Health Services (London)

HC Deb 20 June 1997 vol 296 cc544-55

11 am

The Secretary of State for Health (Mr. Frank Dobson)

With permission, Madam Speaker, I wish to make a statement on the future of health services in London.

Under the previous Government, there was growing concern about the health service in the capital. Londoners were especially concerned about the programme of hospital closures, which had almost halved the number of acute beds, and also about the availability of accident, emergency and ambulance services and the lack of adequate primary care.

At the general election, we made it clear that we wanted to make sure that every Londoner had access to high-quality services ranging from primary care close to home, to major specialist services in teaching hospitals of world renown. We promised a moratorium on all hospital closures in London while the future of health care for Londoners was reassessed against what Londoners really need.

We are keeping that promise, and today I can announce details of our review of health care in London. Londoners are entitled to expect that the review is conducted by people of distinction, integrity and independence. I am therefore pleased to be able to announce that the review will be conducted by an independent advisory panel. The five members of the panel are Sir Leslie Turnberg, president of the Royal College of Physicians, who will chair the panel; Francine Bates, assistant director, Carers National Association; Professor Ian Cameron, provost and vice-chancellor of the University of Wales college of medicine; Professor Brian Jarman, professor of general practice at Imperial college; and Denise Platt, head of social services at the Local Government Association. I am most grateful to them all for taking on this task.

The panel will review health services in London based on available information and any further work that it decides to commission. It will review health authority plans, to ensure that people living in every part of London have ready access to top-quality primary care provided by general practitioner practices or in new centres offering a wide range of services; top-quality continuing care—including rehabilitation services—for elderly and infirm people, provided at home, in community care centres and in nursing and residential homes; top-quality mental health services, including care at home, in the community, in residential accommodation, in acute psychiatric wards or in a secure environment; services that benefit from improved co-ordination between the national health service and local social services; accident, emergency and ambulance services capable of meeting foreseeable needs; local hospitals, whether providing a full range of out-patient and in-patient services or mainly day care, minor injuries and diagnostic/out-patient services; and major specialist hospitals providing excellence in treatment and care and in teaching and clinical and scientific research.

All that is in line with the Government's vision of a range of top-quality services for all Londoners. The panel will ensure the coherence of plans by health authorities and trusts, including plans for capital investment. The panel will advise, in particular, on the future of Bart's hospital, Queen Mary's' Roehampton and Harold Wood and Oldchurch hospitals. The review will also take account of the new impetus that the Government are giving to improving public health through better health promotion and prevention.

The panel will report to the Minister of State, my hon. Friend the Member for Darlington (Mr. Milburn). It has been asked to report by the end of October this year. Its advice will be published, and the material that it considers while carrying out its review will be made available to people who want to see it. Individuals or groups who wish to submit written evidence to the panel are invited to do so. Any meetings or presentations will be at the invitation of the panel. In parallel with that, my hon. Friend will be visiting London health service organisations and meeting various stakeholders.

In line with our election promise, no hospital in London will be closed during the period of the review. Agreed service changes that do not involve hospital closures will continue, as will planning and consultation procedures, but any future changes at present being considered will be reviewed by the independent advisory panel.

In law, the panel cannot make binding decisions on the future of individual hospitals, but all such decisions in future will have to be taken in the light of the published recommendations of the independent advisory panel.

The arrangements that I have outlined meet our manifesto commitment to the people of London. I am confident that they will result in a real review, by an independent panel of great experience and integrity. I hope that the panel's recommendations will command the respect of all concerned.

I commend the proposal to the House.

Mr. Stephen Dorrell (Charnwood)

I am pleased that the right hon. Gentleman is now making the position clear on the election pledge to a health review in London. Why has he chosen to announce the review on a Friday, when most hon. Members are in their constituencies? Is not it completely absurd for a statement of such significance to be made on a day when the great majority of hon. Members have planned to be away from the House, looking after the affairs of their constituents? Is it because the right hon. Gentleman recognises that it is yet another review of London's health care which, frankly, is the very last thing that the national health service in London needs?

