HC Deb 10 February 1994 vol 237 cc458-73 4.13 pm
The Secretary of State for Health (Mrs. Virginia Bottomley)

With permission, Madam Speaker, I wish to make a detailed statement to update the House on changes to strengthen the health service in London.

We set out the direction of policy last February. We have followed that policy through with the determination which we promised. I pay tribute to all those who have played a part. My announcements today take us a further significant step along the road that we charted then.

The heart of our policy is to improve primary and community care. That will relieve pressure on hospitals, thus helping to reduce waiting times and give Londoners the high-quality services common elsewhere. To this end we have committed substantial investment of £170 million over the next six years.

Within the areas of greatest need, well over 100 schemes are going ahead this year. That means improvements to general practitioners' premises, new health centres, more community nurses, and better services for the mentally ill. Those schemes will assist the dedicated doctors, nurses and support staff working in often difficult circumstances. In addition, we are exploring with the professions ways further to improve the numbers and skills of primary care staff working in the capital.

We are determined to build on that. I can therefore tell the House that the Government will double new investment in London's primary and community care next year to £85 million. We have also agreed with the medical profession two new arrangements for financing general practice premises in the London initiative zone.

I have today laid before Parliament regulations giving family health services authorities—FHSAs—a new power to acquire, develop and dispose of land and property within the London intiative zone for the provision of general practice premises. That new arrangement will enable FHSAs to play a greater part in initiating and co-ordinating developments with their local practices, to act as an engine of change and to promote joint ventures with the independent sector.

We are also increasing FHSA discretion within the initiative zone over the level of improvement grants payable to GPs to develop existing practice premises. From today, the current ceiling for improvement grant reimbursement is being raised from 66 per cent to 90 per cent. That will offer greater flexibility to support projects which could not be achieved through other means. Both new powers will be available until 31 March 1996 and will be subject to review before then. Further details are being published separately today.

Investing in primary care means that we must unlock the resources tied up in the high overhead costs of London hospitals. Subsidising those costs year in, year out is not right in London and is not fair to the rest of the country. We have to invest in modern care, in London as elsewhere, not sustain a pattern of services which no longer meets current and future patient needs. That is why there must be change to London hospitals.

I begin with those hospitals which have applied to become national health service trusts. We have agreed a new central funding mechanism with the eight research-oriented postgraduate special health authorities, to be effective from April. Those arrangements are sensible and fair. They put the SHAs on a more equitable footing with other hospitals and will sustain high quality research and development.

Against that background, the Moorfields eye hospital, the Bethlem Royal and the Maudsley hospitals and the Royal Brompton national heart and lung hospital will all become NHS trusts from 1 April.

There has been much speculation about the future of the Royal Marsden. I am pleased to announce that it too will become an NHS trust from April. Together with the generous initial funding which, as a former SHA, the Marsden will receive, that decision gives it every opportunity to shape its own future, responding to patient choice.

I have not been able to approve the trust application from the national hospital for neurology and neurosurgery because it could not meet the financial requirements for a stand-alone trust. The hospital will continue as an SHA, while it explores options for safeguarding its highly valued teaching and research work.

Similarly, the Eastman dental hospital has not been approved because of concerns about financial viability. It too will continue as an SHA while options for its future are explored. The Chelsea and Westminster hospital has applied to be a trust in its own right. Consultation on that will conclude in March.

The Hammersmith and Queen Charlotte's SHA, together with the Charing Cross hospital, recently applied to become a joint trust. I shall take a decision on that, following statutory public consultation which ends in March.

Discussions are taking place between the Hammersmith and Charing Cross hospitals to bring together their considerable service, academic and teaching strengths. Both recognise the benefits from merging their facilities on to a single site. Sir David Phillips, former chairman of the Advisory Board for the Research Councils, and Sir Rex Richards, a former vice-chancellor of Oxford university, are undertaking a special study to identify measures which would be needed to maintain that research excellence in the event of services being consolidated on one site. We welcome those developments.

I have agreed to establish a new trust incorporating the Royal London, St. Bartholomew's and the London chest hospitals. Bringing together these three hospitals, which encompass major accident and emergency provision, local acute specialist services and teaching and research, offers a great opportunity to establish a first-class institution serving the City and east London. The new trust will take forward decisions about the future location of services across the three sites.

University college London hospitals originally submitted a joint trust application with the Royal National throat, nose and ear hospital trust. In response to public consultation, the region is now exploring the option of UCLH going forward as a trust in its own right, with the RNTNE trust continuing separately. I shall make a final decision in March following consultation on the revised application.

