HC Deb 03 February 1998 vol 305 cc843-58 3.30 pm
The Secretary of State for Health (Mr. Frank Dobson)

I wish to make a statement on the future of health and health care in London.

At the general election, we made it clear that we wanted to make sure that every Londoner has access to top-quality health care. We promised a moratorium on all hospital closures in London while the future of London's health care was reassessed against what Londoners really need. We have kept that promise.

On 20 June last year, just seven weeks after coming to office, I announced that a swift and independent review of London's health needs was to be carried out by a distinguished panel chaired by Sir Leslie Turnberg, then president of the Royal College of Physicians, formerly consultant physician at Hope hospital, Salford, and professor of medicine at Manchester university.

Since then, the review panel has done a remarkable job. It has reviewed all the evidence, consulted widely and carried out a large number of meetings and visits. The panel received and considered more than 1,800 responses from local people and organisations. It submitted its report on 18 November. Since then, it has been considered very carefully by the Government. We have been faced with some tough decisions.

Today, seven months after the panel was established, I am publishing the report of the independent review panel—the Turnberg report. I am also publishing the Government's response. The Turnberg report spells out a clear set of recommendations for the improvement of health services in London. I am glad to be able to announce that the Government accept all its recommendations. Many are in line with our proposals in the White Paper "The new NHS" for a 10-year general improvement programme to make the NHS modern and dependable. All are accepted by the Government, and the necessary further work is already being put in hand.

Time does not permit me to list all the important recommendations in the Turnberg report, so I shall concentrate on a limited number of most immediate interest to Londoners. The report recognises that in many parts of London—especially in the most deprived areas—primary care, mental health, intermediate care and community services are simply not up to the standard to which everyone in our country is entitled. The report proposes a range of measures to bring things up to scratch. We accept those measures. We shall provide an additional investment of at least £140 million in those services for London over the lifetime of this Parliament. An extra £30 million will be targeted on those services in the coming financial year.

The report recognises the need for new arrangements to ensure a Londonwide strategy for health and proposes, as a medium-term aim, a single NHS regional office for London. Without Londonwide strategies and actions, the necessary improvements in mental health services and the proper integration of services for children and older people will be hard to achieve, if not impossible.

The report concluded that there is no evidence that there are more acute hospital beds available to Londoners than the English average". The Government have therefore abandoned the presumption that we inherited from our predecessors, that London is overprovided with acute hospital beds. As a result, any future changes in bed numbers in London will be in line with those in the rest of the country.

The review panel was asked to look at the plans of London NHS trusts and health authorities, including their plans for capital developments. It was asked in particular to advise on the future of Queen Mary's university hospital in Roehampton, Harold Wood and Oldchurch hospitals in east London and St. Bartholomew's hospital. For those purposes, the panel reviewed London hospital provision in terms of five sectors covering north, south-east, south-west, west and east London respectively. It faced some awkward choices and made some tough recommendations. The Government have made similarly hard-headed decisions.

For north London, the panel said that a new hospital building was "sorely needed" to bring University College hospital, the Middlesex hospital, the Hospital for Tropical Diseases and the Elizabeth Garrett Anderson hospital for women together on one site. That would provide top-quality local and specialist services, with academic and research facilities shared with University college nearby. As the local Member of Parliament, I warmly endorse that proposal. The panel also recommends urgent capital investment at the Whittington hospital. We shall invite plans for such improvements. The need for swift action is understood, but it will take time to carry out all the necessary evaluations before work can proceed.

For south-east London, the panel endorsed the proposal to build the new Queen Elizabeth hospital at Greenwich through the private finance initiative. It also supported the proposals for further improvements to King's College hospital on the Denmark Hill site.

The panel considered the proposal to close the accident and emergency unit at Guy's hospital and called for a re-evaluation of the proposed closure to ensure that alternative services will be able to cope. That evaluation has taken place. Additional accident and emergency capacity is already in place at King's and Lewisham hospitals. The situation will continue to be closely monitored in the lead-up to the closure of the Guy's A and E department and beyond. Contingency plans will be put in place to provide additional services if patient numbers are higher than expected.

The panel also called for a re-evaluation of the proposed shift of other services from Guy's to St. Thomas's, to ensure that best use is made of some of the facilities at Guy's which, on present plans, would be vacated. That is likely to keep more services at Guy's than was planned by the previous Government.

In south-west London, the panel favoured plans for investment in the development of a community hospital on the site of Queen Mary's Roehampton. That means the replacement of acute services currently provided at Queen Mary's by improved alternative acute services at Kingston hospital and St. George's hospital. The Government accept that proposal. The panel also endorsed a proposed shift of services between St. George's and Atkinson Morley's hospital.

