Westminster Hall Sitting of 25 May 2004

Preamble
[MR. EDWARD O'HARA in the Chair]

Specialist Health Services (West London)
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Gareth Thomas.]
9.30 am
Mr. John Randall: I am grateful to have the opportunity to raise issues that are important not only to my constituents but to people in the wider area of west London—perhaps I should say Middlesex.
When London's specialist health services are mentioned, people tend to think of the famous names—for instance, the Great Ormond Street children's hospital, Moorfields eye hospital and the Royal Marsden hospital. However, the area of which I speak, although designated as west London by the national health service management, is outside that central, inner core.
I am delighted to see my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson) here today and, in our part of west London, Harefield and Mount Vernon hospitals and the Royal National Orthopaedic hospital at Stanmore come to mind as beacons of excellence. All are situated in beautiful and peaceful rural surroundings—the antithesis of city life—and all are efficient, respected and valued. Having spoken to many patients, I would say that they are loved and cherished.
None of those hospitals is more famous than Harefield; under the leadership of Sir Magdi Yacoub and his team, it has pioneered advances in heart care, and has carried out more heart transplants than any other hospital. The result is that the name of the English village in which it is situated, from which it takes its name, is known all over the world. Sir Magdi Yacoub's heart science centre is also on that site, ensuring that bed and bench—patient and research—are near each other, to the benefit of all.
Last August, Harefield's clinicians again demonstrated that they remain in the forefront by performing the first heart bypass in this country with a local rather than a general anaesthetic. We should congratulate them on such a wonderful advance. Risks will be fewer for such patients, and recovery times will be shorter, which will ease pressure on hospital beds.
Despite such advances in patient care outside London, two of the specialist hospitals that serve my constituents and so many others are under threat. They are Mount Vernon and Harefield. The public reaction to that threat was anger tempered with disbelief, made more so by the fact that the views of patients and the public have been ignored. The way that they have been treated, and continue to be treated, makes a joke of the Government's policy of patient and public involvement in health care.
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Those who are fighting for Harefield's survival have tried to gain the ear of the Secretary of State for Health. However, the request by my hon. Friend—the hospital is in his constituency—that the Secretary of State meet the hospital's representatives has been refused.
Mr. Andrew Lansley: My hon. Friend refers to patient and public involvement in health. Last week, I sought the names of the members of the patients forum at Addenbrooke's hospital in my constituency, only to be informed by the Commission for Patient and Public Involvement in Health that such names were not yet available. Indeed, the commission said that it proposes this week to write to members of the forum to ask whether their names can be made public. As the forum has existed for some time, and as its role is meant to be representative, that seems rather remiss. Has my hon. Friend had any greater success?
Mr. Randall: I am hardly surprised by that lack of success. My hon. Friend may be interested to know that, as a result of a recent parliamentary question, I found that the turnover of members of such forums has been surprisingly high, with a large number of resignations. Perhaps the commission cannot give the names because members do not stay long enough.
As I was saying, the request made by my hon. Friend the Member for Ruislip-Northwood to meet the Secretary of State for Health with the representatives of Harefield hospital was unfortunately unsuccessful. A similar request, made by the chief executive and chairman of the hospital, was ignored by his predecessor. However, my hon. Friend has previously given us much of the history, so I shall move on to the issue that interests me: the business side of the Paddington health campus scheme.
By taking its work, the Paddington health campus would close Harefield hospital. My interest in the issue grew after I learned that the project costs had escalated from £360 million in 2000 to £800 million in 2003. By then, the press were beginning to compare the campus to the millennium dome and estimated the eventual cost at £1 billion. The doubling of the costs in that short period is equivalent to a financial fire alarm going off—it means that the original business case is bound to have been flawed.
When it also became clear that the Paddington scheme did not have planning permission, despite having applied for it in 2000, I asked a question in the House. NHS management does not have expertise in schemes such as the Paddington health campus, so they must make use of external advisers. Given that so little visible progress had been made, I wanted to know how much had been spent on advisers. The Minister's response in November 2003 was that £3.177 million had been spent on external advisers up to the end of March 2003. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) later asked a question on the same subject and found that more than £5.5 million had been spent by the end of December 2003. That is well over what was spent on the new patient centre at Harefield hospital.
On 23 March 2004, I asked the Minister for a progress report on the Paddington health campus. I noted that

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the word "progress" was rather a contradiction in terms when applied to the scheme because there had, quite blatantly, been none. I said:

"seldom has so little been done by so many at such great cost to the public purse"—[Official Report, 23 March 2004; Vol. 419, c. 695.]

I respect the Minister, who takes these matters seriously, but I am afraid that on that occasion—perhaps because he was in the bear pit of Question Time—he rejected my concern on the grounds that I was against the project. I am not, however, against the project per se—I am against wasting public money on a project that has lacked viability since September 2002.
I was surprised that the Minister rather brushed aside such legitimate concerns, given that the doubling of the costs has led to an independent inquiry. The Department is one of the participants, and the others are the Treasury and the National Audit Office. The inquiry is reviewing not only the rise in costs but how the situation arose. Given that it is supposedly independent, I thought that the Minister might have given a slightly different answer—that he was aware of the concerns but would reserve judgment, pending the independent inquiry's report. However, I have never reached the dizzy heights of being a Minister so I do not understand quite how such answers are produced.
The Minister did not inspire great confidence when he did not appear to know that the Treasury and the NAO were involved in the independent inquiry into the project, which he said his Department was reviewing in conjunction with local health bodies. I would not describe the Treasury or the NAO as local health bodies. Furthermore, the statement that the Minister expected to make before the end of March about the future of the Paddington health campus has not yet materialised.
Sadly, no amount of spin can disguise the fact that the project is in crisis. We cannot ignore the fact that if the Government had listened to the solid arguments that well-informed bodies raised against the scheme, it would not have gone ahead. By informed bodies, I mean the community health councils of Harrow, Brent, Hillingdon and South West Hertfordshire, all of which objected to the scheme, but all of whose objections were dismissed. Barrie Taylor, then the chief officer of South West Hertfordshire CHC, which covers Watford, pointed out that should the project go ahead, it would lead to a diminution in patient care.
Mr. John Wilkinson: My hon. Friend makes some exceedingly important points. Does he remember the extraordinary fact that the health council that promoted the Paddington basin project was the one that was charged with analysing the results of the consultation? That is an amazing state of affairs. Everything was geared up from the start to produce the result that the Government desired, namely that the Paddington health campus project should go ahead regardless of public opinion, fairness or objectivity.
Mr. Randall: My hon. Friend is absolutely right. However, I am never surprised these days. I came to this place free from conspiracy theories, but the longer I go on, the more cynical I become, and the more inclined I am to believe such things. Perhaps one day I shall have my innocence restored to me.
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Perhaps hon. Members representing the area should concentrate on ensuring that Paddington's local hospital, St. Mary's which desperately needs attention, is improved. For a fraction of the cost of the project, both Harefield and Mount Vernon hospitals could be expanded and improved, and so retain invaluable staff. That would also solve the problem of space on the Paddington site. That is what Sir Magdi Yacoub counselled in May 2000, when he welcomed progress in London, but not at the expense of Harefield. Over the last four years the need has grown to retain specialist hospitals outside the capital. They are far less likely to be disrupted by threats of terrorism and transport problems.
Any building development, NHS or not, is governed by whether it is practical, affordable and good value for money. Paddington health campus does not meet any of those criteria. By September 2002, those managing the project knew that they were nearly one fifth short of space on the designated site and that it was impossible, within existing planning regulations, to accommodate such a shortfall on an inner-London-constrained site. There was also the knock-on effect of the £360 million estimated cost having been shattered by the need for more space.
Correspondence shows that, instead of stopping and reassessing the viability of the project, the management attempted to keep knowledge of the shortfall out of the public arena: it depicted the 17.5 per cent. shortfall as a 17.5 per cent. rise in the elderly population in the Paddington area. That is not borne out by census statistics. The term that is often heard in such circumstances is cover-up. However, why should one occur if there was no mismanagement? How could a project team put in its third amendment to a planning application, get a "minded to grant" in August 2002, and then realise the following month that that was useless, due to there being nearly 20 per cent. too little space? The only rational explanation is that the project team did not take into account the need for greater space in hospital planning, due to the higher consumer standards introduced by the Department of Health. Whatever the reason, by September 2002, the project had more problems than it had had at the outset.
Further losses could have been prevented by a reassessment of viability. Instead, the project management team ploughed on, seeking extra space off-site in the Paddington area, which would only add further cost to the project. It is self-evident that those who spend public money have a duty to ensure that it is spent wisely. Inability to get planning permission for a project on a designated site equates to the end of that project when the development is tied to that site. I do not think that I am painting too harsh a picture of the failure of the management of the project. A recent edition of Building magazine described it as problematic and the "PFI from hell". When those with knowledge of the construction industry make such severe criticisms, they cannot be brushed aside as being against the project.
An equally critical article in Construction News in March commented:

"Faced with burning millions bidding for a scheme that has not got planning permission, many firms will turn and run."

The conclusion must be that such an ill-fated scheme has brought the NHS and Government policy on PFI builds somewhat into disrepute. However, such remarks are

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perhaps rather unfair to PFI in this case, because no PFI partner was involved, neither has a PFI partner been advertised for. Whatever blame there is falls, I am afraid, on the management team.
Since 2000, the proposed Paddington health campus has been hard sold as an everything under one roof development for specialist services in west London. Harefield hospital is one of the most successful hospitals in the world, but the fact that it would close if the development were built has been ignored. Relocating Harefield is impossible, because its staff will not work in London, but that has also been ignored.
In response to a staff survey conducted as early as 2000, only 10 per cent. of Harefield's nurses said that they would be willing to work in the capital. In the latest independent staff survey the figure fell to 8 per cent., while the figure for all Harefield's staff was 7.1 per cent. In 2003, the Institute of Employment Studies reported that 19 per cent. of respondents intended to move, 46 per cent. had said no, and 35 per cent. were unsure. However, those percentages hide big differences between the Royal Brompton hospital and Harefield hospital. At Brompton, 24 per cent. of respondents said yes, 35 per cent. said no, and 44 per cent. were unsure. At Harefield, 8 per cent. of respondents said yes, 64 per cent. said no, and 28 per cent. were unsure.
When senior NHS management of the trust concerned has so obviously failed to persuade its staff that the project is worth while, there is a lesson to be learned. It is bad management to consider moving an organisation that employs skilled staff if they will not relocate and there is little or no possibility of replacing them in the proposed new area. The lack of management skills is compounded when the area chosen to relocate to is extremely expensive, making reasonably priced accommodation, whether rented or bought, an impossibility. Firms are relocating out of London, not into it, for that very reason. The shortage of NHS staff in London is well known. It results in huge agency costs, which strain NHS finances. Adding to that problem is irresponsible. Retention of staff is as important in the NHS as recruitment.
When permission was given to plan the project, certain undertakings accompanied it, including one to continue surveying staff attitudes to the proposed move. Rather than carrying that out and discussing the results sensibly, however, in 2002 the survey was evaded. In the latest staff survey, trust management refused to include the one question that was suggested on behalf of Harefield's staff by Heart of Harefield, which is an organisation fighting for the hospital's survival. The question was on retention of staff and simply asked what Harefield staff would say if the project did not go ahead. The probable answer to such a key question in assessing staff attitudes to the Paddington health campus made it unacceptable to those promoting the project. The Health Service Journal described it as a hair-raising question. NHS staff are its most important asset and we should treat their opinions with respect.
It is also unacceptable for those hard-selling the project to promote their scheme by denigrating the facilities at Harefield hospital. Harefield has a new patient centre, with the most up-to-date technology, two new operating theatres and new pathology labs, and ongoing plans to remove its older, disused buildings.
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There is still room for improvement, but Harefield is at a stage when patients ask whether the intention to close it down is due to the money being spent on it.
A Paddington health campus briefing note of 19 December 2003 gave the opposite impression of Harefield, however. Those reading it would be misled into believing that the hospital was almost contravening health and safety regulations and was so short-staffed that it would soon be closed. Such allegations are untrue. The briefing said that should Harefield hospital remained open for a longer period, it would

"require significant investment to remain safe and viable. This will exacerbate the already acute staffing and clinical governance problems that this site prevents".

