HC Deb 03 June 1998 vol 313 cc300-23 10.59 am
Mr. Tony Colman (Putney)

The Labour party welcomed the Turnberg proposals in February this year. As I could not ask questions of the Secretary of State following his statement in the House, I will concentrate the bulk of my comments on the effects of the proposals on my constituency. Some of my hon. Friends have said that they will touch on the report's wider implications and what has happened since February. The report was widely welcomed, not least in Putney, whose residents suffered years of cuts in services and uncertainty, particularly in the provision of hospital services.

May I make a declaration of interest? Since 1966, my family and I have been treated at Queen Mary's hospital, Roehampton, my local hospital. I have fought for its retention almost all my adult life. My predecessor also fought for it, but in the last two years of the Tory Government, Queen Mary's suffered severe cuts. Under the Tories, and before I became the Member for Putney, the hospital lost acute surgery, paediatrics, orthopaedics, maternity services—my sons were among the last to be born there—gynaecology and obstetrics. Also before the last election, the accident and emergency department was downgraded. Those cuts totally undermined the viability of the burns and plastics unit remaining on site.

I state those facts because the local Conservatives have been reinventing history in the recent local elections. It is worth reminding the House that those cuts in services were not opposed by my predecessor or by the local Conservative council at the time. It is only since the general election that the Conservatives have done a U-turn, conveniently forgetting that they made the cuts themselves. The cuts were not opposed by the Conservative nominees on the community health council, with the honourable exception of the late councillor, Duncan Hawkins.

The doctors and nurses at Queen Mary's hospital, Roehampton have coped brilliantly and have performed miracles over the past year to cope with those Tory cuts. The Turnberg report gave a vision for a new, secure Queen Mary's hospital—a secure community hospital for the 21st century. I shall devote the remainder of my speech to the future of Queen Mary's and how it has fulfilled that vision in implementing the Turnberg proposals.

More than 90 per cent. of the services previously provided on the site will continue into the next millennium. The transfer of the remaining acute services to neighbouring hospitals is proceeding to plan and the new wards at Kingston hospital will be available in August. However, the out-patient services, which form the vast bulk of the services available to my constituents, will be immeasurably strengthened and improved by a new, integrated care centre offering rapid diagnosis and treatment, out-patient and clinic services in ENT, gastroenterology, elderly care, dermatology, gynaecology—including ante-natal, post-natal and assisted conception—neurology, oral and orthodontics, ophthalmology, orthopaedic and fractures, paediatrics, pain control, plastics, rheumatology, urology and HIV-AIDS, haematology, and a beta-cell diabetes service.

Some 200 in-patient beds will cover rehabilitation and respite care, mental health and elderly continuing care. Day units will continue, including the Bryceson-White unit for elderly people, the mental health resource centre and the Bader rehabilitation unit. The nationally renowned skin bank will remain.

I could go on with a laundry list of all the services available at the new Queen Mary's, but suffice it to say that it is a substantial hospital. I thank the Minister for his rapid and positive response to the referral of the proposals from Wandsworth community health council this year. I am grateful for his support for the rapid diagnostic centre, the minor injuries unit, the day surgery up to level 9 under local anaesthetic, and primarily for his support for the financing of brand new hospital buildings through the private finance initiative under a successful business case. A project manager has been appointed; the business case is being worked on and should go to the Minister this autumn. We all hope that building will commence within the next three years. In the meantime, the hospital will continue to use the existing buildings that have served the area well for so long.

The number of acute beds moving from Queen Mary' s is 172 but, as I said, more than 200 non-acute beds will remain; 137 replacement beds will open at Kingston, 34 will open at St. George's, 12 will open at Chelsea and Westminster, and two will open at West Middlesex. Those new beds reflect the range of choices that the people of Putney should have. I obtained those figures before yesterday afternoon's announcement of additional beds for London.

The movement of the burns and plastics unit will be accompanied by an identical number of beds in its new location. The new wards that will be available at Kingston in the autumn are of the portakabin type, and it is important that capital is made available for permanent buildings at Kingston and elsewhere. It is also important that the once-an-hour bus service between the two hospitals becomes a half-hourly service. Kingston out-patient services are becoming overcrowded. With shorter waiting lists at Queen Mary's hospital, local health care experts should perhaps look at transferring all out-patients to Queen Mary's hospital from Kingston, thereby releasing space for the required permanent acute care facilities at Kingston.

Sir Sydney Chapman (Chipping Barnet)

I reassure the hon. Gentleman that we have one thing in common: both our sons were born in Queen Mary's hospital. However, I am not sure what the hon. Gentleman is trying to convey to the House. He has listed new services and said that many of the services have been moved to other hospitals around Putney. Is that not precisely what is necessary to give rationality to our health service? The hon. Gentleman complained about Tory cuts at Roehampton, but have any of those services been restored on-site? If not, is he not saying that the Labour Government are continuing the previous Government' s policies of rationalising the NHS?

Mr. Colman

Clearly, the hon. Gentleman does not realise that, once services are moved off-site, doctors, nurses and facilities are also moved. That has happened. If he suggests that the Tory cuts can easily be reversed, he should go to his local hospital and ask how transferred services can be brought back.

Sir Sydney Chapman

The hon. Gentleman asks me to understand that point; it is a pity that some of his hon. Friends did not make that point when Edgware hospital was closed. They gave the impression that the accident and emergency department at Edgware could be reopened.

Mr. Colman

I am sure that my hon. Friend the Member for Brent, North (Mr. Gardiner) will make his point adequately if he is able to attend this debate. I must make it clear that what happened at Edgware and Queen Mary's happened under the Tory Government, and they were responsible for those changes.

The transfer of acute beds from Queen Mary's to Kingston created a balance, but it is important that, as soon as practicable after the transfer of those acute beds, the transfer of beds from Putney hospital should take place. There must not be a gap when Queen Mary's hospital is not used to its full capacity. Following that transfer, I look forward to new health care facilities in a public-private partnership with the local council, housing associations and the private sector, ensuring that Putney hospital continues to be a health care facility for the people of Putney. I further endorse the use of accommodation at Putney hospital by students of the Roehampton institute, a university that has a number of proposals on how it can work in partnership with the hospital across the road.

There is an urgent need to train general practitioners and hospital staff in management issues, particularly in the development of primary care groups and trusts. That could dovetail well with the Roehampton institute's plans for the expansion of health care subjects.

As I said, Queen Mary's continues to have the world famous Bader rehabilitation unit for amputees, with associated prosthetics and orthotics manufacturing workshops, and wheelchair manufacture and service. The workshops have been provided by two private companies—RSL and Steepers—which, in the past few days, have merged. I am pleased to tell the House that I have received assurances from Stephen Horam, the finance director of RSL, that there will be no reduction of the continued operational work force of more than 500, and Roehampton will continue, through the public-private partnership of the NHS and those companies, as a world centre for prosthetics and orthotics.

I welcome the White Paper on the future of the health service, particularly because of the way in which it backs up the principles outlined in the Turnberg report. I especially welcome the encouragement of trust mergers, and I look forward to a reconfiguration of trusts in south-west London, potentially based on the Queen Mary's site. A dialogue has now opened in south-west London between trusts, health authorities, GPs, local authorities and local communities. That dialogue must continue and seek ways in which to achieve a more holistic approach to community services in particular. With the development of larger hospital trusts, there must follow the development of a larger critical mass for community services, to provide an appropriate balance.

