HC Deb 05 April 1995 vol 257 cc1789-812

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Andrew Mitchell.]

6.10 pm
Mr. Hugh Dykes (Harrow, East)

I am grateful for this important Adjournment debate, which contrasts with the previous harmonious stages of a Bill on which hon. Members on both sides of the House seemed agreed, the Licensing (Sunday Hours) Bill. This is a painful moment, because it gives me no pleasure to take issue with the Government and with my hon. Friend the Under-Secretary of State for Health and other colleagues responsible for the threatened closure of Edgware general hospital's accident and emergency department.

That outrageous decision is unacceptable to me, to many of my hon. Friends and to the local population. A campaign was launched to save the hospital and to maintain its existing range of services. I must express my considerable anger and resentment at the manner in which the matter has been handled, notwithstanding ample exchanges earlier in the House. The last thing you want, Mr. Deputy Speaker, is for me to be repetitive or to refer to other hospitals threatened with total or partial closure. For that reason, although I am tempted to refer to other threatened London hospitals, I shall confine my remarks to Edgware general.

I use the word "threatened" deliberately. The Government have said that they agree with the proposal to close Edgware general's A and E unit. My hon. Friend the Under-Secretary will not be surprised to hear me say with great force that a massive local campaign will be unleashed to save the hospital's facilities and to persuade the Government to change their mind.

Since the campaign for Edgware general was launched more than one year ago by my hon. Friend the Member for Hendon, North (Sir J. Gorst) and by me, it has grown in conviction. It is not, as some bureaucrats suggest, an emotional campaign but a carefully thought-out campaign, with medical evidence supporting our arguments.

I share the resentment of other hon. Members that the dreadful announcement of the proposed closure of Edgware general's A and E unit was made in a written answer to my hon. Friend the Member for Broxbourne (Mrs. Roe) on Tuesday, because the hospital is precious to our constituents and an important part of the all-London health service care system. Today, the Secretary of State was obliged to come to the House, to respond to a private notice question from my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke). I cannot recall an occasion in recent years, or even decades, when a former Secretary of State who was until recently a member of the Cabinet insisted, justifiably, on a proper statement to the House—if that is the right word for the Secretary of State's lamentable announcement. That statement about Edgware general and other hospitals was not acceptable to right hon. and hon. Members on both sides of the House.

Again and again, the Government gave a solemn undertaking that there would be no adverse effect on primary health care facilities in our part of north-west London. Manifestly, that undertaking will be betrayed and traduced cynically and ruthlessly by the decision to close Edgware general's accident and emergency facilities. Local Members of Parliament will be fighting hard to ensure that the Government change that decision.

I take no pleasure in saying that, if that does not happen, the Government will face defeat if there are any votes on those matters in the House. I take no pleasure, because I do not want to anticipate that position being reached. However, that is the stark situation that confronts us and the Government.

The whole panoply and the way in which the matter has been handled are encapsulated in the terms of the early-day motion that my hon. Friend the Member for Hendon, North and I, and other hon. Friends tabled on 3 April—the day before the announcement about Edgware general's A and E unit was made. By then, there was an indication that the Department of Health had not listened to any of the local arguments for retaining that facility. It will take a long time before local Members of Parliament change their minds. I much resent the way in which Sir William Staveley and his colleagues on the regional health authority dealt with the many objections to the closure, and to the recent meeting at which that decision was taken. I was unable to attend it myself but received a full report from my local colleagues that the issue was not dealt with satisfactorily.

I shall refer to one or two important elements in our early-day motion, because that is the most convenient way to explain why we feel so strongly and why the A and E unit must be kept open beyond 1997. My constituency and Hendon, North would be most affected, because the hospital borders them on the Edgware road. A large number of my constituents use the hospital, including an above-average number of elderly patients who rely on the services of this outstanding and successful district general hospital.

Today, we received a deputation comprising mainly schoolchildren but also councillors and others. All the children had been born at Edgware general and their parents regularly make use of it—although, obviously, no one takes pleasure in a hospital being regularly used by people who are ill. Edgware general is regarded with great affection locally.

When the Royal National Orthopaedic—a famous teaching hospital—in my constituency was deprived of its accident and emergency facilities 10 years ago, Government spokesmen said that those facilities and immediate treatment would be maintained and enhanced at Edgware general and that there would be no deterioration in the service.

My difficulty, my constituency being on the Harrow side of the border of the Edgware road, has been that decisions have been recommended mainly by Barnet district health authority, whose remit is outside the area which I represent. Close contact and liaison have been maintained, however, between Members and the protest group over many months. There has been close liaison with the understandable exception of a good friend, my hon. Friend the Member for Chipping Barnet (Mr. Chapman). As he is a Whip, he is not permitted to act on these matters. I fully acknowledge that he is in a different position from other colleagues in the area when it comes to the future of Edgware general hospital, because of the proposal for the extension of Barnet district hospital.

The early-day motion to which I referred reminds the House and the Government with great solemnity that the proposal to close the accident and emergency unit is contrary to the overwhelming opinion of those residing in the catchment area … these proposals are based on debatable clinical assumptions allied to conjectural statistics … there are strong social considerations in favour of retaining an Accident and Emergency Department at Edgware; notes that these consideration include transport and traffic problems". Edgware general hospital is in an extremely congested area. I note the arrival of three distinguished colleagues. I am glad to see that they wish to take part in the debate. I refer to my hon. Friends the Members for Hendon, North and for Hendon, South (Mr. Marshall) and my right hon. Friend the Member for Brent, North (Sir R. Boyson). Given the recent Jopling procedural changes, it may be possible for us to speak on this Adjournment debate for a little longer than is usual. We might not wish to continue for as long as some pessimists imagine, despite the great importance of the issue.

Mr. Deputy Speaker (Mr. Michael Morris)

Order. I shall assist the House. The rules are clear: the Adjournment debate can continue until 10.30 pm. I remind hon. Members, however, that this is a specific debate that is confined to Edgware general hospital. The House spent an hour earlier on other health service matters. The Chair will be strict in ensuring that the debate is confined to Edgware general hospital.

Mr. Dykes

That is why I was trying, Mr. Deputy Speaker—obviously, I was not especially successful—to choose with great, exquisite and painful care a balance of words that would give the impression that we had the right to continue for longer than usual, but that it was understood that to do so might be rather taxing on the patience of other colleagues, including the occupant of the Chair, especially if the expansion of time were to be excessive in all the relativities. I would welcome such an expansion, however, if it were feasible and possible. As I have said, we are dealing with a crucial issue.

That being so, my colleagues present in the Chamber will understand that I shall not necessarily, unless they are minded strongly to intervene, be prepared to give way. They will have the opportunity to make their own contributions, which I shall welcome warmly. That is subject only to the fact that I have to see one of the Harrow deputations on this subject later this evening. Its members will be coming to the House. I would have to leave the Chamber, if the debate were lengthy, to see them. I also have a speaking engagement later today. In any event, we shall see how the debate goes.

