HC Deb 06 December 1996 vol 286 cc1352-64

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

2.14 pm
Sir John Gorst (Hendon, North)

The Government's plans for dealing with emergency arrangements in the Edgware district came on to the agenda shortly after the 1992 general election, and they have been there ever since. The issue has broadened from one relating to the facilities provided by a hospital to the local population, and now encompasses the whole question of how individual Members of Parliament can represent the unanimous wishes of their constituents to Ministers. Above all, it raises the question: what can a Member of Parliament do if, having received assurances from Ministers, and made them public, he discovers that such assurances will not be honoured or have been seriously distorted?

The matter goes to the heart of the relationship between a Member of Parliament and the Government of the day. Over broad swathes of public policy, Members of Parliament are expected to defer to the power of the Executive because of the Executive's greater knowledge, superior resources and wider strategic grasp. On the other hand, it has always been acknowledged that, in understanding and interpreting local sentiment, a Member of Parliament has a unique authority —one that no Department can ever match. When, in addition to that, Members of Parliament have negotiated a settlement with a Minister that safeguards their constituents, it is no light matter to discover that the Executive proposes to misconstrue —let alone ignore —the terms of that settlement.

No Member of Parliament can retain a shred of legitimacy with his constituents if he is prepared to accept such a one-sided relationship. To do so would render the constituency Member of Parliament a redundant species. One might as well have a bureaucrat, nominated by the Government —a cipher who would see it as his duty to sacrifice the interests of his constituents to the convenience of the Executive.

The facts of the matter that I am raising are plain. From 1992 to 1994, I argued privately with local health authority officials against their plans for Edgware general hospital. The plans enjoyed no local support whatever—and that is universally conceded. I also took delegations to see Ministers, and I had a comprehensive Adjournment debate on the subject on 18 March 1994. I left no stone unturned to explain the special features that justified the pleas being made to Ministers.

At that stage, Ministers took refuge in the doctrine of the unripe time. Repeatedly, over many months, Ministers claimed that the matter had not reached their level for a decision and they would not intervene. Then, in the spring of 1995, after less than a week's reflection, brushing aside all protests and arguments put to her, the then Secretary of State, my right hon. Friend the Member for South—West Surrey (Mrs. Bottomley), sanctioned the closure of the accident and emergency department. The time had become ripe to ignore my constituents' wishes and needs completely. Naturally, I then voted against the Government.

When a new Secretary of State was appointed, my hon. Friend the Member for Harrow, East (Mr. Dykes) and I, who have never accepted the foolish decision, headed another delegation to Richmond house. My right hon. Friend the Secretary of State was reassuring, and emollient; he promised to look again. The necessary adjustments, although significant and vital for my constituents, required only a modest change by the Government.

Six months elapsed. Nothing seemed to be happening; so my hon. Friend the Member for Harrow, East and I, conscious of the rapid approach of the safe waters of the summer recess —safe waters, that is, for the Government —had another meeting with the Secretary of State. This time, we received specific assurances and promises: there would be a casualty department capable of saving lives. In June this year, we had at last obtained promises that a potentially life-saving casualty unit would replace the existing A and E department when it closes early next year. Alas, that is not, unfortunately, the end of the story. Less than another six months later, we are now told something entirely different. We are informed that we are back to a MATS —a minor accident treatment service —unit. We are back to a service that will do little more than bandage cuts and bruises.

I cannot see how, in honour, the Government can deny any of this. Indeed, I assume that they will be reduced to claiming that my hon. Friend and I have deluded ourselves; that we have got into a semantic muddle, that, although promised merely a MATS unit, we mistakenly supposed that the Secretary of State was promising us a casualty unit; or, least plausible of all, that if a MATS unit is sufficiently embellished with frills, such as GPs, longer hours and extra funds, it somehow upgrades itself —in short, that it becomes something that it is not. I am afraid that none of that will wash. The range of our discussions would make such an elementary confusion illogical and implausible.