In west London, the panel supports the shift of services from Queen Charlotte's and Chelsea hospital to the Hammersmith site. It also called for special attention to be given to the need to foster the national and international role of Hammersmith hospital and its relationship with Imperial College medical school. A series of service reviews is now under way in west London, addressing that aim and the need to serve local people.

It was in east London that the panel faced the most difficult problems. It was asked to consider proposals involving the future of Harold Wood and Oldchurch hospitals. It supports the development of a new hospital at Oldchurch, rather than at Harold Wood, to provide the full range of services for that area—not least because that is where the majority of the population live, including those with the greatest health needs. Like all the other new reconfiguration proposals that I mentioned, that proposal will be the subject of local consultation.

For the east end, the panel recommended a package of measures to counter the deprivation and ill health of many of the local people. It proposes investment in intermediate and community services. It also proposes the full utilisation of beds at Homerton hospital and Newham general hospital and new investment at Newham general hospital. It endorses the proposal to rebuild Royal London hospital Whitechapel, but with 900 beds, rather than the 1,100 in the current stalled plans for that redevelopment. Those have been difficult decisions.

That leads me on to the future of St. Bartholomew's hospital. The Turnberg report recommends that Bart's should not close. The Government agree, and Bart's will be saved. [HON. MEMBERS: "Hear, hear."' We will not countenance the closure of that great hospital, which has faithfully served the people of London for 875 years.

During the time when the new Royal London hospital is being built and other hospital developments are taking place in the east end, Bart's will continue in its present role. When that period comes to a close, in line with the proposals of the Turnberg report, Bart's will concentrate on its renowned specialist expertise, with a focus on cancer and cardiac services.

We owe a great debt to Sir Leslie Turnberg and his colleagues for their work and their wisdom. I believe that the Turnberg report will prove to be a far-reaching and far-sighted plan for the improvement of health services in London. The Turnberg proposals have the backing of the Government, and the personal backing of the Prime Minister. They will provide a firm foundation for a 10-year programme to provide London with a modern and dependable health service. That programme paves the way for the investment of well over £800 million to provide London's health service with the fine modern buildings that patients and staff deserve. At least £140 million will be provided to support primary care and mental health. That amounts to a boost of almost £1 billion for health care in London.

There have been many reports on the future of health care in London. Some have mouldered on library shelves; others have been the subject of endless and indecisive debate; and all the while buildings have been left to deteriorate, staff have been left uncertain and patients have been left to wait. That will not be the fate of the Turnberg report.

By accepting all its recommendations, the Government have turned that excellent report into an action plan to modernise London's health service. From today, we shall be mobilising all those who care about London's health services, not just the hard-working people who work in the NHS, but people in local government, universities, scientists and other researchers, people in business, patient groups and local people, to work together systematically to deliver the improvements that Londoners want to see, year by year. That is what the Turnberg report recommends. That is no more than Londoners deserve. The chattering times are over. The time for action has come.

Mr. John Maples (Stratford-on-Avon)

As has become the habit of the Government, the report was comprehensively leaked before it was given to the House. The White Paper was leaked; the Green Paper on public health has been printed almost in full in the Health Service Journal; and yesterday, the Financial Times was obviously accurately briefed on the Turnberg report. It is a great and continuing discourtesy to the House that it is not informed of such decisions first.

I echo the Secretary of State's thanks to Professor Turnberg and his colleagues for their work, which will provide a valuable basis of information for planning health services in London. The panel was established last June so that it could report by October. Why has it taken the Secretary of State more than two months, nearly three, to publish its report? The answer is that it did not solve the right hon. Gentleman's problem, because it was supposed to give him cover for keeping Bart's going to provide local services. It has not done so.

It is now clear that another problem was the Treasury, which apparently believed that Bart's should be shut completely and that all services should be transferred to the new hospital, the Royal London. The Secretary of State has been forced to come up with a face-saving formula which, according to the Treasury, does not stand up financially.

Labour Members cheered when the Secretary of State said that he had saved Bart's, but let no Labour Member kid himself that Bart's has been saved for the people of east London. We welcome the tertiary referral centre—it will no doubt provide wonderful services for cancer and cardiac patients from throughout the country—but Bart's hospital will not provide any of the local services usually provided by a district general hospital.

May I ask the Secretary of State some questions? [Interruption.] I should like to ask the right hon. Gentleman some questions; perhaps he would like to hear what they are without interruption. Do the boards of the Royal Hospitals NHS trust and East London and The City health authority agree with that decision? Did they want to continue local services on the Bart's site, or did they believe that it would have been more efficient to transfer all the services to a new hospital on the Royal London site? Is it not the accepted wisdom of most expert opinion that such specialist hospitals are not a really good idea and that real breakthroughs occur when all the specialties are on the same site? Has the Secretary of State asked the royal colleges for their opinion on splitting those hospitals?