I was expressing the anger that we all feel. My hon. Friend the Member for Hendon, North and I, with the strong support and approval of other colleagues, have led the campaign because our constituents are the most affected physically and geographically. As I have said, the hospital is on the border of the Edgware road. I think that I am right in saying that the majority of patients and others using the hospital probably come, notwithstanding that the figures fluctuate and float, from my constituency and that of my hon. Friend the Member for Hendon, North. I accept, of course, that many come from elsewhere, sometimes from quite far afield. They come to an excellent hospital. It is extremely popular and part of the local human and social community. That must be emphasised to our ministerial colleagues. I have in mind that which others and I said about Edgware general hospital in unhappy exchanges with my right hon. Friend the Secretary of State for Health.

I am worried about all aspects of the closure proposal. That is why others and I will be fighting hard and relentlessly to persuade the Government to change their mind. I am especially concerned about traffic congestion. It is an extremely congested area. If people are obliged to go to Barnet, Northwick Park or the Royal Free hospitals, their journeys will take a great deal of time. That would be unacceptable for emergency treatment, including other treatment that patients should receive in a hurry. We would be extremely irresponsible as Members if we put up with such bureaucratic nonsense from the Department. I say to my hon. Friend the Under-Secretary of State, as I said earlier to my right hon. Friend the Secretary of State, that it is the job of politicians in the Department of Health to balance the ruthless arguments of accounting and financial officers, along with those of the bureaucrats, with the human and political considerations that relate to the needs of our constituents and patients generally.

We were given to understand quite a few years ago that there would be no reduction in the services at Edgware general hospital. The hospital is needed, as much as Barnet hospital needs to be expanded. I welcome that expansion, as long as it does not cause Edgware general to suffer. Northwick Park hospital is too far away. It is a major district general hospital with research facilities. St. Mark's hospital is happily going into it, as it were, as a new unit of excellence and special research. All these services are being provided, but a long way away. I estimate that if a journey were made in normal traffic conditions—not in the rush hour—from Edgware general to Northwick Park, it would take about 45 to 50 minutes. In an emergency, that is far too long a journey to an alternative installation.

That journey time shows how inhuman and ill thought out is the judgment with which we are faced. We are faced with a complex—indeed, Byzantine—set of arguments and statistics. I pay tribute to the Evening Standard, which campaigned mostly on behalf of inner-London hospitals, but also for London hospitals generally. There may be some arguments open to the bureaucrats and politicians in the Department of Health that enable them to say that there is some duplication of physical facilities and financial resources in some national central London teaching hospitals, some of which are centuries old. Their long standing is a factor in itself. I can understand the anger that is reflected in the campaign being mounted on their behalf.

At the same time, outer-London hospitals do not have enough facilities. The idea that they have too much is absurd. That is the position in north-west London. In the area that I represent, people are waiting far too long for treatment. It is dispiriting and frustrating for those who have to wait an extremely long time for non-emergency treatment.

The idea that we can close with equanimity, and with callous disregard for the needs of local people, accident and emergency facilities that are so precious to the community is unacceptable. It is not enough for us to protest today about the closure. We will not be doing that because we shall be fighting the proposal all the way through. We shall wage a massive campaign to persuade the Government to change their mind.

It would not be a weakness on the part of Ministers to change their mind and to consider these matters again. They should look again at what has been wrongly decided by the regional health authority. I referred earlier, before the arrival of my hon. Friends, to the cavalier manner in which Sir William Staveley dealt with the proposals at the last consultation meeting. In fact, it was not a consultation meeting. We have been inundated with thousands of views and opinions, including those from medical practitioners and medical experts in our constituencies. I do not know of anyone—if any evidence can be furnished to me to the contrary, I shall happily correct myself at a later occasion—who has given support to the closure proposal. I am talking of people who know about the sharp end or coal face of medical treatment and what is needed for the interests of patients and their families.

It must be understood that a hospital should not be a cold, callous place, one part of what is the greatest health service in the world in many ways, despite the depredations that we have seen in recent years. A hospital is not, as I say, a cold, callous place where people are merely admitted for clinical treatment. It should not be thought of as a place where people receive a necessary bald measure of treatment, and that is it.

Edgware general hospital lives in the hearts and minds of local people. Many people have known it since it started to function and developed with its post-war services. They have known it since it expanded and became a commanding district general hospital in an area of great population growth. It has a particular attraction and affection in the hearts of elderly people locally because of the excellent treatment that they receive in all respects, including accident and emergency services.

About a year ago, on 19 April, I asked my right hon. Friend the Secretary of State various questions about the hospital. I thank the Under-Secretary, my hon. Friend the Member for Bolton, West (Mr. Sackville), who answered, for attending the debate this evening. I hope that some of his answers will be designed to convince us that the proposal is sound. I have my doubts, but I shall give him the benefit of the doubt before his reply.

The campaign against the proposal has continued for a long time. Many hours have been devoted to it. It has been a massive and popular campaign. Detailed arguments have been calculated and considered. It is not merely an emotional campaign, although there is bound to be emotion, of course, when a hospital is threatened with closure. I do not apologise for that. If the bureaucrats in the Department said that it was an emotional campaign, I would agree. But the campaign is not only that: it is based on hard-nosed calculations by us as Members of Parliament and by all the people who are involved in the campaign of what is needed in that area, the population pressure, the lack of facilities if the hospital is closed down, and other related factors.

I asked my right hon. Friend the Secretary of State a year ago, on 19 April, what representations against the proposed closure of the A and E services at Edgware general had been sent to the Department since the beginning of 1994. We had started the campaign well before that; we became pessimistic and alarmed about the matter a long time ago. That is why we worked in a cohesive group, and I pay tribute to my hon. Friend the Member for Hendon, North, who has led our campaign with great distinction. The Under-Secretary, my hon. Friend the Member for Bolton, West, gave the usual bland temporary service reply: Any proposal for a major change in services would be subject to a period of public consultation. The matter comes to Ministers if there are objections. All factors are taken into account including public representations."—[Official Report, 19 April 1994; Vol. 241, c. 475.] Those representations have been brushed aside in this case, by the Department, by the direct agency responsible and, indeed, by Barnet. That is the unacceptable part of this whole business. The anger expressed in the House today about other hospitals is reflected, repeated and mirrored in this Adjournment debate when we express and redouble our expression of anger about the views of people and the medical experts being dismissed with flimsy statistical justification. I particularly resent that, as they know more about the subject than all of us.

The accountants have an obsession that, somehow, money will be saved. I doubt that very much. I think that it would cost more in the end if the services were transferred to the other two hospitals and to the Royal Free. The Royal Free—like most hospitals, sadly—is severely overloaded, and so it is one of the least practical suggestions.

After I received the reply from the Under-Secretary, I commented, saying: I regard the last part of the answer as crucial"— referring to the public representations and consultations. The vast number of objections to closure will I trust be conclusive in the end, partly because they include most informed medical opinion in the area as well. At that stage, a number of medical people were arguing on behalf of the Barnet proposal instead. That is true, but I think I am right in saying that that support has died away, and the longer the campaign has gone on, the more angry and resentful has become the medical and the wider social world. The people whom we respect in the local community: the opinion formers, the professional people—without being pompous to others—the people whose opinions are respected by members of the public, because they are leading representatives of the community in a non-political sense, are all against the proposal. It is not just a knee-jerk reaction that happens when facilities are reduced.

The old pledge that Conservatives gave—I regarded it as a most solemn pledge to my constituents, was happy to echo it and was delighted when it was said from Conservative party platforms and repeated by the noble Baroness Thatcher, and afterwards—that the national health service would be safe in our hands, was one of the most solemn pledges given by any political party in recent decades—

Mr. Andrew Mitchell (Gedling)

Outrageous.

