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Simon Hughes: Is it going to happen?

Linda Perham: Well, the Secretary of State has expressed his support and backing for the Crossrail project, but financing is a problem. There is a lot of money involved. At the end of the day, however, the Government have made a commitment to it, and I know that it will be of enormous benefit to London. It will link the key business areas of the City and Canary Wharf to Heathrow, with huge increases in jobs. It will enhance our standing as the best financial district in the world and as one of three global financial centres. It will have a benefit-cost ratio of 1.99:1 and will contribute about £19 billion to the British economy. The regenerative benefits of Crossrail alone include 40,000 new jobs in the Thames gateway, so the regeneration aspect will be a huge boost to the London economy and the economy of the whole country.

There have been six regeneration projects since 1997 in my London borough, two through the London Development Agency, the town centre development through the sustainable communities fund, and the three single regeneration budget projects including a health ladder social inclusion project.

On health, there have been vast improvements to my two local hospitals since 1997. King George hospital in Ilford is now a two-star hospital, which has been improved by a cancer centre and a primary care walk-in centre, which opened this month. At Whipps Cross hospital, in which my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) and I have taken a great interest in recent years, there will be a redevelopment of the whole hospital site worth £331 million, and lots of other improvements including a new renal unit and an upgrading of cardiac services. Last year, primary care services spent £400 million on schemes such as community volunteers, mental health, health improvement and user involvement and regeneration. My local health centre will be improved vastly through a new local improvement finance trust programme. Continuing improvements have taken place in reducing waiting lists and times in primary and secondary health care.

In education, children's services have been transformed, with vastly improved opportunities for parents who want their children to have nursery education at age three and four. The Sure Start scheme, which I hope to get in my area—there is already one in Ilford, South—has been an enormous success. A new museum has also been provided under the new lottery scheme, which is wonderful.

In my experience, the words "failing public services" in the Opposition motion do not apply either London-wide or locally. Services are improving thanks to the
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commitment and investment of the Labour Government and the London Mayor, in policing, transport, regeneration, health, education and the whole spectrum of life in London. As far as I am concerned, London is the greatest city in the world. A Labour Government and a Labour Mayor have been good for London. The re-election of a Labour Mayor and a third term for a Labour Government can only mean that things can only get better.

6.8 pm

Angela Watkinson (Upminster) (Con): It is almost impossible to generalise about London, as its 32 component boroughs are so diverse. The London borough of Havering, for example, which includes my constituency of Upminster, is 50 per cent. green belt, and appears to have more in common with our Essex neighbour in Brentwood than with our nearest London neighbours, Dagenham and Redbridge. The difference between outer and inner London boroughs is even more pronounced, in terms of socio-economic profile, environment, density of population and development. Each has its own specific problems and advantages, which is why the provision of public services is such a challenge. Education and health services for the people of Greater London must reflect the widely varying circumstances and range of needs that prevail in all those diverse boroughs.

All-London averages of general health indices are similar to those for the nation as a whole. Of course, that masks the individual differing statistics in individual boroughs. Life expectancy and infant mortality, for example, are worse in Lambeth, Southwark and Newham than in Richmond, Bromley and Kensington and Chelsea. There also seems to be a gender divide in life expectancies, which is greatly accentuated in poorer areas and reflected in the national average. That particular phenomenon has always intrigued me. Women in poorer areas often combine family and domestic responsibilities with several part-time jobs outside the home, often of a fairly arduous nature, over a number of years; yet their life expectancy seems to overcome all the odds. It is a tribute to their survival abilities that somehow they still seem to outlive men. I do not know the explanation, but statistically that seems to be the case.

The demand for health care outstrips the capacity for supply, and always has. It follows that in a densely populated area like London that effect will be exaggerated. Most GPs, for example, are overworked and have significantly more patients on their lists than is recommended by the national health service. Many of the traditional single practitioners are likely to be replaced on retirement by group practices in health centres, as property and staff costs in London are too high for newly qualified GPs to set up in single practice.

As more GPs reach retirement age, recruitment in London will become more and more of a challenge, particularly in outer London boroughs like Upminster, which fits neither the very rural nor the inner-city profile—both of which are particularly attractive to new GPs. Hospitals in London tend to have more staff per head than hospitals elsewhere, because they also treat patients from all over the country; but according to statistics from finished consultancy episodes, which are used as a standard measure of hospital activity, the 37.9
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per cent. increase in funding for health care in London has been translated into only a 1 per cent. increase in hospital activity, and waiting times for consultant appointments and operations remain a serious concern for my constituents.

One of the main challenges is increasing the capacity of the health service to enable it to keep pace with ever-increasing demand and expectations. I welcome the Government's aim not just to allow patients to book every hospital appointment and elective admission by 2005, with a choice of convenient date and time, but to allow them to choose the hospital in which they will be treated. London has a natural advantage, in that it has more hospitals and a transport system. Sixty-three per cent. of patients involved in the London patient choice project exercised that option.

It makes absolute common sense to take advantage of the spare capacity in the provision of health care wherever it is—in an NHS trust, a treatment centre or a private hospital, or with a specialist primary care practitioner. It matters little to the patient who the provider is; it is the quality of care that counts. The NHS needs all the help it can get, from wherever it can get it. There are many opportunities for the public and private sectors in London to work together to mutual advantage and, more important, to the benefit of patients in shortening their waiting times.