At present the UCLH group is scattered across several sites. It needs to consolidate services into fewer buildings. A number of options are currently being explored. Any proposals need to safeguard and strengthen UCLH's position as an international centre of excellence in service, teaching and medical research.

The Great Ormond Street hospital for sick children will remain where it is. It too will become a trust from April. This decision provides it with an opportunity to build on its worldwide reputation. Separate management arrangements will be made for the Queen Elizabeth hospital, Hackney, within its local community.

Sir Bernard Tomlinson's analysis that current and future patient demand cannot sustain four major hospitals in south London is widely supported. Both Lewisham hospital and King's are securely established, each serving its own local population, and both are benefiting from new capital investment.

By establishing Guy's and St. Thomas's as a single trust last April, the Government signalled their determination to bring to an end the duplication of services between the two sites. This is not just a necessary response to the gradual withdrawal of patients that the trust faces. The trust's clinicians at both Guy's and St. Thomas's have argued strongly that patient care will be improved by concentrating clinical services one one site. This view is storngly endorsed by the main purchasers.

Strong arguments were put forward in favour of each site. After careful consideration, our judgment was that, overall, the St. Thomas's site offers a better location and environment for a hospital and serves a bigger local population. The need to safeguard what is the largest and one of the busiest accident and emergency departments in London was also crucial to the decision. We therefore intend to ask the trust to pursue proposals that, over time, will concentrate acute and specialist hospital services at the St. Thomas's site. As well as clinical teaching accommodation, a strong research presence, in conjunction with acute clinical services, will be retained on the St. Thomas's site.

Under these proposals, the Guy's site would offer a wide range of modern hospital and health services focused on the needs of the local community. As we have undertaken elsewhere, an accident and emergency department would remain at the site until alternative facilities were developed and were working satisfactorily, particularly at King's College hospital and Lewisham.

We also intend to build on the considerable academic and research strengths at Guy's. We strongly support moves to integrate the united medical and dental schools with King's college. Bringing these elements together builds up to an attractive vision for the future of the Guy's site. State-of-the-art local health services would exist alongside a major new centre of teaching and research. This proposal offers the oportunity for Guy's to evolve along new and imaginative lines. It would become a high-quality health and academic campus, serving local patient needs, training tomorrow's doctors, dentists and nurses and exploring the boundaries of medicine.

I have asked Sir Tim Chessells, chairman of the London Implementation Group, to take forward this work. He will bring together the key parties, including the main purchaser, the trust board, UMDS, King's College London and the special trustees of both hospitals.

It is also proposed to develop both the Guy's/St. Thomas's trust and King's college hospital as specialist cardiac centres for south-east London and Kent. For neurosciences, a strong new centre would be developed, based around King's, building on the links with the institute of psychiatry at the Maudsley. In order to strengthen both these proposed new specialist centres, cardiac and neurosciences would be transferred from the Brook hospital, which is in very poor condition. Statutory consultation will now go ahead on these proposals.

In the light of this, discussions between my Department and the Ministry of Defence are well advanced about the possible sale of the Queen Elizabeth military hospital, Woolwich to the Greenwich Healthcare trust. The aim would be for this hospital to replace the Brook and, eventually, most of Greenwich district general hospital. Subject to settling some outstanding issues, I hope that the matter can be put out for consultation in the spring or early summer.

In south-west London, the regional health authority has completed some work on the distribution of services, the results of which have been made available to local health authorities and hospitals. It will now be for those locally charged with assessing and meeting health needs to take into consideration the effects, over time, of proposed changes in central London and the views of those living in the area served before deciding whether local service changes should be proposed for public consultation. Subject to that process, I do not anticipate significant change to the current pattern of hospital services in the near future.

Finally, I am pleased to announce that I have approved two further trusts in London whose applications were referred last year: Newham acute hospital, and the Tavistock and Portman clinics. Both will become trusts on 1 April.

Today's announcements represent considerable further progress toward reshaping London's health services. Of course, much remains to be done. We will maintain the pressure for change and improvement.

Most of London's hospitals are now NHS trusts. Together with local health authorities, they will take change forward at a local level. Their decisions must reflect the needs of patients, the importance of consolidating London's excellence in specialist services, teaching and research, and essential strategic issues such as maintaining comprehensive accident and emergency cover.

We shall also continue to pay attention to the needs of staff, particularly the arrangements for helping displaced staff find new jobs within the NHS, which are working well.

I have announced today further measures to enable London's hospitals to respond to the changing demands of their patients. I have announced eight new NHS trusts for the capital. I have announced a doubling in new investment in primary care and a substantial programme to improve the local health services which Londoners need. We recognise, as others recognise, that change in London is needed and long overdue. My statement today is proof of our commitment to shape London's health service to match London's needs, now and into the 21st century.