The truth is that the right hon. Gentleman recognises that this is a cheap election gimmick that is best put out of its misery as quickly as possible. [Interruption.] The right hon. Gentleman is likely to be put out of his misery pretty quickly. How is it possible to take seriously a review that will follow the Tomlinson process, which took four years, carried out a detailed examination, by specialty, of the health care provision in each hospital across London and conducted a detailed review of the implications of service provision for research, medical education and the development of primary health care? How is it possible for all of that now to be dispatched in four months, including holidays? It simply is not credible. It is the thinnest veneer that the House has been presented with in a very long time.

How can we take seriously a review that the right hon. Gentleman said only last month, from the Dispatch Box, would be charged with looking at the same evidence that Tomlinson looked at, applying the same disciplines that Tomlinson applied, yet would be debarred from reaching the same conclusion as that independent review? How independent is a review that is told that it cannot reach a specific conclusion which was the considered conclusion of the previous review?

Is not the true purpose of the review revealed in the list of hospitals that the right hon. Gentleman announced in his statement? He promised that there would be a particular review of Bart's, Queen Mary's' Roehampton and Harold Wood and Oldchurch hospitals. The House may wonder what those hospitals have in common—it is the fact that they have been the subject of public excitement by Labour Members. The House will notice that absent from the list is Edgware hospital, yet during the general election campaign, the Labour shadow Secretary of State for Health gave a specific commitment to a review of the service changes planned for that hospital. Why are the Government now reneging on that specific commitment?

Why are the major changes for Guy's and St. Thomas's—which will be of concern to the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), the Liberal Democrat health spokesman—not the specific subject of review by the panel? What will be the major changes? What will be the panel's specific role in the current reorganisation of London's medical schools? Does the Secretary of State envisage proposals being made to alter the current process of change in those schools?

If the panel is to focus on issues of particular public concern, will it focus on the reorganisation of accident and emergency provision in London, which has been under way for several years? The right hon. Gentleman will be aware of the Audit Commission report that recommended that accident and emergency provision should be concentrated in departments with more than 50,000 attendances a year. Do Ministers agree with that recommendation, or do they have a different view? Will the panel examine that recommendation, and will it make recommendations on future accident and emergency provision in London?

What assumptions will the panel be told to make about resources for London's NHS? Is the Secretary of State aware of long-standing evidence of the imbalance in available resources between inner London's health service and the health service on the London ring? Are Ministers committed to continue correcting that imbalance, or will they explain to communities on the London ring that resources available for their health care will continue to be less generous than those available in inner London?

What assumptions will the panel make about charges for NHS services in London? What assumptions will it make about charges for general practitioner services, and what assumptions will it make about charges for hospital services? Does the Secretary of State think that charges within the NHS will be a means of squaring the circle of all the commitments that he has made?

The truth is that the review fools absolutely no one, and it will merely delay until the autumn the day on which the Secretary of State will have to make real decisions about the future shape of London's health service. He will then not be able to prevaricate any longer. He will have to earn his salary and start making the decisions that are his and his alone to make.

Mr. Dobson

That was a regular rigamarole of insults against a very distinguished group of people—who, at my request, have undertaken to conduct an independent review of health services in London. They believe that the task can be accomplished under the tight timetable that we have established. We have discussed with panel members their terms of reference, their method of working and the timetable under which they will operate. They will do their best, and I do not think that the former Secretary of State's string of insults will accomplish anything.

The former Secretary of State said that we have made the announcement today because all hon. Members are in their far-flung constituencies. The announcement is about London, however, and there are very few far-flung constituencies in London. Moreover, a substantial number of my hon. Friends representing London constituencies are in the Chamber. He may call the announcement a "cheap election gimmick", but we call it keeping our promises. We will keep all our election promises.

Mr. James Clappison (Hertsmere)

What about Edgware?

