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Lord Burnham: My Lords, one cannot always be right--usually, but not always.

Lord McIntosh of Haringey: My Lords, I am delighted to hear that recognition on the part of the noble Lord. I agree with the noble Lord, Lord Taverne, that although it was originally the Labour Party's idea to have these debates, they started off rather grandly as an overview of economic policy and attitudes towards Europe but they degenerated.

I do not claim to have anything like the expertise of my noble friend Lord Eatwell who participated in the debate earlier this year to such effect. I remind the House--I do not need to remind the noble Lord, Lord Burnham, because he knows--that my noble friend was able to expose great differences between Mr. Malcolm Rifkind and Mr. Kenneth Clarke on the very day of the debate about entry into European monetary union. That has been scarcely referred to in this debate, but we are determined that the debate on European monetary union should continue and that it should be intelligent and well informed.

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This very day the Chancellor of the Exchequer made a speech at Chatham House in which he referred to the need to make the right decisions for Britain and to have an open and intelligent debate on the single currency. He said that British business would be affected whether or not Britain joined the first wave. He said that in the context of a very serious report that my noble friend Lord Currie produced for The Economist intelligence unit which goes into the pros and cons of EMU. I commend that report to your Lordships as deserving careful study. It has been republished in summary form by the Treasury. It is now free, compared with the original price of £195--or even £395.

I contrast the view of my right honourable friend the Chancellor of the Exchequer that there should be open and intelligent debate with the views of almost all the candidates for the Conservative leadership, notably the successful candidate, Mr. William Hague. He appeared to close down the debate by saying that not only was he against the single currency on principle--which he had said on many occasions--but that as leader he would rule out as his party's policy anything other than to say that it was against EMU. That is not just cutting himself out of the debate; it appears to be cutting his entire party out of the debate. I find that regrettable.

The noble Lord, Lord Taverne, made a number of points about the criteria for EMU and the obstacles in the way of our entry into it. I recognise that these are serious points. He has said that the fiscal criteria are not the most significant factors and that inflation--which I am glad to see he believes is containable--is more important. He is quite right to refer to the exchange rate as a serious problem. I do not believe that he is right to say that we should consider rejoining the exchange rate mechanism, even less committing ourselves in advance to rejoining it at any particular point, whether it is at 2.50 deutschmarks or not. We have never set a target exchange rate, and it would be dangerous to do so.

I recognise that there is a danger in having too high a level of sterling. We recognise the difficulties for industry. But we expect exports and manufacturing output to continue to grow and to benefit from expanding home and overseas markets. That has been the theme of our Budget.

To respond to the particular question posed by the noble Lord, Lord Taverne, about entry into the exchange rate mechanism, we look not so much for any particular exchange rate but for price stability and, without prejudice to the objective, to support the Government's economic policy, including targets for growth and employment. We define price stability by an inflation target which the Chancellor confirmed in his Budget, but we do not believe that it is right to adopt a target for the exchange rate itself.

Both noble Lords have done this debate the honour of treating it seriously and I am grateful to them for the points that they made. The Red Book sets out the arrangements that we have made to ensure the financial stability and sound public finances needed to underpin a stronger and more robust economy. The Government have made these long-term commitments to achieve

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their central economic objective. That is why they support European Union level procedures which promote these economic policies in other member states. It is in the interests of all member states that the European economies are dynamic and successful. That is why the Government support the procedures in which Section 5 allows them to participate.

On Question, Motion agreed to.

Consolidated Fund (Appropriation) Bill

The Bill was brought from the Commons, endorsed with the certificate of the Speaker that the Bill is a Money Bill, and read a first time.

Birmingham Hospitals

5.17 p.m.

Lord Howell asked Her Majesty's Government what is the future of the Birmingham hospitals.

The noble Lord said: My Lords, I am grateful for this opportunity to raise the question of the future of Birmingham hospitals, a subject shrouded in mystery and accompanied by chaos. I am especially appreciative tonight of the presence of my noble friend Lady Jay who will reply to this debate.

