HL Deb 03 February 1998 vol 585 cc518-32

3.47 p.m.

Baroness Jay of Paddington

My Lords, with the leave of the House, I should like to repeat a Statement on the future of London's health services being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

"At the general election we made clear that we wanted to make sure that every Londoner has access to top quality healthcare. We promised a moratorium on all hospital closures in London, while the future of London's healthcare was re-assessed against what Londoners really need. We have kept that promise.

"On 20th June last year, just seven weeks after coming to office, I announced that a swift and independent review of London's health needs was to be carried out by a distinguished panel chaired by Sir Leslie Turnberg, then President of the Royal College of Physicians, formerly consultant physician at Hope Hospital, Salford and professor of medicine at Manchester University.

"Since then the review panel has done a remarkable job. It has reviewed all the evidence, consulted widely and carried out a large number of meetings and visits. The panel received and considered over 1,800 responses from local people and organisations. It submitted its report on 18th November. Since then it has been considered very carefully by the Government. We have been faced with some tough decisions.

"Today, seven months after the panel was established, I am publishing the report of the independent review panel, the Turnberg Report. I am also publishing the Government's response. The Turnberg Report spells out a clear set of recommendations for the improvement of health services in London. I am glad to be able to announce that the Government accept all its recommendations. Many are in line with our proposals in the New NHS White Paper for a 10-year general improvement programme to make the NHS modern and dependable. All are accepted by the Government and the necessary further work necessary is already being put in hand.

"Time does not permit me to list all the important recommendations in the Turnberg Report. So I shall concentrate on a limited number of most immediate interest to Londoners.

"The report recognises that in many parts of London, particularly in the most deprived areas, primary care, mental health, intermediate care and community services are simply not up to the standard to which everyone in our country is entitled. It proposes a range of measures to bring things up to scratch. We will be providing an additional investment of at least £140 million in these services for London over the lifetime of this Parliament. An extra £30 million will be targeted on these services in the coming financial year.

"The report recognises the need for new arrangements to ensure a London-wide strategy for health and proposes as a medium-term aim a single NHS regional office for London. Without London-wide strategies and action, the necessary improvements in mental health services and the proper integration of services for children and other people will be hard to achieve, if not impossible.

"The report concluded that there is no evidence that, 'there are more acute hospital beds available to Londoners than the English average'. The Government have therefore abandoned the presumption we inherited from our predecessors that London is overprovided with acute hospital beds. As a result any future changes in bed numbers in London will be in line with those in the rest of the country.

"The review panel was asked to look at the plans of London NHS trusts and health authorities, including their plans for capital developments. It was asked in particular to advise on the future of Queen Mary's Hospital Roehampton, Harold Wood and Oldchurch Hospitals in East London and St. Bartholomew's Hospital.

"For these purposes the panel reviewed London hospital provision in terms of five sectors covering north, south-east, south-west, west and east London respectively. It faced some awkward choices and made some tough recommendations. The Government have made similarly hard-headed decisions.

"For north London, the panel said that a new hospital building was sorely needed to bring together University College Hospital, the Middlesex Hospital, the Hospital for Tropical Diseases and the Elizabeth Garrett Anderson Hospital for Women. This would provide top quality local and specialist services with academic and research facilities shared with University College nearby. As Secretary of State—and as the local MP—my right honourable friend warmly endorsed that proposal.

"The panel also recommend urgent capital investment at the Whittington Hospital. We will invite plans for such improvements. The need for swift action is understood. But it will take time to carry out all the necessary evaluations before work can proceed.

"For south-east London, the panel endorsed the proposal to build the new Queen Elizabeth hospital at Greenwich through the private finance initiative. It also supported the proposals for further improvements to King's College Hospital on the Denmark Hill site.

"The panel considered the proposal to close the accident and emergency unit at Guy's Hospital. It called for a re-evaluation of the proposed closure to ensure that the alternative services will be able to cope. This evaluation has taken place. Additional A&E capacity is already in place at King's and Lewisham Hospitals. The situation will continue to be closely monitored in the lead-up to the closure of the Guy's A&E department and beyond. Contingency plans will be put in place to provide additional services if patient numbers are higher than expected.