Mr. Dobson

The former Secretary of State referred to the Tomlinson report. All I can say is that I want a report that commands if not the approval, at least the respect of everyone concerned. That certainly cannot be said of the Tomlinson report, which was ripped to shreds by Professor Jarman, who is a member of our independent panel.

The reason why I listed specifically four hospitals is that they are currently directly threatened with closure because of the activities of the right hon. Gentleman and his predecessors. It is therefore necessary to review specifically those hospitals, although all other hospital closures and proposals for change will be covered in the review.

Mr. Clappison

What about Edgware?

Mr. Dobson

The former Secretary of State asked me to give a specific commitment about medical schools. I can tell him—

Mr. Clappison

What about Edgware?

Madam Speaker

Order.

Mr. Dobson

Apparently someone wants to get somewhere on the Northern line. The hon. Member for Hertsmere (Mr. Clappison) would be able to get there quicker if the previous Conservative Government had not prevented ABB getting the new rolling stock rolling.

The former Secretary of State asked me about the review of medical schools. Under the panel's terms of reference, it will advise on how best to maintain the pre-eminent role of medical education and research in the capital. He also asked about A and E departments. It may be that all types of official bodies have said that they are satisfied with provision of accident, emergency and ambulance services in London. From the experiences that I and my hon. Friends have had over the years in talking to people, however, we know that there is a great deal of concern among Londoners about the adequacy of accident, emergency and ambulance services. We therefore want our independent panel to review the proposals.

I have dealt with all the sensible points made by the former Secretary of State—so far as he made any sensible points. We have established a highly reputable, widely respected and independent advisory panel that will review the future of health care in London, from the point of view of Londoners who need those services. If he is not satisfied with that, I am sorry for him.

Mr. Peter Brooke (Cities of London and Westminster)

The House will recall the notice in a maternity hospital ward that said, "The first three minutes of your life can be the most dangerous," under which someone had written, "And the last three can be pretty dodgy, too." In that context, four months in the history of a hospital that is nearly 900 years old are but a hiccup in history. I welcome what the Secretary of State has just said.

Given that, in the past 20 years, the resource allocation working party formula—which was introduced under the Labour party and sustained by the Conservative party—has been responsible for the movement of considerable NHS resources out of London, will the Secretary of State tell us—at a time when anything is thinkable in the NHS—that he will not rule out extra resources, should the panel determine that they are necessary?

Mr. Dobson

I thank the right hon. Gentleman for his characteristically generous welcome for what I said. As we have made clear, we are conducting a comprehensive spending review of every aspect of the activities of the NHS. I can make no promises before the outcome of that review, although I realise that, over the years, there have been significant pressures on London. As the right hon. Gentleman said, those pressures are the result, over a long period, of the policies of successive Governments.

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

I warmly congratulate the Secretary of State on today's statement and applaud the fact that he has assembled a first-class review panel, which will command the confidence not only of the House but of Londoners and of people in the rest of the country. Will he arrange for a copy of his statement to be sent to Colonel Boorman, the chairman of the Royal Hospitals NHS trust—because that man, white with rage, has pledged himself to close Bart's, regardless of what civil servants, Ministers and perhaps even the review panel may wish to do?

Mr. Dobson

I thank my hon. Friend who, like the right hon. Member for Cities of London and Westminster (Mr. Brooke), has campaigned long and hard to save Bart's. I undertake to carry out his request to send my statement to all those concerned.

Mr. Simon Hughes (Southwark, North and Bermondsey)

I thank the Secretary of State for his statement—unlike his predecessor but one, who made hers in writing. I also congratulate him on his choice of panel members. I share the views expressed that they are an entirely suitable group. The timetable envisaged is properly balanced between a need for deliberation and a need for speed.

I have three specific questions. First, does the Secretary of State's statement mean that all the undertakings given by his predecessor as Labour health spokesman, on what will be reviewable, will be honoured? Secondly, in places such as Edgware and Barnet, will he undertake that, between now and consideration of the review by Ministers later in the year, there will be no further reductions in beds or services? Thirdly— inevitably, this point has a constituency dimension, but it is also of much wider interest—will he confirm that the panel will have the authority to review the transfer of services from Guy's hospital, which would mean a reduction in the number of beds from about 1,000 to about 100 and the closure of the A and E department? Will all transfers not yet acted on but which are part of a plan be capable of review and a different decision?