Birmingham is an important city. It has some fine hospitals and an excellent medical school at the university. It also has large-scale deprivation among its citizens which imposes great strains upon hospital services. Undoubtedly, it is not receiving fair and adequate funding to meet its needs. My main concern tonight is that there is no overall strategic authority to direct the thinking and decision making that is vital to the future of the service. There is no meaningful public consultation before decisions are taken, or not taken, and there is little involvement of the general practitioner in what planning there is.

The trust system is failing because there is no such overall authority. Trust competes against trust. The purchasing authority, Birmingham Health Authority, controls the funds but does not have the authority for any hospital development programme. A classic example of all this confusion has recently come to my notice and caused me to initiate this debate. I informed my noble friend of the circumstances. I know that she has made inquiries, which I much appreciate. The document that I obtained was a set of minutes of a meeting held on 19th February this year of the Birmingham Health Authority Consultants' Committee which was attended by Mr. Brian Stoten, chairman of the health authority. These include the statement that Mr. Stoten and his colleagues at the authority would be happy to see one or two hospitals in the whole of Birmingham. The implications of such thinking would be calamitous for the whole of Birmingham. It would mean the closure of several hospitals and the services that they provide for the public. I immediately faxed my concern to Mr. Stoten and to my noble friend. Mr. Stoten responded immediately, saying that he had been misquoted and that he had written

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to Mr. David Farrer, the chairman of the consultants' committee, pointing out that what they had been discussing was the need to rationalise scarce medical resources and the concentration required for patient tertiary and secondary care services. Mr. Stoten also sent me a copy of the reply that he had received, dated 9th June this year, from Mr. Farrer, saying that after consulting his notes he agreed that their conclusions were that Birmingham required,

    "One or Two Specialist centres with intermediate hospitals and primary care satellite units"--

and that that unfortunately had been transcribed as "one or two hospitals". However, Mr. Farrer went on to say:

    "personally, I think that with increasing specialisation and reduction in junior staff hours, there is a high likelihood that only one or two hospitals for Birmingham would be viable for the future".

I fully accept those corrections from Mr. Stoten, but there is no doubt that these breathtaking concepts were discussed at that meeting of consultants in his presence. Such thinking could lead to disastrous consequences for the future of the hospital services in Birmingham and this is being conducted without any public awareness or involvement. I have sought this debate to bring the matter to the attention of Birmingham's citizens and I should also like to take this opportunity to comment on some of the proposals which we know to be under consideration.

There is general consent among my parliamentary colleagues that the Queen Elizabeth Hospital, our principal teaching hospital, is in a parlous state and needs to be rebuilt. I would give that a very high priority. However, the trust which controls it also controls Selly Oak Hospital, one of our large and essential district hospitals. The trust wants to demolish both hospitals and to rebuild them as one state-of-the-art hospital. One of the trusts's problems is that it cannot find a site big enough to build such a hospital and provide car parking.

The cost of such an enormous project would be several hundred million pounds. It seems that the trust, the University Hospitals Trust, hopes that the private finance initiative could produce the money. Ministers have properly made it clear that the number of such schemes would be very limited and I cannot conceive that such a gigantic project would ever get off the ground.

I must also make it clear that there would be enormous public opposition to the closure of Selly Oak Hospital, which also includes the recently rebuilt Accident Hospital; nor do I think that any suitable site is available, so it is better to kill off this notion earlier rather than later and concentrate thinking about the rebuilding of the Queen Elizabeth Hospital upon which we can all agree.

The City Hospital which I know very well is also contemplating rebuilding. This would cost another £150 million of private finance money. Having regard to the statement of Ministers, I do not think this has any chance. In this case, I believe it to be unnecessary. City Hospital does magnificent work among the most disadvantaged neighbourhoods. It needs modernisation; some £50 million would work wonders. But any

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thoughts of closure, such as the thinking of the consultants' committee suggests, and which I have raised in this Chamber on a previous occasion, would be met with public outrage.

Ten years ago Sir James Ackers, the then chairman of the regional health authority, declared its policy for Birmingham to be for four district general hospitals--City, Selly Oak, Heartlands, and Good Hope. He was right. The only criteria has to be the service such hospitals provide for the public.

The geographical make-up of Birmingham's population demands these four hospitals. The demands upon their medical and acute beds is overwhelming, as I know from personal experience. In spite of all the day surgery and technological advances, there are no empty beds in those four hospitals. At peak times, there is overflowing and chronic shortage. The Birmingham public will believe that anyone contemplating the closure of any of those four acute hospitals has taken leave of his senses.