"The panel also called for a re-evaluation of the proposed shift of other services from Guy's to St. Thomas's to ensure that the best use is made of some of the facilities at Guy's which on present plans would be vacated. That is likely to keep more services at Guy's than was planned by the previous government.

"In south-west London the panel favoured plans for investment in the development of a community hospital on the site of Queen Mary's Roehampton. This means the replacement of acute services currently provided at Queen Mary's by improved alternative acute services at Kingston Hospital and at St. George's. The Government accept this proposal.

"The panel also endorsed a proposed shift of services between St. George's and the Atkinson Morley Hospital.

"In west London the panel supports the shift of services from Queen Charlotte's to the Hammersmith site. It also called for special attention to be given to the need to foster the national and international role of the Hammersmith and its relationship with Imperial College. A series of service reviews is now under way in west London, addressing this aim and the need to serve local people.

"It was in east London that the panel faced the most difficult problems. It was asked to consider proposals involving the future of Harold Wood and Oldchurch Hospitals. It supports the development of a new hospital at Oldchurch, rather than at Harold Wood, to provide the full range of services for this area, not least because this is where the majority of the population live, including those with the greatest health needs. Like all other new reconfiguration proposals, this proposal will be the subject of local consultation.

"For the East End the panel recommended a package of measures to counter the deprivation and ill health of many of the local people. It proposes investment in intermediate and community services. It also proposes the full utilisation of beds at the Homerton and Newham Hospitals and new investment at Newham.

"The panel endorses the proposal to rebuild the Royal London Hospital at Whitechapel but with 900 beds rather than the 1,100 in the current stalled plans for that re-development. These have been difficult decisions.

"That leads me on to the future of St. Bartholomew's Hospital. The Turnberg Report recommends that Bart's should not close. The Government agree. Bart's will be saved. We will not countenance the closure of that great hospital which has served the people of London for 875 years.

"During the time the new Royal London Hospital is being built and other hospital developments are taking place in east London, Bart's will continue in its present role. When that period comes to a close, in line with the proposals of the Turnberg Report, Bart's will concentrate its renowned specialist expertise with a focus on cancer and cardiac services.

"We owe a great debt to Sir Leslie Turnberg and his colleagues for both their work and their wisdom. I believe that the Turnberg Report will prove to be a far-reaching and far-sighted plan for the improvement of health services in London. The Turnberg proposals have the backing of the Government. They have the personal backing of the Prime Minister. They will provide a firm foundation for a 10-year programme to provide London with a modern and dependable health service. That programme paves the way for the investment of well over £800 million to provide London's health service with the fine modern buildings that both patients and staff deserve, with support for primary care and mental health of at least £140 million. That is a £1 billion boost for London.

"There have been many reports on the future of healthcare in London. Some have mouldered on library shelves; others have been the subject of endless and indecisive debate. And all the while buildings have been left to deteriorate, staff have been left uncertain and patients have been left to wait. That will not be the fate of the Turnberg Report.

"By accepting all its recommendations the Government have turned this excellent report into an action plan to modernise London's health service. From today we will be mobilising all those who care about London's health services, not just the people who work in the NHS but also people in local government and universities, scientists and other researchers, people in business, patient groups and local people, mobilising them to work together systematically to deliver the improvements that we all want to see year by year. That is what the Turnberg Report recommends. That is no more than Londoners deserve. The chattering times are over. The time for action has come".

My Lords, that concludes the Statement.

3.57 p.m.

Earl Howe

My Lords, I am most grateful to the Minister for repeating the Statement. This is long awaited news and, to the extent that decisions have been taken to resolve some major uncertainties, it is news which is decidedly welcome. As the Minister said, our thanks are due to the Turnberg Committee for its careful and diligent consideration of these difficult issues. For the most part, too, the content of the Statement should be welcomed. However, I am a good deal less sanguine about one aspect of the announcement. I feel that the decision to reinvent Bart's as a specialist tertiary referral centre, attractive as that option may appear, requires very careful explaining indeed as regards its cost-effectiveness.