Mr. Dykes

I heard my hon. Friend the Whip say, "Outrageous". It was loud enough for me to hear. If it is outrageous for me to remind my Government colleagues, whom I normally support loyally and faithfully, that a pledge that the national health service would be safe in our hands is now being undermined by the closure of district general hospitals, I make no apology and would ask him to be a gentleman and apologise later on. Perhaps next time he will be wiser.

I am quite intrigued that my hon. Friend the Whip is laughing and smirking when I am protesting and doing what a Member of Parliament never has to apologise for, to any Department or Minister—defending the interests of his own constituents when a vital medical health installation is threatened with closure. If that is a matter for laughing and smirking, my hon. Friend is not fit to be a Government Whip, because most of my colleagues who are Government Whips would not behave like that. [Interruption.] My hon. Friend is continuing to laugh. I am glad that he has a well-developed sense of humour. Perhaps it will stand him in good stead later on when his constituents reflect on his performance as a Member of Parliament, because now that he has to take the Trappist vow of silence as a Government Whip, he will have to work that much harder locally to appeal to them with his local performance.

In contrast to my hon. Friend the Whip's behaviour—he is continuing to laugh—I am glad to pay tribute to our hon. Friend the Member for Chipping Barnet, who cannot, of course, speak on this matter, and is bound to have a different view on the matter because of the position of Barnet hospital in his constituency. My colleagues in the Whips' office in general—perhaps with one exception—are decent people and behave properly on these occasions. Once again, I am sad to see that kind of reaction when I am doing what I perceive to be my duty. But I am and remain a loyal supporter of the Government.

I hope that that will reinforce the scope and extent of my protest, because I would not attack all the proposals that the Government are making: trying to make the NHS more efficiently managed and better run financially with a greater rational sense of the use of resources. That is right and it is the duty of any Government. All Governments, of whatever colour, would have to be extremely careful about the use of NHS resources—the unlimited demand for them—and I pay tribute to their efforts to do that. But that should not mean closure of district general hospitals or, indeed, the most important part of the services. When I say closure, I do not mean the whole hospital but the A and E unit, which is the major part of a hospital. Without an A and E facility in Edgware hospital, the hospital would die. We know that. It would be a very small rump hospital, without the essential services that are needed on these occasions.

My hon. Friend the Member for Hendon, North has kindly allowed me to quote from a letter from one of his constituents. I shall not identify the constituent's name, as that would be wrong. It is from a constituent who has always been a strong supporter of our party. We have been inundated with thousands of letters on the subject, as would be expected. The letter reads: I cannot see how the Labour party could destroy our health service any more than it is at the moment". That is a rather over-strong statement, which I do not accept, but one can understand that reaction when people see what is happening to this precious local unit. The letter continues, in more acceptable language: The closure of Edgware Hospital as a community hospital serving all the needs of the local people is appalling. Don't tell us that this is not directly the Governments responsibility, it could be if they wanted it to be. The people most affected by the changes at the hospital will be the young people with young children and the elderly, who do not have cars to take them to the other hospitals who are supposed to make room for the people of Edgware … It is also very difficult to get to particularly in the busy times when it can take 50 minutes by car. That is a figure that I have timed in my own car to get to, say, Northwick Park hospital. Anyway, it is a different catchment area. That must be emphasised.

The letter continues: An elderly friend of mine was admitted as an emergency at Edgware only to find herself in a bed at Chase Farm, Enfield. With no family and only other elderly friends to rely on, this lady was stranded. It would have taken three buses for her friends"— one can imagine how long it would take, waiting at bus stops, the changes, and so on— to reach her at this hospital. They were frightened of travelling so far and also coming home in the dark. Incidentally, the staff kept reminding her that she was not in their catchment area and they did not know what the procedures would be for after-hospital care … She also had to pay for a minicab to take her home. That is just one example of the thousands of letters that we have received. Do I accept the suggestions of my hon. Friend the Whip and just ignore them? Should I dismiss them and say, "Don't you complain. You are just voters and constituents. You don't matter. We've had consultations. We have thrown all the papers away?" That is impossible. No Government can ask their supporters in the House to put up with such a proposition. That is why the campaign will continue.

It gives me no pleasure to talk in those terms. I am sure that my hon. Friend the Under-Secretary will understand how strongly my hon. Friends and I feel. I look forward to his reply. It is not too late for the Government to reconsider these matters. This is only the first stage. As has been said, the circumstances of the announcement were extremely regrettable and clumsy, but that can be corrected. The Government can think again.

There may be some arguments at the margin about some of the central London facilities, although I hesitate to agree too wholeheartedly with that because I would like them all to continue if they can be afforded. Outer London hospitals in general and the Edgware general hospital in particular are in a different position from the point of view of catchment, transport links, congestion and the needs of the elderly, the young in particular, and all those who need accident and emergency facilities.

My hon. Friend is a conscientious Minister. We thank him for his attentions in the past. He has acquired something of a reputation for being more reasonable in many ways than others, whom I shall not name, in his responses to our efforts to obtain a just solution to this difficult problem. I hope that he will be able to reassure us today, even as a temporary measure, by saying that the matter will be looked at again.

That is a heartfelt plea. I say with great sincerity that it is important that our local people are reassured. They have had many economic and social hammer blows in recent years and this is the last straw in the local area. They cannot put up with it and we want the Minister to say that he will reconsider the matter, take further advice and see what can be done. I would be most grateful if he could reassure us on this occasion.

6.41 pm
Sir Rhodes Boyson (Brent, North)

I concur entirely with my hon. Friend the Member for Harrow, East (Mr. Dykes): this is a major issue in our constituencies. I have visited Edgware general hospital on a number of occasions. I have timed the journey to it by car. I have talked to patients inside and to its staff. They are unanimous that the accident and emergency department should continue.

I know the roads in the area as well as any Member of Parliament who is here because they go through my constituency. From Edgware general hospital to Northwick Park hospital is a journey of six and a half miles on congested roads. On a Saturday afternoon, early in the morning or during the second rush hour the journey can take anything up to an hour and a quarter or an hour and a half. At those times I usually have to make a detour in order to complete my journey in a reasonable time.

We are asking for a reappraisal. There is no local support for the closure of the accident and emergency department. Closure will add to the difficulties in other hospitals as people have to be sent further and further afield.

I trust that this is a listening Government. All Members of Parliament from the area feel strongly that the accident and emergency department should remain at Edgware. Even at this late hour, the matter can be reconsidered. A sensible Government can do sensible things at any time, just as an non-sensible Government can do non-sensible things at any time. We ask for a full reappraisal so that those of us who feel strongly about the matter are not forced to take action in the Lobby that we do not wish to take.

6.43 pm
Mr. John Marshall (Hendon, South)

I thank you, Mr. Deputy Speaker, for calling me. Perhaps preference should have been given to hon. Friend the Member for Hendon, North (Sir J. Gorst), but I am sure that he too will catch your eye.

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)

Order. The hon. Gentleman was fortunate to catch my eye as I took the Chair.

Mr. Marshall

I should not complain about my good fortune, Mr. Deputy Speaker. I thank you for your kindness now and for your kindnesses earlier this morning.