It is disgraceful that a deliberate smear tactic against Harefield hospital should appear in a briefing document from the Paddington health campus project. It would have remained hidden, giving Harefield no chance to refute it, had the briefing note not been leaked to Mrs. Jean Brett, who leads the campaign to save this great hospital.
When such distasteful tactics are used, the Paddington health campus loses all credibility. Desperation and misinformation have now become its hallmarks. Misinformation also reared its head when the project team sought to make up the shortfall in space by leasing the Point building, a prestigious office block on the other side of the canal to St. Mary's hospital. The cost of leasing it would be enormous, and it was absolutely ludicrous for the project team to describe it as an investment, because money would be going out with no prospect of a return.
Leasing the Point building would incur costs in addition to the £800 million already on the table, yet in two presentations in 2003 the Point was talked up as the ideal solution for the decant of St. Mary's hospital and to the space problem. The most important fact was not mentioned, which is that the Point is the least suitable building for decanting a hospital.
The terms of the lease forbade any in-patient treatment, meaning that no patient could stay in the Point overnight. As unclear was the fact that the only access to the main Paddington health campus site from the Point was by a public footbridge over the Grand Union canal. In addition, only 25 per cent. of the Point could be used for medical purposes, and within that was a restriction on any substance abuse clinic. It needs to be remembered that we are talking about the Paddington area of London. Just as oddly, the use of the ground floor, which is the most accessible, for patient care was denied for clinical purposes. There are different ways of being economical with the truth—misleading by the omission of relevant facts is among the worst.
Such details mean that we have a fatally flawed project, where saving face has become more important than openness, accountability and a willingness to admit that serious mistakes have been made. Since February 2003, the project team has been made aware by Westminster city council that it has to put in a new planning application in order to make any progress. Fifteen months later, that new planning application is still not in. If there had been a viable solution to the space problem, it would have been found.

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[Mr. Randall]
Can the Minister confirm whether his answer of October 2003 about the number of beds in the Paddington health campus scheme still holds? The House was assured that the project would have 1,088 in-patient beds—80 more than those provided by St. Mary's, the Royal Brompton and Harefield hospitals. Will he also confirm whether the assurance still stands that the Paddington health campus now planned

"is 20 per cent. larger in size and will treat a higher number of acutely ill patients"?—[Official Report, 20 November 2003; Vol. 413, c. 1407W.]

The bottom line is that there has been an arrogant determination to force through this project, despite the lack of viability. The same arrogance of attitude was displayed in dealings with patients, members of the public and the objections of the community health council. The public consultation process was a farce. Before it had even started, a planning application for the project had been put in to Westminster city council. Planning applications for complex schemes take time, trouble and expense. Clearly, the public consultation process was to be cosmetic.
The lack of respect for the public consultation process was underlined when the post of project director was advertised before the consultation had ended. That is shocking and inexcusable. Events have now overtaken those planning the destruction of Harefield hospital. Two years away from its original completion date of early 2006, the Paddington health campus has not only made nil progress, but it is in a worse position than when it started. The completion date now varies between 2012 and after 2014, depending on which statement of the project is referred to. Its capital costs are unaffordable, its space problems insoluble and a supposedly independent review into how its £360 million outline business case was so flawed is still ongoing.
It is time to draw this tale of inefficiency to a close by abandoning the scheme. It was always described as a vision. I have no problem congratulating people on having a vision and wanting to achieve it, but I am afraid that that vision has turned into a bit of a mirage.
The clinical argument that every specialty needs to be under one roof, adjacent to accident and emergency departments, is as flawed as the management skills of those running the Paddington health campus project. Accident and emergency departments feed into Harefield—not the other way around. Due to advances in the skills of paramedic ambulance crews and the equipment that they carry, cardiac patients who need specialist care will be taken straight to Harefield. That has already happened, and it increases patients' survival chances.
Also flawed is the argument that because differing health problems sometimes appear in the same patient, other specialties should be on tap. It is well within modern technology for clinicians to confer on a patient visually without being in adjacent buildings.
The gross mismanagement of the Paddington health campus demands that there should be an independent inquiry, alongside which there should be an inquiry into why the public consultation process was such a mockery. I would welcome an explanation as to why, in
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December 2003, the Minister assured a London MP in writing that the Secretary of State had written to the Chief Secretary to the Treasury expressing confidence in the project and making it clear that he expected it to go ahead. There could not be greater interference during an independent review than for one of the involved parties to pressurise another.
I make no apologies for concentrating on Harefield hospital because of its link to the flawed Paddington health campus scheme, and because it illustrates how plans for major private finance initiative schemes can implode. The if it's not broken, don't mend it argument applies equally to Mount Vernon and to Stanmore orthopaedic hospital.
It is ironic that the chief executive of the excellent hospital at Stanmore was, for years, one of the main drivers for the Paddington health campus. Stanmore does not have an accident and emergency department and, like Harefield, is a specialist stand-alone hospital. However, instead of promoting its closure, its chief executive, Andrew Woodhead, is promoting a PFI plan to improve it. Those who support Harefield's retention agree with London clinicians that the bed and bench should be together for the benefit of all, as at the Harefield site. The research could not be led by a more eminent clinician than Professor Sir Magdi Yacoub. The Government's contribution to the heart science centre at Harefield contradicts any decision that could result in the loss of the adjoining hospital.
When the right hon. Member for Darlington (Mr. Milburn) was the Secretary of State, he officially opened the second phase of the Harefield research centre. That was greeted by applause from the assembled Heart of Harefield campaigners, but a far bigger cheer will go up when Harefield hospital is saved. The relocation of Harefield hospital is a euphemism for its destruction. The core problem is that its success has made it vulnerable to what might be termed clinical takeover bids from London.
In my seven years in this place, I have tried to take the middle line on most things, but with my business experience, and having looked at all the options, I am quite angry about this project. The Government would show great courage by putting an end to this project, and would save the public a lot of wasted money that is desperately needed in the NHS. It would be apt for the Government to remember that when the Home Secretary was the shadow Secretary of State for Health, he described a threat to Harefield hospital as vandalism. Vandalism does not cease to be vandalism just because there has been a change of Government.
Several hon. Members rose—
Mr. Deputy Speaker: Order. Hon. Members wishing to participate in the debate should bear it in mind that the Front-Bench speeches must commence not later than 10.30 am.
9.59 am
Mr. John Wilkinson: We owe a deep debt of gratitude to my hon. Friend the Member for Uxbridge (Mr. Randall), who has taken a sustained interest in NHS services in west London as a whole. His presence, his exposition and the attendance

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of the hon. Member for Harrow, West (Mr. Thomas) demonstrate that concern about the future specialist services in the NHS in west London extends far beyond my constituency, in which Mount Vernon and Harefield hospitals are located.
Since 1997, no health subjects have consumed more parliamentary time than the future of Mount Vernon and Harefield hospitals. We have had countless debates on each hospital, and a few years ago in this very Chamber, we had a similar debate on the future of hospital services in west London. To day's debate shows that instead of getting a grip on the situation and rectifying several of the problems, the Government are still floundering about and cannot provide the sort of specialist hospital services in west London in which the public can have confidence.
To be candid, that is an unutterable disgrace. If the general public knew how much time Parliament, Ministers, NHS officials, consultants, the Department of Health and others had devoted to these questions, and still so little progress made, they would be even more critical of the NHS and of Her Majesty's Government. I suggest a slogan for the hustings in the London elections: "Remember Harefield and Mount Vernon, and look at what is happening in the Paddington basin." That says it all. If we want a monument to the inefficiency of centralised, socialist control in providing the sort of specialist hospital services that people want and need, we have only to consider the stillborn Paddington basin project and, of course, the uncertainty about the future of those two admirable hospitals—Mount vernon and Harefield—which my hon. Friend rightly calls beacons of excellence.
Let us consider the hospitals one by one and in alphabetical order. Objective, fair-minded observers would find it utterly incomprehensible that Harefield hospital should be under threat of closure when it is regarded worldwide as probably the most pioneering, innovative and imaginative hospital in the cardiothoracic field in the United Kingdom, particularly with regard to transplantation. Those observers would point to the amount of support that Harefield hospital has always enjoyed from a variety of organisations such as the ReBeat club, whose members have had surgery but who have improved, continued in good health, and maintained their interest in the hospital, and the Heart of Harefield organisation, a marvellous organisation led by Mrs. Jean Brett, which, in the many years since the project to move to Paddington basin was announced, has produced a formidable range of well researched memorandums, papers and presentations, has admirably conducted meetings with high officials, the public and others, and has sustained great interest.
Members of the Hamsters—a club formed by people who have had transplants—do not speak against Harefield hospital or say that it must move to Paddington basin. On the contrary, their experience has been that there is no better environment than Harefield hospital for recuperation and the sustained treatment that they require after transplantation. Its quiet, rural location is ideal for the purpose. I invite hon. Members to imagine going out into the Paddington basin area near Praed street after surgery, if not on one's Zimmer
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frame, then hardly able to move. One is more likely to be mugged than to make a good recovery.
I wish that the NHS would listen to the counsel of good, sound common sense. We are not talking about any advice that I may have given, but about the advice given by the tens of thousands of members of the general public who have written to the consultation in support of Harefield hospital. It is remarkable that a Government who are, as my hon. Friend said, supposedly so amenable to public opinion, should fly in the face of all the advice of all interested parties and the general public and press ahead with the move of Harefield to Paddington basin.
My hon. Friend has said most of what there is to say about Paddington basin; however, I, who have never, in my 28 and a half years in the House, had cause to initiate a National Audit Office inquiry, asked the National Audit Office to look into the Paddington basin project. I did so because the consultation was a fraud. It was a fraud, because, first, as I said in my intervention, the Kensington and Chelsea and Westminster health authority, which is promoting the project, was the body that analysed the responses and reached conclusions based on them. That is improper and wrong.
Secondly, the Government, under the leadership of the right hon. Member for Darlington (Mr. Milburn) when he was Secretary of State, had initiated an NHS plan, which was to put most attention and most resources into the care of heart problems and cancer. In both instances they were hellbent on closing the most fantastic facilities in London and moving them at vast expense to places where people did not want to go, although the money could have been used to improve the facilities even further and to build on their success. As the military men say, one should build on success, not reinforce failure. That is one of the first things that one learns at staff college, and the same applies to politics and management; it is common sense.
After I initiated the National Audit Office inquiry I was promised that the outcome would be made known in April. Of course, it was not. The fact that it has been so delayed is proof in itself that the project is hardly going well. All the leaks from the specialist journals to which my hon. Friend referred show that even the construction industry has no faith in the project.
I call the consultation a fraud because in that consultation the project was predicated on cost figures that have been exceeded to what most people would consider an incomprehensible degree. We were told that the cost of moving Harefield to Paddington basin would be something of the order of £360 million gross, and after the land sales, presumably of the Harefield and Royal Brompton sites, about £135 million net.
We are now talking about £837 million, if the latest article is to be believed. The Secretary of State gave a figure of £800 million. That is utterly grotesque. It damages the economy of the country, making the Chancellor borrow more and making everyone poorer, but above all it has delayed the full improvement of the cardiothoracic facilities at Harefield, and again the public have suffered.
Similar points can be made about Mount Vernon. One would have thought that after all the trauma of the Harefield episode the NHS, under the present Government, would have learned a lesson, but no.