Whereas health professionals should be free to make clinical decisions, it is the function of Government to create the conditions in which they work and to take a wider strategic view of improving the health of Londoners. Preventive measures play an essential role in reducing demand for health care. For example, London has a higher mortality rate from asthma than England and Wales as a whole, despite having a lower proportion of individuals receiving treatment for asthma. Strategies to improve air quality through engine efficiency, to discourage smoking, to reduce alcohol and drug abuse, to combat obesity and to encourage immunisation take-up all contribute in general to improving public health and quality of life for Londoners, while helping to reduce future demand on the NHS.

Tuberculosis rates have risen consistently in recent years, and new drug-resistant strains have developed in eastern Europe. People coming to this country from some of the accession countries in Europe are more likely to choose London than anywhere else in the country to live and seek work. There will be specific health problems attached to that, and the NHS will have to cope with them as well as with superfluous numbers.

At a time when both A and E departments and GP surgeries are under tremendous pressure from the sheer numbers of patients, the expansion of the role of pharmacists in the NHS is one way—which I know the Government are considering—in which capacity to treat could be increased. It would also be more convenient for patients. Where could be more convenient to access preventive medicines such as smoking cessation, contraceptive or dietary advice than in the high street chemist?

If the relevant professional bodies were receptive to the idea, pharmacists could also prescribe as well as dispense. After all, they have a comprehensive knowledge of prescription drugs and a personal relationship with their regular customers, which makes
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them ideally suited to play an increased role, and densely populated areas such as London lend themselves to pilot schemes.

I know one pharmacist in my constituency who recognised the sound of a particular cough when two of his regular customers came in to buy cough medicine and advised them to go home and get their gas fire checked—it was found to have dangerously high emission levels, and that piece of advice could have been life saving, which demonstrates the level of personal service that pharmacists already provide and shows how readily their role could be expanded.

The diversity of London boroughs brings challenges in education that match those in health. Havering schools have an excellent reputation and there is fierce competition for places. Indeed, many schools are doing very well, so raising the standard of London's failing schools to the level of the successful ones is a priority. The success of a school rests largely with the head teacher. An inspirational head teacher motivates staff, parents and pupils alike, but it is an uphill struggle in schools where there is little parental interest, a high level of absenteeism, discipline has broken down and disaffected pupils are emboldened by their knowledge of the limitations of the disciplinary measures available, their perceived rights and the threat of litigation. That minority of pupils has a disastrous effect on the education of the rest, who suffer disruption of their lessons and the resulting low morale in their teachers.

Removing from the classroom pupils who are unable or unwilling to behave in an acceptable way is the first essential. Finding the reasons for their behaviour and ways to modify it is a separate and difficult challenge, but it is essential to redirect those disaffected pupils so that they do not leave school unfit for employment, with low self-esteem and unable to interact with other people in a socially acceptable way. These are the very pupils who would benefit from high-quality vocational training. Anyone who lives in London knows how difficult it is to find a plumber, electrician or bricklayer without having to wait for six months. These practical skills are in great demand and can offer more secure employment opportunities than many very popular degrees such as media studies and information technology, which are reaching saturation point, and would not involve the attendant university student debts.

It may be that more flexibility in the curriculum would benefit failing schools. Head teachers might feel that learning and achievement in core subjects could be encouraged in other ways, for example through the introduction of more sport, music or drama. A creative head teacher knows his or her own school and what changes could be tried to help to turn it round. Once a school becomes unpopular and the numbers fall, its funding is affected. This can lead to staff losses and a downward spiral towards unviability.

Recruitment and retention of teachers in London is also affected by high property prices. Outer London boroughs such as Havering have a higher proportion of older, experienced teachers, who are extremely valuable to the school but are at the top of the pay scale, which makes staffing costs very high. Schools often lose newly appointed teachers to inner London, where the
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additional allowance makes all the difference in meeting the cost of housing in London. Some of my head teachers have travelled as far as New Zealand and South Africa in search of staff, when the normal procedures have failed to attract applicants. Some very enthusiastic young teachers have been found by this rather drastic method and they have been very popular with the children, but the drawback is that they may not stay very long.

There are two areas of concern that affect both health and education equally: sex and drugs education. Rates in London of serious sexual diseases such as HIV/AIDS, chlamydia and hepatitis B have risen dramatically, echoing the rise seen nationwide. Last year, the Health Committee declared itself "appalled" by the crisis in sexual health. Although parental responsibility is the dominant factor in the guidance of children, sex education in schools has a strong influence, and if misguided can do untold damage. The reluctance to moralise and the simple provision of information have in effect condoned sexual promiscuity in some young people. Safe-sex education has ignored abstinence messages and led to many young people becoming sexually active long before they are emotionally mature enough to cope with the consequences. Girls need to be warned of the likely outcome of having sex with a boy who has no interest in getting married or becoming a parent, and who has no income to support a child—[Interruption.] I am sorry if hon. Members think that that is amusing.

A teenage girl will find that 24-hour-a-day single motherhood in a free council flat is not the exciting adventure that it might have seemed to her, when her education is brought to an abrupt halt, she can no longer go out shopping or clubbing with her friends and her baby is effectively fatherless. Sex education has often given too much information and too little guidance. This is not a subject on which we can afford to be non-judgmental, as our alarming teenage pregnancy statistics demonstrate. The figures are the highest in Europe.

I take a similar view of drugs education, in that it has relied on the neutral provision of information to young people before they have the maturity of judgment to deal with it. The Home Office website "Frank" is enough to tempt many impressionable young people into experimenting with drugs. I apologise because I have made these points in the House before, but I shall give examples from the "Frank" website:


There are lots of examples like that, although I shall not go on because I know that time is short.

Drugs education material for use in schools gives more details about illegal drugs, their effects, how they are administered—

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