Mr. David Blunkett (Sheffield, Brightside)

If anyone needed justification for supporting the proposals in our document "Health 2000", the Secretary of State has just given it. Does she agree with Sir Bernard Tomlinson's comment that planning and the internal market are incompatible"? The announcement of eight new trusts this afternoon spells not a new way forward for London but a disaster in terms of further rationalisation and closure.

Over the past 12 months, since the Secretary of State responded to the Tomlinson inquiry, has there not been uncertainty and demoralisation throughout the capital? Does the Secretary of State agree that neither local and national representatives nor the people of London have played a part in the proposals put before the House this afternoon? Just a few weeks ago the Secretary of Slate announced outside the House that she had saved University College hospital from the effects of the internal market. She also announced the effective demise of Bart's. This afternoon, she has made an announcement along similar lines about proposals for trusts and rationalisation that will inevitably lead to less service and less provision for people in the capital.

Perhaps the Secretary of State will tell us this afternoon what happened to the promises that were made a year ago about improvements in primary and community care in London. Will she tell us why there has been a 2 per cent. drop in the number of GPs employed in the London Implementation Group zone since the reorganisation started in London; why there has been a 5 per cent. drop in the number of health visitors; why 319,500 people are on the waiting lists of the four Thames regions; and why in the past quarter alone the number of people waiting for more than a year has increased by 13,340—a 12 per cent. increase? Is there room for closure and rationalisation with such figures?

Perhaps the Secretary of State will tell us about the planned changes to Guy's. Did not the Government parade Guy's hospital as the flagship trust of the Tory party? Has not that flagship trust been holed below the water line this afternoon by the Secretary of State? Was not the captain of the flagship trust thrown a lifebelt with a £130,000 golden handshake while 2,000 people working at those hospitals are threatened with redundancy and redeployment? Is not it a fact that the £140 million that was spent on the unit at Philip Harris house will now be set aside and used in a completely different way from that in the proposals? Will the Secretary of State tell us whether £44 million of the £214 million that it will cost to reconfigure the two hospitals will have to be repaid to the charities that raised money for the hospital?

Is it not a fact that the Secretary of State's announcement this afternoon of a trust for the Royal Marsden hospital is not a lifeline but a hangman's noose? Is it not a fact that that great teaching and research hospital, with its world-renowned cancer unit, will be finished not by any announcement by the Secretary of State, but by the impact of the internal market? Will she make a statement this afternoon to clarify that she will order the two major purchasing authorities to continue buying the services of the Royal Marsden hospital? If she does not, the Royal Marsden will gradually be strangled, as will other hospitals, by the operation of the system.

Will the Secretary of State confirm that it is not the good news announced by her but the bad news implemented by the market that really matters? It is similar to the announcement on pit closures that was made by the President of the Board of Trade: announcements are made that give the impression of saving services, while the reality gradually strangles them on the ground. Rather than a transfer of resources, a pulling forward of money to pretend that new money has been announced this afternoon for next year's primary care investment, would not planned change and rational investment in primary care be a real improvement in primary services?

Should it not be for a London regional health authority to plan that development and care? Would not the involvement of local people bring accountability? Would not a fresh start for London bring clarity for the years ahead, not uncertainty and demoralisation? Should not it be the Secretary of State's duty this afternoon to announce that things will not once again be put off until the end of March, and lift the threat from those who receive the services and those who deliver them, to give London the world-class services that it deserves?

The Lord President of the Council and Leader of the House of Commons (Mr. Tony Newton)

On a point of order, Madam Speaker. The House might like to know that the Prime Minister has just received a message saying that the two Members of Parliament in Somalia are now out of the hands of the people who were holding them, are back with their Action Aid team and will be flying back tomorrow.

Mrs. Bottomley

As ever, the hon. Member for Sheffield, Brightside (Mr. Blunkett) is long on discussion papers, but cannot face a decision. London needs decisions.

Tomlinson set out a programme for change; we have followed that programme carefully, and have been involved in a probably unprecedented consultation and discussion, not only with the purchasing authorities which are charged with seeking the best interests of local patients—local people—but with the universities and research institutes. According to Paddy Ross, head of the Joint Consultants Committee, As a result of meaningful consultations they"— that is Ministers— have produced a Government response the broad thrust of which is supported by the medical profession at national level. I pay tribute to all the distinguished members of the medical and research community who have participated in the effort to draw together the evidence necessary for the taking of some extremely difficult and sensitive decisions—decisions which, however, had to be made. That is the difference between being in government and being a permanent Opposition party.