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Again the approach was to ignore all the consultation and to take not a blind bit of notice of community health councils, Community Voice, or the thousands of people who wanted the cancer centre to remain because the facilities on the Mount Vernon site are second to none.
There is a complementarity of facilities at Mount Vernon. Expertise is to be found there, particularly in radiotherapy, and there is cancer research at the Gray Cancer Institute. Macmillan Cancer Relief is there; Michael Sobell house is a facility for cancer patients; cancer patients can go to the Bishopswood private hospital and enjoy the services of consultants in the NHS but support Mount Vernon; there is a centre for reconstructive, plastic and burns surgery, while the Restoration of Appearance and Function Trust supports research in the field of reconstructive surgery; and, of course, there is a scanner centre.
Only a fortnight ago I was at the scanner centre—the Paul Strickland centre—for the opening of a £1.5 million combined PET-CT scanner. I think that it is only the second in the United Kingdom. Like all the other scanners there, it was installed through the support, sacrifice and dedication of people who charitably provided the money—it was not NHS money. By golly, what a comparison. Some £837 million has been spent at Paddington basin, but there is still nothing there, while £1.5 million from people's pockets has provided yet another scanner at Mount Vernon's Paul Strickland centre.
The mind boggles, but it boggles further when one considers that we do not even know where the proposed cancer centre is to go. All that we have been told is that it will be in Hatfield, but one could not have anywhere further removed from my constituents in north-west London. Hatfield is difficult to get to, and accessibility is important for not only patients but the many people who want to visit them. Yet, the centre will be on the old British Aerospace airfield or somewhere else, although we do not know where. Honestly! What a way to run things. It is deeply sad.
People at the opening of the scanner centre told me that the proposed scheme was wrong-headed. It is far from certain that specialist centres alongside or incorporated into general hospitals are the right way to provide the best patient care. A strong body of clinical opinion believes that specialist centres such as Mount Vernon and Harefield are the optimum locations for work at the frontiers of medical science.
I hope that the debate will at least cause Her Majesty's Government to think again. There is no point in putting vast amounts of public money into projects that the public do not support and that are in the wrong locations. The opportunity cost to the NHS is enormous. Harefield and Mount Vernon do a superb job as it is, but if just a little of that money had gone into them since the start of the Government's term in office in 1997, how wonderful they would be now. When the Heart of Harefield team asked specialist consultants to look into how much it would cost to modernise Harefield, the answer was just £18 million to £20 million.
To conclude, I shall support Harefield, Mount Vernon and other specialist centres of excellence until my last day in the House of Commons. We are grateful
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to my hon. Friend for introducing the debate and for his interest in the issue. We are also grateful for the interest shown by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), whose constituency includes the Papworth heart hospital, and who only recently took the time and trouble to go to Harefield. That gives us great hope for the future because we trust that, before very long, he, and not the Minister, will be in government. Time is passing, politics in the United Kingdom is changing and we are looking for a new start under a new Government and for the revivification of Harefield and Mount Vernon hospitals.
10.13 am
Mr. Paul Burstow: congratulate the hon. Member for Uxbridge (Mr. Randall) on securing the debate and the hon. Member for Ruislip-Northwood (Mr. Wilkinson) on his contribution.
I come relatively fresh to the issues of Middlesex health care and reconfiguration, although, over the past few days, I have carefully studied some of the issues that the hon. Member for Uxbridge has brought to the Chamber. What has struck me—it is self-evident from the passion that has been expressed in the debate—is the fierce loyalty and pride that people feel for their local health care systems and hospitals. As a result of the health care that they receive, people form an emotional attachment to their health care facilities and may, as the hon. Gentleman said, even come to love them.
In considering reconfiguration, it is important that we are satisfied that the processes on which we have embarked—their conclusions are unfolding and being implemented in part of London and in Hertfordshire and Bedfordshire—are objective and robust and have properly taken into account all the economic, social and health-related factors. Therefore, I shall simply ask a few questions by way of a contribution.
Both hon. Gentlemen referred to the reconfiguration proposals that will affect Harefield and the Paddington health campus, and Mount Vernon hospital. I want to talk primarily about Harefield, but I shall touch on the other programme. The hon. Gentlemen told us of their experience and knowledge of Harefield, saying that it is a centre of excellence and at the leading edge of developments; they also told us of their own and their constituents' concerns.
The hon. Member for Uxbridge mentioned that a meeting with Ministers had been sought. I know that, a little while ago, a petition was presented to the House about the need for dialogue with Ministers in respect of Mount Vernon. In connection with that and with progress on the Paddington health campus, I hope that Ministers will take the opportunity to meet local Members of Parliament. I hope that the Minister of State will say today that it will be possible.
Concern has been expressed about access to patients forums, a subject that came up only last week when the Minister of State appeared before the Health Committee. Problems are said to be the result of data protection difficulties I say difficulties, but I am not convinced that that is the real reason for denying access to information about who is representing the public. The forums are meant to enable a genuine public involvement in the making of health care decisions; it is

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unsatisfactory that people cannot yet find out who are their representatives. I hope that the Minister can say a little more about that than was said in exchanges at last week's Select Committee meeting.
The costs of the Paddington health campus have been rehearsed today, especially the fact that they increased from £360 million in 2000 to £800 million in 2003. The Minister said in a written answer in September that that was due to an increase in the size of the campus. It is not clear from the written answers that I have read on the subject what level of scaling up we are talking about. There seem to be an extra 80 beds compared with the original plan; and, as we heard, there will be a 20 per cent. increase in capacity or activity. Will the Minister elaborate in his response on how a 20 per cent. increase or an extra 80 beds can account for the more than doubling of the cost of the project? It would be useful to know.
Will the Minister also say a little about the exercise being undertaken by the National Audit Office and the Treasury? Back in March, it was said that that exercise would inform the next stage of the project. What are the findings? As the hon. Member for Ruislip-Northwood said, it would be useful to know when they will be published. If we are to be confident that taxpayers are getting value for the money that they are putting into the project, that work needs to be in the public domain.
Reference has been made to PFI Today's debate is not so much about every last dot and comma of PFI, or even about the principle. However, when reading an article in last week'sHealth Service Journal, I was struck by some of the consequences of PFI projects. The journal gave the example of Norwich university hospital PFI, which was completed in 2001, Under that scheme, the isolation wards were supposed to be plumbed into the ventilation system, but when the system did not work and the ceiling tiles were removed, it was found that the ventilation pipes were still unconnected. Such problems could arise with conventional building methods, but in that case it was laid at the door of PFI.
Consultation with staff at Harefield covered the issue of staff retention and recruitment, which has been touched on already. I was struck by the fact that the survey mentioned by the hon. Member for Uxbridge said that 33 per cent. of Harefield staff and 27 per cent. of Royal Brompton staff cited transport as one of the issues that would be either a barrier or an inducement to moving, and that free transport might be a deciding factor. Will the Minister say what weighting was given to the question of transport and access by staff to the new campus? Are moves afoot further to ease the concerns of staff on that matter?
Costs have been referred to, and we have heard that the use of agency staff is a big factor. About half the total cost of agency nursing in the country is borne by London. The current cost, according to answers supplied by the Minister, is about £1.4 billion a year—a huge sum. Although a specialist centre might find it easy to attract staff to work at it more readily than others, we must ask whether any facility in central London will always be able to get the full range of staff, from the porter up to the consultant surgeon, to work there. I hope that the Minister will say how those concerns were weighted in the assessments to date.
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The situation that the hon. Gentleman described at Harefield hospital is obviously of great concern to him and his constituents. I conclude with a question about time scales. It has been said that the original completion date was 2006, but most of the material that appears on the websites associated with the project seems to talk about an opening date of 2010. Will the Minister say when the campus will open, if that nirvana of a Conservative Government, which the hon. Member for Ruislip-Northwood described, does not come to pass at the next general election?
Mount Vernon is of great concern and generates fierce loyalty among residents in that part of the world. The Bedfordshire and Hertfordshire strategic health authority has led the project. In reading the documentation from its consultation exercise, I was struck that comments that London Members had made were not even listed, although I can understand why. The material came solely from those outside London.
Mr. Wilkinson: Will the hon. Gentleman give way?
Mr. Burstow: I am not making a criticism.
Mr. Wilkinson: The hon. Gentleman makes an important point. To an objective observer, it is amazing that a health authority from outside London should dictate the future of cancer services inside London. It is par for the course, is it not, that London MPs should be ignored, because the objective was, quite clearly, to build a hospital in Hertfordshire and to ignore the opinions and needs of Londoners? We know that, but I am grateful that the hon. Gentleman has highlighted it.
Mr. Burstow: I am grateful for the hon. Gentleman's intervention. When the Minister reviews the consultation exercises that have led to the decisions to change the character and content of services provided at Mount Vernon hospital, will he satisfy himself that the process is robust enough to ensure that the health needs and aspirations of the population in north-west London, in Middlesex, have been properly taken on board? There seems to have been a parallel exercise in north-west London, which was solely about Mount Vernon, but the changes to the hospital have been entirely driven by decisions made outside the strategic health authority. That other exercise almost seems to have been lost.
The hon. Member for Uxbridge has used this Adjournment debate in a powerful fashion to raise some important concerns, which have already been rehearsed through written answers, oral questions and debates. I look forward to the Minister's response.
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Mr. Andrew Lansley: I join others in congratulating my hon. Friend the Member for Uxbridge (Mr. Randall) on initiating this debate and on the way in which he opened it. He rightly pointed out that during his seven years in the House he has sought to strike the right balance and adopt what one might characters as moderate views on issues. He spoke with great concern and commitment to his constituents. He will recall that I played a small part in his victory back in 1997—actually, I played no part,