Edgware general hospital serves two wards in my constituency—Hendon and West Hendon wards. I know the accident and emergency department quite well because I have twice had to take my youngest son there. On Sunday I decided that I would drive to Barnet hospital to try to work out how long it would take me to take him there compared with Edgware. The difference is some 50 per cent. On a Sunday afternoon when there is relatively little traffic, that does not make a great deal of difference. During the week it would take substantially longer to take a child or a patient from Hendon to Barnet than it would from Hendon to Edgware.

Some of the wards served by Edgware general hospital are among the most socially and economically deprived in the London borough of Barnet and in the north-west of London. The West Hendon ward and the West Hendon estate have much social deprivation and car ownership is much lower than elsewhere in the borough.

My right hon. Friend the Secretary of State is suggesting that in-patient facilities should be transferred from Edgware, which is relatively convenient for visitors, to Barnet general hospital, which will be inconvenient for visitors living in the West Hendon ward. Therefore, I ask my hon. Friend the Minister to think again.

Earlier this afternoon I asked my right hon. Friend the Secretary of State how much money would be spent on additional primary care facilities in the London borough of Barnet. We are told that some £210 million will be spent across London. But it is no use constituents using the Edgware general hospital being told that facilities are not going into West Hendon or Burnt Oak but into Hackney or Islington. That is not providing the additional facilities that are necessary to relieve the pressure on hospital facilities in north-west London.

As part of the change, we are told that in-patient facilities will go from Edgware general hospital to Barnet, the Royal Free and Northwick Park. My agent has twice been into the Royal Free in recent weeks and she says that it is already bursting at the seams. The thought of additional patients going to the Royal Free is just not on.

I should like my hon. Friend to tell the House what the net change in in-patient facilities will be when the new Barnet general hospital is completed. Obviously, in addition to the beds required at Barnet general for patients who currently use that hospital, beds will be needed for those transferred from Edgware. We should be told how many that will be.

The proposed closure of facilities at Edgware also concerns the London ambulance service. I have been in correspondence with my hon. Friend the Minister on that subject from time to time and I should like an updated statement on the efficiency of the London ambulance service.

We should also be given some concept of the change in timing as a result of yesterday's announcement. When the subject went out to public consultation it was suggested that the facilities would be removed in April 1997. My right hon. Friend the Secretary of State has put certain conditions upon the decision announced yesterday and I should like my hon. Friend the Minister, if he can, to say how long he envisages it will be before those conditions are confirmed.

Some three years ago there was a proposal to close Barnet hospital and we all agreed with our hon. Friend the Member for Chipping Barnet (Mr. Chapman) that the roads between Barnet and Edgware were so poor and the journey time between them so long that they were two different communities and that it was wrong to say that they should have to use the same hospital. Just as it was wrong to propose the closure of Barnet general hospital—my hon. Friend the Member for Harrow, East (Mr. Dykes) was also at the forefront of that battle—I ask my hon. Friend the Minister to look again at these proposals and answer some of the specific questions that I have asked him this evening.

6.49 pm
Sir John Gorst (Hendon, North)

I shall not go over the same ground as my hon. Friends, all of whose comments are worthy of consideration by the Government. A year or so ago I secured an Adjournment debate on this subject; my hon. Friend the Member for Harrow, East (Mr. Dykes) was present then, and may wish to remind himself of what I said.

Let me try to bridge the gap between what my hon. Friends and I think should be happening, and the Government's view. The Government see the current hospital closures in the light of facts, statistics and other rational considerations, but I ask them to consider the wider issues before making the wrong decision.

Let me explain the difference between the job of a politician and that of a civil servant. Let us suppose that a building development on the property of my hon. Friend the Member for Harrow, East is proposed, and that the proposal is cost-effective, rational, logical and immensely convenient to many other people. Let us also suppose, however, that my hon. Friend and his neighbours take exception to the proposal, along with people living in the village and, indeed, the district.

It is the job of a politician—a Minister, perhaps—to say, "Of course it all sounds reasonable, but this Dykes character will not wear it, and nor will anyone else living in the district. Go away and find another plan that will not involve his house."

When I spoke to the my hon. Friend the Minister and my right hon. Friend the Secretary of State late last week, I pointed out that when a calculator is asked to add two and two it can produce only one answer: four. I ask Ministers to go back to their civil servants and say, "We want you to make a different calculation." They can very easily come up with a different plan.

We, as politicians, must recognise that there is another element in the equation: human feelings—human fears and reactions. We are talking not just about someone's house but about people's lives. We are talking about a place where people are born, where they may go in a traumatised state if they are ill or have an accident and where—alas—some of them will die, and be visited in their final days. I ask my right hon. and hon. Friends to bear in mind that deeply emotional dimension, rather than merely producing statistics to prove the clinical importance and the rationality of the decision.

We have heard about the clinical, financial and social considerations. My hon. Friends have spoken eloquently about the social considerations, and I spoke of them a year ago. However, there are also political considerations. I am not talking about the number of votes that my constituency will attract or lose; I am talking about intangible issues relating to people's real concerns.

I hope that my right hon. and hon. Friends will re-examine the position. No one wants to resort to extreme measures in the Lobby, but I repeat my commitment to vote against the Government if they will not reconsider—and I can give no assurance that I will not withdraw my support in the Lobby for their plans for London's health service as a whole. They are not considering the important element that we were elected to deal with: the human element. I hope that my hon. Friend the Minister will reflect carefully on what I have said.

6.55 pm
Mr. Jim Dowd (Lewisham, West)

I congratulate the hon. Member for Harrow, East (Mr. Dykes). The fates have conspired in his favour: not only is the debate particularly opportune, but he has a good deal of time on his hands, not normally granted to those who have the luck to secure Adjournment debates.

I freely admit that I am not as well briefed on issues relating to Edgware and Barnet as others who have spoken, but I believe that issues surrounding the decisions that have been made also apply to other parts of London, particularly the part that I represent. As the hon. Member for Harrow, East pointed out, the nature of consultation is important: how much weight is given to the views of those who are consulted?

Many people throughout London feel that decisions were made at the outset, and that little or no regard has been paid to the subsequent consultation exercise other than very selectively. They feel that the views that they have been asked to submit on issues affecting the areas in which they live have been jettisoned, or at least placed so far down the scale as to be rendered virtually meaningless. People will rightly feel aggrieved about some aspects of what is happening to Edgware general hospital: what they want cannot be given to them, for reasons that have not been adequately explained.

Earlier today, in a question to the Secretary of State for Health, the hon. Member for Hendon, North (Sir J. Gorst) defined democracy, or its purpose, as giving people what they want. Obviously, we cannot always do that; there are constraints on resources. I served on an area health authority, and subsequently a district health authority, from 1976 to 1990, so I am well aware of the difficult decisions that must be made. However, I strongly share the instinct voiced by the hon. Member for Hendon, North—the feeling that, if we cannot give people what they want, there must be glaringly compelling, overpowering reasons for not doing so. The technical assessments of what may or may not be right simply do not measure up to the task of providing what people want.

It is generally possible to make budgetary decisions from one year to another that can be improved in better times, or avoided in the light of experience. In the case of the closure of hospitals that have served generations of people in certain localities, however, much of the action that is now being suggested will prove to be irreversible. I feel that people and their Members of Parliament are fully entitled to know that every possible step has been taken, and every implication considered, before such irreversible decisions are made.

