§ Motion made, and Question proposed, That this House do now adjourn. —[Mr. Newton.]
4.52 pm§ Mr. John Wheeler (Paddington)I am glad of this early opportunity to raise the issue of the future of St. Mary's hospital medical school, in my constituency. The Government are no doubt aware that as a result of their policy on overseas students' fees the University of London has had its resource allocation reduced this year by £6.3 million, of which £3.8 million has fallen on postgraduate medical schools. It is now being suggested that the St. Mary's hospital medical school will have to close.
I was especially concerned and surprised to hear that the university senate was considering this course of action, not least because it goes against a number of recent expert recommendations on the organisation of the university's faculty of medicine.
For example, in February 1980 the Flowers committee reported on medical education in London. Having spent much time and effort in obtaining evidence from all points of view, the committee strongly supported the future development of St. Mary's as a school and as a hospital to serve the local population. Furthermore, the committee's recommendations are compatible with the recommendations of the Department of Health and Social Security, the London Health Planning Consortium and the regional health authority.
St. Mary's hospital medical school has a fine tradition of solid achievement. It can boast two Nobel Prize winners—Sir Alexander Fleming, who discovered penicillin, and Professor Rodney Porter, who won the prize for his work on how the body protects itself against infection—work that is of great benefit to all countries of the world.
In the early 1970s, with an academic staff of under 100, the school had no fewer than four fellows of the Royal Society on its staff. The school's academic record is good. Its output of research publications per member of staff is higher than that other medical school in London and its examination record is well above average. In addition to these factors, the school costs comparatively little to run. About 28 per cent. of its income comes from money that is independent of the University Grants Committee. That income is used for research projects. It is won in open competition and constitutes a higher proportion of funding than that for any of the other London medical schools. The closing of the school would not only be sad and wasteful; it would have a disastrous effect on St. Mary's hospital itself.
The medical school provides the hospital with numerous support services—for example, a pathology department to diagnose illnesses. It also enables the hospital to attract the highest-quality staff. The best junior doctors are recruited, because they want to work under the prestigious professors in the medical school. The best technical staff are recruited, because they want to be trained with the latest sophisticated equipment, which is provided by the medical school. Nurses benefit from the lively social environment of the teaching hospital.
Perhaps the people to benefit most from the medical school are the patients, who can be treated with technology that is 10 to 15 years ahead of that which would be found in a non-teaching environment. The main hospital is about 220 to be rebuilt and the medical school would be an integral part of it. To all intents and purposes the hospital and the school are inseparable. Without the school the hospital would deteriorate beyond recognition. In effect, it would be crippled.
This is a matter of the deepest concern to me and my constituents. St. Mary's hospital is a general hospital, which provides excellent bread and butter routine services for the community. For example, it deals with hernia repairs and appendicitis conditions that could not be treated adequately by the other specialist hospitals in the area. About 75 per cent. of its patients come from within three miles of the hospital.
The demands on the hospital made by my constituents are heavy. Social deprivation in Paddington is considerable and 20 per cent. of all families with dependent children are headed by lone parents. About 25 per cent. of births in the area are illegitimate, compared with a national average of 9 per cent. Severe house crowding results in real health care problems. Psychiatric cases and drug abuse cases are of a level well above the national average. All these facts, which can be verified by statistics issued by the Department of Health and Social Security, combine to put an enormous burden on the local hospital. St. Mary's hospital has therefore become essential to the health care of my constituents.
The Government have said that decisions on the closing of London medical schools are for the university senate. I understand that the senate is to meet on Wednesday 25 March, when it will most probably make a decision about the future of the London medical schools. The vice-chancellor of London university is to address the academic board and school council of St. Mary's hospital on Monday 23 March, when I know that important decisions will be reached.
Unfortunately, it is not as simple as that. The closure of St. Mary's hospital medical school would have repercussions far outside the academic world. It would cripple the hospital and destroy the health care that is essential to my constituents. To some it would be literally a matter of life or death. I urge the Government not to wash their hands of this matter but to face the real problem and to accept part of the responsibility for resolving it.
§ Mrs. Gwyneth Dunwoody (Crewe)We should be grateful to the hon. Member for Paddington (Mr. Wheeler) for raising this subject because it is obvious that with the enormous pressure being put on medical care in the inner cities the closure of St. Mary's hospital medical school will be of enormous importance not only to the people who normally receive training in that school but to those who live in the area.