I should like to return to the question of Bart's in a moment, but perhaps I may come, first, to the main thrust of the announcement. It is fair to say that the problems being faced and the decisions to be taken as regards healthcare in London are absolutely no different from those currently being addressed in a number of big cities around the world. Acute hospital services need to be concentrated in fewer sites to maximise the benefits which patients can receive from specialist skills and expensive equipment. Accident and emergency departments need to be positioned next-door to intensive care and other specialist services and, not to be forgotten, medical and nursing staff need the best possible environment for training.

There is no argument about London's importance as an international centre of excellence both in treatment and in teaching. Whatever is done to change the nature and structure of London's hospitals, nothing must be allowed to place that excellence in jeopardy.

At the same time the thrust of Turnberg has been to acknowledge that, with the decline in London's population and with the huge advances in diagnostic and surgical techniques, the status quo is simply not an option. Londoners themselves need a different hospital service and indeed a change in the balance of health services as between those provided by GPs, by hospitals and in the community. The detailed decisions which the Government have taken have no doubt been complex. I do not think we should underestimate their considerable emotive aspect for Londoners all over the capital. No doubt Londoners, like Members of these Benches, will need time to digest what has been announced in terms of the scope and coverage of local hospital care.

The Minister has said that the presumption that London is over-provided with acute beds is to be abandoned. I think that that is a perfectly fair conclusion. Indeed, I believe we should welcome it. It was always said by Tomlinson in his report that if the rate of emergency admissions should increase, more beds would he needed. Professor Jarman was right in the views that he advanced consistently on this issue. It makes sense for Guy's to meet some of the need, as the Minister indicated that it will.

I turn to the issue which has perhaps aroused the greatest degree of interest in London, that of Bart's. The Statement refers to that noble hospital having been saved. I wonder whether that description is entirely appropriate. Of course we can only welcome the tertiary referral centre in terms of the services that it will provide. I have absolutely no doubt that the standards of care for cancer and cardiac patients from all over the country will be second to none. But the point that will not be lost on Londoners is that Bart's will no longer provide any of the local services normally provided by a district general hospital. Can the Minister say whether the boards of the Royal Hospitals Trust and East London and City Health Authority agree with the decision on Bart's? Did they believe that it would be more efficient to maintain split sites rather than transferring all services to a new hospital on the Royal London site? Do they agree with the decision to split hospital services and reduce the size of the new hospital which is being built with private funding?

I repeat that the standards of care to be offered at Bart's are not in question, and nor should they be. However, does not the Minister agree that such specialist hospitals—as Bart's is now apparently to be—run contrary to most expert opinion? Do not the Government believe that there is real advantage in having all specialist services grouped together on a single site? Equally important is the budgetary aspect. What estimate has been made of the additional cost of this decision as compared with the alternative which was to close Bares altogether? I understand that the local health authority is already running a sizeable deficit. The question needs to be asked as to how it will be reimbursed for the additional costs to be incurred.

It looks very much as though before the election Labour exploited the save Bares campaign, but now that Labour is in office it is not prepared to give local people what they want, which is a local district general hospital service on the Bart's site. What is being offered is a tertiary facility which could just as easily—and less expensively—have been provided as part of the new Royal London. It looks very much as though the people of East London will have to pay for that expensive decision. Will the Government publish the cost estimates of the two alternatives? Does the Minister agree that what is needed in East London is really better primary care, and that there are surely knock-on effects of the Bart's decision in that regard? Will she confirm that the extra costs arising from these decisions will reduce the budgets for local services, including primary care services, and that the people of East London will not gain much advantage from these tertiary services at Bart's, although they will be excellent in their own way? I feel that there is much in this Statement which is good news for London but much that needs to be explained. I look forward to hearing what the Minister has to say.

4.6 p.m.