6.59 pm
Mr. Hartley Booth (Finchley)

I am one of the four Members representing Barnet and last year we waged a local battle to maintain facilities at Barnet general hospital, which has been referred to by my hon. Friend the Member for Hendon, South (Mr. Marshall). We won that battle. It would be churlish to begin what I believe is a unhappy chapter this week without at least giving credit to the Government for saving Barnet general hospital at considerable expense to the taxpayer. We believe that the Government meant what they said, and certainly we approved last year when the Government decided to rebuild, modernise and improve Barnet general hospital at a cost of some £90 million.

Yesterday afternoon we heard the decision that the accident and emergency department at Edgware general hospital is to close when the facilities at Barnet general hospital are considered adequate to cope with patients from west Barnet and, doubtless, the constituents of my hon. Friend the Member for Harrow, East (Mr. Dykes).

My hon. Friend the Minister is known for listening and I would put it to him that when we offer the Government guidance on the health service and try to get them to take the right decisions on such issues as the Edgware general hospital, we cannot go by the old socialist bureaucratic rule book that everywhere has to be identical. That is flying in the face of reality. Every health district is different.

Barnet health district has one of the most extraordinary differences from other health districts which must be taken on board. We have between the west and the east of Barnet the huge block of the A1. I have spoken about it before, and I am grateful to my hon. Friend the Member for Hendon, South for mentioning it tonight.

The A1 cuts through what was a network of little villages around London. Those little villages were joined up in a way which is now causing the most terrible traffic jams. People have had appalling traffic experiences. It is physically impossible for me or my wife to deliver three children to different schools in the locality between the hours of 8 and 9 in one car journey in the morning. The roads are seized up regularly.

The Government must recognise that our local traffic problems are reaching the point at which lives will be at risk in emergencies when people drive their cars through the traffic jams to try to get past the A1 with its rows of juggernauts. They will not always make it and there will be deaths.

I was grateful to have been permitted an intervention in earlier proceedings and to have received a reply from my right hon. Friend the Secretary of State for Health that the Department of Transport will be consulted. Inevitably, recommendations will made and they will cost money. Let us face the facts now that consulting experts will cost money.

I am concerned about whether the Government will be able to deliver their promises of better health for the people of our locality. Secondly, we are a Government known for good management of resources. If, as a result of all this, when we have delivered a good hospital in Barnet general, but we have closed another accident and emergency department, it is found that the net cost—including the traffic costs and all the other problems—will be greater than keeping the unit open, we will not be known for good management and we will be hide-bound by the bureaucratic rule that we had to get rid of one accident and emergency department because Whitehall said so.

I understand the feelings expressed in the House this afternoon that other localities in Britain suffer even more. My hon. Friend the Member for Colchester, South and Maldon (Mr. Whittingdale) said that some of his constituents have to travel 60 miles to a hospital. In time, not in distance, it can be worse in Barnet. It can take two hours to reach a hospital when one is travelling through a solid traffic jam.

We are told that any emergency cases will go by ambulance. Certainly the blue light of the ambulance will carve a path through seized traffic, but I am worried that if someone is bleeding to death or dying of some illness, their wife, mother or brother may attempt to drive them to Barnet general hospital and get stuck in traffic. It is a real problem. We all see it as local Members of Parliament and we hope that my hon. Friend the Minister will recognise the problem.

We hope that my hon. Friend will listen, as he is noted for listening, address the matter in his research and come back and candidly tell us what is in the report from the Department of Transport so that we can consider it before the closure of the accident and emergency department at Edgware general hospital.

7.6 pm

Mrs. Barbara Roche (Hornsey and Wood Green)

May I first join the congratulations to the hon. Member for Harrow, East (Mr. Dykes) on his success in gaining this evening's Adjournment debate the day after the secretive announcement about hospital changes in London, which included announcements about Edgware general hospital, and the day on which the Secretary of State had to be brought to the House, to use the rather colourful expression of one of my hon. Friends, kicking and screaming to account for herself.

I represent the constituency of Hornsey and Wood Green in north London. It is in the borough of Haringey, which adjoins Barnet. It is fair to say that in north London, certainly in the boroughs of Barnet, Enfield and Haringey, what happens in one of those boroughs certainly has a knock-on effect on health provision in the other boroughs.

Today we are debating the proposed closure of the accident and emergency facilities at Edgware general hospital. In Haringey and Enfield we were much concerned about the possible amalgamation of the accident and emergency facilities between the North Middlesex and Chase Farm hospital. We were aware that there could have been a knock-on effect on Barnet. When we consider what is happening in one area of north London, we should be mindful that a much wider area might be affected, so it is extremely important that we are having this debate this evening.

Let me say something about accident and emergency facility in a hospital. The hon. Member for Hendon, North (Sir J. Gorst) put his finger on it when he said that in essence they are the life blood of a hospital. If the accident and emergency unit is closed it signals the death knell of a hospital. That has happened in many of our hospitals, of which Bart's is a good example.

Something that has distressed me, both today and on other occasions when London Members of Parliament, from both sides of the House, have come together to discuss health issues, is the apparent anti-London bias among some Conservative Members. There is a feeling that London is well provided for. That is not the case. Indeed, what we have heard tonight about the future of Edgware general hospital shows that it is not over-provided for.

In the context of the wider picture, I draw attention to the Whittington and North Middlesex hospitals and the consequences for them of the proposed closure of the accident and emergency unit at Edgware. I am extremely worried about the effects of that.

Hon. Members have referred to the traffic problems in London, about the problems of having to travel some distance to a hospital and about the problems of the London ambulance service. I do not need to remind hon. Members about the difficulties and problems of the London ambulance service, which all Members, of whatever political persuasion, recognise. The Department of Health has shown a gross lack of management of that service. It has not given proper support to the excellent men and women who work for that service—a service to which we, as Londoners, owe such a great debt.

I end by referring to our responsibilities as Members of Parliament. The hon. Member for Hendon, North (Sir J. Gorst) touched on that. We all owe a duty to our constituents, no matter which party we represent. Week in, week out, at our constituency surgeries and in our postbags, we receive representations from our constituents. We come to this place not just to have the pleasure of listening to our colleagues or to the sound of our own voices; we are here as the voice of our constituents.

In London, as elsewhere, local people have a great attachment to their local hospitals. They identify with them. The great difficulty with health provision, and this is not often recognised by the Government or the bureaucrats, is that part of getting well and of feeling well cared for is not just the excellent professional care that people receive in their local hospitals, it is how people feel about the hospital itself. It is how the family—husband, wife, son or daughter—feel about it. Most important, it is what the community feels about the hospital. That is absolutely vital.

It appears that in dealing with Edgware general hospital, the Government, once again, have not taken into consideration the feelings of local people and those who use our local facilities. I urge the Government to think about the consequences for the Whittington and North Middlesex hospitals and also to think again about all the central London hospitals that have been so badly affected by the Government's policies.