I declare a mild interest, because a member of my family works in the hospital. I hasten to add that my views are not coloured by hers.
What concern me deeply are the far-reaching suggestions for the amalgamation of medical schools. When I was a very young doctor's wife I remember that a decision was taken to cut down the number of medical students being trained. Consequently, in a short time there were not enough doctors to fill the relevant posts. At present, we have a difficulty because many Commonwealth doctors are, almost by accident, treated as second-class citizens. They fulfil house jobs and senior house jobs in the Health Service. One of the Government's 221 avowed objects has always seemed to be to produce sufficient home-grown doctors to fill all those posts. It is totally contradictory on the one hand to say that we are concerned about the number of doctors produced and their quality and on the other hand to talk about taking piecemeal decisions on medical school training.
There are many questions for the Government to answer. The subject should be dealt with in a very much broader way than by shutting down some units, irrespective of the overall plan for medical education in the inner city. It is not simply a matter of training doctors. St. Mary's hospital contains many acute beds and provides positive health care for those living in the area. There is a suggestion that the ambulance, rehabilitation and rheumatology units will be closed. In fact, the rehabilitation and rheumatology units have already been closed. It was always understood that the changes would come about when other hospitals in the area had developed alternative services.
I make it clear that I am not in favour of maintaining any old hospital irrespective of the standard of care. It is depressing that in 1981 there are so many new office blocks, many of them standing empty, and so many inferior hospitals. The same energy should have been put into building new hospital units that has been put into developing property for the profit of a small section of the community. I am not saying that irrespective of the quality of the health care we must keep hospitals open and working. However, before the Government go ahead with the closure of a unit that is providing a generally needed service they must plainly demonstrate that alternative facilities are available. I understand that the ambulance station is modern. It is not housed in inferior buildings.
We have recently had clear evidence that the health care provided for those in the inner city is in many instances inferior. Too many general practitioners work from lockup shops. Too many people have difficulties in finding a doctor. There are instances where deputising services are routinely used. All those factors mean that a general unit in the area inevitably takes a large amount of the emergency work. If there are not sufficient primary health care units, inevitably the local population relies on the casualty department for basic services. That will be materially affected if parts of St. Mary's are closed.
In considering the provision of health care and the further training of doctors we must bear in mind that lumping together medical training facilities does not automatically produce a higher quality of care. The Government are free with their statements about how they want to support the National Health Service. The Ministers have a little monologue that goes: "Look, we are giving the same amount of financial aid to the National Health Service that our predecessors gave". They carefully skate over the fact that over the past five years there has been a 50 per cent. cut in capital costs. They do not spell out the point that by increasingly seeking to use the facilities of the National Health Service to cross-subsidise medical facilities in the private sector they are merely helping the cash flow of the private units.
If there is excess money from National Health funds to pay for facilities in the private health sector, that money should be spent on upgrading hospitals such as St. Mary's. It should be used to improve the facilities for the citizens of Paddington. It should not be used to support private hospitals to enable them to make a profit.
222 In a nutshell, the problem of the inner city is that of old hospitals, inferior facilities and, too often, management decisions which are dictated far too much by a sort of book-keeping exercise. Because of the staff cuts, we know that there will be problems in providing services. In an area such as Paddington, the local social services committee finds it virtually impossible to replace the facilities that once were provided by hospitals. The personal social services are now so badly overloaded that local authorities are faced with an intolerable choice. Do they cut down their services, their home helps and social service workers to such an extent that they cannot provide cover, or do they put such a burden on the rates that the ratepayers, many of them pensioners living in substandard housing, cannot afford to pay them? That is the practical effect of the Government's policies.
The Government's attitude to inner city care leaves a great deal to be desired. There is another problem with hospitals such as St. George's. The Secretary of State is anxious to draw a great deal of money back into the National Health Service. Why, then, have we heard so little about what is happening to the NHS site at St. George's hospital? A planning application has been made to Westminster city council for that site when it is not wholly owned by those who have applied for planning permission. There is clear evidence that, far from getting the best price for the hospital, because of considerable difficulties in negotiations, the Department is allowing Grosvenor Estates to benefit at the expense of the taxpayer.
I realise that it is difficult for the Minister to answer questions off the cuff, but I want him to take time in the forthcoming weeks to tell us exactly what is happening about St. George's hospital. How much is being paid for the site? How much will the Health Service benefit from the sale? Where will that money go? Why should it not be spent on inner city care and on an expansion of the facilities at a hospital such as St. Mary's?