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because as I went round Uxbridge everybody knew who he was. They knew perfectly well that, with his integrity and commitment to Uxbridge, he was exactly the person to represent them. He was a shoo-in.
My hon. Friend has always represented his constituents in the most exemplary fashion, as indeed has my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson), who has shown passion and commitment to his constituents and to Harefield hospital. I know that my hon. Friend's record is recognised, not least because when I visited Harefield on 15 April I was told so. I am glad that I had that opportunity. I did not know that we might have a Westminster Hall debate on the subject then, but I knew that it was right to visit, because these problems are increasingly coming to a head. Even then, it was clear that the strategic health authority could not be too far away from making an announcement.
If I recall correctly, the Minister told us during oral questions in March that an announcement would be made by the end of the month. It was not; nor was it made in April. So far, none has been made in May, and I suppose that none can be made before the elections on 10 June. If, indeed, the strategic health authority is to say anything, it will say it much later than was anticipated. However, as my hon. Friend made perfectly clear, such is the nature of this project that, so far, nothing has happened according to the anticipated timetable.
I shall make a few observations about the issues that my hon. Friends have raised. I will not, however, confine myself to Harefield hospital, but will discuss other specialist hospitals—in effect, tertiary services—to which they referred. There are important issues relating to the future of tertiary services. Interestingly, I first became familiar with the benefits of tertiary centres of excellence at the Royal National Orthopaedic hospital in Stanmore, which I visited while I was private secretary to Norman Tebbit. Margaret Tebbit was receiving treatment at the hospital at the time.
I got to know some of the clinicians at the RNOH very well through Aspire, the Association for Spinal Injury Research, Rehabilitation and Reintegration. The Minister will be familiar with Aspire and its work. I engaged in fundraising to provide Aspire with facilities to treat spinal injury patients at Stanmore in the mid-1980s, and have been privileged to remain a patron of Aspire ever since.
The clinicians told me how they could improve outcomes significantly, and attributed much of that to their ability to operate as an independent centre of excellence. Patients at the RNOH were receiving their second hip replacement when patients in many other hospitals throughout the country would have been having their third hip replacement, such was the quality of its artificial hips and the work done there. I have never needed to be persuaded that centres of excellence can deliver the best clinical outcomes. The question that we need to answer is how best to protect and maintain those centres of excellence—a question that is especially relevant to Harefield hospital.
Several questions should be asked about the Paddington health campus and Harefield. First, why is the cost of the project escalating, and why is the project
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being managed in a way that fails to deliver what was originally intended? What is going wrong? Such questions demonstrate precisely why my hon. Friend the Member for Ruislip-Northwood was right to call for a review, and why the National Audit Office is party to it. The NAO is not there to decide whether this is the right project for the future, but to discover why a project that was supposed to cost £360 million will cost in excess of £800 million. As the hon. Member for Sutton and Cheam (Mr. Burstow) rightly said, only a 20 per cent. increase in capacity is required—although that is still a significant increase—so why has this happened? If we knew the answer, we would not need the NAO, the Treasury and others to conduct a review.
I am still uncertain and sceptical as to whether the announcement that is due from the strategic health authority will be accompanied by a transparent publication of the results of that review, so that we know what has happened in the past and not simply whether the strategic health authority is asserting the business case for the Paddington health campus in the future on its changed costings.
The question of the management of the project goes beyond the escalating costs, and prompts the question whether the project will meet the original business case. The business case was essentially constructed around the co-location of a range of services, including those of St. Mary's, Royal Brompton, Harefield and the medical faculty of Imperial college. If the nature of the site and the compromises that have to be struck are such that the benefits of co-location are not being realised and split-site or dispersed activity is being engaged in around the Paddington site, serious questions are raised.
The third point, which I found most compelling and had not fully appreciated before visiting Harefield, is that although it is asserted that the business case for the Paddington health campus remains strong, from the standpoint of either of the two main trusts—particularly that of the Royal Brompton and Harefield NHS trust—the environment that the health service lives in has significantly changed from the environment in which the original business case was constructed. To look at it from Harefield's point of view, that is true in a number of respects, including in terms of clinical practice and outcomes in relation to heart disease.
Only a few weeks ago, I was present when the British Heart Foundation launched the results of its minutes save lives campaign in the Jubilee Room. Dr. Roger Boyle, the national director for heart disease, made presentations, and others spoke about the dramatic changes in the treatment of heart disease resulting from not only the prophylactic benefits of stains, but the improved call to needle times for thrombolysis for heart patients. These developments are changing the volume of activity, certainly at Harefield. The idea that one can simply assume, as one did three years ago, the levels of demand for cardiothoracic work in the future is far from obvious. The business case needs to be revisited on that basis.
If Dr. Boyle is right, and 20 years hence—or perhaps it was 10 years—if we do the right things and lead the right lifestyles, there will be no need for anyone under the age of 65 to experience a heart attack, the nature of commissioning of specialised cardiothoracic surgery across the UK will look very different from now. However, that is not the only matter that impacts on the

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business case. The Minister knows that, as we talked about it throughout the proceedings on the Health and Social Care (Community Health and Standards) Bill last year and since. Other matters include the structure of payment by results, the structure of the national tariff and its implications, and the possibility of hospitals becoming foundation trusts and being able to manage and determine their futures to a greater extent.
All such matters have an impact on the business plan. The ideals of the days when PFI projects were essentially negotiated on the basis of guarantees by primary care trusts for future income now seem to be misplaced. As the hon. Member for Sutton and Cheam said, this is not really the place to discuss the whole future of PFI, but one particular point is apposite. Unless I am mistaken, it is necessary to go back to the original business case for the Paddington health campus and to re-establish it, not on the basis of guarantees from PCTs but on expectations of the levels of work, the nature of tariffs and the volumes of activity that will support the future of the trust.
I hope that the spirit of greater freedom for NHS hospitals, which we subscribe to, will be embraced in the decision. This decision is not for the strategic health authority to make. It is for the boards of the Royal Brompton and Harefield and the St. Mary's NHS trusts to decide whether to go ahead. They are accountable to their local communities. In due course, if they become foundation trusts, they will be genuinely accountable to their local communities?much more so than patients forums appear to be; it is difficult to understand how they work.
My hon. Friend the Member for Ruislip-Northwood referred to Papworth, which, as a cardiothoracic institute, shares many of Harefield's characteristics. I believe that last year more heart transplants took place at Papworth than at Harefield, but I do not want to argue about the pre-eminence of one cardiothoracic institute over another. They are very similar, as the Minister knows, and the debate continues as to whether Papworth should move from its Papworth Everard site to the Addenbrooke's campus, creating a further extension of the south Cambridge medical campus.
There are strong arguments for such a move, and many clinicians at Papworth are in favour of it. Not the most important argument, but one with which people identify, is that a person involved in a road traffic accident, who suffers major trauma and has both chest and head injuries, might have to be transferred from Papworth to Addenbrooke's in order to have neurosurgery, or the other way for chest surgery. That may not happen often, but it does happen.
Clinicians want to be at Addenbrooke's because they want to be where the research is taking place, and near the large biomedical campus that is likely to be created alongside them there. Ever since the move was mooted some four years ago, I have been clear—as has the Papworth board—that two things are necessary. The first is that the staff should be carried with it. There are substantial differences in the willingness or otherwise of staff who are vital to the provision of services at Harefield to migrate to Paddington and that of staff at Papworth to move—in many cases, to return—to Addenbrooke's.
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The second is that Papworth and Harefield should retain their independence as separate institutes. We are not talking, nor should we do so in future, of merging tertiary centres of excellence, which have very successful, positive outcomes, into large hospitals where their services become part of what is offered by a much larger organisation. It is clear from the clinicians at Harefield that they have to maintain their focus on using their expertise to deliver the best outcomes for their patients, to the exclusion of other considerations. If that focus can be maintained only on separate sites, that is a compelling argument, notwithstanding the other considerations.
My hon. Friend the Member for Ruislip-Northwood said that he hoped that we would, in due course, be in a position in which these issues would come before us as Ministers, rather than before the present Government. With that in mind, I cannot now say how Conservative Ministers would judge the issues, not least because of the desirability of decisions, including project finance decisions, being made by the boards of NHS trusts on behalf of their patients and the communities that they serve. However, I shall put four key issues to the Minister, because I hope that he will share the view that they must be thoroughly guaranteed before the Paddington health campus proceeds or the future of Harefield is decided.
The first is that the financial sustainability of any such project can be brought into question not only by cost escalation but by changing commissioning and cardiothoracic care requirements. No project should go ahead if it is not financially sustainable in the long term. Looking 20 years ahead, I see some big changes to the health service in prospect.
Secondly, there must be opportunities for service development. We know only too well the difficulties that can ensue from putting hospitals in urban, city-centre locations on sites that are too constrained, with the need to manage service development and possible consequent changes in service.
Thirdly, we must be able to realise the benefits of synergies between clinicians and scientists, such as those at Imperial college's faculty of medicine and Sir Magdi Yacoub's heart science centre, which I have visited. There will be competing considerations with regard to synergies in research in relation to Harefield, and the best interests of Harefield's patients, in terms of location, will need to be carefully considered.
The last and absolute requirement is that the independence of the Royal Brompton and Harefield NHS trust and its sense of focus on its task must be retained, as must its ability to deliver positive outcomes for its patients, regardless of location.
I have not mentioned Mount Vernon hospital and I will not go on about it, but it, too, can be used to illustrate by analogy. The Royal Marsden hospital has a site in the constituency of the hon. Member for Sutton and Cheam, and if one were to say to it, "Well you've just got to put everything from Sutton into Chelsea, because the benefits of co-location and the synergies of research with clinical practice are so compelling," notwithstanding that there is a substantial research facility on the Sutton site, I think that the Royal Marsden would reply, "Don't be foolish; we cope now,

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and we have the benefit of two sites. We are preeminent." That hospital is the leading cancer specialist tertiary referral service in the country.
The reconfiguration of services sometimes seems to be driven more by bureaucratic objectives than a desire to meet the needs of patients and clinicians. It is not an obvious decision. For example, it will be difficult to decide whether Papworth hospital should be transferred to the Addenbrooke's site, and if there is a good reason for Harefield to transfer, it has not been compellingly made. In fact, the reverse is true for the clinicians, staff and patients of Harefield.
10.43 am
The Minister of State, Department of Health (Mr. John Hutton): I warmly congratulate the hon. Member for Uxbridge (Mr. Randall) on securing the debate. This matter is, quite rightly, of concern to him and his constituents and to millions of NHS patients in west London. The same applies to the hon. Member for Ruislip-Northwood (Mr. Wilkinson).
It comes down to this: the challenge that we all have to face—whether we are in or out of government—is how best we can maintain the clinical excellence of those important services in a rapidly changing scientific and medical environment in a way that maximises as their convenience and patients' access to them. It is not easy to do that, especially in a way with which everyone, including patients, the public and staff, can always agree. The NHS has set out proposals to achieve that for specialist services in west London, but it is obvious from this debate, and from the previous occasions on which this issue has been raised in the House, that those plans have generated considerable controversy.
I have listened carefully to hon. Members, but I am not at all clear about what alternatives the hon. Member for Uxbridge has to those plans, or about the level of medical or clinical support that any such alternative would have. Neither he, nor the hon. Member for Sutton and Cheam (Mr. Burstow), nor the hon. Member for South Cambridgeshire (Mr. Lansley) set out any such alternatives today with any clarity.
The hon. Member for South Cambridgeshire made a thoughtful contribution, which was devoid of some of the passion that the hon. Members for Uxbridge and for Ruislip-Northwood, who have constituency interests, brought to bear. His speech may have served as cold comfort to his two hon. Friends. The hon. Member for Ruislip-Northwood shakes his head, but I saw the look on his face.
One thing is clear. We have not heard from the official Opposition today any promise to keep Harefield open or to keep Mount Vernon in its current state. They put the best face they can on the matter, but that is the uncomfortable truth for those two hon. Gentlemen.
The hon. Member for Uxbridge has often raised the question of the future of Harefield hospital on behalf of his constituents—rightly. Under the inspirational clinical leadership of Professor Sir Magdi Yacoub, the hospital has been remarkably successful in its development of heart and lung services and has rightfully earned a reputation as a centre of excellence for that specialist work. Research and development
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have become an integral part of its work to improve life expectancy and the quality of life for those with serious cardiothoracic conditions. Like all hon. Members who have spoken in the debate, I pay tribute to the staff at Harefield who have contributed over many years to the hospital's excellent work.
Specialist care of the type that has been pioneered at Harefield will continue to form a crucial part of the overall network of services that are provided for people with coronary heart disease. As the hon. Gentleman is aware, in October 2001 the Department of Health confirmed that it intended to move ahead with plans to develop a new health campus at Paddington—a development that could bring together three world-class hospitals alongside cutting-edge research facilities. The decision was reached after full local public consultation and after the proposal had been referred to my right hon. Friend the Secretary of State for a final decision.
It is obvious from the remarks of the hon. Member for Ruislip-Northwood that he views the consultation exercise as a fraud. That was the word that he used. That is a pretty serious accusation and it is noteworthy that the outcome of the consultation was not challenged. Certainly no challenge was made to the decision of my right hon. Friend.
Mr. Wilkinson: I am grateful to be able to give an explanation of my remark. Is the Minister aware that there was virtual unanimity in the responses? People were unanimous in not wanting the transfer of Harefield to Paddington basin. Notwithstanding that fact, the Government pressed on, and that is an insult and a fraud. If consultation means anything, there has to be an active response to try to modify proposals in the light of what people want. Otherwise, why engage in consultation in the first place?
Mr. Hutton: I shall come to that point, but the hon. Gentleman has been around the block many times. He will remember the outcry in his constituency when a Conservative Government closed the accident and emergency unit at Mount Vernon, despite widespread local opposition. He said today that decisions that had been taken about Harefield represented centralised socialist control of the NHS. What a load of nonsense that allegation is. I do not remember him making that allegation about the right hon. Member for Charnwood (Mr. Dorrell) when he made that decision to close accident and emergency services at Mount Vernon.
I do not want to embarrass the hon. Member for South Cambridgeshire any further than I may already inadvertently have done, but his speech showed balance and a recognition that in such matters it is not always possible to make decisions about services that guarantee unanimity among the public. Sadly, that is the responsibility of Government. He recognises that and his hon. Friends do not. That is a difficulty for him, not for me.
Despite the wish of the hon. Member for Ruislip-Northwood to brush over the matter, doubts have been expressed by clinicians about the ability of a single specialty hospital to continue in relative isolation. That