7.14 pm
Mr. Nicholas Brown (Newcastle upon Tyne, East)

At lunchtime today, I had the great privilege of representing the parliamentary Labour party when meeting a delegation of very young constituents of the hon. Member for Harrow, East (Mr. Dykes), who had come to the entrance of the House to ask us to save their hospital. I understand that most of those young children had been born in that hospital. They had spent time preparing leaflets and making a banner and badges to set out the case for their local hospital. They had obviously been encouraged to do so by their teachers and parents, but their strength of feeling about the hospital was made clear to me and to their local Members of Parliament, who are all Conservative Members.

I congratulate the hon. Member for Harrow, East on having secured this important debate. I congratulate his colleagues the hon. Members for Hendon, North (Sir J. Gorst), for Hendon, South (Mr. Marshall), and for Finchley (Mr. Booth) and the right hon. Member for Brent, North (Sir R. Boyson). It was not easy for them to make the important contributions that they have made today. It is not easy to speak in a manner that will not find favour with one's Front Bench. It requires courage to do that and I congratulate them on it. I recognise the case that they are making, which is not for a change, but for a review; a ministerial reflection. That case has been well made today.

I agree with my hon. Friend the Member for Hornsey and Wood Green (Mrs. Roche) that the manner of the announcement yesterday left just about everything to be desired. It was sneaked out in a written answer. The range of changes announced to the hospital service in London was so significant that it merited a statement in the House. Indeed, the private notice question to which the Secretary of State had to respond today—she came here because she had to, not because she wanted to—the number of interventions that were made and the fact that some hon. Members were still rising at the end of a generous hour's questioning show how strong the feeling is on both sides of the House.

That strength of feeling transcends party politics. Every Member of Parliament, regardless of party affiliation, wants to do his best for the constituents who elected him to come to this place to represent them. I congratulate both Conservative Members and Labour Members on doing just that. The Secretary of State for Health has done herself no good—nor, indeed, the office that she holds—by perpetually sneaking out difficult announcements under the cover of some other statement. Yesterday, it was the statement on the report of the Privileges Committee; not long ago the announcement of the increase in prescription charges was sneaked out on the day of the Northern Ireland announcement. That is no way to serve democracy and I deplore it.

This debate is important because it enables the House again to express its view—a virtually united view—to the Under-Secretary of State for Health. He can be in no doubt about the strength of feeling or the sincerity of the local Members of Parliament. It was deplorable that they were laughed at by the Government Whip. This is not a laughing matter. The constituents of those Conservative Members take it very seriously indeed. Those hon. Members perfectly properly have done what they should do: represented their constituents' views. That should have the sympathy of the House; it certainly should not be treated as a laughing matter.

The Secretary of State has never provided a debate on any health issue in Government time. Any such debate has always had to have been dragged out of the Department by a Member or it has been provided through an Opposition Supply Day. The narrow issue, although there is a wider context, is the plan to close the accident and emergency unit at Edgware general hospital. The claim is that the geographically nearby Barnet hospital will be able to cope.

The piecemeal way in which decisions have been made in London is deeply flawed. London will rue the day that those decisions are implemented. Of course, the points made about traffic issues are well taken, especially in the context of the shortcomings of the London ambulance service. To say that those facilities will be replaced with primary health care eventually is just not good enough. Local people and their elected representatives rightly worry that they will lose the accident and emergency service, and that primary health care will, at best, come later. I notice that the Secretary of State has not been forthcoming about how much is to be spent. More important, she has not been forthcoming not only about how much revenue expenditure is to be committed, but about when it will be committed. That failure to make a definite statement is clearly fuelling the uncertainty, as well it might.

Further investment in primary health care is right for London, but it will not lead to a reduction in the demand for secondary care. An increase in primary care may stimulate demand for secondary care and for the sort of services that are provided at Edgware general hospital. My hon. Friend the Member for Hornsey and Wood Green made the good point that the loss of an accident and emergency unit was the thin end of the wedge, and that the general closure of the hospital would not be far behind.

As my hon. Friend the Member for Lewisham, West (Mr. Dowd) said, this exercise is driven by financial considerations. No one could have taken any comfort from the light statement that the Secretary of State made about the revenue issues involved in that exercise.

Hon. Members have made the point about consultation. If one is to consult local people, one should do it in a meaningful way. One should be willing to listen to what they have to say. However, in the whole debate on secondary health care in London, no evidence exists of the Department listening to anyone. Clinicians, managers, local people, their elected representatives and members of local authorities are screaming at the Government to think again.

When the parliamentary Opposition say to the Government, "Think again", they satirise our position as requiring a review of a review. I have said this before and I make no apologies for saying it again. If one is going in the wrong direction, there is no shame in pausing, thinking and saying, "Perhaps we ought to turn around". That is the position that the Government find themselves in today. I urge the Minister to listen to what just about everyone is saying to the Department. I urge it to come out of its ivory tower, and to mix with real people rather than a handful of professional advisers.

Sir John Gorst

As the hon. Gentleman is talking about listening, may I tell him that, when the regional health authority finally considered the matter, the admiral of the fleet who chairs that organisation said—I cannot vouch for this, but I have been informed that it is so—that it was a meeting in public, but not a public meeting.

Mr. Brown

That is a new concept to me. The Government are clearly doing to the national health service what they have done to the Royal Navy, and they are using the same people to do it. Representing Swan Hunter shipyard, I speak with some feeling.

The exercising of political judgment is the real issue. The Secretary of State and her team of Ministers do not seem able to do that. They rely on specialist advisers. They do not allow anyone else to put a point across to them, no matter how widely the public support that point. They make decisions and do not have the courage to announce them proudly in the House of Commons, or in any other forum where they can be criticised, and then they seem to be slightly resentful of the fact that they are eventually dragged here to explain what on earth they think they are doing.

That is a hopeless state of affairs. The only way out of it is an independent review, which should be conducted not by the Government's political opponents—although that may happen soon enough—but by an independent body that can take evidence. The people who serve on it should be respected across the professions as well as local communities. A post-Tomlinson reassessment is needed because much of the evidence on which Tomlinson was founded is deemed by many people to be so deeply flawed.

I congratulate the hon. Member for Harrow, East on securing the debate. I assure him that I support his request for a review.

7.24 pm
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I congratulate my hon. Friend the Member for Harrow, East (Mr. Dykes) on bringing this debate before the House. I have no doubt as to the great sincerity with which he has done that, or about the feelings that the matter has engendered in his constituents and in those of my hon. Friends. I congratulate all those who have spoken and, in particular, with one exception, I commend them on the brevity of their speeches. I welcome the fact that the debate has attracted expert witness from as far away as Lewisham and Newcastle. I have no doubt about the importance of the matter raised by my hon. Friend the Member for Harrow, East.

I should like to make one important point first. Edgware hospital will not close. As has been said, it will continue as a major provider of health care in the region. I shall briefly run through the matters that will be out for consultation, but, at Edgware hospital, there is likely to be a great range of out-patient services, rehabilitation, mental health facilities and palliative care, not forgetting minor accident treatment, which is likely to be used by many people—a large proportion of those now using the accident and emergency department.

I have been asked about beds.

Mr. Nicholas Brown

Will the Minister give way?

Mr. Sackville

I think that I shall continue. The hon. Gentleman has already intervened at some length in the debate.

Currently, there are 747 beds in the Wellhouse Trust, excluding psychiatry. Following the changes, the potential capacity is 635, a reduction of 112. The House might like to know that, since the publication of the consultation document, an additional 50 beds have been opened at Northwick Park hospital, with additional plans already in hand for a further 62. An extra ward of 24 beds has already been brought into use at the Royal Free hospital, and the provision of an extra 44 beds in existing wards has been made.