In his Budget speech the Chancellor drew attention to the financial savings that can be made by a merger of trust administrations. I believe that one simple authority for Birmingham hospitals could produce such savings and provide the strategical authority the city needs. In its absence some trusts are contemplating a merger of administrations, such as between the City Hospital and Sandwell. This would save money and is understandably probably welcome, provided it is absolutely clear that West Bromwich and Sandwell need their hospital and that the west side of Birmingham needs the City Hospital. I hope that my noble friend can give me concrete assurances upon those considerations.

The trust administrations of the Queen Elizabeth Hospital and Selly Oak Hospital are already merged, as are those of Heartlands and Solihull. There is no doubt that substantial savings could be made by merging the administrations of City Hospital and Sandwell. So far as Good Hope Hospital is concerned, its natural population extends into Warwickshire and Staffordshire, a population of some 400,000 and growing. There is room for further administrative economy if Good Hope assumed responsibility for the community hospitals of Tamworth and Lichfield which would be a sensible development.

At the moment we have 11 trusts in Birmingham, which shows the expensive nonsense which my noble friends have inherited. These have to be drastically reduced. As I have indicated, I prefer one single strategic authority for Birmingham with four centres of management based on the Queen Elizabeth Hospital and the four general hospitals.

Finally, this leads to the one and only priority consideration: how can our hospitals best serve the needs and the convenience of the Birmingham public? There is not much support for the concept of a mega-hospital, even if enough land and financial resources were available, which they are not, so we need to rationalise our hospital services at the acute general hospitals that we now have established.

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An example of what can be achieved can be seen from the astonishing figures that I have been given this week for the Heartlands and Solihull Hospitals, which are now administered by one trust. Solihull Hospital is now taking 23,000 more patients than a year ago. Heartlands is up by 55,000. Incidentally, their accident and emergency admissions are up 12 per cent. Last week when I inquired--mid-summer--they had the same patient load as they normally expect in mid-winter. The other Birmingham hospitals are subject to similar pressures. Every bed is full, illustrating the absurdity of any further district hospital closures.

City Hospital and Sandwell have scope for some very sensible rationalisation, especially in the departments of vascular surgery and cardiology.

Birmingham has some great strengths which need to be built upon. These are high quality hospitals, an excellent university and a fine medical school which must be urgently expanded. Sadly, as I stated, the main teaching hospital is totally sub-standard and must be rebuilt.

An example of the world standard research being undertaken at the university, about which I have personal knowledge, is the Institute of Cancer Research which now has a staff of seven professors and 200 researchers in residence. Professors David Kerr and Alan Rickinson are working as a team to develop new cancer treatments from an understanding of the science underlying causes of cancer. They are leading the world in terms of gene therapy, using viruses to treat cancer.

Birmingham has the largest liver transplant team in Europe, led by Professor Paul McMaster, and is considered an international centre of excellence. Birmingham is also developing a team for neuroscience, bringing together surgeons, physicians and scientists to combat neurological illness.

In fact, the Queen Elizabeth Hospital is a referral pathway, not just for Birmingham but for the region and the country. Its standard of excellence cannot be tied to just one district general hospital. That hospital, Selly Oak, should have the same relationship with it as do the Heartlands, the City, Good Hope and other hospitals in the region.

Birmingham requires leadership--a strategic authority to make and implement decisions. I know that health action zones--I hope I have their title right--are being created to deal with such situations. I ask my noble friend whether we can please have one created for Birmingham. As a leading administrator said to me very recently--this week in fact--Birmingham has spent so long arguing about what should be done that nothing has been done. It is time for a change, which is why my noble friend sits on the Front Bench carrying all our hopes and good will.

5.32 p.m.

Baroness Cumberlege: My Lords, perhaps I may say how very pleased I am to be in the Chamber this evening, not least to pay tribute to the noble Lord, Lord Howell. Your Lordships will be aware of the immense contribution which the noble Lord has made as a

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distinguished and effective Member of Her Majesty's Government. If my memory serves me right, he was given the unenviable position as Minister for the elements and to the joy of the general public, he only had to say, "Let there be rain", and there was, and there was an end to the drought; and when we were heavily snowbound, he only had to say, "Let there be a thaw", and there was. As someone who comes from a farming community, I have to say that we were greatly indebted.