According to the further policy document produced by the hon. Member for Brightside, the policy for London should be a vision of a new health service built from the bottom, with primary and community care as the focus of our thinking. Those are the hon. Gentleman's words; they are also the words that describe the commitment that we have demonstrated today.

Like other Members of Parliament, the hon. Gentleman will receive in his postbag details of the 127 primary care schemes that are already under way. There are 350 additional nurses, 81 new paramedic and counselling staff and 23 new "hospital at home" schemes in the London area; £7.5 million is being spent through the voluntary sector—quite apart from the extra money that I have announced today.

The hon. Gentleman referred to the difficult decision concerning the Guy's/St. Thomas's trust. It is agreed that those hospital services must be concentrated on a single site. The purpose of the new building on the Guy's site was to provide health services, research and teaching; those services will continue to be provided. The special trustees, the dean of the medical school and representatives of King's College will be involved with Sir Tim Chessells in deciding on the details of how that balance can best be achieved to serve the needs of the future. Our vision, however, is of a campus concentrating on learning, research and health services, which will play an important part in training future generations to work with and for the health service.

My announcement sets the strategic direction for the future. I well understand the difficulties of the staff involved; but, if we spend 20 per cent. of the money on 15 per cent. of the people—if London has one doctor to 500 people, while the rest of the country has one doctor to 1,100—that is evidence that no Government can responsibly refuse to address. My announcement has set the direction for the future: it means better health services for Londoners.

Several hon. Members

rose—

Madam Speaker

Order. I must strike a balance between this very important statement, another statement and the equally important debate that follows. I therefore seek the co-operation of all hon. Members—including Government Front Benchers—when I ask for brisk questions and brisk answers. That will enable me to call as many hon. Members as possible.

Mrs. Marion Roe (Broxbourne)

Along with millions of Londoners, I welcome the decisions that my right hon. Friend has announced to remove uncertainty from the future of London's health services—especially the decision to invest £85 million of new money in local health services in areas of need next year. Does my right hon. Friend agree that the lack of proper primary and community care puts additional strain on hospital services, and increases waiting times?

Mrs. Bottomley

I entirely endorse what my hon. Friend has said. One of London's dilemmas is caused by the fact that nearly 50 per cent. of those who use accident and emergency departments in hospitals are people who, in other parts of the country, would have used the services provided by their family doctors. That is one of the difficulties involving discharging patients from hospitals. If we can improve primary care, it will be better for patients to be seen by their family doctors and the practised teams who know and have stewardship of families for a lifetime.

Ms Liz Lynne (Rochdale)

Does the Secretary of State agree that, on the same day that UNISON announced the demoralisation of staff within the NHS, her announcement and the way in which she has handled London hospitals will increase that demoralisation? What weight does she give to the advice from the independent reviews on specialist services for London, given that she seems to have ignored that advice and the views of Londoners about Guy's hospital?

Finally, I welcome the money that she has put into primary care. It is a great service for London, but I should like to know where it will come from. Is it new money, and will it really help people who need acute beds when primary services cannot help them?

Mrs. Bottomley

There is no doubt that UNISON staff feel demoralised because they have seen the Labour party's documents. The hon. Lady referred to the specialty reviews. There were research views and specialty reviews and the interests of purchasers were taken into account. The decision on Guy's and St. Thomas's was finely balanced, but there was strong agreement among the clinicians on both sites.

When my right hon. Friend the Minister for Health visited both hospitals, it was clear that they wanted services to be concentrated on one site. It is a difficult judgment. The strong view of the purchasers was that it should be the St. Thomas's site, and the London ambulance service advocated the important part played by that accident and emergency department. I shall not conceal from the hon. Lady the judgment and balance in that decision, but a decision had to be taken.

As for the extra money, the hon. Lady will know that, unlike the Opposition, who had to edit the price tag out of their policy document—after a row with the shadow Chancellor the £6 billion price tag disappeared up the chimney—we were able to—[Interruption.]

Madam Speaker

Order. I have asked that hon. Members refer only to the statement and that they get brisk answers.

Mrs. Bottomley

The Opposition do not want to hear about the £1.6 billion extra for the national health service this year, or £83 per household.

Mr. David Congdon (Croydon, North-East)

I welcome my right hon. Friend's statement, which strikes a good balance between central direction and letting the internal market decide the pattern of provision in London. Many Londoners recognise that there is an inequitable distribution of resources between London and the rest of the country. In implementing the changes, will she not lose sight of the fact that resources are also inequitable between inner and outer London and that outer London must get its share of resources?