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is because it is becoming crucial for the success of single specialty hospitals to have access to a wider range of related sub-specialties. The hon. Member for South Cambridgeshire sensibly drew attention to the strong arguments for such relocations in relation to Papworth and Addenbrooke's. Fortunately, he could not see his two hon. Friends' reaction.
Harefield, being several miles from local general hospitals with accident and emergency departments, is not in a position to draw on support from the wider range of specialties that are found at such hospitals, or to benefit from the closer relocation of tertiary services. I am sure that the hon. Member for Uxbridge will agree with me—to be fair to him, I think that this was his starting position—that we should all be prepared to accept that hospital and community services will, from time to time, need to change if they are to continue to fulfil patients' needs and improve services.
Services should not remain state forever, frozen in time, but should reflect advances in technology and clinical practice. The only way to achieve those benefits in the case of Harefield's specialist heart and lung services would, I am advised, have been to build a completely new general hospital on the Harefield site. Such a proposal would seriously have threatened the viability of three other existing hospitals—Hillingdon hospital, Northwick Park hospital and Watford general hospital. With the benefit of not only hindsight but a bit of common sense, I do not think that that it would have been sensible or wise to take such a course of action.
That is why a different way forward has been chosen. It will incorporate St. Mary's hospital, the Royal Brompton and Harefield hospitals and Imperial College's faculty of medicine on a new, purpose-built health campus in Paddington.
Mr. Lansley: Lest we proceed under a misapprehension, let me ask whether the Minister is really suggesting that Harefield has literally no alternative but to go to the Paddington health campus? If so, I disagree. I am not signing up to the alternative of re-provisioning the tertiary cardiothoracic institute on the existing site, but Harefield clearly has that option, and the same is true of Papworth.
Mr. Hutton: I am grateful to the hon. Gentleman for reconfirming that he is not promising to keep Harefield open. Of course there are other options, but the question is which is the optimum one. Which will guarantee the highest standards and the benefits of new technology and closer collaboration between specialties? That is the choice that we face, and it does not serve the purpose of this debate or the wider debate to suggest otherwise. I am certainly not suggesting that there are no alternatives: there have always been alternatives, which have been considered, but, crucially, they have not been supported by the clinicians involved, and I shall come to the reasons why in a second.
The purpose of the health campus will be to create a new centre of clinical excellence, innovation and teaching research in one of the capital's major urban regeneration schemes. The hon. Member for Uxbridge said that the vision was originally exciting, and I think that it remains exciting.
The hon. Gentleman accused me of wrongly saying that he opposed the Paddington health campus project, but given his contribution today, I would prefer to stand
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by my remarks. I do not know whether he originally supported the Paddington health care campus, but he certainly has reconfirmed his opposition to it today.
Mr. Randall: The Minister seems to think that it is wrong to oppose it. I am concerned that the costs and everything else in the business case are escalating out of control. We have discussed the other options before, but my point today is that I am deeply concerned about the project itself.
Mr. Hutton: I understand the hon. Gentleman's concerns. I, too, have concerns, to which I shall come in a minute. However, his view might have had more credibility if he had supported the Paddington health campus in the beginning. I understand, however, that he always opposed the campus because he wanted to appease local campaigners over Harefield's future.
Mr. Randall: The Minister is being unfair. He says that hon. Members oppose something only when they want to appease someone, and it is unfair to suggest that we cannot make up our own minds. My own business experience tells me that some of these things, which have been dreamed up by people with wonderful vision, simply cannot be afforded.
Mr. Hutton: Hon. Members will come to their own view on all these matters when they read the debate and the hon. Gentleman's remarks. However, it might be helpful if he could confirm whether he supported the Paddington health care campus on the basis of the original costings.
Mr. Randall: I have not been a supporter of the Paddington health campus because I thought from the outset that it was a fraud.
Mr. Hutton: Well, there we are. I said that the hon. Gentleman had always opposed the campus, and he said that that was not true, but now we know the full story.
Mr. Randall rose—
Mr. Hutton: I shall not give way to the hon. Gentleman again. We have had several exchanges on the issue, and this one is pedantic and is not taking us much further forward.
Given the steep rise in the costs of the new campus development, a review of the outline business case and the management of the project to date was begun late last year, and rightly so. The team was led by officials from my Department and included officials from the Treasury and the National Audit Office. The review has now been completed, and the North West London strategic health authority will, I think, make a statement on the outcome in the next fortnight. It will cover the timetable for the new campus, as well as its affordability. It was right to conduct that review: costs have risen steeply, and delays in the project have become obvious. That cannot be allowed to continue without adversely affecting the proper organisation of those crucial NHS services.
The recent review has brought a new and necessary focus to the project. The NHS and patients in west London need to know soon that the project can be taken

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forward quickly and expeditiously. I shall ensure that those hon. Members who raised concerns today will be fully advised of the outcome of the review; we can share the results of the report.
The hon. Gentleman raised a number of questions on staff, specifically whether staff will consider transferring to the Paddington health campus. It is true that only a small percentage of Harefield staff have said that they will definitely relocate, and that a large number have not yet decided. That is hardly surprising, as the move will not take place for several years; it will not be until 2010 at the earliest. However, it is important to recognise that the project continues to enjoy broad clinical support. Leading clinicians at Harefield continue to give their support for the Paddington health campus and the model of care that it proposes, and they recognise the part that the campus will play in preserving the heritage of Harefield.
Dr. Rosemary Radley-Smith, associate director of the Royal Brompton and Harefield NHS trust, has made clear her firm support for the move to Paddington. She has worked at Harefield for more than 30 years, treating many thousands of patients, but she recognises that without the support of other disciplines Harefield may not be a viable choice for transplant surgery in the longer term, an issue rightly raised by the hon. Member for South Cambridgeshire. Other centres could provide a better and safer service for patients; as a consequence, they will be sent there. That is not in the long-term interests of Harefield, nor of what it stands for.
Dr. Charles llsley, chair of the Harefield medical committee, confirms the wider support of hospital consultants at Harefield hospital, saying that they are fully behind the relocation of services to Paddington. Those are serious voices; we should pay them serious attention.
Not all of Harefield's work will transfer to the new campus project. Only a third of Harefield's cardiology patients will need to travel to Paddington; 65 per cent. of all cardiology patients will be treated in local services at their nearest acute hospital. For cardiology outpatient and day-case patients, the figure is even higher at 82 per cent. Up to 25 per cent. of surgical patients already travel to St. Mary's or the Royal Brompton hospitals for care. Because the treatment is highly specialist and complex, it depends on proximity to the specialist care provided by St. Mary's.
With much of the clinical work load staying locally, staff will have the opportunity to do the same; they will be able to transfer to a local district general hospital—
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for example, to Hillingdon or Watford—if they do not want to remain with Harefield in Paddington. As I said, staff at Harefield have enormous skill and expertise, and I am confident that they will not be lost to the NHS family.
In the couple of minutes left to me, I want to deal with Mount Vernon hospital. The hon. Gentleman was right to speak about the future of the hospital and its cancer services. For the past two years, the NHS in Bedfordshire arid Hertfordshire has worked extremely hard with its local communities in the North West London strategic health authority to develop an agreed strategy for health care, including specialist cancer care. Between June and September 2003, Bedfordshire and Hertfordshire SHA held a formal consultation on the future configuration of health services in the two counties.
It took more than two years to come to a conclusion—rightly so, because it is a complicated and important issue. The chosen option will see Bedfordshire and Hertfordshire retaining and developing the five existing hospitals, and building a new hospital in Hatfield to replace the QEII hospital at Welwyn Garden City. The plans for the new hospital will include the provision of a new cancer centre.
In light of the Bedfordshire and Hertfordshire proposal and the subsequent decision to establish a cancer centre in Hertfordshire, two further consultations were held in 2003 to determine and guarantee a future for Mount Vernon hospital. It is important to ensure that that future is made available. I know that that is what local people want to see. My hon. Friend the Member for Harrow, West (Mr. Thomas) led a delegation from his constituency to press home the point to me only last month. He has fought tirelessly for Mount Vernon, and I want to record my appreciation for the way he has put the argument to me.
The consultation has resulted in a clear commitment to maintain cancer services, including radiotherapy and chemotherapy, at Mount Vernon. Its future as a cancer centre is not in dispute. I accept that more work needs to be done on the details of the services that will be provided on the site. That will be determined through the development of a new strategy for cancer services across the whole of north-west London.
Bedfordshire and Hertfordshire strategic health authority is continuing to work closely with colleagues in North West London SHA on the development of its cancer strategy, which includes future cancer services on the Mount Vernon site.
Mr. Deputy Speaker: Order. We must now turn our attention to the commercial use of Hyde park.