But more seriously, the noble Lord did and continues to do an immense amount of good in promoting sport. Locally, he has probably done more than almost any other individual to promote Birmingham. Marrying those two together, I think I can say that the vast majority of us shared his acute disappointment when his sophisticated and energetic bid for the Olympic Games suddenly failed. This evening, in his customary forthright manner, we have heard in this debate his determination that the NHS in its turn should not fail his proud city and its people.

On 6th December 1994 we had a debate with a very similar title, but the situation today is not the same; it is altogether different. In that debate, your Lordships recognised the recent, very unhappy past of the South Birmingham Health Authority and its unresolved deficits. We also recognise the interest and investigation undertaken by the Public Accounts Committee and the department's reply. But that was in 1994 and so much has happened since then.

At one time there used to be five health authorities for Birmingham guided and steered by a regional health authority. The regional health authority was abolished and the five authorities reduced to one. The new, or rather newish, Birmingham Health Authority, is the largest in England and its purpose, among other things is to give strategic direction in consultation with the local people.

It also has a duty to live within its means, and I should like to congratulate it on achieving that. That is no mean feat when there have been so many changes with which to contend and it had to start its work from such crumbling foundations. It had to eradicate a £23 million deficit in three years. That is a huge achievement and I believe that there are lessons here for other large cities in the United Kingdom.

However, Birmingham has not achieved all this by standing still. On the contrary, it has taken some brave decisions, not least in moving the children's services into the old general hospital. Before long these paediatric services will be in place, at a cost of £25 million, and will be in a position to lead the country. Even the great and marvellous Great Ormond Street hospital, with which I know the Minister's mother was closely involved over many years, will need to look out.

The excellence of some of the other clinical services is also unquestioned. The noble Lord has mentioned some of those. The liver, renal and cardiac services have not only a national but an international reputation, and that is without going into the many areas of research and development, for which Birmingham is world famed, and again the noble Lord has mentioned that this

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evening. If anyone has any doubts about the delivery of service, then the recent publication of the performance league tables can leave them in no doubt. I am sure that the noble Lord, Lord Howell, whose very life has been gripped by league tables, must have been thrilled to read the headline in the Birmingham Post: "Best Hospitals in England".

I recognise the noble Lord's fears for the City Hospital. I do not know the detail of the next strategy about to be published, but I would be surprised if, for example, the available places for training medical students, which we know are very important in keeping up standards, were to be reduced. There is a 500 increase in the planned numbers of medical students and they will need clinical experience. Where better to have that than in the City Hospital in Solihull and other local hospitals, albeit the nature of some of the clinical specialist and other services will be changing. That is right and proper if we are to meet the ever-increasing demands of the population and the new developments in technical medical advances.

In our heart of hearts most of us resent change, and never more so than when it is a local and much loved hospital which in our eyes is providing a first-class service. But some changes are inevitable. The merger of the Solihull and Heartlands Hospitals is a case in point. Indeed, it was where the Royal Colleges felt unable to accredit for teaching purposes unless there was a better quality of clinical experience for the medical students.

But mergers do not necessarily mean demolition. I should be very surprised if there were a suggestion that Solihull, with its spanking new A and E department were to be demolished. No doubt the Minister will be able to reassure us about that this evening.

I believe also that there is a limit to the numbers of tertiary centres which can be sustained if we are to maintain or, indeed, improve the quality of care which today is complex, sophisticated and enormously successful. With a population which increasingly seeks redress through the courts, care must be given to ensure that health professionals have the equipment, access to diagnostic testing and access to the skills and expertise among other areas which we know they need in order to provide a first-class service. But we cannot begin to provide everything for everyone in every hospital.

Tonight the noble Lord made a plea for a single strategic authority. A week or so ago, I think, I heard him suggest that Birmingham needs an exercise similar to that performed by Sir Bernard Tomlinson for London or an expert panel similar to the one just set up by the Government under the leadership of the distinguished former president of the Royal College of Physicians, Sir Leslie Turnberg.

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