Mrs. Bottomley

I am well aware of the pressure from those in outer London and the concern that decisions on inner London should be brought to a conclusion. We have to move as fast as we reasonably can, taking all views into account.

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

Will the Secretary of State confirm that her close friend and colleague Lord McAlpine, the president of St. Bartholomew's medical college, has persistently and savagely criticised her mad proposal to close the accident and emergency unit at Bart's? Is she aware that leading counsel has advised that the decision was improper and unlawful and such that no reasonable person could take it, and that she is about to be brought before the courts?

Mrs. Bottomley

I am well aware that each of the great hospitals in London has supporters and those who would champion its cause, but I am also aware that it is necessary to take decisions. No change is no option, and I would urge the hon. Gentleman to read the speech on the subject by the Opposition spokesman in the House of Lords before Christmas. She said then that when the changes to Bart's and the Royal London hospital were implemented, could we please make sure that they were properly funded. Those changes needed to be taken across London? I can also report—[Interruption.] I add my own words at the end. It is a point of record. The point was made about the need to move to the Royal London hospital, but the changes are necessary. I urge the hon. Gentleman to speak to some of those at St. Bartholomew's whose vision for the future includes working with a stronger university hospital treating the needs of future patients.

Mr. Matthew Carrington (Fulham)

My right hon. Friend will know that Charing Cross hospital in my constituency has strong local support. Although the merger with Hammersmith hospital is popular, Charing Cross hospital has modern buildings, a superb location and the convenience of a heavily used accident and emergency department. It is also well supported by purchasers and local GPs. When the decision is taken about putting the hospitals on to a single site, will my right hon. Friend ensure that patients' needs are put first in deciding the location of hospital facilities in west London?

Mrs. Bottomley

Indeed. My hon. Friend is a great champion of Charing Cross hospital. It is an extremely popular hospital that was favourably reported on in the specialty reviews. He will know that work is under way to examine the configuration of services and the possibility of Charing Cross and Hammersmith hospitals coming together as a trust.

Mr. Peter Shore (Bethnal Green and Stepney)

The Secretary of State made a long statement, but she omitted several important facts. What is her estimate of the loss of beds in London hospitals during the implementation period? How many skilled doctors and other medical professions will no longer be employed in London hospitals? What is her estimate of the size of the London hospital waiting list during the implementation period?

Mrs. Bottomley

The right hon. Gentleman will be aware that London has about 3.9 acute beds per thousand compared with about 2.5 elsewhere. The change of use of London hospitals and the increasing use of day surgery rather than in-patient admission mean that the need for beds in London is changing fast. Tomlinson estimated a loss of about 2,000 beds over a longer period, but I would not want to put a figure to the precise numbers because we have to match provision to the needs of services. Similarly, we envisage an increase in the number of people employed in the community and primary care sectors.

We anticipate having fewer health staff in London. That is why we set up the London clearing house to help people to find jobs elsewhere in the country if they are no longer necessary in the London health service.

Mr. Peter Bottomley (Eltham)

It is good to have a boost for primary care services. People in Eltham want to have staff at the Brook hospital working on the other side of Shooter's hill, if the Queen Elizabeth hospital can be brought into national health service use. There are still some who are unhappy that the neurosciences should go to Denmark hill rather than coming into the Guy's/St. Thomas's collection of surgery specialties.

Mrs. Bottomley

I am aware of my close and hon. Friend's constituency interest and the need for the uncertainty to be brought to an end. I also understand his point about neurosciences. Tomlinson's report and the research reviews strongly commended the establishment of a world centre of neurosciences at Denmark hill, with the neurosciences going to King's hospital, working closely with the Maudsley in the same location.

Mr. Clive Soley (Hammersmith)

Is the Secretary of State aware that, although there is strong support for the combination of Hammersmith and Charing Cross hospitals, there is severe doubt that we can squeeze a quart into a pint pot by closing down one of the sites and transferring all the services to the other site? Will she give an undertaking that, if there is a decline in patient care, she will ensure that the services are available on the two sites if that is appropriate? When will she take that decision? Frankly, the effects on staff morale at Charing Cross and Hammersmith are severe.

Mrs. Bottomley

The purpose of change in London is to improve services for patients and to establish a better balance between the specialty services, the routine hospital services and primary care. Change will not take place unless and until it leads to improvements for patients in London—decreasing waiting times and overall improvements in health care.

The trust application is out to consultation. I am not able to make a decision about that until March, when the consultation finishes.