Lord Newby

My Lords, we on these Benches are also grateful to the Minister for repeating the Statement and also for the extraordinary amount of work which the Turnberg Committee has undertaken in producing a comprehensive report in such a short time. We should ideally have liked to see the report at the time the Government received it so that we could have studied it at the same time as Ministers. We cannot see any particularly strong reason why that should not have been the case. It is, of course, much more difficult to influence decision-making at the point when Ministers have not only had the report but have had several months to chew it over before anyone else has seen it. and then produce firm proposals.

That having been said, we find much in the report to welcome. We also welcome the Government's commitment to a strategic review of the provision of health services in London. We are therefore slightly surprised to read the weasel words that the report proposes as a medium-term aim the establishment of an NHS regional office in London. We find the words "medium term" somewhat worrying as regards what appears to be a relatively modest institutional change within the NHS. Can the Minister help us by explaining what kind of timescale she envisages as medium term? Much as we enjoy discussing these issues in this House, as do our colleagues in another place, we believe that the correct place primarily to discuss the strategic needs of London health services is within a strategic authority for London and Londoners. Does the Minister believe that strategic healthcare is a matter that could sensibly be added to the powers of the proposed GLA? We would welcome the Minister's views on that.

We wish that the Statement had included what most strategic documents mention; namely, overall figures on beds, doctors, nurses and those other matters that concern Londoners when they consider healthcare. I raise that matter because we believe that when new hospitals are built under the PFI there is an inexorable pressure to reduce the number of beds. We have seen that in the proposals before us today in respect of the Royal London Hospital where it is proposed that 200 fewer beds are now provided than was originally proposed, at a time when some estimates at least suggest that the 1,100 that were originally provided might be insufficient. We wonder therefore whether Bart's might face a slightly odd fate, even when the Royal London is open, in that there will simply not be enough acute beds elsewhere in East London and Bart's will be required to continue to provide that kind of facility well beyond the medium-term, however that is defined.

Your Lordships will be relieved to know that I do not propose to discuss the individual proposals in detail. However, I raise a general point with regard to Queen Mary's at Roehampton. In many cases what we are talking about here is replacing one provision with another. We are moving from one static position to another. We are concerned about what happens in the meantime.

I welcome an assurance that the provisions of Kingston—they need to be enhanced to match the increased demand which will arise as Queen Mary's services are transferred—will come on stream before they are required rather than months afterwards, and after patients have faced additional difficulties during the transitional period.

Two overriding issues are dealt with in the Statement. The first is a proper strategic framework for decision making in London. We feel that the Government have made some progress on that. Some of the progress is to be welcomed, but we believe that there is need to go further. The next key question relates to whether the Statement is satisfactory in terms of the overall level of resourcing of the special health needs of London. We are pleased to hear confirmed the additional funding for primary services, mental health, intermediate care and community services. Those funds are desperately needed. There must be more cases of acute under-provision in London than anywhere else in the country. Those of us who live in south London have in mind, for example, the horrendous murder in Tulse Hill a couple of weeks ago by a patient with severe mental health problems. That patient was not receiving the care in the community required. We can only welcome any action to improve and increase the level of funding for those Cinderella services. It is desperately needed, in particular in London. We are unconvinced that the proposals will be enough to provide the first-rate health services that Londoners need and deserve.

If we were confident that an NHS body, or the GLA, would discuss the issues at a strategic level, we might allow the matter to rest there. However, those bodies are unlikely to be in position for some considerable time. I hope that after an appropriate period the Minister will report again to the House on the progress made towards achieving the ambitious goals set out in the Statement. At the same time I hope that the noble Baroness will come forward with any further proposals necessary for funding or structural arrangements to meet those goals.