The next five years should bring much larger trusts, in terms of geography and service provision. Their roles will include co-ordinating and providing health promotion services, professional development of nurses and other clinical staff, provision of specialist managerial advice and support and, of course, the efficient running of comprehensive primary and community health services.

Queen Mary's and other hospitals like it in London have a key role to play in providing a more local and accessible service for their communities, while seeking ways in which to achieve greater flexibility in developing partnerships in care, and shaping local health services to meet the future needs of local people.

On a contentious note, as a former local authority leader, I feel that health authorities should be replaced by joint commissioning by primary care groups and local councils. The Berlin wall could then finally be removed from health care. Local health authorities, forced as they were under the Tories continually to cut back services, often did so in ways unacceptable to local residents—as is the case with Queen Mary's, as fully described in the Turnberg report. It is important to realise that local councils have been managing care in the community for the past six years with considerable success, and with at least 85 per cent. of services purchased from the not-for-profit or profit sectors. That has worked. Local councils should replace local health authorities in London.

I also welcome a single London-wide health authority, as recommended by the Turnberg report, but I hope that on the back of successful trials of local council purchasing of health care, the Greater London authority could take over that London-wide role. I realise that that may take time.

In the meantime, I pay tribute to the work of Sir William Wells, chairman of the South Thames regional health authority until its demise next year. He has done a huge amount in the past five months to ensure that the Turnberg proposals have been put into action in the South Thames region. I wish him well in his new role outside London.

Queen Mary's hospital has been through a difficult period over the past three years, but the time since February has been managed well. The new chief executive, Veronica Cotterill, has led her staff well into a secure future. I pay tribute to Dr. Elizabeth Nelson, the new chair of the Richmond, Twickenham and Roehampton trust, who has done so much to lead from the front and who has plans way beyond those that I have mentioned today. Finally, I pay particular tribute to Mrs. Alex Elliott, chair of the Queen Mary's League of Friends, who is sitting in the Gallery. She represents the most important people—the Queen Mary's community. She spoke last Sunday about an exciting new future for Queen Mary's and the friends' plans to support it. She has been brilliant.

After Turnberg, Queen Mary's has a different future. In the 50th year of the NHS, Queen Mary's future has been not only secured, but strengthened as a model of how the national health service can adapt itself to reflect new patterns of health care, while serving local residents in the most appropriate way for the 21st century.

11.13 am
Mr. Simon Hughes (Southwark, North and Bermondsey)

I thank the hon. Member for Putney (Mr. Colman) for securing this debate, which is the first since the Government's announcement on the Turnberg proposals four months ago. On 3 February, I generally welcomed the report. It was also widely welcomed in the House and outside, as the hon. Gentleman said. It set out many good paths for the health service in London, and we can see that progress has been made.

First, I congratulate the Government on acting speedily on one of the recommendations, by accepting the logical proposal that London should have one strategic health authority. Many of us have argued that case for many years, and the Government have announced that it will be set up next year. Like the hon. Gentleman, I welcome that, but, as the Minister knows, I also believe that we should go further and make the Greater London authority, when it is set up, the strategic health authority for London. In all logic, that should be the case. I know that there are implications concerning what should be done in the rest of country, and that different management structures would be in place, but it would be far better if strategic planning were done by elected people rather than by people whom nobody knows or chooses.

Chapter 4 of the Turnberg report examined locality commissioning, and work is being done on that. I hope that the Minister will accept that there will be a problem if there is not a common set of boundaries with local government. There is a desire to have such common boundaries, within which locality groups fit, and for health authority and local authority boundaries gradually coming together. That would be common sense. However, there is a democratic deficit, and some people have a problem with the idea that developments in primary care will be led by practitioners, rather than by the public, who would make sure that practitioners did what the patients wanted.

The Secretary of State and I had an exchange yesterday on public involvement in health services. He was wrong to say that no party has ever proposed that there should be democratic management of the health service. My party believes that health and social services should be merged under local government control, and that the local authority should therefore also be the health commissioning body. The Government have not come that far, but they are moving in that direction.

The hon. Member for Putney rightly said that the Berlin wall in health care must be broken down. I ask the House and Ministers to accept that there will come a time when we merge health and social services commissioning, as in Northern Ireland. Those services deal with the same people at different stages in their treatment and need, and the illogicality of one service being a local government social services function and another being a separate health authority function does not work for the patient or the practitioner.

I hope that the Government will also seriously consider making more democratic the representation on trusts and health authorities, as well as evaluating the idea of health commissioning eventually being merged with local government. The Government are committed to reforming local government structures; let us not ignore health structures.

The Minister is well aware of the problems in primary care alluded to by Turnberg. In London, we face a severe prospective crisis in the number of doctors and GPs and, in some areas, of nurses and other practitioners. That is very worrying. Some areas of London have staff shortages of up to 20 per cent. By the end of the next five or 10 years, the health service must deal with these problems, particularly in the capital, where pressures are greater and travelling and housing are more expensive.

Ministers probably say privately to their colleagues over the road that they do not want Chancellors, including the present one, to insist on pay awards being staggered, as was done this year. Pay awards should not have been staggered this year. It has not helped; nurses were furious and other workers were unhappy. If the economy allows it, as it currently does, pay awards should be made in full to encourage people to come into nursing and the other professions in public services, such as medicine and therapies. I hope that the Minister will tell us—if not today, then soon—how he plans to deal with recruitment needs in London. If we do not meet those needs, we shall be unable to implement all the proposals made by Sir Leslie Turnberg and his colleagues.

On intermediate care, the health service is at an interesting stage. We now realize—as do the Government, and I commend them for it—that the community does not need only intensive care beds, high dependency beds or long-term beds, for respite care or convalescence, or to reduce blocking hospital beds. It needs a network of community hospitals in London, which we used to have. I do not blame this Government for closing them down. I should be interested to hear how the Government plan to respond to that need and open them up.

All areas of London should have a community hospital. To take a local example, I know that, when people, particularly the elderly, from the north of Southwark no longer need acute care, or need other care, they often cannot find it locally. They are cared for at home, if that is possible, or sent a long way from their community, where their partners, spouses, families and friends cannot easily visit if there is no public transport or they have no private transport. I hope that the need for a second tier of in-patient care in London, with and without nursing help, will be addressed.

Sir Leslie's report rightly concentrates on the needs of mental health care in London. Ministers understand the pressure, but the long-awaited paper on mental health has still not been published. It has been much delayed, and we keep being told that it is imminent. The Minister may make an announcement on that. The Under-Secretary of State, who is responsible for mental health matters, has promised to announce the Government's policy in this area.

My plea to the Government is that they ensure soon that London has the 24-hour services that Sir Leslie and his colleagues recommend. People's crisis needs can be greatly alleviated if there is somewhere they can go at any time. Mental health provision for people who are not in-patients is extremely under-resourced.

