London Implementation Group (Hansard, 6 July 1993)

§ 1. Dr. Goodson-Wickes
To ask the Secretary of State for Health what is the proposed programme for the Government's response to the report of the London implementation group.

§ 5. Mr. Tony Banks
To ask the Secretary of State for Health when she expects to conclude the reorganisation of hospital provision in London.

§ The Secretary of State for Health (Mrs. Virginia Bottomley)
"Making London Better" sets out the timetable for improving London's health service, including our £170 million programme for strengthening primary care in the capital. The need for change is most urgent in inner London, where a number of hospital site option appraisals are already under way. Another key element will be the recommendations of the recently published independent specialty review reports. The main proposals for the future configuration of services in inner London will come forward in the autumn. Any major proposals to change services will, of course, be subject to full public consultation.

§ Dr. Goodson-Wickes
I recognise my right hon. Friend's problems and motives in rationalising health care in London. In the present economic climate, and with particular reference to Bart's, about which there has been so much public concern, can she give the House an absolute assurance that adequate funds will be available for the movement of units from Bart's to the Royal London hospital? If she is unable to give the House that assurance, will she say that the units, which have been recognised as centres of excellence in the specialty reviews and generally, will be allowed to operate on two sites so that nothing of value is destroyed?

§ Mrs. Bottomley
I give my hon. Friend a clear assurance that the intention of "Making London Better" is to improve and strengthen the specialist services. Independent commentator after independent commentator has reinforced the point that the London specialty services are fragmented, duplicate each other and will not 166 be national, let alone international, centres of excellence unless change is embraced. My hon. Friend is right; we need to take great care and show consideration for preserving excellence, but I commend to him the words of Professor Besser when he said: Bart's would not have survived 870 years if it had not been flexible. I welcome the discussions that are under way between Bart's and the Royal London hospital and I am sure that strengthened services and the safeguarding of excellence will emerge out of them.

§ Mr. Banks
What does the right hon. Lady have to say to the statement made by Mr. Sandy Macara, the new chairman of the British Medical Association, who said that the national health service would be dead inside seven years unless the rot was stopped now and that it was underfunded by £6 billion?
What does the right hon. Lady have to say to Professor Jarman, who published an article a couple of weeks ago in the British Medical Journal that proved conclusively that London was not overstocked with hospital beds? When she answers, will she please not read out a list of misleading statistics produced by Conservative central office—as she normally does—because the more she does that, the more she sounds like a Dalek in a nurse's uniform?

§ Mrs. Bottomley
The hon. Gentleman and other hon. Members should read the edition of the British Medical Journal from the week after the specialty reviews were reported, which said: The specialty reviews show clearly that some clinical services in London are not as good as they should be … Those who ultimately make the decisions on London should not lose sight this summer of the fact that their aim is to improve services for Londoners and the people of the Thames regions … it is not to protect institutions. It is well understand that primary care is not up to a sufficient standard in London. I commend to the hon. Gentleman some of the developments in his area, such as the increase in the number of community psychiatric nurses and district nurses and the investment in primary care, as well as the £11 million development at Homerton hospital.

§ Mr. Congdon
Will my right hon. Friend bear in mind the need to implement the changes to health care in London at a sensible rate, in line with the changes in demand? Will she ensure that the changes in the number of acute beds are in line both with changes in demand and with improvements in primary health care?

§ Mrs. Bottomley
I give my hon. Friend that clear assurance. We said that we would not make progress in London until we had invested in primary care. This year, £43.5 million is going into primary care, in 78 different capital schemes. Tomorrow, I shall open the South Westminster health centre, a £1.7 million investment in family doctor and community services. There is an urgent need to take our proposals forward because, all over the south-east, district health authorities are changing their patterns of referral. The London specialty services treat, on average, about half the number of cancer patients that are treated in other parts of the country, so it is extremely urgent, if their excellence and their reputations are to be protected, that we take change forward.

§ Ms Primarolo
Does the Secretary of State agree that the way in which she has handled the Tomlinson report and the specialty reviews has blighted the whole of London's health service and that she is responsible for the low morale of staff, for undermining patients' confidence, for talking down the national health service and for causing chaos, because she does not have a clue what to do now that the reforms have failed? Are not the reforms that she said would save the national health service destroying it like a creeping cancer?

§ Mrs. Bottomley
Again, I urge the hon. Lady to do her homework. I commend the words of Christopher Ward, a consultant at Charing Cross hospital, who said: Too many specialist services are supplied to the dwindling population of London. These vary from the excellent to the inadequate". I commend also the words of Paddy Ross, of the Joint Consultants Committee, who said: Ministers should be congratulated on the way they have responded to the Tomlinson Report. As a result of meaningful consultations they have produced a Government response the broad thrust of which is supported by the medical profession at national level". There is great agreement that changes need to come. We shall move as swiftly as we reasonably can. With such serious decisions to be made, it is right to take properly into account the independent specialty reviews and the reviews of the special health authority research which will be published shortly.

§ Mr. Couchman
As my right hon. Friend takes the momentous decisions that she has to take to strengthen primary health care in London, will she bear in mind the fact that the destruction of a world-famous centre such as the Royal Marsden hospital would need justification stronger than that thus far offered by the differing opinions of Tomlinson and of the review group? Furthermore, will she also take into account the facts that London's gain over many years has been the loss of areas such as mine and that she will have to bear a great burden in deciding where to direct the resources that she takes from London and redistributes to the provinces?

§ Mrs. Bottomley
I certainly respond to the second part of my hon. Friend's remarks, because London has been spending 20 per cent. of the money on 15 per cent. of the people. There have been improvements, but there has been a distortion in the balance of provision in London because of the numerous duplicated speciality services and the great number of sites and institutions that have not changed at the same pace as the delivery of health care and the great investment outside London.
In reply to what my hon. Friend said about the Royal Marsden, I want to do nothing more than to protect and enhance London's national and international reputation for clinical services, research and education. My hon. Friend and other hon. Members would be hard pressed to find any authentic representatives of the academic or the medical profession who do not agree that services in London are duplicated and too small and that they need reintegration and rationalisation to become stronger.