I do not rest my argument purely on an appeal to logic. I made careful and detailed notes of what the Secretary of State promised us in our talks with him during that evening of 11 June. I propose to quote from the notes that I made immediately after the meeting, only pausing to say that the Secretary of State will, no doubt, have his own record of the meeting. One of his officials was present and taking notes. I have little doubt that, if the two versions were published, they would prove to be virtually identical.

From my notes, the crucial point of the discussion is clear. What I noted is as follows: Having referred throughout to 'emergency service', 'emergency unit' and so on the Secretary of State concluded by saying that 'casualty department' was his preferred phrase to describe what we had been discussing. It was best understood by everyone. He also favoured the phrase because it distinguished between an A and E Trauma Centre and a MATS Unit". I shall repeat the last passage: the Secretary of State concluded by saying that 'casualty department' was his preferred phrase to describe what we had been discussing …because it distinguished between …Trauma Centre and a MATS Unit".

Not only did the Secretary of State promise us a casualty unit; he was also thoughtful enough to caution us against any possible confusion between a casualty unit and a MATS unit. Indeed, that distinction appears again and again in subsequent letters that I have sent to him.

On 3 August, I wrote: May I emphasise once again: a MATS unit dealing with minor injuries would be completely unacceptable and contrary to what was understood between us in June. MATS units are not for saving lives: emergency casualty units are. Two months later, on 4 October, I wrote: All along Hugh Dykes"— my hon. Friend the Member for Harrow, East— and I have made it clear that we are arguing for a casualty service which is capable of handling emergencies". On 25 November, I reiterated that point: Throughout our discussions on 11th June we talked about an emergency unit: about an 'enhanced emergency unit' —but never about 'enhancing a minor accident unit'. Both Hugh Dykes and I agree that enhancing a MATS unit with doctors and more hours cannot possibly be construed as turning it into an emergency unit in the sense we discussed with you.

Only in the past few days has the Secretary of State taken the trouble to dispute that. A cynical observer might say that, if one is leading someone up the garden path, one does not tell that person what lies at the end of it —but I acquit my right hon. Friend of such deviousness. Nevertheless, I am still at a loss to find a convincing explanation for the yawning gap between his perception and ours.

The position is, therefore, blindingly clear. My hon. Friend the Member for Harrow, East and I asked for a casualty unit and we were promised a casualty unit by the Secretary of State. We were told that the Secretary of State drew the clearest possible distinction between a casualty unit and a MATS unit; yet we now have a MATS unit; and not the casualty unit that we were promised.

There can no confusion about the fact that that is a straightforward example of breaking a pledge. It is not something to be brushed aside as a matter only of my injured feelings. Naturally, my constituents are indignant too —and so they should be. They have been misled and it would not be surprising if many of them thought that their Conservative Member of Parliament had deliberately deceived them.

How do the Government wish me to defend myself? Do they wish me to say that I told my constituents what I believed to be the truth, but that the Conservative Government deliberately took my hon. Friend and me for a ride? Do they want me to tell my constituents that, despite the fact that they understand as clearly as does the Secretary of State the difference between a MATS unit, which they do not want, and a casualty unit, which they do, they should put up with the former because they cannot expect the Secretary of State to keep his promises in the face of administrative pressure on him not to do so?

This matter is one of the gravest concern to our whole system of constituency representation, because, unless the Government can tell me that they are prepared to honour the pledges they made to my constituents through me, I must take the view that the mutual obligations that exist between us are at an end. The Government will have abrogated them unilaterally. They will have done so to the discredit of every Back Bencher in the House —and to their own shame.

2.28 pm
Mr. Hugh Dykes (Harrow, East)

I am grateful for the opportunity to speak in this debate. To follow my hon. Friend the Member for Hendon, North (Sir J. Gorst) is an honour and it gives me great pleasure to be able to do so —pleasure in the sense of being able to pay tribute to him for having taken the lead in this campaign and for having responded to the finest duties that a local Member of Parliament can carry out for his constituents. That is the extent of the pleasure —the rest of it and the Government's response throughout have been nothing but pain.