What was the Treasury's estimate of the additional cost of the decision? The local health authority is already running a significant deficit and if there are, as I expect, additional costs, will it be reimbursed for those additional costs?

During and before the general election, Labour exploited the Save Bart's campaign, but it is not now prepared to give the people behind that campaign what they wanted—the continuation of local services on the Bart's site. The review and the decision have not been about saving Bart's; they have been about saving the Secretary of State's face, and it looks as if the people of east London will have to pay for it.

Can the Secretary of State confirm that the new Royal London hospital will go ahead? Does he agree that what is really needed in east London is better primary care, and can he confirm that the extra costs of the decision will reduce budgets for local services, including primary care?

What really improves cancer care is early diagnosis by general practitioners. If that is made less likely by the decision and its extra costs, the people of east London will gain little, if any, advantage from the new tertiary services.

I welcome the decision to provide more beds in London. In the Tomlinson report, Sir Bernard Tomlinson said that if the rate of emergency admissions increased, more beds would be needed, and that has clearly happened; but they are most needed in long-term care, and that problem results largely from Labour local authorities' appalling performance in providing nursing home beds.

We cannot let this decision pass without reminding the House of some of the Government's broken promises on London hospitals. [HON. MEMBERS: "Oh."] They do not like being reminded of them. It has not taken long to get some broken promises.

Before the election, Labour candidates in Putney and Brent, North obtained promises from the then shadow Secretary of State to keep open Edgware general hospital and Queen Mary's university hospital at Roehampton. The Secretary of State promised a moratorium on closures while the review was under way. All those promises have been broken. Both accident and emergency departments have been shut—effectively a death sentence for a hospital. Queen Mary's has been run down to the point of unviability. We all suspected that we would soon be told that it could not continue with such reduced services and that what remained would have to be moved to the Kingston site. That has been confirmed this afternoon.

The same is true of Edgware. There is no way that Edgware general will remain a district general hospital. Last week, when I challenged the Secretary of State, he tried to wriggle out of that, saying that he had not promised no service rundowns, only no closures. It will not take long for the people of Edgware and Putney to discover that they mean the same thing, and they will not be impressed by the Secretary of State's distinction.

It will be interesting to see whether the new Labour Members for those constituencies—the hon. Members for Putney (Mr. Colman) and for Brent, North (Mr. Gardiner)—who campaigned heavily, ruthlessly and with great bravado on the issue before the election, now have the courage to stand up to the Secretary of State and fulfil their election commitments.

The Government have so many reviews going on that it is difficult to remember which is which, but this is the one that was to give the Secretary of State cover for keeping Bart's open. It has not. Bart's will close as a district general hospital providing local services to local people in east London and the City. The Secretary of State has neither saved Bart's nor, I suspect, improved local services. His solution will probably cost more. Promises have been broken at Edgware and Roehampton, and it remains to be seen whether the new Royal London hospital ever actually gets built.

Mr. Dobson

As I said when I telephoned you earlier today, Madam Speaker, I am disgusted by the leak of part of the proposals to the Financial Times yesterday. That was a discourtesy not just to the House, but to the excellent team of people who produced the report. There may be some ersatz upset on the Opposition Benches, but if Opposition Members had seen me when I got into my office this morning and discovered that the leak had taken place, they would have realised that I was rather more upset than they are.

Let me make it clear that the purpose of the Turnberg panel was to produce an independent report from five excellent people of the highest integrity. They have done that, and we have accepted every one of their recommendations. Any suggestion that what I have announced today is a face-saving formula is an insult to the integrity of the people who produced the report and recommended everything that I announced today.

The hon. Gentleman referred to accepted wisdom. The accepted wisdom is that Papworth, which might be described as a single-subject hospital, is an excellent hospital, that the Royal Brompton, which is similar, is an excellent hospital, and that the Christie hospital in Manchester is an excellent hospital. There is no reason why we should necessarily go along with what happens to be the current fashion in health care.

The hon. Gentleman asked whether we had consulted the royal colleges. We have not consulted them, but I cannot do much better than ask the then president of the oldest and most distinguished of the royal colleges to conduct the review.

With regard to primary care, I have made it clear, the report makes it clear and I made it clear in my statement that we want much more effort to be put into improving primary care, particularly in east London, where it is in a bad state.

When it comes to broken promises, there is none. We have kept every single one of our promises in relation to health care in London. We promised that no hospital would be closed while the review was undertaken: no hospital has been closed. We promised that there would be a review: there has been a review. We did not promise to accept every recommendation in the review, but we have done so, because they are first-rate, wise and sensible recommendations.

On Edgware hospital, the scheme that has been worked out by the Minister of State, my hon. Friend the Member for Darlington (Mr. Milburn), commands the support of the bulk of the people in the Edgware area.