Baroness Jay of Paddington

My Lords, I am grateful to both noble Lords for their general welcome of the Statement, and in particular for their acknowledgement that the time has come to take some definitive action about the problems of London. On the final point of the noble Lord, Lord Newby, I always welcome the opportunity for further discussion of these issues. Indeed, I believe that there is a debate tomorrow in your Lordships' House in which they may well be covered

I am grateful, too, for both noble Lords' commendation of Professor Turnberg and his committee for their hard work, and for precise recommendations which we have welcomed and accepted. The noble Lord, Lord Newby, raised concerns about the way in which the proposals may have been set already in immoveable concrete. I hope that noble Lords understand that all the proposals that the Government have accepted which refer to major service reconfiguration will be subject to the normal consultation processes in which the health service always engages at these times.

The noble Lord, Lord Newby, referred to the need for a strategic approach to London's healthcare. The Government entirely accept that. It is the reason that we accept the proposal of Professor Turnberg and his panel that there should be one regional office for London. The use of the words "medium term" simply refers to the need, as we see it—and as he sees it, I think, given his subsequent remarks—for the potential for including the development of the London regional office for health alongside, and in connection with, the greater London authority which is still subject to the legislative process and the other complications with which your Lordships are familiar. In that sense, medium term simply refers to development rather than kicking the issue into touch in any sense.

The noble Lord also referred to the difficulties of mental health services in London. The report acknowledges, as do the Government, that they are a specific problem. The noble Lord and other Members of your Lordships' House will be aware that at the end of last year we undertook a review of mental healthcare. We are about to receive the report. I hope that it will inform some of the difficult decisions which need to be made. The noble Lord may know that additional funding of £5 million has been allocated to mental health services to help reduce the pressures on acute psychiatric beds by buying extra residential 24-hour nurse-staffed places for what we hope will be more effective approaches to patient crises. We hope that that will reduce in-patient admissions. Noble Lords may be aware of the concerns publicly expressed by my right honourable friend the Secretary of State about the validity or otherwise of dealing with some of those acute psychiatric problems exclusively in the context of community care. We shall bear that very much in mind as we develop the plans in London.

The noble Lord referred to the revised plans for 900 beds in the Royal London Hospital in the new redevelopment programme. He spoke, as did the noble Earl, about the acceptance that the original assumptions made by Professor Tomlinson on the need for acute beds in London may perhaps have been over-optimistic in the sense of the needs of London as we progress.

The noble Lord, Lord Newby, mentioned the conjunction of beds in the Royal London and Bart's. It means that as beds are kept open at Bart's, the need for the 1,100 beds on the original PFI project is regarded as unnecessary. But that in no way diminishes our concern to maintain the overall numbers of acute beds.

As it was the main burden of the noble Earl's concerns, I turn to the question of whether or not re-inventing Bart's, as he describes it, was an unnecessary procedure. The noble Earl will be aware, as indeed will your Lordships, of the success of specialist hospitals in other parts of London and the country. I cite the example of the Marsden Hospital, Christie Hospital in Manchester, or the Papworth Hospital in Cambridge. They suggest that such specialist hospitals for particular forms of tertiary care play an important role in our health services and healthcare. They are often very much part of the local community although they provide a specialist service. Although the noble Earl felt that it would not be an attractive proposition to the population which surrounds Bart's Hospital, I emphasise that again there will be an element of public consultation. I suspect that the local population will applaud the fact that the site is to continue to be used for health services rather than for some of the perhaps glamorous but not necessarily health-related suggestions made in the past.

As regards relative costs, the Government have considered with concern the precise difference between capital expenditure and revenue costs. At present the view is that the plans now proposed will not be radically different in capital costs from those proposed in the previous plan although the proceeds from a potential sale of the Smithfield site will no longer be available. Account will also have to be taken of the revenue costs associated with running the two sites. That will he an immediate issue for the East London health authority which the noble Earl rightly says will take the lead in developing the new strategy. I must point out to the noble Earl that these plans have been developed with its understanding and concern to work through that new strategy in a positive way, both to develop the high quality community services as well as the acute services for the East End.

I conclude by saying that I am pleased that both noble Lords made reference to the development of primary care in London. I believe that that is the priority with which we need to be concerned. I was glad to report that there will be substantial investment in that area. We feel that it will be the most important ingredient in transforming many of the everyday services which mean most to families living in London and in the long run will make the greatest difference to the status of the health services throughout the capital.