Hyde Park
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Mr. Mark Field: I have called this debate because of my constituents' increasing concerns about the commercialisation of Hyde park. In recent years, Hyde park has been host not only to millions of resident Londoners, commuters and tourists relishing the tranquillity of one of London's world attractions, but to noisy rock concerts and large-scale, commercially sponsored events, such as the Red Bull Flugtag and the Star Trek show. Such activities have led to destruction of the fabric of the park, from which it will take many years to recover.
Not only are even more such events planned for this summer, but only last week the Mayor of London, Ken Livingstone, proudly boasted that he intended to bring the royal parks under his control in the years ahead, presumably in order to turn them into entertainment playgrounds for Londoners and tourists. In the programme for Hyde park over the next few months, there are three rock concerts, the annual party in the park for the Prince's Trust and a special event in July for Simon and Garfunkel. Not only am I a keen rock and pop music fan, but Simon and Garfunkel are among my favourites. I will have to avoid going or being invited to that concert, although I suspect that I shall be able to hear one or two of their songs, given the amplification and the fact that I live quite nearby. It is also increasingly traditional to hold the proms in the park in September.
Although those commercial activities raise significant sums— £1.5 million last year—that does not fully compensate for the damage and disruption to Hyde park. I look forward to what the Minister says about that. The Department for Culture, Media and Sport grant for the royal parks as a whole was frozen in the three-year period from 2002 to 2005. The grant will presumably be subject to similar if not tighter pressures in the next public sector expenditure round. Although Hyde park bears the brunt of many money-spinning events, relatively little of the money comes back to help maintain the park, being instead spent on other royal parks under the Department's auspices.
London's eight royal parks rank among the UK's greatest outdoor attractions. Free and open to everyone, they are a special cultural and recreational resource, as I am sure everyone in the Chamber would agree. They face a miserable future, whether they operate as an Executive agency under the Department for Culture, Media and Sport, as they do now, or fall under an increasingly power-crazed mayor, excited by the prospect of one rock band after another and their multitude of fans appearing in Hyde park. During the Iraq war, we also saw weekly demonstrations in central London, a number of which decanted into the Hyde park area. There is also the spectre of the park being used as the starting point or decanting point for the Notting Hill carnival, on which I shall comment later. Are there no traditions in this city or country of ours that the Government do not wish to trash?
I have files of correspondence from local residents who have watched the commercialisation of Hyde park with utter dismay. After last year's Bon Jovi concert, my
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postbag was full of letters from local residents who could not believe how loud the noise was. That applied not only to roads in the immediate vicinity, but to roads in Marylebone and Mayfair. Nor am I talking about one afternoon or evening of mayhem. The erecting and dismantling of a concert site means literally a week of noise and upset to the park's tranquillity, including juggernauts moving along roads that were not built for such heavy vehicles. Last year's Flugtag was the most destructive event the park has ever witnessed. Trees were badly and permanently damaged, and there was a lot of graffiti in the area. Many who love the park have observed that the parade ground has been ruined.
This year, on 18, 19 and 20 June—a Friday, Saturday and Sunday—more than 80,000 paying people will come each day to watch the Red Hot Chilli Peppers. As one of the world's biggest rock bands, they will, I fear, attract huge numbers of additional people, who will congregate in the area, causing great disturbance. I invite everybody here to go to the park on the Sunday evening of 20 June, and perhaps again on the Monday morning, to see the crowds and the mayhem and to witness the mess left behind.
I am a great fan of popular music, and I recognise the attraction of such events. However, Hyde park is a special place. The frequency of such events means that it is being damaged beyond repair. Everybody would agree that it should be a people's park, but let us remember the countless people who wish to use this priceless London amenity as an oasis of calm in the midst of the hustle and bustle of city life. Such people tend not to be very vocal, but the popularity of Hyde park, rain or shine, is a testament to their passion for the place. For heaven's sake, let there be some balance between the desire to party, and, as we have discussed, to raise funds, and the need to relax and recharge one's batteries.
London is unlike many cities in the world in having such a central park. Access to Hyde park, St. James's park and Green park is among the charms of living in the city. I know that many people in the UK look askance at the busy life that we lead in cities. They would be amazed by the tranquillity that we enjoy and the way in which, particularly in the summer, the park is used by young and old for rest and relaxation. While I do not say that we should not have any large-scale events, increasing commercialisation will subtly but, I fear, irreparably change the manner in which the park is used as an all-round asset.
I am in regular touch with Kenneth Stern, chairman of the Friends of Hyde Park and Kensington Gardens, with the dedicated officers of a multitude of local residents associations, such as Sir Anthony and Jennifer Cleaver, who live south of the park in Belgravia, and with many residents who live close to the park. They are entirely realistic. They are concerned about the increasing commercialisation, but they would not turn the clock back. With the party in the park, sponsored by Capital radio, the proms and other events, London's parks are a centre of attraction for the nation, and it is right that certain events should take place in the vicinity. My grave concern, as the Minister will know from my correspondence with her Department in the three years since I have been the local Member of Parliament, is that the views of residents associations and individual

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residents are all too often ridden over roughshod. On occasion, decisions are made without reference to such interested parties.
It is important to my constituency that it has vocal and articulate amenity organisations with a vocal strength that I sometimes encounter as the constituency MP. Their views are important. They should be heard and, to an extent, they should hold sway. In so far as there is to be a restructuring of Hyde park, I sincerely hope that the Minister will give some thought to reserving places for the officers of local residents groups and amenity societies so that their voices can be heard. Many who love Hyde park fear that there is an undeclared agenda to transform part of it into a permanent entertainments area. The Mayor's words of last week have confirmed those worst fears.
I want to add a little bit of context. It makes sense to look across the water to New York, a city of similar size, aspirations and importance in world affairs. Last year, the president of New York's Central park conservancy said that no more large-scale outside events were to be allowed in Central park because of the damage caused in the past. What is true for New York should be no less true for London. The cost of policing large-scale rock concerts, for example, and the expense of clearing rubbish, fall as ever on Westminster's council tax payers, and are a greater insult given that they have to suffer disturbance for many days. As yet, thankfully, no one has been seriously injured at any of the events. However, with the Mayor's proposal for the Notting Hill carnival to start in Hyde park, I fear that there will be distressing and distressful news one weekend night over an August bank holiday in the future.
Last year, I carried out quite an extensive survey among the 4,000 of my constituents who live nearest to Hyde park and its environs. One question that I asked was how they felt about Hyde park featuring in the route for the Notting Hill carnival. Some 80 per cent. of the respondents were totally against it, and only one fifth felt positive about the idea. The idea of the Notting Hill carnival, with its massive street march beforehand, struck fear into the hearts of most of the respondents. That included many who have first-hand experience of the carnival, either at a previous address or as interested nearby residents.
Discussions with some of the organisers of the carnival and some of my constituents who live on the current carnival route have shown that there is a strong belief that redirecting the procession to include Hyde park should not happen, because it goes against the whole tradition of the carnival and because such a change would undermine its relevance. The carnival would risk becoming another central London event, rather than one focused on the Notting Hill area. Obviously, I do not need to rehearse the arguments about the great history and tradition of the event and why it was located there after the 1958 race riots in that part of London.
The Mayor seeks to go ahead with the idea against almost everybody's wishes. It is almost as though the Government and the Mayor want Hyde park to be the central focus of all large-scale outdoor London events. I would be interested to hear the Minister's vision for the future, not just for Hyde park but for all the royal parks.
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In short, commercialising Hyde park is a short road to destroying one of London's most beautiful jewels. It is globally recognised as a place of great beauty in the middle of a great world city. If we parliamentarians cannot play our role in halting that destructive force, I wonder whether we can look forward to a day under this Government and Mayor when College green and Parliament square will be home to revenue-earning car boot sales and not much else.
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The Minister for the Arts (Estelle Morris): I recognise the obvious and keen interest with which the hon. Member for Cities of London and Westminster (Mr. Field) has chosen Hyde park as the subject of the debate, and I understand its central importance to his constituents. As well as looking at what it contributes to the life of London and the nation, he has a particular responsibility to look after the near neighbours of the park. He has a special role that no other Member has, and I acknowledge that at the start.
In summary, this is about getting the balance right. I welcome the comments that the hon. Gentleman made about not wanting to turn the clock back or to deny people from areas other than those immediately surrounding the park the pleasure and joy that it can bring. I would not like to reach a position in which one could not find solace, solitude and quietness in the park without being bothered by loud noise or lots of people. We will do what we can over the next few years to get the balance correct.
The Royal Parks Agency's vision perhaps sums up the combination better than I have. It talks about trying

"to achieve the perfect balance, where all understand and value the Parks, where everyone finds something in the Parks for them, and where no one's enjoyment of the Parks is at the unacceptable expense of others, now or in the future".

It is important to make that statement. I do not think that that is a difficult vision statement to sign up to for people on either side of the discussion—I will not call it an argument—about Hyde park. The key question is how we make such an approach a reality and balance the interests of one side with those of the other.
It is important that there are commercial events in Hyde park. I do not think that the hon. Gentleman wants to go back to a time when there were no such events. When one looks back through the history of the nation, one sees that the large parks and main outdoor areas in London have always been centres where we have celebrated our traditions, as we did the jubilee; where we have expressed protest, as with the "Stop the War" marches; and where there have been pop concerts. He referred to the concerts that had been planned; I might well sign up for the Simon and Garfunkel one. The practice is not something started in recent years—the Rolling Stones played there in 1969.
In Hyde park, we have somewhere that some people see as solitude and solace. For others who live nearby, it is neighbouring land, and it has a place for the nation as a centre for traditional gatherings and the expression of national protest, as well as for celebrations in the form of pop concerts. I do not want that to change. The

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balance is about right. One of the unifying characteristics of the nation is that we have places where we feel comfortable holding such events. However, I readily accept that there is an obligation on those with responsibilities for the park to ensure that such events happen in a way that does not make life impossible for the people who live nearby.
As the hon. Gentleman said, the royal parks are funded predominantly by the taxpayer with an annual grant of £24.2 million. That is the right thing to do, but the sum involved is sizeable. Inevitably, Government finances must be raised and spent carefully. It is correct for the royal parks to augment that funding from other sources. The subject of the debate is commercial activities in Hyde park, but we have talked mainly about the big events, which were the focus of his comments. Nevertheless, catering, boating and deckchair hire are all commercial operations in Hyde park. Over the years, other, bigger events have been added to those activities.
I should think that we would want to welcome as many people as possible from this country and abroad to see the educational, cultural and recreational benefits of the park. I have no doubt that if it were not for those commercial activities, some people would not think to go there. If they visit the park for commercial events they may return for other events, perhaps including some of the quieter, free events.
As the hon. Gentleman said, money is indeed raised by the park's activities. Last year, £1.2 million was raised, and I believe that this year's target for income through commercial events is £1.6 million. Of course, there is a downside, as is inevitable in any place where once a week or once a month, lots of people with lots of equipment are imported to do things that do not happen for the rest of the time.
The hon. Gentleman summed up the matter well. Wear and tear to the parks and then fabric is a sensitive issue to which professional planners and managers should have regard.
Mr. Field: I have two concerns that I want to raise on behalf of my constituents. Clearly, there should be professional managers. Furthermore, the issue that I have raised is of grave concern to residents and people who cherish the amenity in question. Will their voice be heard in the strategic and day-to-day decision making about whether to prioritise work on wear and tear or work on other, larger-scale developments?
Estelle Morris: Perhaps I should deal with that point now; I was going to deal with the consultation later. I think that the hon. Gentleman would admit that his constituents are consulted, and I admit that we need to get better at carrying out such consultation. It is easy to say that we should consult people, but it is sometimes difficult to get the balance right. It is crucial that the people whose everyday lives and environment are most affected by events in the park should be consulted in a way that leaves them feeling that the consultation was meaningful and that they were listened to.
I hope that the hon. Gentleman will acknowledge—I accept that he has not made such a suggestion—that we could never get to a point at which residents had an effective veto on what went on in the park. I took it from what he said that people still feel to an extent that they
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have not been fully consulted, and I shall refer that issue back to my right hon. Friend Lord McIntosh, the Minister for Media and Heritage, who has the primary ministerial responsibilities in this regard. I know that Lord McIntosh has regular meetings with the Hyde park and other royal parks friends associations, which is why he will be particularly keen to read today's debate. The chief executive also has regular meetings.
Mr. Field: For obvious reasons, Lord McIntosh is not in a position to take part in this debate, but I wish to put it on record that I hear positive words from many of those to whom I speak. He has a true commitment and he spends a significant amount of time and effort trying to understand our concerns. I make no criticism whatever of particular Ministers; rather, I question the strategy about where the park should be in the general scheme of culture and recreation in central London in the next 20 or 30 years. I hope that the Minister may be able to elucidate on that point.
Estelle Morris: I am grateful for those comments. I shall summarise by saying that the consultation is not perfect. When I was preparing for today's debate, the Royal Parks Agency told me that it is working on its consultation, and that the process is better than it used to be. However, the agency knows that it must continually keep it eyes and ears open in order to make improvements and to help make local residents feel more involved. I wonder whether the agency was trying to make that happen in its recent consultation on the events strategy, which leads me to the next subject.
As the hon. Gentleman knows, the royal parks have been consulting on the draft events strategy for the past few months. That is important, because it is time that we had such a strategy. Over the past few years, bits of change have been building up year by year—just one more each year—until, as he said, we run the danger of seeing the late spring, summer and early autumn entirely taken up with events. We may not want such an environment for the park. That is why I put a lot of store by the events strategy. Consultation has taken place, and more than 50 organisations have expressed views.
I want briefly to record the aims of the strategy. It should ensure the effective management of events; make the parks accessible for major cultural and sporting events that are important to the profile of London as a world cultural capital; make the parks accessible to people wishing to hold community events; develop a programme of low-impact events that increase appreciation of the parks' natural environment and history; and, lastly, allow a programme of commercial events to enable the parks to maintain current levels of income from events in 2005–06. We have received comments on the strategy. Lord McIntosh will reflect on them, and he hopes to respond before the summer recess. I hope that the events strategy will be the blueprint for the future.
Crucial to the strategy is how it is put into action. It is no good having a strategy unless we have a clear way of turning the words into action. I hope that the hon. Gentleman and his constituents see in the strategy a determination to plan events so that people know what is coming up. I think that, most of all, people would welcome a reduced dependence on Hyde park. Despite the fact that the Royal Parks Agency is responsible for