Some welcome announcements have been made about bed closures. Will the increase in the number of establishment beds in London be permanent? Yesterday's announcement referred to the new beds as beds to deal with the waiting list and waiting times problem. I welcome that, but will they be available next year and the year after? Turnberg said—thank goodness—that we could no longer afford any further closures of hospital beds in London. The NHS Confederation says that, between 1990 and 1996, the number of acute in-patient beds fell by 2,761, which is a hell of a lot of beds. It would be helpful if the Minister could tell us whether it is Government policy to have a particular number of beds and what that number is, and whether the new beds will be included in future projections.

The report considers that the sensible way in which to deal with the planned five parts of London is a separation of acute and elective care to ensure, among other things, that people's planned operations are not cancelled. If that can be achieved—it is the logic of the Bart's decision—it will be welcome. The two services should not be muddled.

The Minister would be surprised if I did not say something about the largest hospital trust in the country, Guy's and St. Thomas's. On or near his desk is a set of papers awaiting his decision about the final configuration of services. We must all try to ensure that no health service money is wasted. The Minister knows that, if we do what the trust proposes and move the paediatric department from Guy's to St. Thomas's, a new building will have to be built at a cost of about £50 million, and seven floors of a relatively new building at Guy's will be left clinically empty. The plan is to use them for administration, which is nonsense.

People in charge of the cardiac centre have told me that, at the same time, they do not have enough money to do their job properly. We must ensure that the money is used where the need is, which, I would argue, would require paediatric services to stay at Guy's without huge additional expenditure, and the cardiac centre to have the money it needs, rather than buildings to be built that are not needed.

I hope that the Minister will make people happy, will make the health service more effective and will use money more wisely by making the popular decision that Guy's shall have 400 to 500 beds and the elective care, while acute care is concentrated be on the St. Thomas's site.

The hon. Member for Putney was trying to ensure that Labour was not blamed for Tory decisions. In my part of London, we still believe that Labour should take its responsibility because it endorsed the Tory proposal to close accident and emergency services at Guy's. The Government cannot get out of their responsibility. That may not apply in the hon. Gentleman's part of London, but it was as much a Labour as a Tory decision to close our accident and emergency services. It was certainly not the platform on which the Labour party campaigned against me at the general election. People were told that Guy's would be saved on day one of a Labour Government. If that did not include saving the accident and emergency services, I do not know what they thought people believed they meant.

Yesterday, the Chancellor said that he would continue to be an iron Chancellor. The health service requires a Chancellor who understands its resource needs. Sir Leslie has said that the health service in London needs the resources to do the jobs that we all want it to do. Health ministers will make their case, but the proof of the effectiveness of the Government's health service pudding will be whether the Chancellor next month announces significant increases in resources for the health service in London and elsewhere. Without them, much of what is in this excellent report will not come to pass.

11.25 am
Mr. Keith Darvill (Upminster)

I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing this important debate. I should like to confine my remarks to two aspects of the report: chapter 11 on Harold Wood and Oldchurch hospitals, and chapter 6 on primary care.

Harold Wood hospital is in my constituency, and Oldchurch hospital is in the constituency of my hon. Friend the Member for Romford (Mrs. Gordon). Both hospitals come under the Barking and Havering health authority and are in the London borough of Havering. The Turnberg report made a firm recommendation. On page 71, it states: We endorse the single site Oldchurch area proposal as optimal on the grounds of access to a large proportion of the most deprived population and the strong support from the local authorities and GPs. Those words, brief as they are, have been taken wrongly by some, including the BBC, to mean the closure of Harold Wood hospital, but that is not the case. I have had numerous discussions with the executives of the Havering hospitals trust, the BHB trust, the area health authority and the regional health authority about the implementation and recommendations of the report and its knock-on effect on Harold Wood hospital. It will undoubtedly mean different health services at Harold Wood, but it does not mean closure.

I could go on at length about the services that are planned and will be delivered in the future at Harold Wood, but that can wait for a more appropriate time, especially in view of the imminent launch of the local consultation process on the future of hospital services in the area. The indications are that positive proposals will be forthcoming, which will be welcomed by my constituents.

Ms Linda Perham (Ilford, North)

As my hon. Friend knows, Members from north-east London have worked well on local hospital issues, but the report acknowledged that its recommendation for Oldchurch will have an impact on King George's hospital in Ilford, which most of my constituents use. Will he join me in urging the Minister to consider the impact on my local services and on services in the whole of the north-east London area?

Mr. Darvill

I am pleased to urge the Minister to consider the impact on hospitals in the surrounding areas.

Health care services will be fit for the new millennium under the proposed package of measures. It will ensure the maximum use of facilities developed through limited investment over the past 10 years. Despite the scare stories that have emanated from some quarters—mainly from our political opponents in the lead-up to the local elections—my main concern is about the time it will take to implement the report's recommendations. The proposals referred to in the report have been developed locally. They are exciting and will provide a new general hospital at Oldchurch close to the existing hospital and just four miles from Harold Wood. The new hospital will be built on land currently owned by the London borough of Havering, which will be exchanged for area health authority land.

After the new hospital has been built and services have decamped from the old hospital to the new, the old hospital will be demolished, leaving Havering council free to build its long-awaited sports stadium. A new hospital close to a public sports facility would enable the link between healthy living and sports injuries facilities to become more than a vision; it would become a reality. Such public facilities, developed in partnership across agencies, would be welcome.

I am concerned about procrastination and about delay which, unfortunately, has been the hallmark of past Administrations. There has been some investment, but it has been piecemeal, and there does not appear to have been a coherent strategy, which has understandably led to public scepticism and frustration. Procrastination and delay in implementing necessary changes have left health services deteriorating, which has affected the constituents of my hon. Friends the Members for Barking (Ms Hodge) and for Dagenham (Ms Church) especially harshly. I fear that further years of delay will fail the populations further, so I urge my hon. Friend the Minister to ensure that this recommendation is high on the list of priorities.

There is a popular misunderstanding about outer east London, which is considered to be a leafy suburb without deprivation. That is not the case, and the area is often overlooked because of that misconception. Recent reports commissioned by the area health authority and the local authorities contain ample evidence of serious health needs that must be addressed.

My constituents and those of my hon. Friends the Members for Barking and for Dagenham need and deserve the new facility, which will provide improved services closer to the centre of population that it would serve. Further delay would do our constituents a disservice; a quick advance would enable the partnership that has developed between the area health authorities, the hospital trusts, the London boroughs, the community health council and Members of Parliament to flourish, in marked and notable contrast to years gone by.

Lack of investment and failure to recognise the area's health needs, especially the almost crisis position of primary care, are evidenced by the Turnberg report, which states on page 33: Despite considerable investment in primary care services in the last few years, services lag woefully behind those in the remainder of the country. The number of practices below recommended standards remains high, too many premises remain poor, single handed practices represent a larger proportion than elsewhere, recruitment is difficult and the total number of GPs has fallen slightly in the face of a rise across England. The table on page 36 shows the acuteness of the problem in east London: only 8 per cent. of premises in the Barking and Havering health authority area are above the minimum standard, and across east London generally, only 20 per cent. are above the minimum standard.

There is a considerable shortage of GPs: the area health authority is 50 short, which has a knock-on effect. GPs who practise in the area have to work under difficult circumstances with long patient lists, crowded surgeries and heavy demands. That has a contributory effect on the average demand on accident and emergency access services.