4.20 p.m.

Lord Annan

My Lords, will the noble Baroness enlighten the House a little further regarding the rebuilding of the hospital opposite University College? Is the new site to be that which is opposite University College, or is it to be the site presently inhabited by the Middlesex Hospital? How will it be possible to build a new hospital in close proximity to University College?

I very much welcome the whole scheme and hope to be convinced by it. I am less convinced by the arguments in favour of Bart's being kept open. The noble Earl put his finger on many spots which require examination. How is it possible, in terms of cost-effectiveness, that 200 beds kept open at Bart's will be cost-effective as compared with the extension of 2 x 200 beds at the London Hospital? The population needs those beds at the London Hospital. not in the City of London.

Baroness Jay of Paddington

In response to the noble Lord's final point, I respectfully draw his attention to the great success of those tertiary centres for specialist care with that size of provision which exist in other parts of the country. As I believe I made clear both in the Statement and in my previous remarks, it was not intended that Bart's should remain as a district general hospital; however, given the specialist services, we feel that there will be very important provisions.

As to the University College Hospital site, that will be on the Gower Street site and will incorporate the Elizabeth Garrett Anderson Hospital, the Middlesex Hospital, the Hospital for Tropical Diseases and the other medical centres of excellence which at present are very broadly in the University College campus, but not in one building.

Baroness Ludford

My Lords, I declare an interest as a leading member over the past five years of the Save Bart's campaign in my role as a local councillor whose ward is a mere 250 yards from Bart's. Like my noble friend Lord Newby, I welcome some elements of the Statement, particularly the new hospital bringing together UCH, the Middlesex, the EGA and so on, the new investment at the Whittington and the Royal London, the retention of more services at Guy's. I also especially welcome the abandoning of the presumption that London was over-bedded.

However, I wonder whether the Minister is correct in saying that local people will applaud the retention of some health services on the Bart's site. I fear that when local people listened to the promise made before the general election by her right honourable friend in the other place, now the Secretary of State for Culture, Media and Sport, that a Labour Government would save Bart's, they would have thought that that meant as a district general hospital, not as a specialist tertiary centre. I fear that local reactions might vary from, "This is half a loaf", to even the word "betrayal". Can the Minister therefore give any reassurance to local people? The NHS White Paper to which she referred contained a reference to the "freedom to refer- of primary care groups. Will there be patient choice, in the sense that if the residents of south Islington or south Hackney wish to be referred to Bart's for a wider range of services—which, as she explained, will remain on the site for the next few years while the Royal London is redeveloped—they will be able to exercise that choice through their GPs? Will the Minister give an assurance that the situation at Bart's will be monitored over those years of transition, so that, if it becomes obvious that London is not only not over-provided but is under-provided with acute beds, there will be a chance to reassess the situation?

Baroness Jay of Paddington

My Lords, the simple answer to the noble Baroness's last point is no. The decision has now been taken about Bart's. I am amazed that she should describe that decision, on which I have elaborated in some detail, in such emotive language as "betrayal". This is a sensible use of the available resources. It uses the plant that exists at the Smithfield site and the very considerable medical and scientific expertise which exists at that site to provide a specialist service. As I said in reply to the noble Lord, Lord Annan, and to the noble Earl, we believe that there are very good examples of that kind of service being well provided. The noble Baroness's remarks merely illustrate the difficulties of the decisions that had to be taken in the context of cost-effectiveness, as pointed out by the noble Earl, and the remarks of the noble Lord, Lord Annan, about the potential for different uses of these beds. The right decision has been made, and that right decision is one that we shall stick with.

Lord Shore of Stepney

My Lords, as someone who has represented for more than 30 years the East London area in which the London Hospital is located, I wish to state how much I welcome—as I am sure local people will—the good sense that the Government have applied in their study and the urgent review that they have carried out. I welcome in particular the conclusion reached in the review, which the Government have accepted, that the previous government got it all wrong—the fons et origo of the mistakes of the past 10 years—in saying that London was over-provided with hospital beds.