Mr. Roger Sims (Chislehurst)

My right hon. Friend will recognise that there will be disappointment in south-east London and north-west Kent at the decision to concentrate the specialist and acute hospital services on the St. Thomas's rather than the Guy's site, but it was inevitable, when the trust was unable to reach a conclusion, that she would have to make the ultimate decision. I accept that the arguments were finely balanced, and I congratulate her on having the courage to take that decision and remove the uncertainty, which has prevailed for too long.

Can my right hon. Friend confirm that there is no possibility of those changes being effected overnight—that they will be gradual, and that they will take account of the understandable worries of the staff, many of whom are highly qualified people?

Mrs. Bottomley

I can confirm that those changes will take place gradually over a number of years. They are highly complex; a great number of organisations will be involved, but there is a need for a strategic direction. I refer my hon. Friend to the comments of the South East London health authority, which said today that the decision to centralise in-patient services at St. Thomas's hospital is the right one. It said that it reduces the amount … spent on costly overheads and allows more to be spent on direct patient care. Similarly, the London ambulance service says: The department at St. Thomas's is an essential link in the network of Accident and Emergency Services in London. Both its strategic position and its accessibility argued strongly for its retention.

Mr. Nigel Spearing (Newham, South)

In respect of Newham general hospital, which is to become a so-called trust, does the Secretary of State agree that the quality of its care in future and its very existence depend on its success in commercial competition? Therefore, the "working for patients", in the words of the White Paper, will not take place—or indeed for the people of Newham, because the staff there will be working for cash and perhaps for their very jobs. Is not such a situation incompatible with the principles of Christianity? Will the right hon. Lady come to Newham and debate that principle before an audience of representatives of the people and of people who work in the health service?

Mrs. Bottomley

Newham's becoming a trust means that it is more able to behave more flexibly to solve its problems to be committed to local patients. NHS trusts are, and remain, part of the national health service, delivering health care to all on the basis of clinical need, not ability to pay. The hon. Gentleman misunderstands the nature of NHS trusts, and does so wilfully. Throughout the country, NHS trusts are delivering more care, reducing waiting times, improving the quality of care.

Dr. Charles Goodson-Wickes (Wimbledon)

I welcome my right hon. Friend's—

Mr. Spearing

See your vicar.

Dr. Goodson-Wickes

I welcome my right hon. Friend's resolve to bring uncertainty to an end; as we have heard, she has been travelling through a political and a medical minefield. Although I recognise that provincial hospitals are developing an ever-increasing standard of care, will she give the House an assurance that the speed of rationalisation of hospitals in London will not put at risk their excellence and their worldwide reputation?

Mrs. Bottomley

Yes, Madam Speaker. The hospitals, the universities and the research institutes need to know the direction of strategic change. It is not right to move with undue haste. The intention is to consolidate and strengthen, to improve services for Londoners and to improve the centres of research expertise.

Ms Glenda Jackson (Hampstead and Highgate)

Is the Secretary of State aware that the cost of her failure, in her own words, to provide high standards of primary care for Londoners that are "common elsewhere" is being paid by Londoners? I give as an example one of my constituents, a homeless man, who is suffering from gangrene. Can the right hon. Lady give here today a firm guarantee to all Londoners that the already limited primary health facilities for their needs will not be reduced by what seems to me a quite scandalous scythe through such existing health care as is provided for them by London's hospitals?

Mrs. Bottomley

I give an unequivocal guarantee, and the hon. Lady will find in her mail a list of the 127 new primary care schemes that exist in London already. There will be more next year, as we have announced that an extra £85 million will be spent on primary care in London. As a result, there will be more doctors, more practice nurses, more hospital-at-home schemes, and more community psychiatric nurses, and better primary and family care services will be delivered in practice.

Mr. Andrew Rowe (Mid-Kent)

Does my right hon. Friend accept that her courageous statement today shows that she understands the changes that are coming over the national health service—for example, the enormous numbers of the population who have moved out of London into constituencies such as mine and the shift from acute care to primary care, showing that the Opposition's concentration on such matters as the number of beds is merely a further indication of the backward-looking attitude that they have adopted towards her reforms?

Mrs. Bottomley

I thank my hon. Friend. The Labour party counts anything other than patients, patient needs and the improvement in the quality of their care.

My hon. Friendis right about people leaving London. When the hon. Member for Newham, South (Mr. Spearing) said, "See your vicar," I thought that he wanted me to discuss the Templeman report with my vicar, because I noticed that the Templeman report, only the other day, suggested that two thirds of the churches in the City should close because the population has left.

Mr. Tony Banks (Newham, North-West)

In view of the fact that Newham is almost a Tory-free zone, will the right hon. Lady give an assurance that she will not pack the new trust at Newham with Tory stooges? Will she also answer the question of my hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) about how much of the £44 million from charities that went to Guy's will have to be handed back?