For those reasons, I welcome the report's recommendations in chapter 6, paragraph 23, especially paragraph 23.6, which states: London's health authorities should be required to ensure that the proportion of practice premises which are below minimum standards should be reduced from the current 50 per cent. by 10 per cent. annually. Funding for cash-limited GP premises nationally should be related to the proportion of practice premises which are below the minimum standards. The Regional Offices should ensure that there is co-ordinated advice and support for general practitioners on all aspects of premises provision for London. In view of that, I invite my hon. Friend the Minister to comment on the timetable for the implementation of those recommendations, for only when they are implemented will we, as politicians who have been elected to improve the health service, have honoured our pledges.

I welcome the debate and the report, which was ordered speedily after the general election and delivered promptly by the independent panel. Its recommendations have been widely welcomed, and we have to implement them with urgency of purpose, so that the people of London have their health services improved and restored.

11.34 am
Mr. John Wilkinson (Ruislip-Northwood)

I also pay tribute to the hon. Member for Putney (Mr. Colman) for giving us the opportunity to comment on the Turnberg report and to make observations on the future of the health service in London, especially hospital services.

I represent a constituency on the edge of Greater London. Mount Vernon hospital, about which I initiated an Adjournment debate on Friday 6 March, is located there. Earlier this year, the Minister of State, Department of Health was good enough to receive a deputation which I took to the Department to discuss its future. On Friday 29 May, Hillingdon health authority produced a consultation document, "A Contract With Local People", which makes drastic recommendations about Mount Vernon hospital and other hospital services, especially Hillingdon hospital in the north of Hillingdon borough.

I fear that the Turnberg report and the Government's plans for the future of the health service in London do not take sufficient note of hospitals such as Mount Vernon, which, historically, have drawn patients from well beyond the Greater London area. I must repeat what I said on 6 March: Mount Vernon is the largest cancer centre in the south-east on a single site. More important, it is probably the premier cancer treatment location in the south of England, if not the country, and combines fantastic clinical facilities for the treatment of cancer with research facilities of international repute, especially the Gray laboratory and the Marie Curie centre.

Furthermore, there is an outstanding hospice, Michael Sobel house, and a scanner centre, the Paul Strickland centre, which have been built up largely by private contributions from generous people over many years. Another charity, the Reconstruction of Appearance and Function Trust, is at Mount Vernon, as is the Cleft Lip and Palate Association. Mount Vernon is a genuine centre of outstanding excellence, but such a cancer centre cannot stand on its own: it has to have a range of supportive services in general medicine, surgery and many other disciplines. They are being put at risk by wide-ranging reviews undertaken for reasons of supposed rationalisation and supposed better organisation of services in the area; but the conclusions are highly questionable and would be prejudicial to the long-term future of the hospital. Indeed, they would call into question its viability beyond the next 10 years or so.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes), from the Liberal Democrat Benches, and the hon. Member for Putney suggested that the health service in London would be better administered by the Greater London authority than by the single health authority for the capital proposed by Her Majesty's Government. I do not understand how the Greater London authority could have the range of competence and the professional expertise to run London's health service. How it would administer the budget is unclear to me.

The suggestion of the hon. Members for Southwark, North and Bermondsey and for Putney is contrary to the proposals of Her Majesty's Government for the future governance of London. The proposals are directed at the strategic development of the capital in terms of industry and commerce, transport, strategic planning and so on. They have nothing to do with the health service, and it would be a retrograde step if Her Majesty's Government took their advice. It would not, as they somewhat disingenuously suppose, constitute an advance towards democratic control of the health service.

Mr. Gareth R. Thomas (Harrow, West)

The hon. Gentleman used the phrase "retrograde step". Does he accept, with the benefit of hindsight, that his failure to oppose the closure of the accident and emergency unit at Mount Vernon hospital when his party was in government was a retrograde step, and will he take this opportunity to apologise to his constituents—and, indeed, mine—for his failure in that regard?

Mr. Wilkinson

I have no reason to apologise. I initiated an Adjournment debate calling for the accident and emergency unit to be kept open at night when there were plans to close it at night. The then Minister—now my right hon. Friend the Member for North-West Hampshire (Sir G. Young)—acceded to my request, and the unit was kept open at night for a while; but the health professionals believed that its closure would constitute a better use of resources. They felt that it would be better to concentrate on A and E services at what they considered to be better-equipped hospitals, such as Watford general, Northwick Park and Hillingdon. Hon. Members are extremely rash if they arrogate to themselves a professional competence in matters of health service clinical judgment which are rightly in the domain of health service professionals.

I was not happy with the proposal. It went against the grain. Local people, however, were informed that the unit had to close; they were told that the cancer treatment service would be built up, and that that would become the hospital's specialist role—which indeed it has, to the credit of all concerned. I am arguing that organisational changes in the health service in London are putting at risk even the long-term future of the cancer centre.

The proposed changes are fundamental. Paragraph 4.34 of the consultation document proposes that from April 1999 inpatient services for acute medicine and care of the elderly, including those provided in the medical assessment and coronary care units, be transferred from Mount Vernon Hospital to The Hillingdon Hospital". That is to happen at the beginning of the next financial year. The document continues: inpatient services for non-acute medicine and care of the elderly, together with medical day care, medical outpatient services and the minor injuries service remain on the Mount Vernon Hospital site". However, the next paragraph states: from April 2001 the above inpatient services of non-acute medicine and care of the elderly, medical outpatients and minor injuries, plus other services, e. g. children's services, should transfer into the community hospital in the north of the borough". In other words, there is a stay of execution. In the early part of the next century, Mount Vernon will be deprived of much of its bread-and-butter work.

Paragraph 4.37 states: Medical staff would work together as a joint team covering both The Hillingdon and Mount Vernon hospitals, providing acute inpatient care at The Hillingdon Hospital and outpatient and day hospital services across the borough. That is all very well, and a reasonable person would commend such proposals to make better use of skilled personnel; but, at the same time, it is proposed that Mount Vernon hospital—which currently forms a joint trust with Watford general—should merge with Hemel Hempstead and St. Albans NHS hospital trusts in Hertfordshire. That will complicate the cross-London boundary dimension of the health service still further.

The North Thames regional executive dealt with both the home counties north of London and London north of the Thames. That allowed co-ordination, which was thoroughly healthy—especially for hospitals such as Mount Vernon, which took patients from north of Greater London. How things will work under the new regional authorities has yet to be defined: I hope that the Minister will be able to explain.

I am particularly perturbed about the future of the burns and plastic surgery units on the Mount Vernon site. Those specialties are crucial to the underpinning of the cancer centre. The possibilities under consideration appear to be the resiting of the entire unit at Northwick Park hospital in Harrow, the resiting of the plastic surgery centre at Northwick Park—with the burns element going to Chelsea and Westminster hospital—and division of the work between Northwick Park and Chelsea and Westminster, with the burns element going to Chelsea and Westminster. I do not comprehend why those changes are proposed; I do not see how they will help to ensure the long-term future of Mount Vernon as a cancer centre.

The same applies to Hillingdon health authority's further proposals. According to paragraph 4.54 of last Friday's consultation document, from April 1999 complex elective inpatient surgery, especially vascular surgery, should be transferred from Mount Vernon Hospital to The Hillingdon Hospital. From April 2001 all elective inpatient surgery should be transferred from Mount Vernon Hospital to The Hillingdon Hospital. Day case surgery for selected patients, together with surgical outpatient services, should remain at Mount Vernon Hospital until such time as a community hospital is developed in the north of the borough. Again, there is only a stay of execution.