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eight or nine open spaces, there has been a predominance of events in Hyde park. The other parks in the royal estate have seen few such events. The strategy has the stated aim of reducing the number of events in Hyde park, which will inevitably increase the number of events in the other parks.
New commercial events on a small scale have taken place in other parks. A good example was the Frieze art fair, which was held last year for the first time in Regent's park and is coming back this year. The agency plans to reduce over time the number of large-scale events in Hyde park and to reduce the royal parks' dependency on income from events in Hyde park alone. I hope that that offers some comfort to the hon. Gentleman and his constituents, and that it gives them a peg for further consultation and discussions with the Royal Parks Agency and Lord McIntosh.
Mr. Field: That good news will obviously be welcomed by many of the constituents who have written to me on the matter, but I wonder whether the Minister might say something in the remaining minutes about the future of the Royal Parks Agency. As I said, there is speculation in the Evening Standard that the Mayor of London—currently Ken Livingstone, but it may be someone else after 10 June—will want some control over the agency. Is any change envisaged in the status of the royal parks and in how they are managed in the years ahead?
Estelle Morris: We have no plans for that. The Mayor can voice his aspirations, but there have been no discussions between the Department and the Mayor about a change in status. The DCMS has a very good working relationship with the Royal Parks Agency, and we have no plans to change that in the foreseeable future. I, too, read the Evening Standard. We in politics are led to believe that it reflects everyone's aspirations, but such things are not always achieved. We therefore look to the future.
As well as ensuring that there are fewer events in Hyde park, and fewer big events in particular, we must find other ways of raising income. The hon. Gentleman may have had time to visit the Inn the Park restaurant in St. James's park, which is also situated in his constituency. In the four weeks in which the restaurant has been open, it has had excellent write-ups. It is in a beautiful building that is built to the highest standards and completely fits in with the environment of St. James's park. The Royal Parks Agency is doing more such things to raise income, and we should welcome the investment that it is making to ensure that it can rely on more than the big event to generate income.
The creation of the new Royal Parks Foundation, an independent charity that was established only recently under the chairmanship of Peter Ellwood to raise funds
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for large projects, is also important. It is very difficult to raise money for the bread-and-butter maintenance of the parks and much easier to gain sponsorship or to raise money for other activities. I very much hope that, with the money given by the DCMS, the foundation will be able to carry out the bread-and-butter repair and maintenance of the parks.
I acknowledge the hon. Gentleman's point about the Bon Jovi concert. Indeed, perhaps I should not say this, but he could have mentioned other events that had gone wrong in Hyde park. I have been told that the sound at the concert far exceeded the permitted level. I am not sure whether he knows this, but a condition of holding such events in Hyde park this year is that the groups use a public address system provided by the Royal Parks Agency, which will ensure that the sound is kept within permitted levels. I understand that Bon Jovi had its own PA system and did not respond to requests made during the event to reduce the noise. I cannot promise that what happened will never be repeated, but the key point to note is that there was a problem with an unacceptable noise level and that the Royal Parks Agency responded by introducing a new requirement to use its PA system so that it can control it.
I also acknowledge that the amount of mess that is left after such events is deplorable, but I should point out that a licence fee is paid for events staged in Hyde park. The fee can be up to £150,000, depending on the scale of the event. That is meant to compensate the borough and the Royal Parks Agency for the cost of clearing up the mess the next day.
The park is the jewel in the crown, and an important part, not only of the capital, but of national life. In or out of London, there is no one who does not know Hyde park. It is one of the factors that unify this country. It is changing, but it must raise some of its own income. It has managed its events haphazardly in the past few years, but some of those events, such as the jubilee celebrations, have been a great success and have become part of our national folklore. Equally, however, some of the events have gone into local folklore as nights that local residents would not want to live through again.
The way forward is to work together with proper consultation. I very much hope that the events strategy will become a reality and that it will be endorsed by September. I hope that it will form an agenda for the Royal Parks Agency and my right hon. Friend Lord McIntosh, so that, along with local representatives and residents, they can find a way forward. If it does so, I very much hope that Hyde park will continue to be a valuable asset as well as a beautiful neighbour to the hon. Gentleman's constituents.
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Sitting suspended until Two o'clock.

Transport (London)
2 pm
Martin Linton: I feel slightly guilty about having called this debate, because when I tried to find the Minister last night, I realised that he was still answering an Adjournment debate on the Floor of the House. However, this is an apposite time to debate Londoners' transport needs, because we are coming up to the comprehensive spending review, and Londoners are about to elect a Mayor for the second time, although that has nothing to do with my purpose in calling the debate.
We should start from the basic point that the Government have an excellent record on improving public, and indeed private, transport in London. Traffic levels have fallen by 30 per cent., which has reduced congestion and shortened journey times. The tube has undergone a £16 billion programme of investment, while bus use has gone up 33 per cent. in the past three and half a years and the number of rail passengers has increased by a similar percentage—I do not have the figure to hand, but I am sure that my hon. Friend will know it.
In calling the debate, it was not my purpose simply to read out a list of achievements. We must not allow ourselves to become complacent as we measure ourselves against the Conservative Government. It was not difficult to do better than them; indeed, it would have been difficult to do worse. We are light years ahead of them, but our achievement must be measured against the transport needs of London and our strategy for meeting those needs, which are growing and changing all the time. That strategy must inform our priorities for capital projects.
Some people have tried to cast doubt on the Government's commitment to the capital projects that are already in the pipeline, such as the East London line extensions, simply because those projects are being considered alongside others as part of the comprehensive spending review. I believe that the Government remain fully committed to the East London line project, and I hope to hear the Minister repeat that commitment today. After all, work has started, the planning permissions have been granted, compulsory purchase powers have been confirmed, legal challenges have been overcome, the frequency and timetabling of the trains have been agreed, and the Minister has signed off the business case. We are already a long way down the track, and all we need now is a nod from the Chancellor to approve the funding.
Obviously, funding decisions must be taken in the context of a capital programme, but I do not believe that that poses any threat to this scheme. I say that not only because the project is already far advanced, but because it is good value for money. Even given the new costing of £1 billion, it is a snip compared with Thameslink at £3 billion and Crossrail at £8 billion —although given the benefits that both of those schemes will deliver, they are well worth the price.
Linda Perham: As my hon. Friend knows, I chair the all-party group on Crossrail. I am sure that he will agree with Ken Livingstone, the Mayor, that Crossrail is London's single most significant transport requirement, and that it would have huge benefits for the whole United Kingdom economy—not to mention the effect that it would have on overcrowding on the tubes and trains, particularly in my area, on the eastern side of London.
Martin Linton: I believe that Crossrail will enormously reduce pressure on the tube system, and I shall return to that after I have dealt with the East London line.
The East London line extensions project—or ELLX, as it is called—will be good value for money, but there are four other good reasons why it must go ahead. First, it makes excellent transport sense, relieving pressure on rail terminuses, enabling commuters to avoid the centre and take the tube straight to their destination, and allowing through-London passengers to bypass the centre and travel straight to one of the interchange stations on the main lines out of London, such as Stratford, Finsbury Park, Ealing Broadway or Clapham Junction. Even though the project may not be considered essential for the Olympic bid, it will enormously facilitate journeys to and between Olympic venues, especially Wimbledon.
Secondly, the project will open the way for a London orbital network by joining the eastern, southern, western and northern London lines and linking them to the interchange stations, or nodes. One could, for instance, get off the Cardiff train at Ealing and go straight to Finsbury Park to pick up an Edinburgh train, rather than having to fight one's way through the centre of London. More importantly, however, it will make cross-London journeys much easier for Londoners.
Thirdly, the project will make excellent regeneration sense. In fact, it has been called the regeneration express, because it will link south London's five most deprived areas—Peckham, Camberwell, Brixton, Clapham and Battersea—with jobs in docklands and elsewhere, cutting many journey times in half.
The scheme will be no good if Brixton and Battersea do not have stations, however. At the moment there are two-mile gaps where Brixton and Battersea stations should be. I have been speaking to Transport for London and the Mayor about a station in Battersea, and we await further discussions when the funding is settled.
Fourthly, the project will be a godsend to parts of London that were left off the underground network in the Victorian era. I see that my hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) is here, and Hackney is a prime example of that problem, as are Peckham and Battersea, and even north Kensington, in the context of the west London line. Many of London's communities are poorly served by the railways. In Battersea we have more railways per square mile than any other constituency in the country. There are lines all over the place—we even have a line that is used by only one passenger train a week, and by freight the rest of the time—but having so many lines is of little use if the trains do not stop.
Joan Ruddock: I congratulate my hon. Friend on securing this debate, and apologise that I shall not be able to stay until the end. He has not mentioned the deprived areas in my constituency, which would also receive economic, travel and other benefits from the southern and northern extensions. We will be privileged to have the Surrey Canal Road station, which will make a huge difference to the opportunities for travel.
Does my hon. Friend share my concern that we are being told to wait for the spending review, because the East London line extension team tells us that little public money is required in the period of the current spending review, and that the major expenditure will be post-2010? There is therefore little reason for delay by the Government. We should press the Minister to reassure us about a development that is so important to us all, especially my constituents. My constituency contains the fourth largest proportion of people in the country who are dependent on rail, and there is very low car usage. The line is essential to us, and I trust that my hon. Friend will continue to press the Minister forcefully.
Martin Linton: My hon. Friend is right. I mentioned the five most deprived areas in south London, and I had thought of Deptford as the sixth most deprived, but it is already connected to the tube. However, she is right to say that a new station in Surrey Canal road—I cycled past the spot this morning—will give Deptford an additional link and start the regeneration express across to Battersea. She is also right to say that the expense that will fall within the period 2005–08, which I understand is the period covered by the comprehensive spending review, is small. That is why I am hopeful—verging on confident—that the scheme will go ahead in its present form, but we must await events.
As I was saying, the usefulness of the project depends on having stations for the trains to stop at. Whenever we raise the question of opening new stations, however, the railway industry reacts with horror. The problem is partly to do with the industry's mindset. The train operating companies tend to be run by people who think inter-city—about getting people to and from London, rather than around London. They do not think about frequent trains and frequent stops, as on the tube. For a large part of London, however, the train is our tube. We need to adopt the same "metro" approach to the inner-city railways as we take to the tube.
There is also a problem of incentives. Privatisation left Railtrack and Network Rail with no incentive to support new stations. They get no more money for new stations, so they do not build them. In the last 10 years, only two new stations have been built in the entire south-east, one of which was West Brompton, in London. However, in my constituency alone we need a new station in north Battersea, on the East London line, and on Crossrail. We also need to reopen Battersea High Street station, on the west London line, but we just get told, "It's a freight problem."
I rejoice in the increased use of rail freight, which I believe is up by 38 per cent.—that figure is probably wrong, but I am sure that someone will correct me.
Mr. Andrew Love: That is right.
Martin Linton: Thank you.
Every piece of freight unloaded at our channel ports and taken to any destination north of London has to travel through my constituency and over the Battersea railway bridge. As a result, there is almost no space left for passengers on the south London and west London lines. If that happened on our road system, and all freight traffic had to use one bridge over the Thames, there would be mothers in prams demonstrating and blocking zebra crossings to draw attention to the situation, but because it affects the rail system, no one asks what local people think.
No one is saying that London ought to take over sole responsibility for railways in London. Obviously, they must be run as part of a national system; the London regional rail proposal recognises that, but others must recognise that railways are part of London's local transport system. Londoners make more train journeys than all the people in the midlands, the north, Scotland and Wales added together. Trains are, overwhelmingly, a London form of transport, but the railways do not seem to be run in the interests of Londoners. We need to reclaim the railway lines of inner London for greater use by Londoners.
Mr. Love: Is not the strongest argument for the change the fact that the railways in London have been run so badly that it could not do anything but improve the situation?
Martin Linton: That is right. As I said in my opening remarks, if we compare ourselves with the Conservative Government, it is almost impossible for what we have done not to be an improvement, but we need to set our standards higher than that. We should aim to create a railway system that serves Londoners' interests.
I return briefly to the East London line. I hope that I have demonstrated that that scheme is good value for money and makes good transport and regeneration sense. For those reasons, I would be surprised if we did not go ahead with it. In football parlance, I would be gobsmacked—indeed, I would be gutted—as I have invested much of my time and campaigning energies in that scheme.
Crossrail 1 and 2 are not as far down the track. They are much bigger projects, with a longer time scale, but they are just as vital. I hope that we keep up the momentum for them. Crossrail 2 is the answer to Clapham Junction's century-long exclusion from the London tube network, although the East London line will, if all goes well, link Clapham Junction to the tube system earlier—2011 is currently the best estimate.
The people living around Clapham Junction station, which, despite its name, is in the centre of my constituency, are puzzled as to why it is not linked to the tube, despite being the busiest station not just in London or the UK, but in Europe. In Victorian days, the reason was that Battersea is built on clay, but it is at least 50 years since clay ceased to be a difficult material through which to tunnel; indeed, it is now one of the easiest. I hope that my hon. Friend will be the Minister who is finally able to announce definitively that the 100-year wait is over and that Clapham Junction will be linked to the tube—possibly to coincide with its overdue redevelopment, which is in the Strategic Rail Authority plan for 2010.