I return to what to me is the relevant point. Why are the Government now prepared—apparently in advance of the decision to be taken on the Flowers report—to close down one unit? I know that we shall return to the old argument "It is not us but them". The truth is that the Government determine the size of the grant, they lay down the priorities, they decide what will happen in terms of staffing and they have a responsibility to tell us what they will do about St. Mary's. They have a responsibility to tell us what they intend to do about medical training. They certainly have a responsibility to tell us how they will provide other facilities for people in the area.
It is all very well to say that a couple of miles down the road alternative facilities will be available. The Minister is a sympathetic man, which is one reason why he so frequently appears at the Dispatch Box to defend the indefensible. He knows that in that area many old people and one-parent families with young children will find it a burden. They do not have ready access to motor cars, and must rely in times of emergency on getting themselves to the nearest casualty unit as quickly as possible, especially if the level of GP cover is not of a high standard
In his reply, I hope that the Minister will tell us "Ah, but we can immediately demonstrate that we are replacing these facilities. We are not simply doing what you might think, being hard-hearted and, in effect, saying that this has nothing to do with us and that decisions on the overall financing are for the people concerned". I hope that he will 223 say that it is his intention to demonstrate, through a large injection of capital into the Paddington area, that he cares about facilities and is prepared to replace the existing substandard hospitals in the area. If he cannot do that immediately I hope that he will not go blindly ahead with a closure programme which will affect not only the medical school but the number of acute beds and casualty facilities for the local population.
If the Minister cannot do so, he will be demonstrating only too clearly the Government's strategy for the NHS, which is that they will not seek to demolish the NHS by a head-on attack but will use a much more subtle approach. They will dig away at the foundations of the Health Service, cut down on facilities and make it more difficult for people to use the service.
Having done that, like the Prime Minister, they will then say "Well, of course, we expect people to use the money in their pockets to provide for their own health care." If that is the best that the Minister can do, he would have been better served by staying in his elegant Ministry.
§ The Under-Secretary of State for Health and Social Security (Sir George Young)Anyone who calls my Ministry elegant is quite misinformed. It is one of the humbler Government buildings on the South Bank which, in theory, is injecting new life into the Elephant and Castle.
I congratulate my hon. Friend for raising the question of the future of St. Mary's hospital medical school. I endorse what he said about the school and its staff and I commend the way in which he so eloquently defended the interests of his constituents. As he said, the debate is aptly timed, because the decision on the St. Mary's medical school is imminent.
I begin by dealing with some of the points raised by the hon. Member for Crewe (Mrs. Dunwoody). I would not dissent from much of her analysis of the health problems in London. She was quite perceptive in identifying some of the shortcomings. It is difficult to reply in detail to the position relating to St. George's. That is a complex problem, because the site is in multiple ownership and there are a number of restrictive covenants. I shall write to the hon. Lady outlining where we have got to in our discussions on the future of that site and shall try to put her as fully in the picture as I can.
The hon. Lady would have more credibility when speaking on health matters had 229 of her hon. Friends not voted last night against the increase in tobacco duty on cigarettes, for which there was the most compelling health reasons. I think that it was with some embarrassment that some of her colleagues found themselves voting against the Government.
§ Mrs. DunwoodyThe Minister tempts me, and I am grateful to him for giving way. Many hon. Members abstained from that vote. Had he been able to carry the same urgency into his discussions with his fellow Ministers, the tax on cigarettes would not have been as low as it was. Therefore, it ill-becomes the hon. Gentleman to attack the Opposition.
§ Sir George YoungI shall not twist the knife any deeper into the wound. It is quite clear that the Labour Party is as divided on health policy as it is on a number of other issues.
In a moment I shall say something about the amount of money that we shall be investing in Paddington as an earnest of our intent to improve health facilities there. The hon. Lady said that we were maintaining spending at the planned levels that we inherited. It is difficult to reconcile that part of her speech with what she said towards the end, when we were accused of undermining the very foundations of the National Health Service. We are also trying to complement Health Service resources by encouraging private provision and by tapping the resources of the voluntary sector.
We have no intention of reducing the number of students trained in London—roughly 1,200 out of 3,800 in Great Britain as a whole. The university is considering mergers in order to provide training more economically. On primary care, we are awaiting an expert report from a study group under Professor Donald Acheson, which has been set up to advise on what needs to be done in this area.