I shall probably be regarded as thick-skinned —one has to be in order to be a politician in these febrile and turbulent times —in respect both of national policies and of many local and constituency issues, but I agree with every word that my hon. Friend said in this important Adjournment debate. We have had a good number of such debates in this painful period. I pay tribute to his leadership; I have taken a lesser role. We have doggedly stuck to our objectives in this matter, with full justification.

I feel profound disillusionment, and bitterness and resentment, at the crass and incompetent reactions of my right hon. and hon. Friends the Health Ministers, whatever the reason for them —it remains a mystery. My bitterness, disillusionment and resentment at such prolonged incompetence, despite the force of our arguments, of the local campaign and of justified objective medical opinion in respect of the insistence that there should be a casualty department—

It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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

Mr. Dykes

The resentment that I feel is reinforced by the latest letter that we have received —yesterday evening, I believe —from the Secretary of State. I shall not weary the House by going through it in detail. There is no need to do so, because, although it has two pages, it says nothing; I shall place it in the Library as a record of a wonderful "Yes, Minister" response. I remember the validity of some of those underlying arguments about the behaviour of civil servants and Ministers, despite the humour of the programme.

Sir John Gorst

May I draw my hon. Friend's attention to the fact that, in the last sentence of the letter, there is a little bit of hope? The Secretary of State writes: I trust that following your adjournment debate tomorrow we shall be able to make some progress on these issues.

Mr. Dykes

I am grateful to my hon. Friend. That would be so, but for the preceding paragraphs, because they are the most wonderful officialese attempt to resist any of our reasonable requests. I quote from the third paragraph on the second page: Against that background"— the long-running argument on the subject— I have sought to respond to the concerns expressed to me on behalf of local people by all the MPs of the area". We had several of our colleagues with us at the start of the campaign, but the pressures made them melt away, for one reason or another. I hope that they will rejoin us. The letter continues: as well as by other representative voices from the community. The demonstrator project which I have detailed represents a significant commitment of central resources to the Edgware area, and a serious attempt by the NHS to respond to the concerns which have been expressed.

That and other parts of the letter are outrageous, unacceptable and untrue and they do not meet the wishes of the local population and of their two parliamentary representatives, and, I believe, of all the local councillors and almost all the members of the community health council in my hon. Friend's constituency —but it is not my constituency, so I must be careful not to misquote.

I fully share my hon. Friend's indignation. In his letter to me of 20 November, he kindly asked to take the lead in this campaign, as he has done ably in the past. I respect that and I respect his need to be in the vanguard of the campaign, in response to legitimate local public opinion. The idea that we should be deaf to local opinion and contemptuously dismiss it on the national and local scene is an absurd notion of our collective and individual role in politics.

As my hon. Friend did in his letter to the Secretary of State of 25 November, I draw attention to the crucial reference in the notes that he took, thoroughly and with great skill. I testify to the absolute exactitude of those notes and thank my hon. Friend for taking them and for allowing me to have the original copies. He wrote in section 4 of the additional notes: Throughout our discussion, the hon. Member for Harrow, East and I"— my hon. Friend— made it clear we were asking for something more than a 'minor accident treatment service', even if it was less than a full-scale 'accident and emergency Department'. The Secretary of State accepted this, and we talked about 'acute needs', 'motorway accidents', 'heart attacks', 'severe allergies', and so on. The phrase 'enhanced emergency unit' was used repeatedly, so I think he got the message as to what we were after. Indeed, he was emphatic that he would be able to agree to this. The only reservation he expressed was that a serious motorway accident would be most likely"— logically, of course— to go straight to the nearest A & E unit in an ambulance, and we accepted that. I earnestly repeat, although I will not spell out, what my hon. Friend the Member for Hendon, North has just said in his detailed speech. Indeed, his speech was a detailed submission in the high court of Parliament, because all that he said was evidential and it is on the record as what was agreed.