Baroness Jay of Paddington

My Lords, I am grateful for my noble friend's support for these decisions. His experience is long and authoritative; it has deep roots among that population in East London. I am delighted that he feels that this proposal will be popular in that part of London. We look to the investment and involvement of the people in that community in developing the right sort of services—not simply through the revised hospital proposals but also in the very important primary care services. I am sure that my noble friend will do what he can to encourage that.

Lord McColl of Dulwich

My Lords, I wish to ask a very brief question about the re-evaluation of the proposed shift of other services from Guy's to St. Thomas's. I declare an interest; I work at both institutions.

I realise the problem of building new facilities at St. Thomas's to take the place of the services provided at Guy's. However, in view of the brand new hospital building there and the excellent facilities, particularly in ENT, who exactly will carry out the re-evaluation of the proposed shift? Clearly it will be quite difficult for the management of the Guy's and St. Thomas's Hospital Trust. I congratulate the Government on the choice of Sir Leslie Turnberg. He is an excellent physician and is very much respected by the profession.

Baroness Jay of Paddington

My Lords, I am very happy to accept that endorsement of Sir Leslie Turnberg's great skill in taking these proposals forward. I think the noble Lord will understand that the questions of management of the change between Guy's and St. Thomas's are, we hope, now that they are in a unified trust, subject to discussion around the table rather than confrontation between rival groups. The noble Lord raises his eyebrows. Perhaps I am more optimistic than the noble Lord, and his local knowledge does not give him that confidence. Sir Leslie's panel highlighted concerns that the extensive building going on at the St. Thomas's site might not represent value for money in the light of the capacity available at Guy's. We accept that view. That means the Department of Health and the NHS executive as well as the local trust, and the South Thames regional office are to review the options, which will probably mean that more services are left on the Guy's site. Precisely which services those are and how they are best configured will clearly be a matter for local discussion.

Lord Winston

My Lords, I declare an interest as a member of the newly-enlarged Imperial College School of Medicine. I believe that the report will be widely welcomed throughout London. The tenor of the Government's response to it is apposite. I particularly like the notion that firm decisions will be taken.

Perhaps I may draw my noble friend's attention to a problem that has dogged London medicine very seriously. As noble Lords will know, London medicine is largely academically led. Many of the hospitals mentioned in the Statement are academic hospitals. One of the problems in London has been a consistent blight on research, and particularly recruitment, because decisions were rather slow in being taken. Will the Minister assure the House that we shall not be kept waiting again and that any decisions needing to be taken will be taken with all speed, so that London medicine and London medical science can get on with the job of improving and maintaining the health of the nation?

Baroness Jay of Paddington

My Lords, I am delighted to reassure my noble friend that decisions will be taken promptly. I cannot give him quite the same assurance about the nature and type of procedures needed to effect some of the changes. For example, some of the capital programmes are subject to the PFI process, in itself a procedure which can take some time. As my right honourable friend said in the Statement which I repeated, this is, like the NHS White Paper, a 10-year programme in which we would expect to see visible improvement year on year but not all delivered within the first year. I hope that my noble friend will have heard the points in the Statement about the need to look at the configuration of London health services in this sectoral way, which enables the connection between the medical schools and the academic medical fraternity to be allied with the service provision in a way which makes sense for both parts of the healthcare system.

Baroness Nicholson of Winterbourne

My Lords, I congratulate the Minister and her colleagues on this remarkable new thinking for London healthcare. I declare an interest in Guy's Hospital as a foster parent of a child who has had many operations in the burns unit. With that experience, perhaps I may ask the Minister to think carefully about the transfer of burns services for London patients long-term from Queen Mary's Hospital, Roehampton, to Guy's Hospital itself. That would give a new reason and focus for Guy's to use the wonderful new facilities which the previous government appeared to be going to discard. As I understand it, there was no long-term planning at all in the previous thinking for London burns patients but merely short-term and possibly mid-term planning.