All in all, it would seem that the powers that be have it in for Mount Vernon hospital—God alone knows why. Mount Vernon is an outstanding institution. Most people who have been treated there, have visited the hospital or have the privilege of working there describe it as a centre of excellence. This death by a thousand cuts would be a tragedy.

I am convinced that my constituents, and those who benefit from the hospital's services, will fight for its future. They believe that it ought to be built up rather than run down, and that the fact that Her Majesty's Government—who have made such play of their commitment to the NHS, during their election campaign and since—should contemplate damaging a premier cancer centre beggars belief. I hope that wiser counsels will prevail.

11.47 am
Mr. Roger Casale (Wimbledon)

I congratulate my hon. Friend the Member for Putney (Mr. Colman) on obtaining the debate. I know how hard he has worked to secure the future of Queen Mary's hospital, both before and since his election. I, too, campaigned, in my neighbouring constituency, to keep Queen Mary's accident and emergency unit open. We did not claim that it would automatically be restored if we were elected, but I venture to suggest that had my hon. Friend been the Member for Putney since 1992 rather than 1997, the situation at Queen Mary's might be very different.

The Tory Government left the new Labour Government an appalling legacy of underfunding and huge regional disparities in health care. However, we also have another inheritance: the Labour party set up the NHS, and initiated the principles and philosophy behind it, along with the commitment to rebuild it. If there was one reason why support for Labour was so strong in my constituency last May, it was the belief that Labour would rebuild the NHS.

Underfunding in London, including my area of south-west London, is a particular problem, as the Turnberg report makes clear. Some time ago, my health authority, Merton, Sutton and Wandsworth, produced a report called "The River Runs Dry". According to the health authority, that phrase most accurately describes our financial position…We do not believe that it will be possible to achieve an income and expenditure balance in the next financial year without major reductions in staff and other costs of our providers. Since the publication of that report, the Government have made additional resources available, and detailed negotiations to secure a bridging loan have taken place with the NHS regional executive.

I do not share the rosy view of the South Thames regional executive that is held by my hon. Friend the Member for Putney. I hope that proper funding arrangements for the Merton, Sutton and Wandsworth health authority can be secured. Difficult and acrimonious negotiations have been taking place. A local GP told me, "The deficit is being passed from the trusts to the health authority and back again. Nobody wants to be left with the deficit when the music stops."

If the Merton, Sutton and Wandsworth authority cannot get a bridging loan to cover the non-recurring part of its deficit, the consequences for my constituents will be severe. They will look to the Government, in responding to the Turnberg report, to address the specific problem of resource allocation in London. The NHS needs more resources nationally and more must flow to where they are needed most.

My constituents welcome, as does Turnberg, the Government's commitment to a review of the national distribution of funds for the health service. Page 26 of the Turnberg report suggests that that should be done through the creation of a working party to review the resource allocation formula and to study the implications of its findings for London. In the report "The River Runs Dry", Merton, Sutton and Wandsworth health authority states: We have major concerns about aspects of the capitation formula. We spend the vast majority of our resources on what we would regard as high priority unavoidable need and the allocation that we receive does not appear to adequately reflect the needs of our population. That assessment is consistent with Turnberg's findings for London as a whole. All is not well with London's health service, and the problems must be sorted out.

Coming to grips with the immensity of London's population and the diversity of health needs and life situations of Londoners will be no easy task. One could do worse than consult the list of special factors that are part of the everyday reality of health care in south-west London and which are cited in the Merton, Sutton and Wandsworth report. Do other areas spend the same amount on AIDS and HIV treatment and care, on serious mental illnesses, on people with learning disabilities and on mentally disordered offenders? Do other regions have the same diverse cultural mix, the same mobility and the same age profile of the population as London does? Does the present capitation formula adequately reflect those factors? My interpretation of Turnberg is that it does not.

If those factors had been taken into account in the Government's review of the formula, the health needs of my constituents would have been more truly reflected, the Merton, Sutton and Wandsworth deficit would be reduced or eliminated, and local health care resources would be increased.

There are some important proposals in the Turnberg report for cutting the cost of administration by the merger of South Thames and the North Thames regional health executives. In the short term, I am sure that the South Thames executive will ensure that my local authority gets the bridging loan that is needed. In the longer term, we must move away, as my authority wishes to do, from the continuing need for such transitional arrangements by making sure that the formula more truly reflects local health needs. We must also increase the share of national income that is spent on health.

Mr. Colman

Does my hon. Friend agree that one of Merton, Sutton and Wandsworth health authority's major problems is underfunding of the treatment of mentally disordered offenders, and that that underfunding amounts to almost £7 million a year? That dates back to the previous Government because I understand that those costs were moved from the Home Office to the Department of Health, and that the issue has never been properly dealt with. Given the importance of Springfield hospital, which is within the Merton, Sutton and Wandsworth health authority—

Mr. Deputy Speaker (Mr. Michael Lord)

Order.

Mr. Colman

—that matter should be addressed.

Mr. Deputy Speaker

Order. When I rise the hon. Gentleman should sit down immediately.

Mr. Colman

I apologise, Mr. Deputy Speaker.

Mr. Deputy Speaker

The hon. Gentleman has already made a speech and he is starting to make another one.

Mr. Casale

I understand that the non-recurring deficit is down to about £5 million. The £7 million to which my hon. Friend refers, if properly reflected in the formula, would solve the immediate funding crisis. I have cited some other pressing underfunding issues, but the one to which my hon. Friend refers would in itself deal with the health authority's current problems.

However, it is not just a question of more money for the NHS, although, of course, more for London and especially south-west London is crucial. As the Turnberg report makes clear, we must also involve and consult local people in deciding how that money is spent. As Turnberg puts it, the problem is not whether the public should be involved but how they should be involved.

The report is rightly critical of old-fashioned and out-moded methods such as public meetings, circulars and so on. It criticises the NHS Executive guidance on public consultation, which, as Turnberg says, needs to be urgently reviewed. Some of the suggestions in the report, such as focus groups and citizen juries, will be familiar to students of modern-day consultation techniques, but consulting the public is a difficult and many-sided job. and deciding how best to do it is difficult. I congratulate the local health authority on setting up a series of regular meetings with hon. Members in my area. They have been valuable, and, as Turnberg acknowledges, the community health councils also play an important local role.

Local civic forums and health forums, and consultations with voluntary and community groups also have a role to play, but the overall question of how genuinely to involve the public remains difficult, given the immensity and diversity of London's population. Moreover, a sustained effort is needed if consultation is to be effective.

My community health council and the health authority produce excellent leaflets from time to time, but, after one or two issues, they peter out. When there is a funding crisis, the flow of information dries up because there is no money to pay for consultation materials. Just when maximum consultation is needed, there is silence followed by cuts in services.