We have shown some good will, despite the resentment and disappointment since the summer and the feeling that the Government were going back, cynically or perhaps for some other reason which has still not been explained, into old territory and promising only a very limited facility, not that in the original undertaking. Those prolonged discussions between me, my hon. Friend, the Secretary of State and other Ministers in the Department ended in deadlock on Tuesday night. That was the end of the road as far as we were concerned, unless the Government were prepared to make a proper, thorough, comprehensive, written response to our reasonable requests.

There are pressures on the local community from other elements in politics —legitimately or not, as other people may judge. This is an opportunity for the Government and the Department of Health, because the Opposition have merely said that they will review the closure of the existing accident and emergency unit. They do not go significantly beyond that. The issue shows the value of the Government thinking again about the cynical departure from their pledge of 11 June.

My hon. Friend the Member for Hendon, North and I tabled almost identical parliamentary questions for priority written answer on 3 December. My right hon. Friend the Secretary of State replied that the health authority had proposed that The casualty service at Edgware, originally planned as a nurse-led service open 13 hours a day, should instead open 24 hours a day and be staffed by doctors;" —[Official Report, 3 December 1994; Vol. 286, c. 29.] That is not a casualty unit in the genuine sense of the word, only a minor accident treatment service unit. I believe that I am right in saying that a new MATS unit has recently been opened nearby at Wembley. The last thing we need is two MATS units and fully qualified doctors on duty 24 hours a day to treat people coming in for cuts and bruises —the walking wounded with mild wounds indeed. This makes me extremely angry and I expect a proper, honest and thorough response from my hon. Friend the Minister today.

I am sorry that the Secretary of State or perhaps even the Minister of State is not here to answer the debate; but I admit that this is a Friday Adjournment debate, so we accept the Under—Secretary of State for Health, my hon. Friend the Member for Orpington (Mr. Horam) —provided that he comes up with the goods and gives us a proper answer.

I have sent my right hon. Friend the Secretary of State a letter today. I hope that he will receive it today, but he may do so later because of the Friday delays in the internal delivery service between Departments and the House. The letter insists and asks with justification —those two verbs go together —that the Government respond to the request of my hon. Friend the Member for Hendon, North. It is not necessary to read it out, but I say two crucial things about it. The letter belongs to him, as it had a private and confidential notation. It is therefore his property. To allay any residual doubts about what was undertaken in the summer, why does my right hon. Friend the Secretary of State not publish the letter to my hon. Friend and me of 11 June, which promised a casualty emergency services facility? I wait for my hon. Friend the Minister to respond on that specific point. I hope that he will do so today or as soon as possible.

I wish to give my hon. Friend the Minister time to respond to the weighty points that we have made on behalf of our local public. We are waiting for a clear answer today, not further procrastination, bureaucratic postponement or further studies agreeing with the district health authority, which has behaved so badly. We are waiting for action and a decision now.

In that context, the Minister may be tempted to repeat the implausible and dubious assertion that the Secretary of State cannot do much once the local entities and agencies —the district health authorities and the others —have come to their decision, after the legal process of consultation. That is not so and I remind my hon. Friend the Minister that the Secretary of State has the necessary reserve powers in the legislation, if circumstances justify invoking them. I believe that these circumstances justify doing so.

The proposal for a MATS unit is totally unacceptable. The congestion in that area makes the distance of the new Barnet facilities, the Northwick Park hospital and the Royal Free hospital too far for people with life-threatening emergencies to be conveyed there in time. It is an extremely congested zone with many elderly residents, so we need the emergency facilities to remain at Edgware, albeit in their new form if the existing A and E unit closes —may I say, in parenthesis, that I recommend that the Government consider postponing the closure of that A and E unit anyway?

Section 17 of the National Health Service Act 1977, as amended by the Health Authorities Act 1995, provides the Secretary of State with reserve powers to take the action necessary. Sections 1 and 3 of the 1977 Act emphasise that the Secretary of State has the legal duty to provide a comprehensive service to meet local needs. I emphasise that section 13 empowers the Secretary of State to devolve functions to health authorities, but the specific provisions of section 17 empower him or her to make directions specifying how those functions are to be carried out —in other words, how the services are to be provided, with detailed specifications. Section 17(2) highlights the duty of any health authority to comply with the Secretary of State's directions, which can be as detailed as the circumstances require.