Baroness Jay of Paddington

My Lords, I am grateful to the noble Baroness, Lady Nicholson. She was kind enough to write to me and also, I understand, to Sir Leslie Turnberg about the proposal with regard to burns services. My understanding is that the burns and plastic surgery services were looked at in the strategic review which reported last autumn. Consideration was given at that time to the possibility of transferring burns services to Guy's or St. Thomas's but the steering group continued to recommend the transfer of those services to the Chelsea and Westminster Hospital, to remain within the South Thames Regional organisation. The noble Baroness will have heard that, as I said in response to the noble Lord, Lord McColl, the capacity at Guy's to retain certain services which might have been moved to St. Thomas's could perhaps produce another possibility in this area. At the moment I can only refer back to the previous appraisal which suggested moving the services to Chelsea and Westminster.

Lord Aberdare

My Lords, I was interested in the mention of the Elizabeth Garrett Anderson Hospital for Women. I have always had a great admiration for that hospital and had hoped that it would continue to be exclusively for women. It is not clear to me from the Statement whether it is in some way to be subsumed into University College Hospital.

Baroness Jay of Paddington

My Lords, I am sure that the characteristics and quality of the services of the Elizabeth Garrett Anderson Hospital, with which I am sure we are all familiar and about which we feel strongly, will retain their independence, but the buildings will become part of the new University College Hospital, which, as the noble Lord knows, is literally across the street from the old site.

Lord Rea

My Lords, as a practitioner who spent most of his professional life working in north London, perhaps I may say how pleased I am that the decision has finally been arrived at with regard to the UCL hospitals. I welcome also the further strengthening of primary care, particularly in east London where it is much needed. Another thing which greatly pleases me is the decision at last to have a strategic regional office for London. This is something my noble friend will recall arguing for over many years when we were in opposition. Can the Minister say what will happen to the current north and south London regional offices? When there is a strategic London office, will the peripheral health authorities be attached to another regional office or will they form their own? Will the regional strategic office be coterminous with the new GLA?

Baroness Jay of Paddington

My Lords, I am grateful to my noble friend for his remarks. He may he pleased to hear with regard to the UCLH building that we expect that the trust and its PFI partner will now be authorised to go ahead to financial close, which we expect to take place reasonably quickly.

With regard to the precise definition of what the regional office will cover and what its remit will be with the peripheral health authorities, I am afraid I cannot take that any further this afternoon. As I said in an earlier reply, this is in a sense rather ephemeral at the moment. Although there is a clear intention, there needs to be precise discussion about the relationship with the GLA, as I mentioned in my response to the noble Lord, Lord Newby, who picked up the use of the description "medium-term" in relation to this plan. I hope my noble friend will be reassured that it is a definite plan. The precise configuration and definition are still matters for discussion. My noble friend reminds me of the determination which he had to try to introduce this in the earlier health authorities Bill. I am sure he will also remember the extremely arcane discussions we had about the nature and definition of any possible strategic authority.

Lord Desai

My Lords, I too welcome the Government's decision as a consequence of Tomlinson. I was not one of those who joined the "Save Bart's" campaign, despite my east London connection, because I was convinced that something drastic needed to be done about the old buildings. I therefore welcome the proposal.

If London is to have a strategic regional authority, will the Minister bear in mind when making decisions the treatment of drug abusers? I do not ask for an answer this afternoon. As she knows, I have a connection with City Roads, a drugs intervention charity. One of the major problems of provisions for dealing with drug abuse in London has been the lack of an overall London authority.

Baroness Jay of Paddington

My Lords, I am grateful to my noble friend. An important part of the report by Sir Leslie Turnberg's panel which we have not discussed in your Lordships' House since it was not mentioned in the Statement—as my right honourable friend said, it was impossible to cover everything—is the great emphasis on the need for greater inter-sectoral and inter-agency working on such issues as drug abuse and the other social problems which contribute so much to the ill health of Londoners. A major recommendation of Sir Leslie's report is to invite health authorities, local authorities and voluntary organisations, such as City Roads, to work together to try to formulate more strategic plans for integrated care.