Mrs. Bottomley

If the hon. Gentleman has the names of people who he wants to be considered for the new trust, I know that my right hon. Friend will consider them. The Labour party has given many names with great success. Helene Hayman, for example, is chairman of the trust at Whittington hospital; Julia Neuberger, a member of the Liberal Democrat party, is an excellent trust chairman. We want, as ever, people who are committed to the national health service, who are prepared to take difficult decisions and who are determined to improve patient care. We appreciate them on the trusts.

Mr. Harry Greenway (Ealing, North)

Does my right hon. Friend agree that, if implemented, the Labour party proposals to abolish the private sector for health will cost a great deal of money, which will come from the remainder of the health service?

Mr. Keith Mans (Wyre)

Yes, £90 million.

Mr. Greenway

My hon. Friend says about £90 million. Would not that proposal, if implemented, slow down her success in getting people off trolleys in hospitals such as Ealing hospital? May I have her assurance that hospitals will not be closed while there is any chance of people having to be put on to trolleys or into emergency situations?

Mrs. Bottomley

I think that the memories of Barbara Castle echo around with the policy document today. The vendetta against the private sector is something that people are used to hearing about from the Labour party. Private patients actually benefit the national health service. My hon. Friend is right. No decisions will be made unless and until it is safe to make them.

My hon. Friend rightly referred to the unacceptable situation of patients being left for too long on trolleys. That cannot be tolerated. The chief executive has written to make that quite clear. There is a major investment programme in a great number of accident and emergency units across London and we are determined to ensure, not only that they are better organised within the hospital, but that some of the left-wing Labour authorities co-operate better with the discharge arrangements.

Mr. Banks

Name one.

Ms Harriet Harman (Peckham)

Would the right hon. Lady not insult my constituents by implying that the reason that they oppose her plans is that they have some old-fashioned and irrational attachment to the idea of measuring the success of the national health service by the number of hospital beds? Does she not realise that people in south-east London are worried about the plans that will result in reduced numbers of hospital beds because they are worried that she will cut the hospital beds before the GP services and the social services improve and, therefore, people such as my constituent, an elderly woman who was on a trolley for 18 hours in King's College hospital last week, will continue to wait in unsatisfactory conditions?

Mrs. Bottomley

This is like the old days. As ever, the hon. Lady fails to welcome the good news. I should have thought that she would welcome the fact that neurosciences are to be moved to King's, which will be a world class centre of excellence. The hon. Lady has never been able to do anything other than talk down the health service, which is a tragedy for King's and for the service itself. The only good news is that she is no longer the shadow spokesman on health.

The hon. Lady should check her facts more carefully. The reason that the lady was left on a trolley at King's, which was unacceptable, was that 40 to 50 patients were waiting to be discharged into the community. The social services in London have received a 75 per cent. increase in the money given to them for community care, and part of it is for them to arrange with hospitals for the discharge of patients. We look to them to deliver.

Mr. John Marshall (Hendon, South)

Does my right hon. Friend agree that critics of trust hospitals should examine the record of hospitals such as the Royal Free, which has dramatically increased the number of patients treated and substantially reduced waiting lists? Does not that provide hope for the people of Newham?

Mrs. Bottomley

It certainly does. The Royal Free has done a magnificent job and the chairman deserves great credit. My hon. Friend will know that the chairman of the Royal Free is about to become the regional health authority chairman for the south Thames area. That bodes well for all of South Thames.

Ms Kate Hoey (Vauxhall)

May I welcome the part of the statement which continues to allow an accident and emergency unit at St. Thomas's and thus permits the hospital to operate most effectively? Does the Secretary of State agree that the people who are making the nasty point that the only reason St. Thomas's will retain its accident and emergency unit is that it is near the House of Commons are doing a great disservice to the thousands of people in my area who have signed petitions, campaigned and worked with dignity to ensure that their hospital would remain open? Will she confirm that 80 per cent. of the Philip Harris unit will still be used for the purpose for which it was originally planned?

Mrs. Bottomley

I thank the hon. Lady for her comments. It was an extremely difficult judgment because the arguments are balanced. I well understand the disappointment of some people at the Guy's site that the decision did not go their way. I can say only that I have been completely direct about the basis on which the decision was made. I believe that there is a great vision for the future at the Guy's site. Indeed, only today the principal of King's College, London said how he welcomed the announcement. He said that it would enable a merger between UMDS and King's College to go ahead with a … commitment to the location at the Guy's site not only of basic medical and dental and life sciences teaching and research, but eventually of the whole of the merged multi faculty College. That is a very exciting vision for the Guy's/Thomas's trust.