Mr. Dobson

I should make it clear that our promise at the election was that there would be no further hospital closures in London, and no hospital closures will take place during the period of the review. We did not promise to stop all change in London, some of which is having to be carried out on the advice of the professions, which say that, in certain circumstances, the services being provided in some hospitals are not safe for patients. Everyone will understand that I would not wish to overrule the professional judgment of doctors who believe that a particular unit is no longer capable of delivering the service to which people are entitled. As the hon. Gentleman knows, we have already set in train a special review of provision in Edgware, and we can deal with that at greater length at some other time.

I cannot give the undertaking that there will not be continuing transfers of functions between one hospital and another. Everyone knows that there is no proposal to close either Guy's or St Thomas's. The intention is to make sure that each particular specialty is concentrated in one hospital or the other, which is only right. There is a swap mechanism in operation—St Thomas's is getting some of the stuff from Guy's and Guy's is getting some of the stuff from St. Thomas's. Again, I am not prepared to say that I shall interfere with that process if it is generally judged that it will bring about the larger specialist units on which top-quality specialist treatment and research depend.

Mr. Tony Colman (Putney)

I thank my right hon. Friend for his statement and welcome the review, especially its concentration on Queen Mary's university hospital, Roehampton. That hospital had many of its services cruelly taken away by the previous Government on 1 April and has suffered review after review over many years. The people of Putney and Roehampton and the long-suffering nurses and doctors of the hospital need to have some certainty about their future. Last month, a quite separate review was announced by the region of the services between Kingston hospital and Queen Mary's university hospital. May I have an assurance that the review announced today will supersede that review, so that the doctors, nurses and patients of the hospital and residents of the area do not face yet more uncertainty?

Mr. Dobson

The object of having the advisory panel is to try to sort out many contentious issues and get advice from professional people of great integrity. There is a vast amount of uncertainty about the future of Queen Mary's, Roehampton and other hospitals round about. We want the panel to clarify the situation, but I cannot predict what it will say, because one cannot tell people of this eminence what their conclusions will be. The whole point of having such people is that they are entitled to make their own professional judgment.

Some statutory procedures for consultation in the area covered by Queen Mary's university hospital, Roehampton and associated hospitals will continue during the review, but the consultation process itself will be reviewed by the advisory panel. We cannot simply announce a stop on everything, because that would mean delays in some changes that are vital to improve the quality of health care in London.

Mr. Bernard Jenkin (North Essex)

Will the right hon. Gentleman assure the House that neither he nor any of his Government colleagues made any effort to give better notice of his statement to Labour Members than to London Conservative Members?

Mr. Dobson

Yes, I can give that undertaking. We warned as many Members from all parties as it was humanly possible to do. That is not a task for civil servants, so it was carried out by my political adviser and one of my parliamentary colleagues. We did not get through to quite all Labour colleagues nor to all Conservative Members, but we certainly got through to some.

Mr. Jeremy Corbyn (Islington, North)

I welcome the Secretary of State's announcement, especially in respect of the team of people who are to undertake the review. Will the review include issues such as poverty in London and the way in which calculations of expenditure for each district health authority are made? It is my impression that such calculations often do not take account of the number of transient and homeless people or, indeed, the travel-to-work people in particular districts, which means that expenditure on health is underestimated in those areas. Will the team be able to make recommendations on the future government of London and the role that it would have in health planning and its relationship with local government?

Finally, will my right hon. Friend confirm that the examination of the future of Bart's hospital will include consideration of new A and E provision? At the moment, there are intolerable waits at all neighbouring A and E departments because of the closure of the A and E department at Bart's last year.

