HL Deb 26 June 1997 vol 580 cc1644-6

3.30 p.m.

Baroness Cumberlege asked Her Majesty's Government:

In the light of the recent statement by the Secretary of State for Health that he will postpone decisions on London's health services, what additional costs will be incurred and how they will impact on other health services in the United Kingdom.

Baroness Jay of Paddington

My Lords, my right honourable friend the Secretary of State for Health has appointed a small panel of distinguished people led by Sir Leslie Turnberg, who is at present president of the Royal College of Physicians, to give him rapid advice about the best way forward for developing health services in London. This follows our commitment to look again at the previous Government's proposals for change in which Londoners had lost confidence. The panel will be short lived, have minimal expenses and will work within the framework of resources available to the health service in London. There will be no financial impact on other services in England, nor on the health budgets in other parts of the United Kingdom, which are separately funded.

Baroness Cumberlege

My Lords, I thank the noble Baroness for that full Answer. I wonder whether the Minister will remember that in a debate in your Lordships' House in December 1993 she said that nearly everyone who has looked at London's health services agrees with Sir Bernard Tomlinson's general conclusion. Can the noble Baroness say why the Government are now promoting a further delay in terms of a further review? I do not agree with the noble Baroness that there will be no financial impact. Delay will cost money. Year after year additional money goes into London to subsidise it from other parts of the country. Where is the money coming from? Will it come from the promised improvements for breast cancer services announced a fortnight or so ago; or from cancelling new hospitals and services in other parts of the country? Those parts of the country for far too long have subsidised London to the tune of around £200 million a year.

Baroness Jay of Paddington

My Lords, in 1993 I believe that we were all more optimistic. I was tempted to say that we were all younger, which is also true. I was more optimistic about the pace and nature of change in London. Since then there has been growing public and professional unease about many of the previous Government's proposals. Perhaps I may give an example. For the past two years I have been sitting on the second King's Fund Commission on London and have seen at first hand the problems that confront the capital. Professor Brian Jarman, who was involved in the original controversy and is now a member of the new advisory panel, has consistently challenged the basic assumptions on which some of those proposals were made.

It is only common sense for the new Government to take stock and tackle the causes of concern about gaps and shortcomings in the provision of services. Once those gaps and shortcomings have been analysed by the new group, the complicated and more difficult questions about relative costs will become relevant.

Lord Howell

My Lords, the absence of statistical information makes it impossible to plan for London. Is my noble friend aware that the appointment of a specialised committee to assess the basic need for beds in London is welcomed and is sensible? Can the noble Baroness satisfy me that she will apply the same procedure to Birmingham, where the same chaos reigns in the hospital service?

Baroness Jay of Paddington

My Lords, my noble friend has drawn my attention previously to the problems in Birmingham, and he does so again with his usual eloquence. As I said in Answer to the original Question, the panel chaired by Sir Leslie Turnberg has a specific remit on a short-term basis to look at London. If that process is seen to be effective, it might well be applied to other cities.

Baroness Robson of Kiddington

My Lords, in view of the further inquiry into health services in London, does the Minister recommend that hospitals at present involved in establishing PFI contracts should put the plans on hold until the committee has reported?

Baroness Jay of Paddington

My Lords, perhaps I may give your Lordships details about specific PFI arrangements in London. They are fairly brief, and may reassure the noble Baroness.

At present business cases are being put forward for the University College London hospitals, the Royal hospitals, Havering, King's, St. George's and Greenwich hospitals. Those business cases will be examined by the London review independent advisory panel chaired by Sir Leslie Turnberg. As soon as the process has been completed, those PFI agreements which are available will be subject to the same rigorous and strategic approach that is being applied to all the national agreements. That may well be within the next few months.

Baroness Gardner of Parkes

My Lords, it has been stated that all decisions as regards London are to be postponed. I must declare an interest. Will the Minister inform me whether appointments to health authorities will also be frozen until the end of the review; or will everyone proceed with reappointment or failure to reappoint irrespective of the outcome?

Baroness Jay of Paddington

My Lords, I should make it clear that there is no moratorium on change which has already been agreed and which is taking place in London. There is a moratorium on further hospital closures until the review is completed. As the noble Baroness, Lady Robson, mentioned, there is the question of further consideration on the PFI arrangements. However, consultancy on individual services in particular hospitals will go ahead where that has been agreed. The question of appointments to health authorities is at present under urgent consideration. We hope to be able to give the go-ahead on that quickly. My right honourable friend the Secretary of State for Health is concerned that people representing local communities should be represented on the health authorities.

Lord Walton of Detchant

My Lords, while confirming that the medical profession has every faith in the wisdom of the new panel to be chaired by Sir Leslie Turnberg, as it had four years ago in the panel headed by Sir Bernard Tomlinson, can the Minister assure us that the recommendations relating to the concentration of highly specialised units such as those in clinical oncology, neuroscience and the like which arose from the Tomlinson Report will not be overturned in the new review? Many of the existing units in those specialties are non-viable. They need to be replaced by a smaller number of much larger viable units.

Baroness Jay of Paddington

My Lords, the noble Lord will appreciate that I cannot anticipate the recommendations of the review. One of the spurs to conducting the review was precisely the extremely slow progress being made on the basis of the specialty reviews in 1993. If I were politely to describe the situation as glacial, that would be optimistic. What was occurring was the simple freezing of arrangements which must go forward, as the noble Lord suggests.

Lord Desai

My Lords, will my noble friend inform me whether the committee will look carefully at the cost accounting procedures which have been used and which have disadvantaged all inner-city hospitals?

Baroness Jay of Paddington

My Lords, the review will cover the financial procedures.