Finally, when the hon. Gentleman speaks of hospitals that have been run down in London, let me remind him that they have been running down for 18 years under his hon. Friends. We are stopping the rundown and sorting things out, and we have been in power only nine months.

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

Does the Secretary of State accept that no praise can be too great for him and the Prime Minister, for removing the death sentence on St. Bartholomew's hospital imposed by the previous rotten Tory Administration—a death threat that barbarians from Whitehall have sought to uphold ever since? Does he accept—here I choose my words carefully, in order to avoid hyperbole—that when the final paragraph of the last chapter of the definitive history of the world comes to be written, and the writer looks up into the sky at the pantheon of the gods—that is, those people who have made a real contribution to humanity and civilisation—the Secretary of State will be there among them? Frank, you've been brilliant.

Mr. Dobson

It would be churlish of me to challenge anything that my hon. Friend said. This may be an appropriate opportunity to say that it is almost impossible to exaggerate the symbolic significance of St. Bartholomew's hospital, which has served London and Londoners in peace and in war, in good times and in bad, for 875 years. A party that calls itself the Conservative party might have thought that there was some merit in its history and tradition, but it has taken a Labour Government to do something about it.

Mr. Simon Hughes (Southwark, North and Bermondsey)

I join the Secretary of State in thanking Sir Leslie Turnberg and his colleagues, without reservation, for an excellent report. From what I have seen so far, it is a professional piece of work that commands the confidence of those with whom they work. I also thank the Government for accepting the panel's recommendations without reservation. When the Government accept a package of general and specific recommendations produced by an independent body, we should recognise that that is a statesmanlike response.

Mr. Dennis Skinner (Bolsover)

However.

Mr. Hughes

No, there are very limited "howevers". I have two specific points. First, I note the Turnberg panel's scepticism about the old Government strategic plan for my part of London, and particularly Guy's hospital. I urge Ministers to look particularly carefully—I know that they are willing to do that—at any proposals remaining on the table to close casualty at Guy's. I urge them to view even more sceptically the advice that they receive from civil servants and officials to the effect that the Government should close and leave empty perfectly good buildings on the Guy's site—whose construction cost millions of pounds of taxpayers' money—and build replacement buildings, costing millions of pounds of taxpayers' money, just down the road. That would be folly. If the Government do not accept that proposal, Guy's hospital may continue to flourish.

Secondly, I believe that the proposal regarding Bart's is realistic and reasonable. It is not what everyone wanted for Bart's, but it will produce a much more viable site for London in terms of size and retain a centre of excellence which, like Guy's, is recognised all over the world. Lastly, I shall put a question.

Madam Speaker

About time.

Mr. Hughes

I know, Madam Speaker.

Does the Secretary of State agree that the message of the report is that London health services require proper funding, no further rundown of beds and, above all, democratically accountable and co-ordinated strategic planning? We must never leave the vulnerable, such as the mentally ill and the elderly, to look for the scraps from the health service while others benefit from the best health service in the world.

Mr. Dobson

I thank the hon. Gentleman for his welcome for the report. I am sure that Sir Leslie Turnberg and his colleagues will be as grateful as I am for his comments.

I recognise the force of the panel's recommendation in relation to the proposed replacement of some excellent, new, occupied buildings at Guy's with others at St. Thomas's, which would involve great expense. There may be merit in moving some of the facilities to St. Thomas's as part of the rationalisation of the two hospitals, but we shall consider that matter carefully. In view of how much careful thought has gone into the report, it would be wrong for me to make an instant judgment as to what facilities should or should not be moved.

The same principle applies to the Bart's-Royal London situation. A very large hospital at the Royal London was proposed to replace the existing Royal London and Bart's hospitals, most of whose buildings are in excellent nick and provide an excellent service. We think that the decision makes financial sense—and every other sort of sense.

Kate Hoey (Vauxhall)

I welcome the Secretary of State's statement, and particularly the lifting of the uncertainty that has surrounded two great hospitals—Guy's and St. Thomas's—for some time. Given that the decision has been made to centralise accident and emergency services at St. Thomas's, will my right hon. Friend confirm that, whatever changes might take place, there will have to be a large women and children's unit at St. Thomas's? Does he agree that this provides an opportunity for all those involved with St. Thomas's and Guy's to begin to work together and increase the positive partnership that has been established in the past two years?

Mr. Dobson

I know that what my hon. Friend wants me to confirm is what she wants to happen. I do not think that I should take important and delicate decisions about the future of two great hospitals while standing at the Dispatch Box. I hope that the re-evaluation will come up with what my hon. Friend wants. It may not, however, and I do not want to comment on that.