Mr. Dobson

As usual, my hon. Friend makes a number of informed and valid points. The panel will certainly be considering provision in London in the light of the Government's commitment to improve public health, not just through the health service but through a wide variety of measures, including the building of decent homes.

As for the role or otherwise of a Greater London authority, that is something that is still being discussed. As my hon. Friend knows, I have some sympathy with the proposition, although it may not eventually be Government policy—I am talking about all sorts of things, which may not ultimately be Government policy.

My hon. Friend asked about the restoration of previous A and E services at Bart's. Nothing is outside the terms of reference of the panel, but I should not like to raise any false hopes or, for that matter, any false despair about the changes proposed at Bart's.

Mr. Paul Burstow (Sutton and Cheam)

I hope that the review will include consideration of co-ordination between social services and health services. The present lack of co-ordination means that many people are left vulnerable and unable to get decent services. As a first step, will the Secretary of State tell the House that he will honour a commitment made by the right hon. Member for Islington, South and Finsbury (Mr. Smith) that social services committee members will be appointed to the boards of NHS trusts and health authorities in London, so that co-ordination can be improved now?

Mr. Dobson

I mentioned the improved co-ordination between national health service and social services departments, and where it is good in various parts of London, it is very, very good, and where it is bad it is horrid. We have to bring the rest up to the standard of the best. As to how we bring that about, regardless of the membership of trusts or health authorities and cross-membership, the crucial thing is to get the officials working together. People at member level may have a role, but they are not the ones who can turn good intentions into good organisation—that needs top-quality management, both in the national health service and in local authorities.

Mr. Mike Gapes (Ilford, South)

I welcome my right hon. Friend's statement. His comments about Oldchurch will be received with great delight by many east London residents, particularly my constituents in Ilford, who would suffer grievously from the closure of the accident and emergency department at Oldchurch and the consequences that that would have for King George hospital, which is already at bursting point and suffering an intolerable crisis.

I also welcome the review of mental health services. Will the review give urgent consideration to the future reprovisioning of Goodmayes mental hospital and the financial consequences of its planned closure? I had a meeting yesterday with my local health authority. I am alarmed about the long-term prospects. If the issue is not dealt with adequately, there will be disastrous consequences for the provision of many services, with budgetary repercussions, in Redbridge and Waltham Forest.

Mr. Dobson

I thank my hon. Friend for his welcome for my announcement. The review panel will consider Oldchurch and the future of mental health services in London. We must await the outcome of those deliberations.

Mr. James Clappison (Hertsmere)

I have three points for the Secretary of State. First, I thank him for at least managing to come to the House to make a statement. Is he not a little concerned that the fact that he has done so on a Friday, when not many hon. Members are here, will inevitably give rise to the suggestion that he has tried to make the statement at a time when he will not be subjected to questions? In view of what he has said about his courteous efforts to inform hon. Members of the statement, will he undertake to discover whether my hon. Friend the Member for Chipping Barnet (Sir S. Chapman) was informed, because he has been concerned for a long time about Barnet and Edgware hospitals?

Secondly, will the Secretary of State ensure that the distinguished members of the inquiry are given access to the evidence and conclusions of the Tomlinson report, the King's Fund report and the many other reports that have been conducted by similarly distinguished people over many years?

Finally, will the right hon. Gentleman tell the people of Edgware and Barnet why Edgware general hospital is not included in the review? Did he make any effort to tell the people of Edgware about that before the general election? He will be aware of the strength of feeling on the subject in Edgware and the way in which his party has handled the issues. Why is Edgware not part of the review?

Mr. Dobson

I do not know whom my staff and my colleague managed to get through to in their efforts to ring all London Members last night, but they certainly made that effort. Before I apologise further for any shortcomings, it is worth reminding the hon. Gentleman that when the last but one Secretary of State for Health made major announcements, including her endorsement of the closure of Bart's hospital, which had been providing a service to Londoners for 821 years, she did not manage to come to the House on any day, but slipped the information out in answer to a written question from one of her mates.