I now turn to the main subject of the debate, which is the future of St. Mary's medical school. Perhaps I could begin by clarifying where responsibility lies, because, as both hon. Members implied, responsibility is split between two Government Departments. My right hon. and learned Friend the Secretary of State for Education and Science has responsibility for funding undergraduate medical education and for determining the overall level of intake of medical students. But, within agreed levels of intake and standards laid down by the General Medical Council, it is for London university to determine how to provide undergraduate teaching. That university is a self-governing chartered institution, which is solely responsible for its own internal organisation.
Although the various medical schools have their own identities and their own governing bodies, they are a part of the university and receive their funds from it. It is the senate and the court which must decide their future. But we do not for one moment pretend that what happens to medical education can be divorced from the Health Service. The two are so closely interlocked as to be in some instances inseparable. That was one of the themes that my hon. Friend developed. It is for that reason that the two bodies that have been looking closely at Health Service problems in London—the London Health Planning Consortium and the London Advisory Group—have included representatives of London university. Those representatives have played an important part in formulating the proposals that both bodies have put forward.
My right hon. Friend the Secretary of State for Social Services has a direct statutory responsibility to make available facilities that are needed to support clinical teaching. This responsibility is discharged on his behalf by the health authorities, particularly those that manage the great teaching hospitals. Not only do they allow students to see patients on their wards; much of the clinical teaching that students receive is given by consultants employed by the Health Service. For that part of the undergraduate course, teaching is very much shared between the Health Service and the medical schools. Staff of the medical schools provide clinical services to patients, 225 and in many cases support services—such as pathology—are provided entirely by the medical school, although on a repayment basis.
The broad position is that while the university must make its own decisions—we cannot take those decisions for it—we would expect it to give due weight to the impact of its actions on the Health Service. The university and the Health Service have been involved in the various committees and bodies that have been set up to plan the future of health services in London.
What is it that London university proposes to do? Here there is still some uncertainty. That the university needs to make changes in the organisation of its medical school seems clear. The university faces three main problems. First, it faces financial pressures. For some years the university has been conscious that medicine was accounting for an increasing proportion of its total expenditure. The more recent impact of the phasing out of subsidies for overseas students which my hon. Friend mentioned, and the general curtailment of university expenditure, have added to the pressure to rationalise provision in medicine.
Secondly, the university had made plans that would, if carried through, have led to its increasing its total intake of medical students above the nationally agreed target levels. Some medical schools in London made a temporary increase in their intakes in the early 1970s, which will need to be reduced when the expansion of St. George's hospital medical school is complete.
Thirdly, the medical schools were concerned about the prospective reduction in the Health Service facilities to be available to support their clinical undergraduate teaching.
I am sure that hon. Members who represent London constituencies, and perhaps others, will have seen the recent report by the London Advisory Group on the provision of acute hospital services in London. That report concluded that a major reduction in the number of acute hospital beds in London was required because of the continuing reduction in the population and because patients now need to stay in hospital for shorter periods. But the advisory group also felt that if used to the full the remaining acute facilities would be sufficient for London university's needs. That is not to say that there is no need for the university to change. There may still be implications for the distribution of students in different parts of London. I shall say more about that in a moment.
Faced with these problems and these pressures the university, on the advice of its medical schools, concluded that a complete re-examination of the organisation of medical education in London was called for and that it might be necessary to consider the closure of one or more schools.
Accordingly, a working party was set up under Lord Flowers' chairmanship, which reported in February last year. Its report proposed the amalgamation of the 34 existing medical institutions within the university into six large schools. Two undergraduate schools—the pre-clinical schools at King's college, London and the Westminster medical school—were to be closed. The report was hotly disputed, and the subject of its contents was raised many times in the House. I see my hon. Friend the Member for City of London and Westminster South (Mr. Brooke) in his place. He fought a formidable campaign within and outside the House for the future of the Westminster hospital school.
226 After a long period of consultation, the medical faculty of the university, through the joint medical advisory committee proposed a revised package which changed some elements of the Flowers' recommendations but supported many of its conclusions. This package was endorsed by the university's joint planning committee and put to the senate last October. While endorsing the general approach of the proposals and encouraging schools to pursue them where agreement existed, the senate was unwilling to accept some of the conclusions without further evidence.
A further working party was therefore set up, under Professor Leslie Le Quesne, of the faculty of medicine, to examine the costs of a range of different options. That working party's report, which was circulated last month, does not make recommendations but provides further factual evidence on which the university can now consider how to proceed. The report has been considered by the joint medical advisory committee but at this moment we do not know what proposition the senate and the court will be asked to consider when they meet on 25 March arid 1 April respectively.
