London Hospitals: Future (Hansard, 26 October 1992)

§ Baroness Cumberlege
My Lords, no. Sir Bernard Tomlinson and his team have supplied a strategic view of London's health services and medical education, taking account of a whole range of factors. The Government welcome his broad conclusions and intend to respond with detailed proposals early in the New Year.

§ Lord Desai
My Lords, I thank the Minister for that Answer. Is she satisfied that enough will be done in implementing the proposals of the Tomlinson Report so that London's health services are not harmed in any way?

§ Baroness Cumberlege
My Lords, the whole purpose of the report and the Government's intention is to maintain high standards of health care for Londoners and to ensure that medical education and research is strengthened and that future developments in primary and acute care are further progressed.

§ Baroness Masham of Ilton
My Lords, will the Minister make herself aware of the breaking up of high calibre clinical research teams which are part of some of the famous London hospitals?

§ Baroness Cumberlege
My Lords, the current position is that within a six mile radius of central London there are 11 major teaching hospitals,14 cardiac specialist units,13 neuro-surgery units,13 cancer units,11 renal units and nine plastic surgery units. That level of specialism cannot be sustained. Indeed, we know that as a result of the problem of having so many units we are falling behind in the international expertise which is necessary.

§ Lord Rea
My Lords, will the Minister assure the House that the primary health care services, which the Tomlinson Report advocates as needing strengthening, will be in place before the hospital service is dismantled in the way that is suggested?

§ Baroness Cumberlege
My Lords, that is a difficult question to answer because the Government have not yet reached any decisions about Sir Bernard Tomlinson's report. They will consider the proposals, take advice and consult many interested parties during the next three months. At the end of that period the 910 Government will certainly make their decisions. I am sure that one of the questions that they will wish to consider is how to strengthen primary care.

§ Lord Mellish
My Lords, is the Minister aware, and will she note, that if she or that Ministry of hers interferes in any way with Guy's Hospital she will be subjected to a row the like of which she has never heard?

§ Baroness Cumberlege
My Lords, I have the great misfortune that both my brother and my father trained at Guy's; therefore, I know the strength of feeling in that hospital.

§ Lord Elton
My Lords, when the Government consider what to do about the recommendations in the report will they add to their list the provision of casualty and life support services within reach of the centre of London in crowded traffic conditions?

§ Baroness Cumberlege
My Lords, I can give my noble friend that undertaking.

§ Lord Carter
My Lords, is the Minister aware that her first supplementary answer will bring considerable rejoicing because she said that the Government have rejected the internal market as a mechanism for solving the problems of London's health service? The Government have said that there will be wide-ranging consultations following the Tomlinson Report. Will those consultations include patients? Furthermore, do the Government accept the main thrust of both the Tomlinson Report and the earlier King's Fund Report that substantial new resources must be invested in primary and community care in London before the closure of hospitals?

§ Baroness Cumberlege
My Lords, I should like to clarify my first Answer. I was asked whether the internal market was the only criterion in deciding the future of London hospital services. I said that it was not; it was one of other criteria. On the question of consultation, no hospital can possibly be closed without going through the formal procedures. Those are lengthy. They involve community health councils and consultation with others before any decision by the Secretary of State. With regard to resources, on Friday in another place my right honourable friend the Secretary of State for Health said that we cannot make any commitment on the level of expenditure until the current public spending round is over. However, we have stressed time and again that our main objective must be to improve health services for Londoners. We cannot achieve that without radically improving primary care.

§ The Earl of Onslow
My Lords, is it not true that this is the greatest opportunity for improving the health care of London? Florence Nightingale complained that St. Thomas's should not have been opened because there were too many hospitals in central London. I believe Florence Nightingale died in 1910. Surely the Government have been offered a way of improving the bottom layer of London health, which is bad, compared to the top layer, which is oversubsidised.

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right. Anyone who has any knowledge of London health services will recognise that the services are out of balance; that primary health care needs to be strengthened and that we must change a system that was coping with, and providing services for, a population which was at its height in inner London at the turn of the century or, if one includes outer London, in the late 1930s. The population has drifted away from London and we must tailor a service to meet the needs of the people of London both for this century and the next.