I shall say, however, that in recent times the board, the management and the clinicians of both St. Thomas's and Guy's have been working much better together than ever seemed possible. I hope that they are now successfully working as one unit, carrying on the fine traditions of both hospitals and providing services both to local people and to people from throughout the country who come to them for specialist attention.

Mr. Eric Pickles (Brentwood and Ongar)

I refer to Harold Wood hospital. The Secretary of State says that there is to be public consultation. Is he aware that public consultation has already taken place and that the unanimous view was in favour of Harold Wood hospital? Is he further aware that, were it not for the review, the contracts were due to be signed, and that construction would have been taking place on the Harold Wood site right now? The further delay means that my constituents will have to put up with accident and emergency services at difficult-to-reach hospitals that are not in terribly good condition.

Is the Secretary of State aware that about £15 million of public money has been expended by Harold Wood so as to be ready for the accident and emergency service? Is he further aware that additional projects are planned for Harold Wood? What is the future of those projects? Will they go ahead? What is the long-term future of Harold Wood hospital? It is a hospital that is close to a railway station, a major road and the M25.

Finally, at a recent meeting of South Essex health authority, which was held in my constituency, I was told that it was the Government's view that money should be taken from prosperous areas so that it might be given to socially deprived areas. Is that an accurate reflection of the Government's position?

Mr. Dobson

We believe in having a proper standard of health care in every part of the country and fair funding between different parts of the country. As for the proposals for Oldchurch and Harold Wood, they represent the considered opinion of an expert panel of great integrity, without any influence from me or any other Minister or anyone else in my Department, so far as I know.

I know that there have been several consultations about several propositions affecting Harold Wood and other hospitals. There will have to be consultation on the current proposal for Harold Wood which, as I understand it, has not been put forward before. I emphasise that I want to get on with these things. We do not want endless rounds of consultation. We need to ascertain what people think and, having borne that in mind, we need to come to decisions and get on with doing some work. People are sick to death of the delays.

As for the money that was expended over the past 18 years on various abortive schemes and consultations, I do not think that I should be expected to accept responsibility for that.

Mr. Clive Efford (Eltham)

No issue could arise and no statement could be made that would underline more the difference between Labour Members and Opposition Members. Will my right hon. Friend join me, as someone who stood side by side with thousands of campaigners to save the national health service from the ravages of the previous Administration, in congratulating the hundreds of thousands of campaigners who fought to save the NHS in the hope that a Labour Government would be elected to make the sort of statement that my right hon. Friend has made today?

Mr. Dobson

I entirely agree with my hon. Friend, as someone who once got the backside of his trousers wet sitting in Euston road protesting in favour of retaining the Elizabeth Garrett Anderson hospital for women. I suppose I might even call myself a humble foot soldier in the campaign that has been fought, but perhaps that is not the right part of my anatomy.

I congratulate everyone in London who campaigned so long and hard to try to ensure that Londoners receive the health service that they deserve. I am sure that every one of them will join me in thanking Sir Leslie Turnberg and his colleagues for their work.

Sir Sydney Chapman (Chipping Barnet)

As funding of the national health service increased from £8,000 million a year to £42,000 million under 18 years of Conservative government, we shall all read the Turnberg report with great interest.

I wish to ask the Secretary of State two questions. First, will there be an accident and emergency department at Edgware hospital? That is a matter on which a number of his colleagues campaigned during the election. Secondly, will the report do anything to reverse the cuts that are being made to the funding of Barnet health authority, which are not in any way due to a lack of resources, but are being made just because it is claimed that Barnet health authority was over-provided for in previous years?

Mr. Dobson

We need to get a few things straight. It was not a Labour Government who closed the accident and emergency department in the middle of the night; it was the Tory Government who did that. We have made no bones about it. Since we came to power, we have accepted that, sadly, the shift of the A and E department is here to stay, but I emphasise that, so far as I know, the scheme that was worked out by my hon. Friend the Minister of State—

Mr. Maples

It is shut.

Mr. Dobson

It was shut when we came to power, and it was shut by the hon. Gentleman's mates when he was out of office because people in his London constituency had rumbled him—even before they rumbled a lot more of them at the general election.

Ms Diane Abbott (Hackney, North and Stoke Newington)

Does the Secretary of State agree that not since the blitz have the people of the east end faced an onslaught such as that which they faced as a result of Tory cuts in the national health service? One of the most important aspects of Sir Leslie Turnberg's report is that he makes it clear that the Tory idea that the problem in London was that we had too many beds was complete nonsense. My right hon. Friend's decision to abandon that concept will be widely welcomed, as will the promise of more resources and the decision to keep open Bart's hospital.

Mr. Dobson

I thank my hon. Friend for her remarks and generally agree with what she said. What is needed is to get the standard of health and health care in the deprived boroughs of the east end up to the level that people in Surrey, Kent and Hertfordshire have come to expect. People in the east end deserve standards that are just as good as those for people anywhere else.