I congratulate the Government on opening the meetings of health authorities and trusts to the public. With the help of my local community health trust, I have obtained the dates of public meetings and, in the coming months, I plan to distribute a list to all interested parties for wide circulation in my constituency. However, we must go further, by having lists of such meetings posted in GPs' surgeries. Perhaps every surgery should have a television set, which could also show films and videos to inform local people. We must grapple with this difficult subject of consultation, so that we can formulate a coherent, sustainable and effective strategy for consultation of local people. It will be a daunting task. The Turnberg report gives pointers, but we need to go further.

Mr. Gareth R. Thomas

The report states that a positive communication strategy is necessary to facilitate pan-London debates on the capital's health service. Does my hon. Friend agree that the excellent result in the recent London referendum augurs well for such a debate under the auspices of a Greater London authority? Does he further agree that one of the reasons for so much under-investment in London's health service is precisely because London has not had a voice?

Mr. Casale

I agree. Londoners are not as aware as they should be of regional disparities in health care. Although the authority may not have a direct role in the expert provision of health care, it should give Londoners a greater say in the shaping of local health care. The Greater London authority will be valuable, as will the London civic forum, in informing Londoners about the key issues of strategic health care in the capital. Involving local people will be the first hurdle that we must surmount, and it is part of the wider consultation strategy on health services in which those bodies will play a vital role.

Local commissioning groups are mentioned in the Turnberg report and they are beginning to take shape in my constituency in line with the White Paper proposals. There is a potential cluster of important primary health care trusts in my constituency. At its heart is the Nelson hospital which can be a hub for the services and a future high-quality community hospital. I am working on that with the full co-operation of the St. Helier trust and I should also like to involve the Government and my constituents in that process. I was delighted by the recent visit to my constituency of the Minister's PPS, my hon. Friend the Member for Salford (Ms Blears), to discuss how we can proceed.

It is the 50th anniversary of the NHS, which should be allowed at least to voice a wish list of what it wants for its birthday. For my constituency, I should like to see not only a start made on improving services at Nelson hospital, making it the hub of new services, linking it with the new primary care trusts, but a review of the capitation formula and more resources nationwide for the health service, so that my constituents and those throughout London receive the health services that they certainly deserve and desperately need.

11.59 am
Mr. Tony McNulty (Harrow, East)

I wish to make just three quick points under the auspices of this debate. I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing the debate. As has been said, it is much needed.

The three quick points that I want to make are, first, that I think I sit somewhere between those who suggest that we should have directly elected borough health representatives and those who suggest that the Greater London authority should fulfil the role. I said on Second and, I think, Third Reading of the Greater London Authority (Referendum) Bill that it was crucial that the Greater London authority had a key scrutiny role at least in relation to strategic provision for London's health. I still adhere to that view and hope that that comes out when we get to the legislation, but I agree that it should have a strategic role rather than a specific Londonwide commissioning role.

Secondly, it is interesting that the hon. Member for Chipping Barnet (Sir S. Chapman), who mentioned me carte blanche, I suppose, with other north-west London Labour Members in relation to Edgware, has now gone. It is touching that he is now suddenly involved and concerned about Edgware's accident and emergency department. I was a key figure in the campaign for that department for four years and can say happily, hand on heart, that we saw the hon. Gentleman precisely zero times throughout that campaign.

Guilty men were involved in that campaign, but happily we have seen their demise as Conservative Members of Parliament. They are Messrs Gorst and Dykes, who—I choose my words extremely carefully—have lied through their teeth to the public in the past year about some silly bit of paper that they had by way of a promise from the then Secretary of State for Health, the right hon. Member for Charnwood (Mr. Dorrell), about the A and E department remaining open.

The only honest person—again, I choose my words carefully—in the whole process in the then Government was the right hon. Member for Charnwood, who said in June 1996 that the A and E department was closing and that he would do all that he could to ensure that it closed long before the general election ensued. He stuck to his promise and, on April fools' day 1997, the department was closed beyond redemption in terms of buildings, legal contracts and assorted other tendering processes. Therefore, we will take no lessons from the now absent hon. Member for Chipping Barnet or from any other Conservative Member—the hon. Member for Rutland and Melton (Mr. Duncan) should please rub the bit about Edgware out of his debut speech from the Dispatch Box.

The third point concerns specialisms, one particular sector on which Turnberg does not really touch; it was not in the brief, which is fine. I have the great pleasure of having the Royal National Orthopaedic Hospital NHS trust slap bang in the middle of my constituency. It carries out orthopaedic work of international repute, which is beyond any challenge. The hospital is a fairly substantial one and carries out a major specialism.

The hospital has been waiting for the best part of 15 or 20 years for the regional health authority to secure its future on the current Stanmore site. The latest bureaucratic nicety from the authority is a musculo-skeletal review, which will determine whether that orthopaedic provision will be available on the Stanmore site, or otherwise. There will be serious ramifications and knock-on effects for surrounding local hospitals throughout north-west London if the future of the Royal National Orthopaedic is not secured.

Happily, the Minister of State, Department of Health, my hon. Friend the Member for Darlington (Mr. Milburn), has agreed to meet me and other north-west London Members to try to resolve the situation. For such a significant national treasure in the NHS still to be floundering after 15 or 20 years with its future not secured is wrong; that situation must come to an end at the earliest possible time. If it does not, and it lingers on and on, the hospital will fail. It will fail ultimately to attract key international personnel, who happily come to it for some work experience and training, and it will fail to attract the brightest national brains in terms of orthopaedic provision and musculo-skeletal work.

I hope that the Minister of State—not necessarily in his winding-up speech, but subsequently, when we meet—will tell us that the position of the Royal National Orthopaedic is assured. I know that His Royal Highness the Duke of Gloucester, who opened a significant scanner on the site yesterday and had the pleasure of visiting a ward there that was named after his father, would endorse the proposals. Everyone in north-west London would. I hope that that proposal, which is, I accept, a non-Turnberg proposal, is addressed sooner rather than later, for the betterment of health provision.

12.5 pm

Mr. Alan Duncan (Rutland and Melton)

The hon. Member for Harrow, East (Mr. McNulty) kindly referred to this as my first attempt to reply at the Dispatch Box, and indeed it is. It is a great pleasure at last to be dealing with doctors rather than spin doctors.

The hon. Member for Putney (Mr. Colman) has done the House a service in raising this topic for debate. It is a matter of great importance and, of course, of legitimate constituency interest to him. However, he suffered something of a memory lapse when he said that Queen Mary's hospital would enjoy a different future. Indeed it will, but it is very different from the future that his party promised in the run-up to the general election.

The Conservative health team will endeavour at all stages to be constructive. As we approach the 50th anniversary of the NHS, our mission is to help to develop and to improve it. It may be fertile territory for political combat, but our side will never join battle at the expense of the NHS. This issue requires mature attention. A capital city is a complicated area for health provision. The issue is politically charged, but where there is rapid medical progress, where there are demographic and infrastructure changes, where there is deterioration in buildings and development pressure around them, there is a need from time to time for a fundamental review, which is exactly what we did with the Tomlinson report and, for rather different reasons, what the Government are doing with the Turnberg report.

It is sad that the response to Tomlinson when we were in government was not mature. The then Opposition did not attempt to improve the health service. It was low party politics. The result was that the present Government became boxed in, which is why the Turnberg report was necessary in the first place. It was designed as something behind which the Government could hide. Perhaps the most cynical would say that it was designed as a convenient dustbin for their pre-election promises. It was not about saving hospitals: it was about saving the Minister's face. It is no thanks to the Government that Sir Leslie Turnberg managed to convert his task into such a useful exercise. His starting point was that primary care in the capital matters. I think that we all share that view and recognise that the debate principally centres on hospitals.