Time is now getting short. There are already disturbing signs of a collapse —or at least a severe fall —in morale among members of staff at that hospital, an erosion of the quality of services for which Edgware general was famous, and a deepening psychological crisis within the accident and emergency unit. It is therefore the duty of any Government, particularly if they assert repeatedly that the national health service is safe in their hands, to do something about that. We await the Government's response.

2.41 pm
The Parliamentary Under—Secretary of State for Health (Mr. John Horam)

As my hon. Friend the Member for Harrow, East (Mr. Dykes) said, we have had a number of Adjournment debates on this matter. As he will recall, I have already replied to one of those, which he initiated. Until today, however, I had not had the pleasure of replying to an Adjournment debate initiated by my hon. Friend the Member for Hendon, North (Sir J. Gorst), but I know of his continuing concern about the issue.

My hon. Friend the Member for Hendon, North dealt, centrally, with the issue of emergency medical care. I should like to consider for a moment the original consultation carried out by Barnet and Brent and Harrow health authorities in 1994. My hon. Friend started the debate by mentioning the history of the project. We have been considering that consultation exercise, on which the changes in service at Edgware were based.

The consultation document made some important points. It said that there is a growing acknowledgement that fewer centres, with a larger population base and a higher number of emergency cases attending them, provide an improved service. That is not just what Barnet and Brent and Harrow health authorities thought; it is what the evidence shows.

That evidence is substantial. A report by the Royal College of Surgeons in 1988, called "The Management of Patients with Major Injuries", said: there are far too many small units treating serious injuries and we consider that smaller departments should be closed or have their ability to treat major injuries restricted.

In March 1995, the Department of Health published a review of the literature on accident and emergency departments and clinical outcomes. I am sure that both my hon. Friends are equally concerned about clinical outcomes. The review stated that existing research …has been enough to mould a consensus, shared by many professional staff and by health authority managers, that larger accident and emergency departments offer better care to seriously ill or injured patients.

That was the context for proposing that there should be a new accident and emergency department at Barnet general hospital, and that the accident and emergency department at Edgware general hospital should close when the new unit opened. The then Secretary of State for Health approved that proposal in April 1995. Since then, matters have moved forward.

Sir John Gorst

All that my hon. Friend says is fair, but one important thing that he leaves out is the social factor. The facilities were to be removed from an area that was deprived in many ways —in terms of income, old age and an immigrant population —but the most important factor was the transport that would take people in an emergency to a nearby A and E department. That problem is not solved by anything that my hon. Friend has said.

Mr. Horam

I shall deal with transport in a moment. My hon. Friend the Member for Harrow, East also raised the matter in the debate that he initiated.

I have described the situation with regard to Barnet general hospital. Edgware will have a new type of local hospital —one that provides a wide range of services for local people. Its services will include a casualty service. The unit at Edgware will be open 24 hours a day. It will have doctors in attendance.

Those are not the features of the original proposals put forward by Barnet health authority, which were for a nurse-led service open only 13 hours a day. Thus, the original proposals have been revised and improved, which represents a real commitment to listening and responding to local wishes. The proposals are in line with my right hon. Friend's assurances to both my hon. Friends. The words were explicitly mentioned in the letter of June this year, which my hon. Friend the Member for Hendon, North mentioned.

I should say to my hon. Friend the Member for Harrow, East that, although I cannot speak for my right hon. Friend in this debate on this particular matter, I do not believe that he would have any objection to publishing the June letter.

Mr. Dykes

The letter refers —I can give the paragraph reference, if my hon. Friend wishes —to the provision of a casualty service and specifically not to a minor accident treatment service.

Mr. Horam

Indeed, the letter uses the word "casualty". My hon. Friend refers to the distinction that I have just made —the uprating of the existing proposals along the lines that I described.

