HL Deb 24 May 1993 vol 546 cc5-7

2.46 p.m.

Baroness Jay of Paddington asked Her Majesty's Government:

When the reviews of medical specialties announced in Making London Better, and due to be completed in May, will be made publicly available, and what opportunities there will be for public consultation before any further action is taken on the basis of these reviews.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, the specialty reviews are due to be presented to Ministers as independent advice in June and will subsequently be published. Together with the review of special health authority research and the assessments of London hospital sites, the specialty reviews will inform decisions on the future pattern of hospital services in the capital. There will be full public consultation, where appropriate, on subsequent proposals for change.

Baroness Jay of Paddington

My Lords, I am grateful to the Minister for that helpful Answer. I am glad that the time limit on the reviews has been extended from the end of May. Is the Minister aware that there is anxiety about the nature of the reviews? As was said in Making London Better and as she repeated in her Answer today, the reviews will have some impact on the modification of acute services; for example, the possible closure of hospitals in London. Will the Minister assure the House that in addition to those involved in the health professions users of the services will be included in the consultation?

Baroness Cumberlege

My Lords, there will not be a full consultation on the reviews per se. Consultation will take place when there is a recommendation to alter the services. But there is a patient representative on each review team; that is, except for the plastic surgery review.

Baroness Jeger

My Lords, is the Minister aware that in the document mendaciously called Making London Better there is an undertaking at paragraph 25 that the London Implementation Group will establish a primary health care forum which will report by 1st April 1993? Has that undertaking been fulfilled, and, if not, why not and when will it be?

Baroness Cumberlege

My Lords, the report states that the London Implementation Group will establish a primary health care forum to develop an agenda for change and that it will report back on a programme for the first two years by 1st April 1993. The primary health care forum has been established and it has reported back on a programme.

Lord Ennals

My Lords, bearing in mind the crucial nature of the decisions which have to be taken and their effect on millions of people in the Greater London area, does not the Minister believe, first, that it would be wise to have proper consultation rather than to wait for implementation? Secondly, I was glad to hear the Minister say that the reports will be published. But will that include also the publication of the evidence that has been given to the review teams?

Baroness Cumberlege

My Lords, there will be proper consultation as soon as recommendations are made on changes to any of the London hospitals or services. There will not be consultation on the individual reviews which have taken place, just as there will not be consultation on the review of special health authority research. Both those studies and the evidence given to the review teams are elements in order to help the regional health authorities formulate recommendations to the Secretary of State on the changes in hospital services.

Lord Ennals

My Lords, I am grateful to the noble Baroness for that reply, but will she tell me whether the evidence which was given to the review teams is to be published?

Baroness Cumberlege

My Lords, as I understand it, not as appendices. It is part of the evidence that has been given to the review teams in order for them to reach their conclusions. The full reports will be published. But I very much doubt whether the review teams will wish to isolate specific evidence.

Lord Skelmersdale

My Lords, one of the problems in London, and, indeed, in the conurbations as a whole, is that people have made far too much use of hospital out-patient departments instead of using their GPs, where those GPs exist in the local area. Will my noble friend say what plans the Government have, first, to increase the number of GPs in under-serviced parts of London and, secondly, to persuade people not to use hospital out-patient departments?

Baroness Cumberlege

My Lords, the Government have set aside for this year alone £43.5 million to invest in primary health care. The Government are anxious that people should use appropriately accident and emergency departments and out-patient clinics, but that depends on the primary care being of the standard which enables them to do so. We have been very much aware that the level of primary health care in London has been poor. That is why we must re-order the services and ensure that less money is spent on acute services and more is spent on primary health care.

Baroness Jay of Paddington

My Lords, perhaps I may press the Minister as regards going back to her right honourable friend the Secretary of State on the nature and timing of proper consultation. Is it acceptable for there to be consultation once decisions have been taken on the reorganisation of acute services rather than, as it said in the original document, in the light of the specialty reviews which may cause modification of those decisions? Surely the time to talk to the users of the services is before decisions are taken.

Baroness Cumberlege

My Lords, the noble Baroness is absolutely right. The Government will consult once the final recommendations have been made.

Lord Rea

My Lords, following the question asked by the noble Lord, Lord Skelmersdale, will the Minister say on what evidence the thinking is based which implies that increasing the primary health care services will reduce the need for hospital services? Is she aware that a substantial body of medical opinion believes that improving primary care in areas where there is deprivation will lead to an increased need for hospital services rather than a reduction?

Baroness Cumberlege

My Lords, recent studies which we have undertaken show that at least 10 per cent. of patients are admitted to London hospitals who, if they were situated and living outside London, would be treated by their GPs. I believe that it is reasonable to suppose that if we improve primary health care services there will be less call on acute hospital services.

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