriving orthopaedic surgical unit providing care at operative, post-operative and rehabilitation and discharge stages, the hospital can now provide only non-surgical care management.

In 1998, orthopaedic surgery ended at St. Vincent's, and the Hillingdon health authority decided to build up the orthopaedic surgical facilities at Mount Vernon hospital nearby. Anomalously and strangely, surgical work is being reduced at Mount Vernon overall; the rationale between the first decision and the second is hard to fathom, especially as the other hospitals in the area to which orthopaedic patients are referred have historically had long waiting lists whereas St. Vincent's has always been short.

In November 1998, 48 members of staff were made redundant, extending right across the board to clinical, medical, surgical and ancillary staff. The hospital has only two wards open: a busy physiotherapy service and an X-ray department, which is also likely to close in the very near future. We do not know what services will be commissioned by the NHS at St. Vincent's. The future is extremely bleak unless favourable decisions are taken. Very little time is left if this cost-effective and dedicated institution is to survive.

St. Vincent's has a small contract with Northwick Park Hospital NHS trust to provide in-patient services focusing on post-operative rehabilitation for orthopaedic or trauma patients who have had surgical procedures and require more time to get back on their feet or are waiting for social services decisions. Many people have to wait many weeks for decisions about residential or nursing home places, so the service at St. Vincent's is very relevant and worth while, enabling Northwick Park to free precious beds that would otherwise be unnecessarily occupied.

St. Vincent's also offers respite beds, but they are not NHS funded. Physiotherapy is an expanding service, which St. Vincent's has provided for the local population since its inception. The service is immensely appreciated and the physiotherapy department, which has contracts with both Hillingdon and Harrow, has a waiting list, on average, of only two weeks, whereas the district general hospitals in the area have waiting lists of about six months.

The Government have made it clear that NHS patients are to use so-called non-NHS establishments only if there are no NHS facilities available for the service required. That is wholly illogical. St. Vincent's is cost-effective, with the lowest possible overheads. There are double standards involved, as about 98 per cent. of the work done at St. Vincent's has always been for the NHS.

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The community services development plan for Hillingdon for the financial year 1999-2002 for services for older people is due for publication on 23 September. The content of that crucial document will decide much of the future, if not the eventual viability, of St. Vincent's.

I know that the hospital's geographic location in the north of the Hillingdon borough poses certain problems, because we have the excellent Northwood and Pinner cottage hospital--which was already in existence as a great war memorial hospital--and Hillingdon health authority is determined to build up Mount Vernon as a community hospital and to run down its burns and plastics unit and its oral and maxillofacial unit, which did greatly admired cleft lip and palate work that was prized by local people.

St. Vincent's can make an invaluable contribution to the health service in many sectors, including the care of older people and respite management; physiotherapy and occupational therapy; radiography; the provision of a healthy living centre; locality phlebotomy; post-operative rehabilitation; in-patient provision for those waiting for residential or nursing home placement; out-patient services in chiropody and rheumatology; and day-care surgery.

St. Vincent's is exactly the kind of small unit that the Government should support if they genuinely believe in a wide range of health care provision for our people. In the whole period from 1979-97, I had occasion to request only one Adjournment debate on hospitals in my constituency: I asked in 1979 about the future of the accident and emergency department at Mount Vernon. In this Parliament, I have had Adjournment debates on 6 March 1998, on the future of Mount Vernon, and on 27 December 1998, on the future of Harefield hospital. This is the third time that I have had to request such a debate.

It seems that the Government are obsessed with big private finance initiative hospitals, such as the Paddington basin project or the great new hospital project in the west of Hertfordshire whose location we still do not know. If that is to the detriment of dedicated charitable institutions such as St. Vincent's, it will be a great tragedy. With good will and imagination, such a tragedy can be averted. The hospital can continue its admirable work if only it can have the contracts and backing that it and its staff fully deserve.

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