One proposal being considered—and this is what has come to my hon. Friend's attention—is that, as a result of the further evidence, St. Mary's hospital medical school may be included in a joint school with University college and the Middlesex hospital medical school. Such a joint school would not, I understand, simply involve the physical concentration of all the facilities on a single site but might involve a reduction in the number of centres used by the schools concerned. For St. Mary's, the main issue seems to be whether pre-clinical teaching should continue at the Praed Street site.
What form the proposal will finally take remains to be seen. What is beyond doubt, however, as my hon. Friend made clear, is the quality of the St. Mary's hospital medical school and the important contribution that it has made over many years to the development of medicine and to the provision of services to patients. One of the great dilemmas of the London scene, and one that makes any proposal for radical change unwelcome, is that so many of London's medical schools can point to a noble history and a valuable present contribution. What is most important is that in making changes that may well be unavoidable the university should look to the future and make changes that will leave a settled pattern of medical education that can rely on continued support from the Health Service.
There can be no doubt that St. Mary's hospital, Paddington will continue to be a major centre for the provision of acute hospital services. Like my hon. Friend, we remain fully committed to the current plans for developing the hospital. Whatever decisions are made by the University of London about the rationalisation of medical education institutions in London, there is a pressing need for improved hospital services in the Paddington area and these must go ahead.
This is a major redevelopment involving expenditure of more than £21 million from the North-West Thames regional health authority's capital funds, as well as central contributions from the University Grants Committee and my own Department. As I shall try to explain, it is a key feature in a number of important strategies for the delivery of health care in London. It may help to allay my hon.
227 Friend's fears if I outline briefly some of the reasons why we regard the hospital development at St. Mary's as being so important.
My hon. Friend will know that over the past few years there has been a considerable amount of debate in London on how to achieve a better balance of health care provision. The problem, which is generally recognised and accepted, may be stated in short in this way: how can London's acute hospital services be developed in such a way as to maintain acute services for local populations, to sustain medical education and at the same time to release resources to enable services for the priority care groups—particularly the elderly, the mentally ill and the mentally handicapped—to be developed from their current inadequate levels of provision?
A number of people have looked at this, and the problems are indeed complicated. That is why we set up the London Advisory Group—a high-level body, including the chairmen of the four Thames regional health authorities, representatives of the TUC, the GLC, the London Boroughs Association and the health professions—to advise on the development of London's health services.
One of the group's first tasks was to look at the crucial question of how acute services should develop in the light of the overriding need to switch resources to other care groups. As I have already mentioned, the group reported in February this year that there was scope to make significant reductions in the capital's acute bed stock in the light of population movements and increasing efficiency in hospitals. It also outlined a strategy for achieving these changes, recommending that acute services should be concentrated on the major hospitals in London and that the savings on acute services should be found in the other smaller hospitals. The report identified St. Mary's, Paddington as one of the major centres for concentrating acute services.
The Government have accepted that as a broad strategy. In welcoming the report, my hon. Friend the Minister for Health said:
London has seen huge investment in major hospitals, including the major teaching hospitals. We must use these hospitals fully to cover the health needs of the people who live in inner London and maintain the greatness in London's health care".St. Mary's, Paddington is an integral part of that strategy and its future is assured.As my hon. Friend graphically pointed out, however, the current condition of the facilities at St. Mary's is inadequate, and it has become increasingly difficult over recent years for the hospital to meet the requirements of a district general hospital and also of a teaching hospital in its existing buildings. Part of the building is over 100 years old, the layout has become almost unworkable, space is inadequate, and communications are very poor. Despite these difficult conditions, the standard of service provided has remained consistently high. As my hon. Friend pointed out, the hospital provides an important local service to the community of Paddington as well as a number of more specialised services. I will not dwell on the reasons why successive redevelopment schemes for the W2 site have failed to get off the ground since the war, but the condition of the fabric of the hospital and its vital future as a provider of acute services to that part of London make it imperative that the scheme goes ahead this time.
228 I have laid great stress on the importance of St. Mary's and its redevelopment within the general strategy for London's health services, but there are a number of other reasons why this scheme is needed at this time.