Sir John Gorst

My hon. Friend the Minister has made an important change in the position because of what he has just said to my hon. Friend. As recently as the night before last, the Secretary of State declined absolutely to permit the letter to be published. Is my hon. Friend now saying that my right hon. Friend has had second thoughts? That is an important factor in demonstrating to a wider public exactly what we were promised.

Mr. Horam

As I said, I cannot speak for my right hon. Friend in this debate, and I have not been privy to any conversations that might have taken place between my two hon. Friends and my right hon. Friend. I do not know what was said on those occasions, but I am saying off the cuff that I do not believe that my right hon. Friend would object to the publication of the letter on his own account. I am merely stating that opinion.

Obviously, transport is a matter of concern —in a sense, access to services is as important as the services themselves. Under the new arrangements, no Barnet resident will need to travel more than six miles to an A and E department. The Wellhouse trust provides a bus service for patients, visitors and staff between the Barnet and Edgware sites. The service, which supplements existing public transport links, will be maintained and improved.

In addition, the Department of Health has commissioned a survey to provide reliable information about journey times and optimum travel routes for people travelling by car from the Edgware hospital catchment area to each of the hospitals that they may need to travel to —that is, Barnet, Northwick Park and the Royal Free. The survey will also provide comparative information about public transport travel times. The survey data will be used to assist the health authorities in providing information to the public about travel times and optimum modes and routes of travel for Edgware residents to the other hospitals.

There has also been work by a project group comprising the health authorities, trusts and local authorities along with London Regional Transport, community health councils and disability groups. The group has identified areas for action in both public transport and special needs transport. A particular aim is to ensure that there are reasonable public transport routes for people who may have difficulty changing buses. As a result of the group's work, discussions are taking place with London Regional Transport with a view to implementing improved bus services between Edgware and Barnet. Work in that area is progressing. I stress that the public transport services will be in addition to the existing Wellhouse trust free bus service from Edgware to Barnet.

The group will undertake a further review and evaluation of the adequacy of transport services in the six months after implementation of the planned changes —including a survey of the transport needs of hospital users and visitors and their level of satisfaction —which will provide an opportunity to initiate more action if that is required. I also draw to my hon. Friends' attention the fact that health authorities are spending no less than £320,000 on improving the London Ambulance Service in their area. I understand that they will provide two extra ambulances and crews to help meet demand in the immediate area.

I have already mentioned that Edgware will have a new type of hospital, and I shall now enlarge on that statement.

Mr. Dykes

My hon. Friend has accepted that there should be a full casualty service, and we are grateful to him for making that promise on the record. In order to avoid any future doubts and procrastination, will he list specifically the conditions that will be treated by the new casualty emergency service at Edgware general when the old unit is closed?

Mr. Horam

I am about to do precisely that.

The hospital will include general out-patient services and a diagnostic and therapy service —for example, radiology. It will also provide day surgery; a breast-screening service; elderly and rehabilitation services; and a range of mental health services, including in-patient units, outreach and assessment services, a base for community mental health teams and a brain injury rehabilitation unit. There will also be children's services, including specialist out-patient clinics and an education and information centre.

That is not all. As my hon Friends know, Barnet health authority is submitting an application for central funding for a demonstrator project at Edgware general hospital, with a number of key elements. First, the casualty service will be open 24 hours a day —I have mentioned that already —and, secondly, a low-risk maternity unit will be provided to allow mothers to give birth close to home. Thirdly, there will be a GP-type admissions unit to provide in-patient beds, to meet the immediate needs of elderly people living locally.

Mr. Dykes

What injuries will be treated by the casualty unit? What services will it provide?

Mr. Horam

It will provide a normal casualty service. My hon. Friend should understand that it is not an A and E department: it will treat the injuries normally dealt with by a casualty service.

Mr. Dykes

What does that mean?