Sir John Gorst

Listening to my hon. Friend, I wonder whether he knows or recognises the difference between when someone is ill or has some slight infirmity that requires hospital treatment, and when someone is traumatised by a sudden accident or heart attack? What an accident and emergency unit does is at the heart of what reassures people. He is telling us that all the peripheral things will be there. He is missing the point of the whole debate.

Mr. Sackville

I was seeking to answer a specific question about in-patient beds. I shall talk later about A and E departments and 999 attendances.

I repeat what my right hon. Friend the Secretary of State for Health has said. The A and E department will not close until new facilities are in place—that is to say, an expanded modern A and E department at Barnet general hospital. Part of the £29 million phase 1a extension at that hospital will include new theatres, wards and other facilities and, of course, bringing the minor accident treatment service at Edgware into operation.

If I were asked briefly to give the reasons that have led to those proposals and the decision, I should divide them into two parts. First, it is true that we want services to be provided more efficiently in the whole region. We are constantly faced with the need to provide health services efficiently. There is indeed a financial aspect to this. There is no doubt that there is a subsidy to the local area which, to a great extent, is a result of the fact that we are currently providing acute services at two hospitals. All hon. Members who have spoken tonight know that this has been presented as an on-going problem which will probably get worse unless some action is taken.

Secondly, as has been mentioned, there are clinical reasons for the decision. We do not want any duplication of specialty services; we want modern facilities of a certain size so that the correct number of patients pass through, thus enabling us to provide, where possible, not only a consultant-led service but a consultant-provided service. We have heard too many stories recently about things going wrong in the NHS in the absence of consultants. That is particularly true of accident and emergency services where, whether or not it is possible to achieve this in the short term, we aim to provide 24-hour consultant cover. One cannot always expect junior doctors to provide the same level of expertise as doctors with years of experience.

Accident and emergency departments in particular—although it is to a certain extent true of other specialities—need a certain flow of patients. It is no good providing a very specialised service—the accident and emergency service is now recognised as such—if the doctors and nurses involved do not see enough cases to develop the expertise to deal with, for example, head injuries. One needs a service that is large enough to develop expertise, or one runs the risk of having unsafe services because for too much of the time one would be running them with too low a grade of medical staff and with staff who do not have sufficient exposure to special problems to be able to offer the best that is available today.

Mr. John Marshall

Does my hon. Friend accept that the accident and emergency department at Edgware hospital is very heavily utilised?

Mr. Sackville

Yes. I believe that it has a volume in excess of 40,000 attendances a year and that something in the order of 25 "999" ambulances use it. It does not have 24-hour consultant cover. We are not aiming for the American model of trauma centres, but we at least want to ensure that anyone who attends an accident and emergency department as an emergency is seen by a consultant. That must be our aim because it can make an enormous difference to the outcomes. Certainly, we have to count beds and consider questions of access and distance, but, at the end of the day, it is the outcomes that are enormously important. That is what the service is all about.

I am well aware of the concern felt by many hon. Members about transport. I can confirm that it will be kept under review. The district health authority and the trust will want to ensure that the necessary action is taken where transport facilities are inadequate.

The issue of "999" ambulances is of grave concern to the public and has already been mentioned once or twice this evening. The London ambulance service has had problems that are unique to the capital. Of the 35-plus services in England, only the London ambulance service has failed to get anywhere near its target time. The target time involves responding to 90 to 95 per cent. of calls within 14 or 19 minutes, depending on whether the service involved is a rural or urban one.

I am glad to be able to make it clear that there has been a very marked improvement in recent months in the London ambulance service's performance from what I admit was a very low base. Not long ago, we were talking about performance figures of only 50 per cent. or just over. Recently, the figure has been 76 per cent., and the latest figures reveal that targets were reached in 74 per cent. or 75 per cent. of cases, which is a favourable development. I suspect that there is now a very much better atmosphere between management and staff than that which bedeviled the service.

Mr. Marshall

In effect, my hon. Friend is saying that the target is not hit in one in four cases. Does he accept that, if that rate continued, the proposal would be unacceptable?

Mr. Sackville

As my right hon. Friend the Secretary of State said, we would expect a further improvement in performance. I can report to the House that there are already plans for extra resources to go directly into the Barnet and Edgware area. In fact, the local health authority is putting an extra £320,000 into local ambulance cover and two extra standby points for "999" ambulances have been provided.

Detailed work has recently been carried out into the journey times of the London ambulance service and it has been calculated that, with the extra resources, the average call-to-hospital time for Brent and Harrow residents would decrease by between one and two minutes with an increase for Barnet residents of just under half a minute compared with current performance. That is the effect that the extra resources, quite apart from the overall increases in performance, would have on journey times. I think that that is encouraging.

Mr. Dykes

In view of the distance between Barnet hospital, Edgware hospital, the Royal Free and the Northwick Park hospital, that input of two additional ambulances will be wholly inadequate.

Mr. Sackville

The question of ambulance cover and where ambulances are stationed has to be worked out on the basis of the demand at different times of the day and the week. We have to leave it to the London ambulance service to make those dispositions, but we demand that the service not only provides additional resources to cover that area but that it makes an overall improvement in performance of the sort that has been achieved all over the country.

The London ambulance service is funded at the same level as, or even better than, any other urban ambulance service. There is no reason on earth why it should not achieve the very high standards of many of the county ambulance services, which are probably as high as any in Europe. We look to the service to do just that.

Primary care is fundamental to all our arrangements.

Mr. Booth

Before my hon. Friend moves on to another subject, may I draw him a little further on transport? He said that he would keep it under review, but does he accept that, unless he has expert advice or an independent inquiry, as suggested by the hon. Member for Newcastle upon Tyne, East (Mr. Brown), there will be nothing to review because his Department is not responsible for transport?

Mr. Sackville

Access to hospitals is fundamental to any monitoring of the performance of those hospitals and especially that of accident and emergency departments. I assure my hon. Friend that the matter will not be forgotten or ignored.

I deal now with primary care because, clearly, all those matters involving the configuration of acute services and hospital services in our major city need to be accompanied by improvements in primary care, in GP services and in community services. I well understand that those improvements are needed.

My right hon. Friend the Secretary of State for Health said, somewhat hesitantly—I will say it more robustly—that there would be £15 million of new, special funding spent over five years for primary care in the Edgware area. Current projects, to give an example, include the extension of home nursing for people who are terminally ill. There have been improvements in GP surgeries and there is an outreach ophthalmology clinic. Further planned projects include improved community therapy services, increases in the number of community nursing staff and a new GP surgery in Burnt Oak.

Mrs. Roche

Can the Minister tell me what community therapy services and community nurses have to do with the closure of an accident and emergency facility?

Mr. Sackville

I was making a general point about improvements in community and primary services. These are specially funded services rather than just what is normally provided by the health authority and the FHSA.

Mr. John Marshall

My hon. Friend has said that there will be an extra £15 million over five years. How much of that is coming in the current financial year?

Mr. Sackville

My hon. Friend has defeated me there. I shall have to write to him on that point.

