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Lord Howell: My Lords, I am grateful for the way in which the noble Baroness is dealing with this matter. But I made no suggestion that Birmingham should have anything comparable with the Tomlinson Report. It may need it but I doubt it. I certainly have not suggested it.

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Baroness Cumberlege: My Lords, I stand corrected. I have misunderstood the noble Lord. It was a debate on a Starred Question which we had about 10 days ago. However, I shall have to re-read Hansard.

I am grateful that the noble Lord does not believe that we need something similar to London. I believe that we already have a strategic authority in place in Birmingham. When we look back to the regional health authorities and their abolition, a few of their functions were transferred to the centre but many more were transferred to the new health authorities. Of course, Birmingham, which has a single health authority--indeed, the largest in England--has shown that it does have a grasp, a management grip, to provide not only the ability to control finances but also to procure some first-class services and also to encourage education and research. It has the capability to provide a strategic approach.

If we look back to the history of Birmingham, it will be seen that in the 1980s we had a strategy entitled, "Building a Healthy Birmingham" and that, in the 1990s, it was "Looking Forward" and later, "Moving Ahead". We look forward in the autumn to seeing another strategic document. I am sure that it is necessary because it is being done, but I hope that it is the last one for some time because I believe that the health service has earned itself a reputation of suffering paralysis by analysis. I fear that this may be another case in point, if we go on just providing strategies rather than action.

Finally, I should like to tell the noble Lord, Lord Howell, that I am aware that he is the recipient of the Olympic Order. I hope that he, in turn, will be able to award a similar distinction to the health services in the proud city of Birmingham, for, although they probably have more work to do, I do believe that they are probably Olympic winners.

5.41 p.m.

The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, I am very glad to have the opportunity to reply to my noble friend's Question about the future of the Birmingham hospitals. I should like to thank the noble Baroness, Lady Cumberlege, for her contribution to the debate which was of course extremely authoritative. As so often, my noble friend has drawn attention to a major issue in this important city which he has represented so ably in both Houses of Parliament over many years. I should like to thank him in this context for his courtesy in discussing the debate with me and letting me know what points he planned to raise.

Naturally I share my noble friend's frustration about the recent lack of strategy in organising and developing healthcare. That has been one of the most destructive outcomes of the National Health Service internal market and is one of the main reasons why this Government will replace it. It has led to the kinds of local administrative excesses which my noble friend vividly described in Birmingham and in many other places.

Birmingham has, nonetheless, a well-deserved reputation for improving its health services, as the noble Baroness described, and has a reputation for outstanding

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medical science. My noble friend rightly mentioned some of the distinguished people who have contributed to that reputation. In the past few weeks, I have had the personal benefit of some extremely useful advice from people like Professor David Kerr, who has been enormously helpful in the Government's new initiatives on cancer.

Today in Birmingham the health authority and the health service managers are also, as the noble Baroness, Lady Cumberlege, described, achieving good results after a very rocky period--results which have been achieved by some innovative action. Birmingham now enjoys some of the lowest waiting times for operations in any city in the country. At University Hospital, which is the largest hospital in the region, no patients have been on the waiting-list for treatment for longer than nine months. I am sure that my noble friend is extremely pleased to acknowledge that performance.

The noble Baroness, Lady Cumberlege, mentioned the impressive performance on the basis of the standards of the league tables, the most recent of which were published just last week. As noble Lords will know, the Government have been critical of the limitations of those league tables and we shall in future introduce measurements of clinical quality, as well as financial and management targets, into the assessments of NHS performance because we feel that they are more relevant to most of the people who use health services. Nonetheless, I am glad to have this opportunity to congratulate Birmingham's hospitals on the great improvement in local standards on the performance measurements which the league tables, as they stand at present, show.

In looking at the particular circumstances of individual hospitals, perhaps I may just recap on the present position. As my noble friend explained and as the noble Baroness, Lady Cumberlege, said, there are four general hospital trusts in Birmingham; namely, City Hospital in Dudley Road, Good Hope Hospital in Sutton Coldfield, Birmingham Heartlands Hospital in the east of the city (which is merged with Solihull Hospital) and University Hospital Birmingham NHS Trust (which combines the Selly Oak and Queen Elizabeth Hospitals). There are also four specialist hospitals: Birmingham Children's Hospital, Birmingham Dental Hospital, Birmingham Women's Hospital and the Royal Orthopaedic Hospital. As well as serving Britain's second city, Birmingham's hospitals are indeed a centre of excellence for the whole of the West Midlands region.

As the noble Baroness, Lady Cumberlege, mentioned, the most recent organisational plan for Birmingham was published three years ago. It recognised the rapid advances in medicine, such as day case surgery, and new technologies which allow patients to leave hospital more quickly after treatment. But that plan confirmed the need for all of these hospitals, while recommending changes in the pattern of services that they offer. As we know, medical techniques continue to develop year on year, and that plan set in train a series of discussions

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about the development of individual clinical specialties. Birmingham Health Authority needs to take that into account in planning its services of the future.

On an earlier occasion--and I believe that this was the one to which the noble Baroness, Lady Cumberlege, was referring--my noble friend raised the question of a fresh look at the overall picture of service provision. At that time, in response to an oral question, I did say to my noble friend that obviously the Government will be looking closely at the outcomes of the short-term review of London hospitals that Professor Lesley Turnburg and his expert colleagues are conducting this summer. It was that form of inquiry which I believe my noble friend was anxious to see replicated in Birmingham.

