Teaching Hospitals in London (Hansard, 13 May 1992)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, as the noble Lord will be aware, Sir Bernard Tomlinson and a team of experts were appointed in October to advise my right honourable friends the Secretaries of State for Health and Education on health service and medical teaching in London. They are making good progress and are expected to complete their inquiry and make recommendations to Ministers during the autumn.

§ Lord Molloy
My Lords, first, perhaps I may congratulate the noble Baroness on her appointment. She will run into squalls now and then, but I wish her good health. However, is she aware that there is concern? The medical profession itself is somewhat divided, but the overwhelming majority seems to consider that the abolition of some of the London teaching hospitals could create a disaster. It is known that there are teaching hospitals in other parts of the country, but the answer is to build teaching hospitals in those areas, not to destroy the ones in London.

§ Baroness Cumberlege
My Lords, I am grateful to the noble Lord for his kind remarks. I hope that on another occasion I shall be able to pay tribute to my predecessor.
I know that there is concern about London teaching hospitals. There have been many comments in the media recently. But it is pure speculation and should be discounted. Sir Bernard is still working; he is at the formative stage. There is no question of a hit list.

§ Lord Glenarthur
My Lords, I congratulate my noble friend on an appointment to which she brings considerable personal experience. Perhaps I may ask her whether her department, and the Tomlinson Report, will consider the distinction to be drawn between those London teaching hospitals which serve a large local community and those which serve patients from further afield.

§ Baroness Cumberlege
My Lords, I am sure that that will be part of Sir Bernard's brief. London teaching hospitals and London services generally are thought to be serving the whole country. Although patients do go to London for treatment, especially highly specialised treatment, only 3 per cent. come from outside the four Thames regions.

§ Baroness Phillips
My Lords, perhaps I may take it from the Minister categorically that Charing Cross Hospital will not be closed.

§ Baroness Cumberlege
My Lords, I am sure that the noble Baroness would like that assurance. However, it would be irresponsible of me at this time to make any prediction as to what Sir Bernard will be recommending.

§ Lord Flowers
My Lords, perhaps I may also add my congratulations to the noble Baroness on speaking from the Front Bench for the first time. In the study that is now taking place about London teaching hospitals will every consideration be given to the other side of the coin, namely, the London medical schools? It is very difficult to consider the two issues separately. That is the position in which we who have done such studies in the past have been placed.

§ Baroness Cumberlege
My Lords, I am very aware of the work previously carried out by the noble Lord, Lord Flowers. I am sure that Sir Bernard will draw upon that work in his future study. We look forward with great interest to the autumn when the report will be before us.

§ Baroness Seccombe
My Lords, does my noble friend agree that the over-provision of hospitals in London was been a long-standing problem? Does she further agree that now is the time to grasp the nettle and settle the problem so that the setting-up of NHS hospital trusts can proceed as quickly as possible?

§ Baroness Cumberlege
My Lords, I totally agree with my noble friend. During the past 100 years there have been 20 major inquiries into the London problem. It has been long-standing. Many changes have taken place in the National Health Service, especially with regard to trusts. We have seen the success of that change and it is time that we got on with the job.

§ Lord Kennet
My Lords, will the Minister say a few words about the team of experts that has been appointed? Why is it that those experts are likely to know better what to do than the leaders of the medical profession on the one hand or the Secretary of State and her advisers on the other?

§ Baroness Cumberlege
My Lords, there are four members of the team. First, there is Professor Sir Bernard Tomlinson who is a distinguished clinician and academic and previously chairman of the northern region. Secondly, there is Professor Michael Bond who is professor and pro-vice-chancellor at Glasgow University. Thirdly, there is Dr. Molly McBride who is an East London GP and secretary to the Royal College of General Practitioners. Fourthly, there is Pearl Brown who is a nurse manager working in Riverside and a member of the Aids Action Group.
The team has been set up because as a result of the reforms the National Health Service is a very different service and it will change radically during the next few years. It is important that we have a comprehensive look at London. This is the first time that a comprehensive examination will have taken place, looking at primary care as well as hospital services and medical education. It is a good initiative and I look forward to the results.

§ Baroness Robson of Kiddington
My Lords, I too congratulate the noble Baroness on her appointment. I welcome her statement that Sir Bernard Tomlinson is to report in the autumn, but I believe that it will be some time before decisions are taken. Will the Government give a guarantee that in the meantime no teaching hospital will go to the wall as a result of the introduction of the purchaser/provider principle, and that they will be safeguarded until decisions are taken on the report?

§ Baroness Cumberlege
My Lords, I thank the noble Baroness for that question. It is true that Sir Bernard may propose some radical solutions. However, it would be totally irresponsible to consider closing any teaching hospital—indeed, any hospital—until Sir Bernard has made his recommendations. I think that your Lordships have that assurance.

§ Lord Carter
My Lords, as this is the Minister's first appearance at the Dispatch Box, I welcome her on behalf of Members of this Front Bench. I congratulate her on her appointment and wish her well in her new post. Will the Tomlinson report deal with the problem that, as a result of their nature, the London teaching hospitals have a higher cost per patient? Due to the working of the internal market, they are likely to lose the provider contracts to the apparently cheaper hospitals. Does the Minister agree that if that happens budgetary problems will result and the hospitals will lose their status as world-renowned centres of excellence?

§ Baroness Cumberlege
My Lords, it is true that London costs are much higher than costs in other areas. Not only are they higher than in other non-teaching areas but they are also higher than in similar teaching areas in other parts of the country. For that reason the report is so important. It is essential that Londoners obtain good value for money.

§ Lord Molloy
My Lords, will the Minister draw to the attention of Sir Bernard Tomlinson the fact that St. Thomas', Charing Cross and Bart's hospitals are 346 referral hospitals for the whole of the United Kingdom? They provide a magnificent service to London, to the rest of the country and to other countries. Will the Government also consider the massive losses in the number of beds and the loss of 10,000 jobs? I believe that all those issues should be considered before a final decision is taken.

§ Baroness Cumberlege
My Lords, I note the comments that have been made. I share the admiration and respect that people hold for the London teaching hospitals. However, without doubt London's population is falling. Less and less is London used as a central referral centre because hospitals throughout the country have gained in status and academic achievement. Part of the success of the London teaching hospitals is that they have exported their students to set up other departments of great excellence.