The Government came to office with a pledge to review London's health service. They came with a certain amount of pre-election baggage because they had promised an enormous amount to local communities. They played on the fears about the future of local hospitals; many of those who voted Labour believed that a Labour Government would save those hospitals, just as Labour had promised, only to find that they are now severely disappointed.

Ms Margaret Hodge (Barking)

Is the hon. Gentleman suggesting that it was a mature decision by the previous Government to close Bart's, and that it is part of the pre-election baggage of this Government to ensure that it remains open as a facility for Londoners?

Mr. Duncan

I will come in a moment to the deceit that the Government have shown on the issue of Bart's and the promises that they made in the run-up to the election which have not been met.

In opposition, the Labour party complained that London had too few hospital beds. One function of the Turnberg report was to allow the Government to claim that London now had about the right number of hospital beds. That was the first step towards their current programme of closures and cuts. The paltry number of extra beds announced the other day by the Secretary of State does not make up the 200 that the Government have slashed from our plans for the new Royal London hospital.

As the hon. Member for Barking (Ms Hodge) has suggested, the Government needed to be able to claim that they had saved Bart's. Turnberg has given them an excellent public relations formula for doing so, despite the fact that Bart's is now closed as a district general hospital for the local community—a fundamental element of the campaign to save Bart's.

Mr. McNulty

Will the hon. Gentleman tell us exactly when he will start being mature and constructive?

Mr. Duncan

The hon. Gentleman should perhaps listen to the facts and feel ashamed that the Government he supports have betrayed so many of the promises which, no doubt, helped him get elected.

A raft of promises were made to the people of Edgware and Roehampton, and the Turnberg report has been able help here, too—offering a convenient way of removing accident and emergency facilities from local people.

I should like to ask the Minister certain specific questions which it is his duty to answer. The Turnberg report recommends the downgrading of Queen Charlotte's hospital, with Hammersmith taking on most of the extra work load. We are concerned, as is Turnberg, about the clinical base of Hammersmith hospital. If it is to be able to handle the extra work caused by the transfer of Queen Charlotte hospital's facilities, significant investment in Hammersmith will be needed, and there are concerns about the suitability of the Hammersmith site for such work. May I have an assurance from the Minister on his plans for investing in Hammersmith?

I should like the Minister to explain how the interim period before such investment occurs will be handled. What plans does he have for increased co-ordination with Queen Charlotte's hospital and Charing Cross hospital? How will the financial base for the hospital be managed? Those are important questions which I hope he will answer.

The Secretary of State was proud to have saved Bart's. He admitted as much in the original debate on Turnberg, when he said that one of his principal reasons for commissioning the report was to avoid the history books recording that it was he who closed that ancient hospital. That was noble of him, but Bart's, in the way he promised, has not been saved. Bart's has been closed as a district general hospital for local people. It will no longer serve the community. To its traditional patient base, Bart's no longer exists.

In addition, health care in south-west London was a significant pre-election battleground for the Government. The people of Roehampton—who the hon. Member for Putney conveniently seems to have forgotten—were given specific assurances by their Labour candidates, and they must feel disillusioned that they put their trust in them. The decision in effect to close Queen Mary's hospital, with the removal of its accident and emergency facilities, has broken Labour's pre-election promise to keep that institution open.

Mr. Colman

I see this as a personal attack on me. Will the hon. Gentleman confirm that the decisions to close the acute surgery service and other acute services and to downgrade the accident and emergency department were taken in the November before the general election and were acted on on 1 April, all fools' day, one month before the election?

Mr. Duncan

All Labour candidates who had an interest in the hospital—and in the party's campaign nationally—led the country to believe that such a decision would be reversed. That has not happened, and it is that deceit which I find so contemptible.

The Turnberg reforms have many merits. There are questions that I hope the Minister will answer, but it is difficult to trust the Government on something like this in the climate in which they are running the NHS today. People should be aware that, when the Government say that they have increased funding, they have not. There is £940 million less going to the health service than would have been the case had the Conservative party returned to office. Waiting lists have gone up by 137,000.

What in Sir Leslie Turnberg's proposals will suffer as a result of the Minister's panic and efforts to restore waiting lists to the levels that the Government inherited from us? I have high hopes for health care in London, but little confidence that the Government will deliver. They are spending less, closing more and making people wait longer. In that context, it is unlikely that the Turnberg proposals will deliver the health care that we all expect.

12.15 pm
The Minister of State, Department of Health (Mr. Alan Milburn)

I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing this debate. This debate is extremely important, not just for his constituents and for him, but for the House as a whole—and particularly for hon. Members representing London constituencies.

The Government share my hon. Friend's aim of ensuring that Londoners in all parts of this capital city have access to the highest-quality health care possible—not just in hospitals, but through primary care and community health services.

For the first time in decades—thanks to Sir Leslie Turnberg and his team, and the Government's adoption of all the recommendations—there is now a clear agenda for health, health services and social care in London. As my right hon. Friend the Secretary of State said when announcing the Government's acceptance of the Turnberg report on 3 February, the time for action on London's health service has arrived.

Sir Leslie Turnberg's team did a remarkable job, and I pay tribute to him and them. The comments of the hon. Member for Rutland and Melton (Mr. Duncan) were astonishing. He must be the only person in this building—he is probably the only person in London—who supported the Tomlinson report, which found no favour with the public, politicians and, most important, with the people who work in the NHS in this city. As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said, there has been universal praise for the way in which the review was carried out, and there has been broad agreement on the diagnosis of the problems.

The recommendations not only tackled major strategic concerns—to which the hon. Member for Rutland and Melton referred—but dealt in a hard-headed way with extremely difficult operational issues. As the hon. Member for Ruislip-Northwood (Mr. Wilkinson) reminded us, those issues do not go away. Change is endemic in the NHS. Turnberg, and the Government's acceptance of the report's recommendations, does not put a halt to change in the NHS; it is the start of a 10-year modernisation programme for the NHS in London and its environment.

Watford and the surrounding hospitals are the subject of consultation. We will bear in mind what the hon. Member for Ruislip-Northwood said and ensure that, when the final decisions are taken, they will be in the best interests of patients in his constituency and others served by those hospitals.

We are at the start of the programme which will see London's health service getting better step by step, year by year. It is important that we make it clear from the outset that there is much on which to build. We often concentrate in these debates on things that are wrong, and there is much that is wrong in London's health service. However, there is a great deal of which to be proud as well—great hospitals at the cutting edge of medicine, science, teaching and research, high-quality local hospitals, GP surgeries and more. There are also formidable challenges for London's NHS. The best services in the land sit cheek by jowl with some of the worst.

Turnberg reversed the absurd Tomlinson position that London was over-bedded compared with the rest of the country. The Government seek to build on that important recognition. The hon. Member for Southwark, North and Bermondsey asked whether the commitment to improving waiting lists was continuing. I remind him that Turnberg called for more detailed work on ensuring that we have the right number of beds. That work is being done, and the evaluation is continuing. We will have to ensure that we have the right resources, staff and bed numbers to ensure that we get waiting lists down—we want to do that not only this year, but in subsequent years.