Sir John Gorst

This is precisely the point that many of us have been making. The announcement has been made and no plans exist. The Minister does not even know the position.

Mr. Sackville

The hon. Gentleman is being unfair. We have to assume that the statement about £15 million over five years suggests that there will be fairly level spending over that period. I am sure that he is right to try to—

Mr. Nicholas Brown

Is not the Minister really saying that once the savings have been realised from the closure of the accident and emergency unit, they will then be ploughed back into primary care?

Mr. Sackville

I am not saying that at all. Primary care is already being improved in London, as it is all over the country because new primary facilities are provided everywhere. I have opened many new GP surgeries and community centres in the past two and a half years. The money is extra money from a special fund aimed at improving community and primary services in the area.

A more general point, which has been made several times, concerns the way in which the changes were announced. I must correct the hon. Member for Hornsey and Wood Green (Mrs. Roche), who said that my right hon. Friend the Secretary of State came kicking and screaming to the House. I was here and I saw her neither kick nor scream during any part of the day. She answered a number of questions extremely convincingly.

On the question of whether my right hon. Friend should have made a statement—much has been made of this—all that I can say, speaking as a north-western Member, not a London Member, is that I have been involved in many major changes in the health service involving the closure of hospital facilities. They are always accompanied, as in this case, by major redevelopments of modern facilities. On no occasion have we made a statement on the subject to the House. I agree that this is a major package of changes, but I believe that there is not, formally speaking, any precedent for making a statement for the agreement of proposals for the reconfiguration of hospital services. It has never been suggested during the two and a half years in which I have been involved in dozens of such proposals.

Sir John Gorst

May I offer a different point of view to my hon. Friend? If the Birmingham theatre closed, I would not expect the nation to have a statement from the Secretary of State for National Heritage. However, if Covent Garden opera house was to be closed, I would expect the Secretary of State to come to talk about it. What has happened here is that two of the monuments of our medical service—Bart's and Guy's—are to he closed in a most surreptitious fashion, with no statement. I honestly believe that it is wrong for the Minister to say that just because no statements are made about Birmingham, no statements should he made about the cathedrals of the medical world.

Mr. Sackville

That is the sort of elitism to which we in the north-west have to listen a great deal. I am not particularly convinced by that argument. These are matters that have been discussed widely in the House and elsewhere over recent weeks and months.

Mr. Dowd

That may have been the Minister's judgment before. He must, however, have noticed, because he sat loyally through the private notice question this afternoon, that it ran for one hour and four minutes, yet there were still at least half a dozen Conservative Members waiting to get in. Does that not now, post hoc, suggest to him that the decision not to present the proposals as a statement was a miscalculation? Will he bear that in mind if something like this happens in future? Let us hope that no such thing happens.

Mr. Sackville

I note that Madam Speaker granted a private notice question; that is a matter for the Chair. I also note that yesterday, she did not grant a private notice question on the subject. This is not a matter I want to go into further.

Although I welcome very much the fact that the subject has been so ably aired by my hon. Friend the Member for Harrow, East, I ask him to read Hansard and to reconsider some of his remarks about my hon. Friend the Member for Gedling (Mr. Mitchell), the Government Whip. He may find that he went a little far, especially as he was talking about an hon. Member who, by long convention of the House, was not able to answer the charges made against him.

Sir Rhodes Boyson

Even at this stage, the Minister must be aware of the depth of feeling on the matter. It should and must be looked at again, and it should be thrashed out. At the moment, it is a question of saying that the proposals will take effect in two years' time; there is time. I presume that the two years apply because there will be two years of consultation. We have had none yet.

Mr. Sackville

Uncomfortable as many of these decisions are, a decision has to be reached in these cases. I do not like being here at the Dispatch Box having to defend this decision because, like many decisions over much-loved local hospitals, it is not popular. People do not like it and they fear the worst as a result of hearing that local health facilities will be closed. I absolutely accept that there are grave concerns. On the other hand, I have spelt out some of the reasons why we have had to arrive at this decision. I have spelt out some of the factors that should reassure people that there will be no closure of the A and E, for example, until new facilities are in place.

As I have already told the House, I have been involved in several such decisions. No one ever likes them. The local health managers and often—it is true in this case—some or all of the clinicians agree with the decision; very few other people do because it is natural that people do not want health services to change. From our point of view, as those responsible for trying to provide a consistent health service around the country, we have to make changes. We have to modernise and we have to concentrate services from two or three places, sometimes into one, simply to provide them not only efficiently, but well and safely. I would not pretend that this decision is popular.

I regret very much that, from the tone of the debate, I and my right hon. Friend the Secretary of State have apparently failed to convince the local Members of Parliament. I can tell them that we have considered these matters carefully. We are quite certain, as are all the others who work in the health service who have contributed to this decision, that the proposals will provide over the area as a whole a better and more modern health service.

Sir John Gorst

It is possible that the House might take a different view—we hoped that my hon. Friend the Minister might have taken such a view, but he has not so far suggested that. If the proposals were to be vetoed by the House on a vote, what would be the position in relation to the London closures? We should know that because it is important when deciding how to treat any vote on the subject.

Mr. Sackville

That is a procedural matter and it involves health considerations that go much wider than the subject of the debate. While I understand my hon. Friend's question, I am sure that he will forgive me if I do not attempt to answer it. All that I can say is that I believe that we have made the right long-term decision for the overall good of health care in the area. We have to make many such decisions.

I resent the suggestion of my hon. Friend the Member for Harrow, East that this is an example of the health service being unsafe in our hands. If we took no such decisions, never made any major changes to hospital provision and went on exactly as we were, we would probably have very few new hospitals, and would be treating fewer patients rather than more, and at greater cost. That is not a recipe for the NHS to be safe in anyone's hands.

Mr. Dykes

I am grateful to my hon. Friend. I think that he misunderstood—I specifically paid tribute to the need for the Government to have disciplined financial management over all matters and all installations in the national health service. I have always supported that policy in general, and think that everybody should do so. I thought that we had made our views crystal clear and I am sorry that my hon. Friend does not seem to be grasping the reality.

The perception is wrong; the public do not trust the process. I am sad and regret having to say that they do not feel that they can accept my hon. Friend's assurance that the consultations have been genuine. The Government have been going through pretend motions, then ignoring and dismissing the views and the thousands of opinions, including expert medical ones. The trouble is that the Government never reassure the public in respect of any such instances. That is why we continue to fight in this case to see whether the process has been genuine and other opinions against the closure of the accident and emergency unit have been heeded. Why should they not be heeded? Why should not the Government say that they disagree with the regional health authority and will keep the facilities open because the hospital is needed?

Mr. Sackville

The Government find themselves agreeing with the regional health authority that we have to make the changes in order to provide an efficient, safe and high-quality health service over the area.

If, over the past few years, we had not made any decisions about hospital provision—many of them unpopular—we would not be treating 120 patients for every 100 that we treated four or five years ago. We would not have better outcomes—

Mr. Nicholas Brown

Will the Minister give way?

Mr. Sackville

No, I shall not as I am just about to finish my speech.

It is sometimes necessary to take decisions which may not always be popular, but which we know to be in the best interests of providing a modern health service in the long term. The decision that we are discussing is no exception.

Question put and agreed to.

Adjourned accordingly at eight minutes to Eight o'clock, till Tuesday 18 April.