Mr. Richard Ottaway (Croydon, South)

What is the future of Purley hospital?

Mr. Dobson

It is not covered by the review.

Mr. Jeremy Corbyn (Islington, North)

I thank the Secretary of State for his brave decision to lift the cosh from Bart's hospital—a decision that will be well received in the borough of Islington—for his determination to put new money into London's health service, and for linking the issues of poverty and ill health, which were so ignored by the previous Government and by all health planning.

I ask my right hon. Friend two specific questions. First, what services does he propose should be developed on the Whittington hospital site, which he mentioned in his statement? Secondly, what will be the longer-term arrangements for more democratic and rational planning of health care and community care needs throughout London, after the Turnberg panel has finished all its work?

Mr. Dobson

I thank my hon. Friend for his remarks. I hope that he and my right hon. Friend the Secretary of State for Culture, Media and Sport, who represents Islington, South and Finsbury, and who is dealing with matters connected with the national lottery at the moment, are pleased with what is being done. When my hon. Friend has had the opportunity to read the Turnberg report. he will see that there are proposals in it for a Londonwide strategic approach, and for changes so that general arrangements in London reflect local needs and priorities better.

On the Whittington hospital, proposals have not gone very far. All we have is a proposal that the hospital needs more investment, and it will get more investment, but the nature of that investment and what it provides will have to be worked out in relation to other services provided by the surrounding hospitals.

Dr. Jenny Tonge (Richmond Park)

Does the Minister share the sadness that my constituents and I feel at the downgrading of Queen Mary's Roehampton to a community hospital? Although we accept that it is inevitable, it is inevitable because of the shambolic policies pursued by the previous Government, in particular the rebuilding of Westminster hospital—with which Queen Mary's Roehampton was linked—in central London on the Chelsea and Westminster site, which was a total waste of money when a good site was waiting at Queen Mary's Roehampton.

Three things worry us very much, and we shall want an assurance about them if we are to accept the solution that the Turnberg report has suggested for hospital services in south-west London.

First, will the Secretary of State pay due regard to staffing problems in hospitals such as Queen Mary's Roehampton, where full services will not be provided, and where staff recruitment is proving very difficult? I have some fears for patients' safety in the interim period during the changeover. Secondly, will the right hon. Gentleman address the travel problems of my constituents who will no longer be able to undergo surgery at Queen Mary's, or to visit patients having surgery there? Thirdly, and most important, will he please ensure that what is provided in the next financial year will include money for all the building work that will be necessary at Kingston hospital, so that my constituents can receive proper in-patient care there?

Mr. Dobson

I share the hon. Lady's concern and sympathy for all those associated with Queen Mary's Roehampton, just as I have always sympathised with people who have lost their hospitals. I think that, in my time, my constituency has lost the best part of 10 hospitals of one kind or another through amalgamation or closure, and I know how upsetting it is.

On balance, however, I think that, given the circumstances that we inherited and which the Turnberg panel was examining, the panel had no alternative but to recommend what it recommended. It may seem like crocodile tears to suggest that we ought not to talk about the hospital's being downgraded, but in a sense it is not downgrading to enable top-quality community services to be provided on a site. I hope that, ultimately, people will realise that there is merit in providing top-quality alternative services.

As the hon. Lady knows, consultation is taking place, and I hope that it will bear in mind all the considerations that she raised. We shall try to ensure that it does before any decision comes to us, if it is challenged by the community health council.

Several hon. Members

rose—

Madam Speaker

I now ask hon. Members to make no comments, but to put one question to the Secretary of State. If they put more than one question, I may be inclined to ask the Secretary of State to answer only the first. I cannot call all hon. Members at this rate, with all the comments that they are making and all the long questions that they are asking.

Mr. Andrew Dismore (Hendon)

May I remind the Secretary of State of the history of Edgware hospital? The previous Government closed it on 1 April, and continued to knock it down in the run-up to the general election. At the election, we promised that there would be a review. The review has happened—

Madam Speaker

Order. I have just made a ruling. We know exactly what has been happening. If the hon. Gentleman has a question to ask the Secretary of State, he must put it, or I shall call another hon. Member.

Mr. Dismore

Does my right hon. Friend agree that the best way of sorting out health service problems is to consult the local community and hold discussions with it? That is what we did when we carried out the Edgware review, and the result of the review will be better services for local people. That did not happen under the previous Government, who closed the hospital.

Mr. Dobson

I entirely agree.

Mr. James Clappison (Hertsmere)

May I return to the second part of the question asked by my hon. Friend the Member for Chipping Barnet (Sir S. Chapman)? What action will the Secretary of State take in regard to the further £7 million programme of cuts in services at Barnet and Edgware which was recently announced?