Mr. Horam

As I am not a doctor, it is difficult for me to distinguish between which injuries will be treated by a casualty service and which will be treated at an A and E department. I think that my hon. Friends will be aware, however, that an A and E department would be dealing with trauma, life-threatening accidents and emergencies of that sort while a casualty service would be dealing with something less. That is the distinction that we are making.

Mr. Dykes

We are going backwards.

Mr. Horam

We are not going backwards.

I refer again to the assurances that were given by my right hon. Friend the Secretary of State to my hon. Friends. My right hon. Friend said clearly in June that a casualty service would be supplied with doctor cover. That was the essence of the promise, and that is exactly what we are talking about. My hon. Friends will be aware that that was set out in a statement made by Barnet health authority on 25 September. The statement was welcomed by my hon. Friend the Member for Hendon, North. He will recall the press statement that he issued at that time, in which he specifically welcomed the casualty service that Barnet health authority then stated clearly would be provided. That is the health authority service that I am talking about.

Sir John Gorst

Will my hon. Friend give way?

Mr. Horam

I do not want to mislead my hon. Friends in any way.

My hon. Friend the Member for Harrow, East asked specifically what the service would include. It will include precisely what was indicated in the statement of 25 September.

Sir John Gorst

The statement in which I welcomed the casualty department to which my hon. Friend is referring was before it was made perfectly clear by the local health authority that it would not be dealing with anything other than MATS placements. That made all the difference in the world. I was still operating on the assumption that my right hon. Friend the Secretary of State had defined things as we understood them on 11 June.

Mr. Horam

My understanding and my clear view, as someone looking at the matter from outside, as it were —obviously there have been conversations and discussions between my hon. Friends and my right hon. Friend for some time —is that what is being said here is exactly in line with the assurances given by my right hon. Friend. It would be wrong—

Mr. Dykes

Will my hon. Friend give way?

Mr. Horam

I have little time left. I have two more points to make before I shall give way to my hon. Friend.

First, the assurances that were given in June are exactly what is being delivered and what was intended by the health authority statement of 25 September. My right hon. Friend sticks by that. Secondly, my hon. Friend the Member for Hendon, North referred to the letter that both my hon. Friends received from my right hon. Friend only yesterday or today, as the case may be. I shall quote two specific sentences. My hon. Friend quoted one paragraph, I think somewhat unfairly, and I shall quote, as I said, two other sentences.

At the bottom of the first page, the letter reads: I anticipate receiving the formal application from the health authority"— that is, Barnet health authority. That was in the few weeks before the proposals that we have been discussing. The letter continues: When it arrives I would of course be happy to discuss the proposals further with you in order to ensure that the demonstrator project reflects as accurately as possible the wishes of local people.

Secondly, my right hon. Friend adds: In addition, therefore, to discussing the details of the demonstrator project with you, I would also like to discuss how these arrangements for the enhancement of healthcare in the Edgware area should be implemented …I trust that following your adjournment debate tomorrow we shall be able to make some progress on these issues.

Mr. Dykes

In the spirit of co-operation —I thank my hon. Friend for his remarks —will he guarantee and undertake now that what we decide in any further discussions will be done immediately and will not be restricted to the district health authority's list of the items that it would cover in a minor accident treatment service, but will be a full emergency facilities casualty unit?

Mr. Horam

I cannot commit my right hon. Friend to that now in the final two minutes of an Adjournment debate. My hon. Friend is an old enough hand to know that that is beyond my power. Clearly, that is something that we shall want to raise with my right hon. Friend. I was pleased at least that my hon. Friend the Member for Hendon, North said that in using the word "hope", and attaching it to the final sentence of the letter, there is an opportunity for further discussion on this extremely important matter.

Both my hon. Friends made the point strongly that there is a unique role for a local Member in these circumstances. I hope that they will understand that, even though I am currently a member of the Government, I, too, well understand the role of a local Member of Parliament in a situation such as this, and understand the position that they have adopted. I hope therefore that they will see that what my right hon. Friend is saying will enable them to discuss the matter further. I hope that they can accept that in the spirit in which it is offered.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.