Mr. Simon Hughes

There was a recommendation that the panel should examine the bed issue. The Minister said that that work has already started. Does he have any idea when he will receive recommendations on bed numbers and the implications of those numbers?

Mr. Milburn

I do not, but I shall let the hon. Gentleman know as soon as I do. If he contacts my office, we can arrange a response.

My hon. Friend the Member for Wimbledon (Mr. Casale) spoke about the sheer size of London and the problems that that creates. Our capital city has a unique health service, which has unique problems in serving massive health needs. We are determined specifically to tackle London's deprivation and inequalities. The fact is that 40 per cent. of Londoners are among the most deprived 10 per cent. of our country's population. Sir Leslie and his team rightly highlighted the special needs of many groups in London, such as elderly people, the mentally ill, ethnic minorities, homeless people, refugees and asylum seekers. We have to translate our good intentions for those groups into action.

Mr. Wilkinson

From the Minister's statement today, may we have confidence that there will never be a translation of financial resources out of London into the provinces? The old resource allocation working party system did the health service in London great damage.

Mr. Milburn

If the hon. Gentleman will bear with me for a moment, I am about to deal with the resource allocation issue, partly in response to the issues raised by my hon. Friend the Member for Wimbledon.

The action necessary to deal with problems cannot occur without partnership. Working together in partnership, across boundaries, is vital if we are to improve services, improve the health of Londoners and—most important—tackle the appalling health inequalities that scar our capital city. We are therefore fostering co-operation in the NHS, by getting rid of the internal market introduced by the Tories when in government. To tackle those inequalities, we are also breaking down the Berlin walls between health and social care, the NHS and local authorities, and the public and voluntary sector.

New ways of joint working are being pioneered in London's two health action zones—which represent a recognition of the fact that the job of improving health is one for local government, employers, community organisations and the NHS. Such an approach to partnership is in line with the Turnberg recommendations.

Mr. Gareth R. Thomas

Will my hon. Friend mention the widely supported proposals on pooling health and social services budgets?

Mr. Milburn

My hon. Friend raises an important point. We will soon produce a consultation document on how to ensure greater flexibility in the provision of health and social care services—for the benefit of patients, especially those who are at the interface of those services, such as elderly people, people with metal health problems and people with disabilities. The document will deal with the pooled budget issue.

The Government accepted all the Turnberg recommendations, and we have acted quickly to create a programme to implement them. We will deliver better services for Londoners through investment and modernisation. The two go together.

We are committed, first, to sustained investment in health services and facilities in London. Since we came to power—to contradict the hon. Member for Rutland and Melton—the Government have invested £300 million in London's national health service. Last year, £26 million went to the capital, to ease pressures on health and social services provision. This year, £48 million has been targeted specifically at lowering waiting lists in London. As a consequence of the tough targets that we have set ourselves in reducing waiting lists, by March 1999 London's national health service should have more than 10,000 fewer patients waiting for treatment than the record level of March 1997 which we inherited from the Tories.

The extra money for this year includes £30 million targeted on primary care, mental health, intermediate care and community services. We will provide at least an additional £140 million of investment in those services for London over the lifetime of this Parliament.

Today's debate has rightly concentrated on London's hospitals. However, primary care is the primary point of contact with the NHS for the overwhelming majority of Londoners. As we know, there is much to commend primary care services in the capital. However, there is also much that is wrong with the services, which we are determined to put right.

My hon. Friend the Member for Upminster (Mr. Darvill) and the hon. Member for Southwark, North and Bermondsey mentioned the problem of recruiting a sufficient number of general practitioners in the capital. We fully endorse the need for Londoners to receive their fair share of GPs. A national group—which includes Professor Jarman, who was a member of Sir Leslie's team—is working to identify a formula that would accord every area its proper share of family doctors. The results should be available in the summer.

Ms Hodge

Is consideration being given to introducing salaried general practitioners in those London areas where it is extremely difficult to recruit people into general practice?

Mr. Milburn

I assure my hon. Friend that we have successfully reached an agreement with the British Medical Association, and have—for the first time in the history of the NHS—introduced a salaried doctors scheme, which I believe will be the way forward in many areas where it is currently difficult to recruit GPs. The scheme will bring new, younger and energetic GPs into general practice, which will be a great improvement in primary care in many parts of London.

My hon. Friend the Member for Wimbledon asked about resource allocation, and how we can ensure that London receives its fair share of resources. As he knows, a working group is dealing with the matter and will report later this year. I expect that its recommendations will be implemented in the next financial year.

As part of a modernisation programme, there is more investment in London's front-line health services. Moreover, that money for front-line services is backed by capital investment, as we cannot build a 21st-century NHS in London in 19th century hospitals. The Turnberg report paved the way for £800 million of new investment to build more new, modern hospitals and to improve existing ones—such as at the West Middlesex, University College hospital, King's and St. George's. It paved the way also for a proper, 21st-century hospital in Whitechapel. Furthermore, we are not only saving Bart's—which the previous Government intended to close—but giving it a great future.

There will also be a great future as a local community hospital for Queen Mary's hospital, Roehampton. Five years of uncertainty is at an end. Queen Mary's will have a robust and healthy future, providing services for local people into the next century. I pay tribute to the work done by my hon. Friend the Member for Putney and by the hospital league of friends. Most of all, I pay tribute to the work done by the hospital's staff, who have ensured that services are delivered throughout a most difficult period of uncertainty and confusion—which is now at an end. Our plans will give staff and the local community a new hospital for a new century.

We have also endorsed the London review recommendation that a new hospital should be built in the Oldchurch area. The Havering Hospitals NHS trust is producing a strategic outline case for that investment. We expect the case for making the investment to be a strong one. If it is, the trust will be able to take forward procurement in 1999.

My hon. Friend the Member for Upminster expressed concern about the Harold Wood site. Harold Wood's future will have to be considered in the light of the Oldchurch development. Similarly, I assure my hon. Friend the Member for Ilford, North (Ms Perham) that plans for the new hospital will take account of the relatively new facilities at King George's hospital, and that clinicians from King George's are actively involved in helping to plan services at the new hospital.

I am aware that, because of work done by the trust, submissions on Guy's and St. Thomas's will be made to me. I also realise that the hon. Member for Southwark, North and Bermondsey has an alternative proposal. As I said when I met him, I should be more than happy to consider his proposal. I should be happy to meet him again, if he thinks that that is necessary.

I also assure the hon. Member for Rutland and Melton that Hammersmith is a very important hospital and that it has a secure future. However, we have to assess how best it should play its part in delivering local health services within the overall context of services in west London. That is why we are reviewing services in the area and the Hammersmith is part of that review.

Those are all far-reaching changes for London's NHS, which will not be easy to achieve and which will require time and careful management. We have faced difficult decisions and an unenviable legacy from our predecessors of uncertainty and failure, but we are making considerable progress, with new hospitals being built, extra cash being invested and a new direction for London's health service being implemented. There is a long way to go to deliver the first-class NHS that the Government want to be available throughout London, but we have made a good start and we are determined to make rapid progress. We believe that Londoners deserve no less.

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