Mr. Dobson

I remind the hon. Gentleman—who, if I remember rightly, was a member of the previous Government—that one of the problems in Barnet was the huge deficit that the health authority and the trust were running. That is having to be put right. We cannot have health authorities and trusts in deficit. The cash increase for Barnet health authority next year is £6,176,000, and for this winter alone it received more than £1 million to help it out; but it really must put its house in order—even if, under the previous Government, it was a disorderly house.

Mrs. Eileen Gordon (Romford)

Will my right hon. Friend pass on our thanks to Sir Leslie Turnberg and his panel for the excellent news for east London and Romford in particular, and also thank them for endorsing the local community's view that hospital services should be at the heart of the community—and that part of the community is Oldchurch?

Mr. Dobson

I entirely agree. As I think Sir Leslie is observing our proceedings, he will receive the message directly and it needs no elaboration from me.

Mr. Andrew Lansley (South Cambridgeshire)

From the Secretary of State's remarks, should we deduce that he regards the decision to retain Bart's as a tertiary referral centre as setting a precedent for resisting the incorporation of such centres into district general hospitals rather than their retention as separate sites of specialisation?

Mr. Dobson

As I have said at the Dispatch Box on innumerable occasions, I am a great believer in horses for courses. I am not necessarily in favour of bureaucratic neatness. Our attitude to the national health service is that we want to keep what works and discard what does not. As the hon. Gentleman well knows, in some regions, some specialist hospitals are doing a brilliant job and if anyone, for the sake of neatness, wants to persuade me to change the position, they will have a lot of talking to do.

Ann Keen (Brentford and Isleworth)

Does the Secretary of State agree that today's welcome report will undoubtedly increase the retention of experienced medical and nursing staff in London, and that now that they are no longer competing with each other and are working on clinical need, with their expertise, that can only assist Londoners?

Mr. Dobson

I hope that our announcement will improve morale and enthusiasm among health service staff in London. I think that they were looking for some action and some certainty. Once we get on with it, they will be even better pleased.

Mr. John Cryer (Hornchurch)

May I remind my right hon. Friend that the decision that was made under the Conservative Government to close Oldchurch and to keep open Harold Wood was based on skewed information and skewed consultation exercises, and that today's decision, on which I congratulate him, will be welcomed as the right one by people throughout Oldchurch, Rainham and the rest of east London?

Mr. Dobson

I thank my hon. Friend for his remarks. I am sure that the Turnberg panel examined carefully and objectively the information before it before coming to its conclusion. I am sure that the panel is sad that it means that Harold Wood will not be a major acute hospital, but these decisions have to be taken.

Mrs. Virginia Bottomley (South-West Surrey)

In spite of the swashbuckling style, the right hon. Gentleman's statement has an extraordinarily familiar ring about it. Having considered the five quadrants, he has said that 95 per cent. of the changes set in hand by report after report should proceed. Obviously, some of the changes will be greatly welcomed by my right hon. Friend the Member for Cities of London and Westminster (Mr. Brooke), but does the Secretary of State agree that the problem was not beds, but the duplication of the specialist units, which has deprived London of the money needed for primary care and mental health services? The urgent need in London is for primary care and mental health services, and that is what we await.

Does the right hon. Gentleman agree with Robert Maxwell's comments when he was finishing his time at the King's Fund? He said that, for 50 years, London had been looking for teaching and research centres of excellence that were linked to the universities and that, at last, it seemed as if that was exactly what was going to happen.

Mr. Dobson

Indeed, and everything that we are doing at Guy's, St. Thomas's, King's College, Bart's, the Royal London, University College, Hammersmith and Queen Charlotte's and Chelsea hospitals promotes top-quality services for local people. Most of those great hospitals are located even now, as they were when they were first founded, in deprived areas where people most need care. That is what we are doing.

As for the suggestion that, in some way or other, battering the hospitals into submission would improve primary care, I quote from Sir Leslie Turnberg's report: Improvements in primary care have not been able to substitute for reductions in secondary care. In view of the fact that the right hon. Lady has asked a question today after her disastrous encounter with Bart's, I refer her to the Book of Proverbs, chapter 26, verse 11: As a dog returneth to his vomit, so a fool returneth to his folly.

Mr. Tony McNulty (Harrow, East)

I thought that the right hon. Member for South-West Surrey (Mrs. Bottomley) was rising to apologise to London. We live in hope.

My right hon. Friend the Secretary of State will be aware that more than 120 groups and organisations took part in the three-day review on Edgware hospital and that those taking part included Conservatives from Barnet and Harrow. The consensus that was built on the review is clearly the way forward for Edgware, and that is the reality for the local community. In the context of Edgware hospital, I ask my right hon. Friend not to listen to any knee-jerk nonsense from Conservative Members.