I spelled out in my statement that the panel will have access to all the available information. The Tomlinson report will certainly be familiar to Professor Jarman, because he tore it to shreds when it was published—and quite right, too.

The hon. Gentleman ought to know—perhaps he does not—that a special review of provision in Edgware and Barnet has already been set in train. There is no proposal to close Edgware general hospital—not even the previous Government made that proposal. We are not accepting any criticism about the future of Edgware hospital from those who were running it down, closing the accident and emergency department as secretly as they could in the middle of the night. None of my colleagues was involved in that.

Mr. Harry Cohen (Leyton and Wanstead)

I warmly welcome the appointment of the eminent review panel and the fact that it will focus on Bart's hospital, which provides a high standard of cardiac treatment, benefiting a number of my constituents. Will the review panel also consider the debt problem, which is crippling health authorities across London, affecting hospitals such as mine at Whipps Cross? Those huge debts have built up because of the cuts imposed by 18 years of the Conservative Government and their internal market. Will the review examine the weighted capitation, which does not take proper account of deprivation and hurts hospitals in east London?

Mr. Dobson

The panel will certainly consider those points. Debt is not exclusive to London health authorities and trusts. Of the 100 health authorities in England, 59 were in debt at the end of the year, as were 128 of the 425 trusts across the country. That was part of the wondrous legacy that we inherited from the Conservatives.

Mr. Thomas Brake (Carshalton and Wallington)

I, too, welcome the statement. I should like to make the House aware of the meeting that I had with representatives of Merton, Sutton and Wandsworth. They revealed that they are £14 million in the red and are cutting back on elective surgery, with waiting lists going up from 12 months to 18 months. I do not want to pre-empt the panel's findings, but I think that it will inevitably find that the authority cannot ensure top-quality care. What will the Government do to ensure that the accident and emergency unit at St. Helier hospital does not have to close its doors to patients and ambulances this winter, as has happened in the past two or three years under the previous Government?

Mr. Dobson

I shall try to confine my answer to the newest point raised by the hon. Gentleman. We have already made arrangements for contingency planning, for the pressures that are bound to fall on the health service this winter. I was glad to be able to announce that we have found £5 million from the money saved on bureaucracy to help improve children's intensive care provision, which should help during the winter.

Madam Speaker

Order. I know that hon. Members are tempted, but some are going wide of the narrow statement, which concerns only the named hospitals. I remind hon. Members that we are concerned with only the hospitals named.

Mr. Malcolm Wicks (Croydon, North)

In welcoming the review into the longer term, may I ask the Secretary of State to give some assurances about the short-term situation this winter? In Mayday University hospital in Croydon and throughout London, too many patients waited for hospital beds last winter, lying in pain and distress on trolleys for hours and hours, sometimes throughout the night. The longer term is important, but what reassurances can the Secretary of State give to Londoners that his Department is doing its utmost to ensure bed provision this winter?

Mr. Dobson

I assure my hon. Friend that we are doing what we can. As I have just said, we have put in place contingency planning to identify places where problems may arise and to ensure targeted management action by the national health service, social services and, in some cases, voluntary organisations, to try to clear bottlenecks that result from older people who would be better off at home having to stay in hospital and therefore preventing other people from getting treatment. We are doing our best. It will be difficult, and success will depend largely on the management skills and commitment of the vast number of medical and nursing staff in hospitals.

Mr. John Cryer (Hornchurch)

I welcome the review and reiterate the words of my hon. Friend the Member for Ilford, South (Mr. Gapes). The review will be welcomed across Hornchurch, Havering and east London, where the potential closure of Oldchurch hospital is a source of great concern. The private finance initiative contracts for the Havering Hospitals NHS trust, which covers Harold Wood and Oldchurch, are already with the trust. A decision is due at the end of July. Could we have a moratorium on the PFI contracts as well, so that we can put the issue to one side while the review continues?

Mr. Dobson

I can give my hon. Friend the assurance that whatever the state of the PFI, it will be reviewed by the panel.

