London Hospitals (Hansard, 27 April 1994)

§ Lord Molloy
asked Her Majesty's Government:
Whether they are continuing to receive representations from those working in the health service about the future of London's hospitals.

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, there have been few formal representations from staff working in the London hospitals; but a series of meetings have taken place over a considerable length of time both with staff working in hospitals and others who work in the community and in primary care.

§ Lord Molloy
My Lords, I thank the noble Baroness for that reply, but is she aware that there are many members of the NHS staff, including surgeons, doctors, staff nurses, nurses and auxiliary staff, who are gravely concerned at what they see as a very serious rundown of the great hospitals in London, including the great teaching hospitals? I hope the Minister will agree that these great hospitals are important not only for London and not only for this country but also in terms of their history and what they can provide in the future for mankind. Those hospitals ought to be preserved and should not be threatened in any way whatsoever.

§ Baroness Cumberlege
My Lords, the National Health Service does have to change with differing needs, both in health and social terms. The King's Fund, a well respected body, has stated this recently. Its director, Robert Maxwell, has said that the, balance of health and social care in the capital is not appropriate to the needs of Londoners. However adjusting the balance will inevitably take time. Now the task is to work through these changes on the ground building up good alternatives that are affordable, that work and that make a better framework for the long term". We agree with that.

§ Lord Carr of Hadley
My Lords, can my noble friend confirm that, while there may be some of those who work in the health service at all levels in London who are pessimistic, it is also true that there are a great many who are extremely optimistic and enthusiastic about the wonderful new chances they have been given to provide a better service to patients?

§ Baroness Cumberlege
My Lords, I am grateful to my noble friend. That is the case. Many nurses are seeking new opportunities outside hospitals, working in the community as nurse practitioners with more responsibility. They are finding it a very fulfilling experience.

§ Lord Strabolgi
My Lords, will the noble Baroness confirm that the Royal Marsden Hospital is now safe so that it can continue its important work in cancer research and treatment free from further uncertainty?

§ Baroness Cumberlege
My Lords, the Royal Marsden Hospital has now become a trust. It has to compete in the marketplace in London. I am sure, knowing of its high reputation, the work that it does and the respect that it has nationwide, that it will succeed.

§ The Countess of Mar
My Lords, will the Minister say whether the continuing reports of patients having to wait in casualty departments on trolleys are merely teething problems while things are being sorted out, or will they continue, and, if they are to continue, will she please see that something is done about it?

§ Baroness Cumberlege
My Lords, we are very anxious that people do not wait on trolleys in accident and emergency departments. We are putting further investment into these departments in several hospitals in London, including £1 million into the Homerton, £8 million into King's and £3.2 million into St. Thomas's. But the noble Countess is absolutely right. It takes time for the completion of all the building work; and all the changes have not yet been made.

§ Lord Boyd-Carpenter
My Lords, will my noble friend confirm that the Royal Brompton Hospital will survive?

§ Baroness Cumberlege
My Lords, it is impossible for me to give a cast-iron assurance for all these hospitals for ever and ever, because we know that things change. This is another special health authority that is now a trust. I believe it has a great deal of expertise and respect and a secure future.

§ Lord Rea
My Lords, does the noble Baroness accept Professor Brian Jarman's careful analysis which shows that London has no greater excess of hospital beds than any other large city in the UK with similar housing and social problems? Those are factors to which Professor Tomlinson may not have given full weight in his report. Does the noble Baroness not agree with Professor Jarman's view that the crux of the problem is that inner London has too few beds for long stay mentally ill and geriatric patients, and that these are blocking acute beds, with the result that general practitioners, particularly now that the total number of beds is going down, are having greater difficulty than ever in getting acutely ill patients admitted?

§ Baroness Cumberlege
My Lords, there is a difference between Professor Jarman's figures and ours. They are on different bases. Professor Jarman's figures are for the whole of London, whereas ours are for inner London, and that is where most of the changes will be. Professor Jarman also included community and long-stay provision. The research that we were doing was on acute services. But we recognise that there is a problem with those who are acutely mentally ill. That is why my right honourable friend the Secretary of State has introduced a very active dynamic plan to put more investment into this service.

§ Lord Rea
My Lords, perhaps I may follow up that point. Does the Minister not realise that general practitioners are finding it difficult to get acutely ill patients with other conditions, not only mental illness, into hospital? The emergency bed service is receiving more calls for help with admissions than it has for many years.

§ Baroness Cumberlege
My Lords, when I last looked into the situation with the emergency bed service about two months ago, it assured me that there had not been a red alert for over two years. I believe that it is going to take a little time for all these changes to come about. But we know that if we are to give a better service to Londoners it means that we have to invest more in primary and community care. Every single statistic we look at shows that they are much poorer in London. To do that we need to get resources from some of the London hospitals. We know that we have too many hospitals and they are inappropriately placed. We need to consolidate and build up expertise in fewer centres of excellence. Then, I believe, we shall have a much better service for Londoners.

§ Lord Molloy
My Lords, is the noble Baroness aware that many of the surgeons, doctors and nurses who are involved are of the opinion that the health service in London is not starved of funds but is not getting as good a crack of the whip as other parts of the United Kingdom? Bearing in mind what I have already said, I feel that everyone in this House will want to see our health service preserved and the great London hospitals enriched so that they do even greater work than they are doing now. In order to achieve that, will the Minister at least be prepared to consider that it might be right to have serious consultations now with the representatives of surgeons, doctors, nurses and ancillary staff so that we can arrive at a sensible conclusion, shared by everybody, to improve London's wonderful service?

§ Baroness Cumberlege
My Lords, we have invested £85 million extra in primary and community care and £105 million in the hospital service this year to bring about these changes. We know that London is better resourced than any other part of this country. Of course we work with staff, but we work on a constant basis. There is continuous dialogue: between the trusts, the London Implementation Group, Ministers and staff.