Mr. Dobson

I entirely agree with my hon. Friend.

Ms Margaret Hodge (Barking)

I join other east London Members in congratulating my right hon. Friend and my hon. Friend the Minister of State on the wise decision on Oldchurch hospital. There has been mention of heaven. Does my right hon. Friend agree that, if my predecessor Jo Richardson is up there, she will be at the centre of the crowd waving a flag, congratulating my right hon. Friend on his sensible decision, which will result in a first-class health service for the people of Barking?

Mr. Dobson

I agree with my hon. Friend. The living approve of what we are doing, and I guess that the dead would also approve if they were still around.

Mr. Stephen Timms (East Ham)

I welcome what my right hon. Friend said about investing in GPs in east London. Can he confirm that the Government aim to have as many GPs per head of population in east London as there are elsewhere, and that the premises from which they operate should be of as high a quality and standard as elsewhere? Does he agree that that is nothing like the case today?

Mr. Dobson

Our recent White Paper, "The new NHS", made it clear that we believe that all parts of the country are entitled to the standards of health care to which those in the richest and healthiest areas are accustomed. The report is a reaffirmation on a London scale of our national commitment in the White Paper.

Mr. Keith Darvill (Upminster)

I thank my right hon. Friend for his statement. Does he agree that the co-operation between Barking and Havering health authority, the hospital trusts, the local authorities and Labour Members during the review process is a fine example of cross-agency co-operation, which we should support for the future of our health service?

Mr. Dobson

I certainly agree with my hon. Friend. Above all, we want to encourage all parts of the health service in London to work together. It is plain that when they and local social services departments and voluntary groups work together, the result is much better than under the old system in which they worked against each other.

Mr. Nigel Beard (Bexleyheath and Crayford)

Is my right hon. Friend aware of the widespread welcome in the London boroughs of Bexley and Greenwich for the decision to rebuild the Queen Elizabeth hospital? That will bring to an end a period of local hospital closure during which the prevarication of the previous Administration did not reassure health services in the area.

Mr. Dobson

I entirely agree with my hon. Friend and look forward to the necessary progress that will enable work to start on the site in Greenwich as soon as possible.

Mr. Neil Gerrard (Walthamstow)

Can my right hon. Friend say when we might see the details of the distribution of the extra money for the next financial year? He may know that my local health authority, Redbridge and Waltham Forest district health authority, is in financial chaos. That is a legacy from the previous Government and is also because of rank bad management. The authority is currently proposing cuts in precisely some of the areas such as mental health and community services that my right hon. Friend has identified as needing improvement.

Mr. Dobson

The authority certainly faces significant problems, which have existed for a long time. It has already received its general allocation. Some of the additional £30 million that I mentioned may be spent on primary care or mental health care in that area. However, it cannot be used just to wipe out the deficit that the health authority has run up.

Mr. Mike Gapes (Ilford, South)

May I add my voice to that of my hon. Friend the Member for Walthamstow (Mr. Gerrard) on the need to deal with the problems in Redbridge and Waltham Forest? Although I welcome my right hon. Friend's statement, I should draw attention to the fact that the new Oldchurch hospital will be only three and a half miles from the new King George hospital, in my constituency. May I ask for my right hon. Friend's assurance that the planned consultation process will include detailed discussions with King George hospital, with Redbridge and Waltham Forest health authority and with local residents on the implications of the decision, so that we can ensure that there is no question of any threat to King George hospital? We want to ensure that we have a new hospital at Oldchurch and a successful and improving—as it is—King George hospital.

Mr. Dobson

I assure my hon. Friend that there will be thorough local consultation, and that any decisions will take account of the possible impact of a new hospital at Oldchurch on neighbouring hospitals. I reassure him that our objective is to build up, not run down, London's hospitals.

Dr. Vincent Cable (Twickenham)

Does the Secretary of State acknowledge that the closure of Queen Mary's as a district general hospital will bring additional pressure on a variety of neighbouring hospitals—particularly the West Middlesex, which is already under severe pressure? What specific action will he take to deal with that?

Mr. Dobson

As the hon. Gentleman knows, public consultation is in progress on the ramifications of the proposal to close Queen Mary's Roehampton. As I have just told my hon. Friend the Member for Ilford, South (Mr. Gapes), the ultimate decision will have to take account of the impact on other hospitals. Everyone knows that the West Middlesex has severe problems that will have to be sorted out; we want to get on with doing just that.

Despite the comments of the Opposition spokesman, the hon. Member for Stratford-on-Avon (Mr. Maples), in replying to the statement, we have conducted the review as quickly as possible. The review has been established, reported and completed, and is therefore off the list of reviews. It has been a very good review, and it will provide the basis for a programme of real action. We cannot simply sit around talking about action. If we did so, Londoners would never forgive us.