I am happy to confirm today that if we do feel that that is a successful method of reviewing services, it could well be used in developing a strategic approach in other places like Birmingham. I should like to take this opportunity to take note of my noble friend's suggestion about Birmingham becoming a health action zone. That is certainly an idea that I shall take back to my right honourable friend the Secretary of State for Health.

Apart from the distribution of services, the other issue which needs to be faced in Birmingham--and again both speakers referred to this--is the physical state of the hospitals. I am sure that I do not need to elaborate on this to my noble friend, but Birmingham hospitals still have many buildings which are in a very poor condition or unsuitable for modern clinical practice and the situation needs remedying. In recent years Birmingham has reduced the number of small outdated hospitals and concentrated services on the four acute trusts that I mentioned. I am sure that my noble friend is familiar with this, but the old Midland Eye Hospital and Birmingham's skin hospitals have closed, with the services being transferred to City Hospital. Moreover, there have been some new buildings on other Birmingham hospital sites. Indeed, the noble Baroness, Lady Cumberlege, referred to some of them.

Those changes have clearly led to improvements; for example, in the upgraded accident and emergency facilities to which the noble Baroness referred. Next spring will see the transfer of Birmingham Children's Hospital to the substantially refurbished General Hospital site in the city centre. Another example is the concentration of cancer services at a centre of excellence at the Queen Elizabeth site of University Hospital, which will enable full advantage to be taken of the collaborative research facilities at the university.

However, despite this and other investments which have taken place, it is striking--and I am sure that my noble friend knows this very well--that the newest of Birmingham's major hospitals actually opened before the last war. My noble friend will indeed know better than I do that investment in Birmingham hospitals is needed, for, as my noble friend and I agree firmly, there needs to be a proper strategic context to plan such investments.

Birmingham is faced with having to meet the constantly changing challenges of medical science in buildings which are often old and in need of heavy maintenance. Consequently, Birmingham Health

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Authority is now seeking views from all stakeholders in the various communities and health services in the city about how it can improve access to services and improve the quality of such services. The health authority wishes to use the process to help it to plan the future direction of hospitals and indeed of hospital development.

I know that that is the main point of my noble friend's concern. I should like to make it absolutely clear that there really is no predetermined view of how those services will change. Bryan Stoten, the chairman of the health authority, to whom my noble friend referred, has said that his authority is committed to working collaboratively to plan strategic change in Birmingham. I know that my noble friend has been worried that Mr. Stoten has a secret agenda for change and, as he said in his speech, that he may have been conducting planning meetings behind closed doors. I reassure my noble friend that I have personally spoken to Mr. Stoten about this matter on several occasions, most recently yesterday evening. I am convinced that he intends there to be an open discussion about the future. There seems to have been some genuine confusion about the status and the content of the meeting in February to which my noble friend referred.

I also wish to emphasise to my noble friend the Government's overall determination to improve openness in the National Health Service. We feel strongly that there must be transparency about decision-making in this vast public service, and proper public consultation, before decisions are finalised. I hope that my noble friend will have been encouraged by the recent announcement of my right honourable friend the Secretary of State that in future hospital trusts must hold their meetings in public. This is an important change which, I hope he will accept, supports our aim of general openness.

I refer to a few of the proposals in Birmingham which are known and already in the public domain. The noble Lord will know that University Hospital Birmingham NHS Trust announced last autumn a series of interdisciplinary clinical service reviews across the trust. In the interim report about six months ago the doctors came out strongly in favour of combining the services

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of Selly Oak and Queen Elizabeth hospitals on one site. At the same time City Hospital has begun work on its own site development plan, with a focus on the services required by the people of Birmingham in the next century. Unfortunately, this work was not at a sufficiently advanced stage to have been included in the recent strategic review of PFI schemes undertaken by the Government.

I recognise, of course, that the noble Lord has a particular personal interest in the proposed modernisation of City Hospital, having long been a good friend and a champion of the hospital. I thank him for raising those anxieties here. I look forward to visiting City Hospital again at the beginning of September and seeing the situation for myself. I believe that the eventual reprovision of City Hospital should result in an enhanced service for the residents of Birmingham, taking advantage of improvements in day surgery and shorter lengths of stay. It is too early to answer some of the specific points, for example, how many beds will be required at the new hospital, and how working practices may change. That will be clear only when plans have progressed further, but I can assure my noble friend that the future of City Hospital will be subject to full public discussion and consultation. As a start, my honourable friend in another place, the Minister of State at the Department of Health, Mr. Milburn, is meeting Members of Parliament from Birmingham before the end of this parliamentary Session to discuss these questions and the next stage of the plans.

Everyone with an interest in seeing improved healthcare in Birmingham, including local residents-- I stress that--will have the opportunity to contribute to the debate. Any final decision on the future size and shape of the new City Hospital and University Hospital in Birmingham and the other two acute trusts will take careful note of the responses during the consultations and the work currently under way in the trusts. I am sure that my noble friend will continue to contribute vigorously to the discussions and to the consultations. I again thank him for raising these issues in your Lordships' House.

        House adjourned at eight minutes before six o'clock.

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