Mr. Barry Gardiner (Brent, North)

I am grateful to my right hon. Friend for making his statement to the House this morning. The clarification that he has given will be welcomed throughout London. More than that, the commitment to health care needs in London will be welcomed. I am also grateful to my right hon. Friend for the interest and concern that he has shown in discussions with me about the hospitals serving my constituency. I take this opportunity to ask whether he can clarify the relationship between the Londonwide review and the separate review of Edgware hospital, which his Department announced on 15 May this year.

Mr. Dobson

The review that is at present being carried out by Barnet health authority will report to the Minister of State, my hon. Friend the Member for Darlington. Its report will be made available to the review panel and will, therefore, be part of the panel's general look at health services in London.

Mr. Edward Davey (Kingston and Surbiton)

Further to the Secretary of State's answer to the hon. Member for Islington, North (Mr. Corbyn), will he extend the terms of reference of the review to include the future strategic management of health across London? In Kingston, we felt the knock-on effects on our hospital services of decisions taken elsewhere in London, and they have made the management of services in our local area very difficult. There was no strategic direction. We should be grateful if the Secretary of State extended the terms of reference of the review.

Mr. Dobson

Having got this distinguished panel to look at the terms of reference and having agreed the terms with the panel members, I cannot unilaterally change them now. I would imagine, however, that if the panel members believe that the strategic aspects need further attention, based on their professional knowledge and concern, they will draw our attention to what they think should be done.

Ms Judith Church (Dagenham)

I join my hon. Friends the Members for Ilford, South (Mr. Gapes) and for Hornchurch (Mr. Cryer) in very much welcoming the review. My constituents in Dagenham are desperately concerned about the future of Oldchurch hospital. The Secretary of State will know that currently, the emergency services unit at Harold Wood is closed and that Oldchurch is dealing with the whole population. I hope that the Secretary of State will join me in congratulating the staff there on the job that they are doing in a quite desperate situation. From visits I have paid in the past few months, I know that the situation is a nightmare for patients and for staff, who have kept the service going as well as they can.

Will my right hon. Friend ensure that when the eminent panel—I congratulate him on getting its services so quickly and on enabling the report to be done so soon—reviews the services at Oldchurch and Harold Wood, it considers the needs of the population and the density of the population, with hospital provision being near the areas where the largest number of sick people are? The proposals in the pipeline mean that the largest number of sick people would have to travel the greatest distances to get emergency services.

Mr. Dobson

I can confirm to my hon. Friend that the intention is that the panel should start from the point of considering what people need in every part of London and that it should take it from there, rather than starting from the institutions and working back.

Mr. Dorrell

Will the Secretary of State clarify one point that has come up this morning in questions from several hon. Members—that is, the extent to which the panel will be able to review the weighted capitation formula and the flow of funds both within London's health service and between London and the surrounding districts? Will it be within the terms of reference of the review to make recommendations for changes to the weighted capitation formula? If it is, can the Secretary of State assure the House that any recommendation would take account of interests outside London, which would clearly be affected if the weighted capitation formula were to be changed?

Mr. Dobson

The panel will look at every aspect that has an impact on health provision in London; that is what we want it to do. If the panel concludes that changes are necessary, it will no doubt recommend them. On the point about the impact of the financing of provision in London on other areas, it is worth remembering that London also provides considerable services to people from other areas. There is a matter of striking a balance.

At the end of all this process, when the independent panel has given its views on all those matters, Ministers will have to take decisions, and we shall not shirk from taking them. As I said in my statement, all those decisions will have to be taken in the light of the public recommendations of this distinguished, independent panel. That will be a change and a step forward for the national health service.

Mr. Corbyn

On a point of order, Madam Speaker. It has been a welcome departure that the Secretary of State attempted to inform as many hon. Members as possible that today's statement was coming up. Can you confirm that under the previous Administration, Opposition Members were never informed in advance of statements?

Madam Speaker

I am not aware of how hon. Members are informed about statements. I am just concerned that they are informed and that I am told in good time myself.