Mr. Rupert Allason (Torbay)

I welcome my right hon. Friend's statement. Will she confirm that it can be interpreted as very good news for people in the west country and those who use provincial hospitals because there will be a switch of resources away from London to meet the greater need of the provinces and, in particular, of the west country?

Mrs. Bottomley

I can indeed confirm that, over time, it will be possible to have a fairer distribution of resources across the country. At the moment, 20 per cent. of the money is spent on 15 per cent. of the people. Areas outside London support London services to the tune of more than £100 million, a situation that cannot continue indefinitely. We are bringing it to an end.

Ms Tessa Jowell (Dulwich)

Will the Secretary of State make available to the House the papers and documentation which informed her recommendations? Are the recommend-dations supported by the London Implementation Group, the four Thames regions and inner-London purchasers?

Mrs. Bottomley

In due course, the programme will go out to consultation before final decisions are made. Management documents were available. There has been a great deal of discussion and debate, not only about the cost, the service configuration and the need to preserve specialties. All the information that is necessary for public consultation will be available before the final decisions are made because we are bound by public consultation. What is important is that a decision is made.

Initially, the trust board provided a number of options. One that had seemed persuasive was to take no decision. At present, the subsidy to the Guy's/Thomas's trust runs at £18 million every year and is rising. The clinicians made it quite clear to my right hon. Friend the Minister of State when he visited each site that they wished for a single-site option, so further work was needed to ensure that we faced the decision—difficult though it was—to set the strategic direction for the future.

Several hon. Members

rose—

Madam Speaker

Order. I must make it clear that hon. Members who have not heard the entire statement but have come in late will not be called. That is not an innovation. The House will recall that I have made that statement several times, and I intend to hold to it.

Mrs. Audrey Wise (Preston)

Will the Secretary of State desist from her shabby trick of playing London off against the rest of the country? It is singularly unconvincing in view of the havoc also being wreaked in cities other than London. Will she clarify her bland statement that the Queen Elizabeth hospital in Hackney is to be incorporated in local services? Does not she mean that provision for sick children in London will be weakened? Was not the Queen Elizabeth part of the Great Ormond street hospital for sick children?

Mrs. Bottomley

The hon. Lady is right in the sense that because of medical advance it is no longer necessary to have the great number of hospitals and beds that were appropriate in many city centres in the past. There has been a dramatic investment in primary care as care increasingly moves into the community. That change is common, in London and elsewhere. London is especially complicated because of the input of a number of colleges, universities and research institutes.

As for the Queen Elizabeth hospital in Hackney, the best way to organise services for children in a local community is with the other hospitals in that local community. Great Ormond street will continue as a specialty hospital of very high renown and the Queen Elizabeth hospital will continue its tradition of serving the local community. It is a hospital I know well.

Mr. Simon Hughes (Southwark and Bermondsey)

Does the Secretary of State accept that the people at Guy's feel not disappointment but anger and a sense of betrayal about the biggest U-turn in the history of this Administration's health policy? The Administration launched a flagship and constructed a state-of-the-art building but a couple of years later they evacuate the flagship and say that the building can be kept but with hardly any beds. The figures do not justify the Secretary of State's conclusion and she has not shown them to anyone. They are secret, but will she now reveal them?

She knows as well as I do that the reality of today's decision is that it was made because of pressure from the establishment. She would not take on people here or in Whitehall who would allow St. Thomas's to be closed. She is once again allowing the people in the south-east of London—the people, not the establishment—to suffer so that she can come to a brave decision while those people receive a worse service. That is unacceptable and disgraceful, and the anger that she is hearing this afternoon is only the beginning.

Mrs. Bottomley

I have made it clear that I understand that there will be disappointment at the Guy's site but a decision has to be made. I set out clearly the basis on which the judgment was made, which included the fact that there was a larger local population, the London ambulance service's strong views and the overall ability of the two sites to provide for alternative needs. There is a vision at the Guy's site for a research campus, a campus of learning, and the vast majority of the new building at the Guy's site will be used for the purpose for which it was intended.

There now need to be detailed consultations with the head of the medical school, the clinicians, the trust board and the special trustees about how to maximise the use of the building for the purposes of research and teaching, precisely the purposes for which it was established, in order to make it a great centre for the 21st century. I am confident that the trust's vision will deliver a first-rate university hospital, not only serving patients, but training future dentists, doctors, nurses and other health professionals.

Mr. James Couchman (Gillingham)

On a point of order, Madam Speaker.

Madam Speaker

Order. I always take points of order after statements.