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Baroness Jay of Paddington: My Lords, I am grateful to both noble Lords for their general welcome of the Statement, and in particular for their acknowledgement that the time has come to take some definitive action about the problems of London. On the final point of the noble Lord, Lord Newby, I always welcome the opportunity for further discussion of these issues. Indeed, I believe that there is a debate tomorrow in your Lordships' House in which they may well be covered

I am grateful, too, for both noble Lords' commendation of Professor Turnberg and his committee for their hard work, and for precise recommendations

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which we have welcomed and accepted. The noble Lord, Lord Newby, raised concerns about the way in which the proposals may have been set already in immoveable concrete. I hope that noble Lords understand that all the proposals that the Government have accepted which refer to major service reconfiguration will be subject to the normal consultation processes in which the health service always engages at these times.

The noble Lord, Lord Newby, referred to the need for a strategic approach to London's healthcare. The Government entirely accept that. It is the reason that we accept the proposal of Professor Turnberg and his panel that there should be one regional office for London. The use of the words "medium term" simply refers to the need, as we see it--and as he sees it, I think, given his subsequent remarks--for the potential for including the development of the London regional office for health alongside, and in connection with, the greater London authority which is still subject to the legislative process and the other complications with which your Lordships are familiar. In that sense, medium term simply refers to development rather than kicking the issue into touch in any sense.

The noble Lord also referred to the difficulties of mental health services in London. The report acknowledges, as do the Government, that they are a specific problem. The noble Lord and other Members of your Lordships' House will be aware that at the end of last year we undertook a review of mental healthcare. We are about to receive the report. I hope that it will inform some of the difficult decisions which need to be made. The noble Lord may know that additional funding of £5 million has been allocated to mental health services to help reduce the pressures on acute psychiatric beds by buying extra residential 24-hour nurse-staffed places for what we hope will be more effective approaches to patient crises. We hope that that will reduce in-patient admissions. Noble Lords may be aware of the concerns publicly expressed by my right honourable friend the Secretary of State about the validity or otherwise of dealing with some of those acute psychiatric problems exclusively in the context of community care. We shall bear that very much in mind as we develop the plans in London.

The noble Lord referred to the revised plans for 900 beds in the Royal London Hospital in the new redevelopment programme. He spoke, as did the noble Earl, about the acceptance that the original assumptions made by Professor Tomlinson on the need for acute beds in London may perhaps have been over-optimistic in the sense of the needs of London as we progress.

The noble Lord, Lord Newby, mentioned the conjunction of beds in the Royal London and Bart's. It means that as beds are kept open at Bart's, the need for the 1,100 beds on the original PFI project is regarded as unnecessary. But that in no way diminishes our concern to maintain the overall numbers of acute beds.

As it was the main burden of the noble Earl's concerns, I turn to the question of whether or not re-inventing Bart's, as he describes it, was an unnecessary procedure. The noble Earl will be aware, as indeed will your Lordships, of the success of specialist

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hospitals in other parts of London and the country. I cite the example of the Marsden Hospital, Christie Hospital in Manchester, or the Papworth Hospital in Cambridge. They suggest that such specialist hospitals for particular forms of tertiary care play an important role in our health services and healthcare. They are often very much part of the local community although they provide a specialist service. Although the noble Earl felt that it would not be an attractive proposition to the population which surrounds Bart's Hospital, I emphasise that again there will be an element of public consultation. I suspect that the local population will applaud the fact that the site is to continue to be used for health services rather than for some of the perhaps glamorous but not necessarily health-related suggestions made in the past.

As regards relative costs, the Government have considered with concern the precise difference between capital expenditure and revenue costs. At present the view is that the plans now proposed will not be radically different in capital costs from those proposed in the previous plan although the proceeds from a potential sale of the Smithfield site will no longer be available. Account will also have to be taken of the revenue costs associated with running the two sites. That will be an immediate issue for the East London health authority which the noble Earl rightly says will take the lead in developing the new strategy. I must point out to the noble Earl that these plans have been developed with its understanding and concern to work through that new strategy in a positive way, both to develop the high quality community services as well as the acute services for the East End.

I conclude by saying that I am pleased that both noble Lords made reference to the development of primary care in London. I believe that that is the priority with which we need to be concerned. I was glad to report that there will be substantial investment in that area. We feel that it will be the most important ingredient in transforming many of the everyday services which mean most to families living in London and in the long run will make the greatest difference to the status of the health services throughout the capital.

4.20 p.m.

Lord Annan: My Lords, will the noble Baroness enlighten the House a little further regarding the rebuilding of the hospital opposite University College? Is the new site to be that which is opposite University College, or is it to be the site presently inhabited by the Middlesex Hospital? How will it be possible to build a new hospital in close proximity to University College?

I very much welcome the whole scheme and hope to be convinced by it. I am less convinced by the arguments in favour of Bart's being kept open. The noble Earl put his finger on many spots which require examination. How is it possible, in terms of cost-effectiveness, that 200 beds kept open at Bart's will be cost-effective as compared with the extension of

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2 x 200 beds at the London Hospital? The population needs those beds at the London Hospital, not in the City of London.

Baroness Jay of Paddington: In response to the noble Lord's final point, I respectfully draw his attention to the great success of those tertiary centres for specialist care with that size of provision which exist in other parts of the country. As I believe I made clear both in the Statement and in my previous remarks, it was not intended that Bart's should remain as a district general hospital; however, given the specialist services, we feel that there will be very important provisions.

As to the University College Hospital site, that will be on the Gower Street site and will incorporate the Elizabeth Garrett Anderson Hospital, the Middlesex Hospital, the Hospital for Tropical Diseases and the other medical centres of excellence which at present are very broadly in the University College campus, but not in one building.

Baroness Ludford: My Lords, I declare an interest as a leading member over the past five years of the Save Bart's campaign in my role as a local councillor whose ward is a mere 250 yards from Bart's. Like my noble friend Lord Newby, I welcome some elements of the Statement, particularly the new hospital bringing together UCH, the Middlesex, the EGA and so on, the new investment at the Whittington and the Royal London, the retention of more services at Guy's. I also especially welcome the abandoning of the presumption that London was over-bedded.

However, I wonder whether the Minister is correct in saying that local people will applaud the retention of some health services on the Bart's site. I fear that when local people listened to the promise made before the general election by her right honourable friend in the other place, now the Secretary of State for Culture, Media and Sport, that a Labour Government would save Bart's, they would have thought that that meant as a district general hospital, not as a specialist tertiary centre. I fear that local reactions might vary from, "This is half a loaf", to even the word "betrayal". Can the Minister therefore give any reassurance to local people? The NHS White Paper to which she referred contained a reference to the "freedom to refer" of primary care groups. Will there be patient choice, in the sense that if the residents of south Islington or south Hackney wish to be referred to Bart's for a wider range of services--which, as she explained, will remain on the site for the next few years while the Royal London is redeveloped--they will be able to exercise that choice through their GPs? Will the Minister give an assurance that the situation at Bart's will be monitored over those years of transition, so that, if it becomes obvious that London is not only not over-provided but is under-provided with acute beds, there will be a chance to reassess the situation?

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