The redevelopment forms an important part of the North-West Thames regional health authority's strategy for redistributing resources within the region. The regional health authority anticipates that the redevelopment, together with the consequent rationalisation of acute services within the district, would produce an annual revenue saving of some £1.9 million. These funds are essential not only for the development of priority services within London, but, as an integral part of the region's overall financial strategy, to allow it to fund acute hospital developments in the county areas of the region£Hertfordshire and Bedfordshire£where there is a shortage of acute services and where a number of important schemes are now coming on stream and are planned for the next eight to 10 years.
Looking at the problem more locally, the redevelopment also plays a key role in the strategy for the North-West district of Kensington and Chelsea and Westminster. That district serves a resident population of 157,700, expected to decline to 139,000 by 1986. The strategy is a twofold one—to improve the acute services, taking into account the reducing population and changing patterns of demand and clinical practice; and to remedy outstanding deficiencies in local health care provision, notably in services for the elderly and the mentally ill, and in community health services.
Phase 1 of the rebuilding of St. Mary's, Praed Street, which should be completed by 1986, will provide a children's department with 60 beds and a child development centre; a psychiatric hospital of 60 beds and 80 day places; 240 acute beds, mainly surgical; eight operating theatres; an intensive care unit; an accident and emergency department, and various other clinical support and ancillary departments. These developments will enable St. Mary's, Harrow Road, to be closed, although some facilities may continue to be provided on part of the Harrow Road site. A joint working party of the community health council and the district management team explored a number of possibilities, and the area health authority has recently agreed a proposal that an experimental community hospital project should be set up for two years if the funds can be found. That will be in keeping with the main strategy, under which the district will have two acute general hospitals—St. Mary's, Praed Street and St. Charles'.
There is a second major capital development, which is fundamental to the strategy at St. Charles' hospital. This long-term strategy is accepted locally. However, the area health authority now wishes to bring forward the closure of about 127 acute beds at Harrow Road, representing about one-third of the hospital's total bed complement, and a consultation document was issued in January last year.
In September last year, the North-West district community health council notified the authority of its opposition to the closure and submitted an alternative strategy. As both the area and the region have reaffirmed their support for the proposal, it is now with my Department.
The health authority wants to bring the reduction of beds forward, for a number of reasons. The district has too many acute beds, and reductions now at W9 are consistent 229 both with current work loads and with the London Advisory Group strategy, which involved the concentration of acute services for this part of London at W2 and at St. Charles'. This would achieve a better balance of services within the district. Secondly, the district has recurrent over-expenditure to reduce, and it has to take steps to bring down its rate of expenditure in order not to leave its successor district with a deficit.
I know that my hon. Friend is concerned that the proposal should be agreed as quickly as possible, so that the district plans can proceed. My hon. Friend the Minister for Health will come to a decision on this as soon as possible.
I have attempted over the last few minutes to explain why, for a variety of reasons, we see a redeveloped St. Mary's hospital as having a vital role in the future of London's health services, in terms of the wider strategy for the capital's services, of the North-West Thames financial and planning strategy, and of the important place that the hospital has within its own district's plans.
I assure my hon. Friend that whatever the decisions of the University of London about the organisation of the medical schools we are fully committed to this redevelopment. My hon. Friend was right to stress the close interrelationship between academic and service accommodation at St. Mary's, and the redevelopment is designed to further this integration.
My Department has made it quite clear to the university that substantial costs would be involved in any major replanning and that this would be undesirable at such a late stage. But there are two further points that I should like to make. First, we would not allow NHS services to be adversely affected by any withdrawal of vital support services. Secondly, it seems to me inconceivable—I hope that this provides reassurance to my hon. Friend—that the university will not continue to use St. Mary's hospital as a major centre for clinical teaching, wherever the siting of the schools may be. To do so would be a foolish waste of what will be excellent facilities, well sited for patients and students. The benefits of the teaching environment, which my hon. Friend mentioned in his speech, should be retained.
I shall make absolutely certain that before any decision is arrived at my hon. Friend's speech is made available to those who have a decision to take, so that they can be well aware of the high feeling and the strong arguments that my hon. Friend has made in support of the medical schools.
§ Mr. Ronald W. Brown (Hackney, South and Shoreditch)Am I to understand, therefore, that if any hon. Members have a similar Adjournment debate, all our remarks will be taken into account by London university?
§ Sir George YoungI have never noticed any reluctance on the part of hon. Members generally to have Adjournment debates on hospitals. Where important decisions are about to be taken I have made a point of making sure that the speeches of hon. Members are sent to the regional health authority and the area health authority before any decision is made.