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Perhaps the most urgent transport need in London has been answered by the introduction of the congestion charge, using powers granted to the Greater London authority by the Labour Government. That charge has reduced traffic by 30 per cent., taken 65,000 cars a day out of the central zone, cut nitrogen oxide and carbon dioxide by 16 and 19 per cent. respectively—not a bad
achievement in itself—and has significantly reduced journey times for people who travel by bus. Battersea is a classic bus commuter constituency. The charge has also reduced journey times for motorists. I cannot believe that the Conservative candidate in the mayoral election has threatened to end the congestion charge on day one. I cannot think of a quicker way to ensure a return to the bad old days of daily gridlock in central London.
I pay tribute to Transport for London and its London Buses for the way in which they have increased bus use—with enormous help from the Department for Transport. On one day towards the end of April, they had more than 6 million passengers for the first time. Bus reliability is at an all-time high, although there is still a long way to go, and bus occupancy is double that outside London. Satisfaction with bus services has risen in each of the last four years and is now at 77 per cent.—although that does not stop me, and, no doubt, my hon. Friends, from receiving the occasional letter of complaint—and the buses are attracting many new users. Perhaps the most impressive statistic is that in London, the percentage of the population who never travel by bus has been reduced front 29 per cent. to 21 per cent.
I should like to make two more points about buses. One is that it is imperative that the comprehensive spending review does not freeze the money going to London's buses. If that were to happen, the frequency of buses would undoubtedly reduce, and that would inevitably affect off-peak and night buses most. The maximum possible revenue from fares and the congestion charge cannot plug more than a small part of the gap. I am sure that my hon. Friend will have said all that in his submission to the comprehensive spending review.
Secondly, buses are improving, although there is still a problem with the training of bus drivers. Frequency is being improved and so is reliability, but I should like to see buses developed as a more luxurious form of travel. Rather than think of them in old-fashioned terms as poor people's transport, why not introduce city express buses that go fast from suburbs to the city? Why not develop buses that will give people a smoother ride? Too many people get thrown around when they stand up in a bus, and for that reason fear to use buses. None of the new rail schemes can produce extra capacity until 2010 at the earliest, so although it is essential that we proceed with them, and build a transport system for London worthy of this century, in the next six years our only way of improving public transport will be to make buses quicker and more comfortable. I therefore hope that my hon. Friend will do everything in his power to make that happen.
2.17 pm
Mr. John Wilkinson: We are all grateful to the hon. Member for Battersea (Martin Linton) for having introduced this timely
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debate. He need not feel guilty for having done so, unless there is guilt by association with the socialist administration in City hall, which has not fulfilled the promises of the Labour Administration to improve transport in London. We shall hear more about that in the election campaign—but for now, on with the debate.
My constituents' principal concern is that the tube system should be improved, and I shall concentrate on that. It is understood that the mayoralty has invested a great deal of money and political energy in London's buses. There are even bus lanes to prove it, and more buses too. There has not been too bad a service on the buses—in fact, there has been an improvement. Whether that improvement has been cost-effective is for others to decide, particularly our representatives on the hustings.
The tube is another matter. I am pleased to see the Under-Secretary of State for Transport, the hon. Member for Harrow, East (Mr. McNulty) in his place representing the Department for Transport, because he will understand the west London perspective. My constituents rely on the tube system for commuting, but it is unreliable: trains are slower than they should be, the track needs repair, the stations are often dirty and people fear that the system is not secure. The public-private partnership has yet to deliver the results that were promised. However, it cannot bring anybody any delight to know that the facilities for disabled passengers are well below standard. I cannot think of one tube station in my constituency, which has eight, with proper lifts and other facilities to enable disabled passengers to get to the platform easily. We need better leadership and higher standards.
We also need much more investment, and that should be the central theme of today's debate. We are all conscious that London is the powerhouse of the country's economy. We are aware that London pays a great deal more in taxes than it receives back in public service investment. We are also somewhat sore that so much of our hard-earned money goes to subsidise the Scots—with no change in the Barnett formula, even after the establishment of the Scottish Parliament—rather than being reinvested in services for the benefit of the Londoners who earned the money.
Let us consider the investment plan for the next few years. Transport for London reckons that under its business strategy, an extra £1 billion of Government money needs to be invested in transport in the capital for the foreseeable future. That is quite right. Even the much vaunted congestion charge is not bringing in the money that had been anticipated; the administrative costs of introduction were far higher than had been programmed, and the mayoralty is facing a shortfall in revenue from that source.
I will make only modest proposals relevant to west London for the consideration of the Chamber and the Minister this afternoon, and I will set them in the context of the air transport requirements of the capital. Air transport is very important to my constituents as a source of jobs, particularly at Heathrow, and as a source of local economic prosperity, but it is also the cause of much congestion on the overburdened road system. We need investment in tube extensions and links that can get people out of their cars and on to the tube system.

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The first proposal that I shall put to the Minister is one with which he is familiar, and with which he probably instinctively has sympathy; whether the Treasury has such sympathy, I do not know. He has reminded me of the spending review being conducted this year, and I am sure that if the Treasury does its sums properly, it will find that the Croxley link to connect the metropolitan tube network to the west coast main line rail network at Watford Junction would bring substantial returns for a modest investment. The line is essentially there already, and it would take a great deal of passenger traffic from the west coast main line directly on to the tube system, and also make it easier for people to get on to the west coast main line.
The second proposal is to extend the Piccadilly line from Uxbridge down to Heathrow. If there is to be a fifth terminal—we know that it would be in service quite soon—it deserves an improvement in the transport facilities that service it. That proposal would be such an improvement, at modest cost. Another idea would be to extend the Central line from West Ruislip to Heathrow.
I suspect that those two extensions are especially relevant because Crossrail, which we so earnestly desire, seems to have slipped further and further into the future. I wish that Her Majesty's Government would put money into it now. We would be much more likely to get the Olympic games if Crossrail was a definitive project, officially supported, properly funded and effectively programmed. The fact that Crossrail is not an official Government-sponsored project creates a built-in headwind for our Olympic promoters. As Crossrail is so delayed, the two extensions of the tube to which I have referred are particularly important.
In conclusion, let us consider the promotion of the Olympics at the Stratford site in connection with air transport in London. London is already well served by air transport facilities—Heathrow, Gatwick, Stansted, Luton and City airports. For business aviation within the Greater London authority area, there is Northolt for movements up to a fixed limit of 7,000 a year, and Biggin Hill. We do not have a shortage of facilities, but we need better transport access to them. Another Heathrow runway would make the road congestion in west London intolerable. Let us concentrate on the road connections that need improving, at modest cost, but above all, on investment in tube infrastructure.
If we can do that, and the extra £1 billion a year can be provided for Transport for London, there is, I think, hope for west Londoners. Otherwise the present financial situation may continue, with money siphoned off from the capital for use elsewhere, and the congestion charge bringing in no more money. In that connection I ask the Minister to state now that he will veto any imposition of a congestion charge for access to Heathrow.
If the Government adopt the modest projects that I have proposed, London, particularly west Londoners, will benefit substantially. Congestion will be eased and a good return will be gained for relatively modest input by the taxpayer.
2.26 pm
Jeremy Corbyn: I shall be brief, because many hon. Members want to speak. It is interesting that so far no one has suggested massive road
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building as a solution to any of London's transport problems. That is a welcome change from debates in past years. We now talk about public transport solutions, and I join other hon. Members in congratulating the Mayor, Ken Livingstone, on the enormous improvement and the investment that he has managed to make in bus services.
I have two pleas for the Government. First, will they ensure that the subsidy level is continued into future years? There will be a serious problem in two or three years if investment falls off. Secondly, will they study the question of the money being made by private operators out of franchised routes? I welcome the improvements in bus services, but it is noticeable that enormous profits are being made by private enterprise bus companies that are essentially operating a closed market on TFL-authorised routes. East Thames Buses, which is directly owned by the Greater London authority, runs a service as efficient and effective as any other, and that seems to me to be a positive way forward.
I endorse what my hon. Friend the Member for Battersea (Martin Linton) said about the need for increased and enhanced bus driver and staff training and the importance of job retention. Turnover is still too fast. There was a time when working on London's buses was seen as a prestige job. We want that atmosphere back, with some degree of parity in salaries with people working on the tube network.
As one who cycles around London a great deal, I was interested in an item on last night's London news about a recent death in a traffic accident on Blackfriars bridge. There is an insane cycle route there, which was apparently approved in some form or other by the Minister's Department. The cycle route goes between two fast-moving lines of traffic, which is completely crazy and very dangerous. One accident like that, which gets a lot of publicity, puts an awful lot of people off cycling.
I urge the Department, when it issues advice, to encourage the continuation of safe cycling routes, not just on the easy bits of main roads, but on the harder bits, such as around junctions. Appropriate safety arrangements and priority should be given. Cycling has increased a great deal in London, but the accident rate is still high. That is in part because of the conflict with traffic at junctions, although it is also in some cases caused by dangerous cycling, such as cycling across pavements and jumping lights. It is also partly because children lack safety awareness, and there is not enough training in schools on riding and maintaining a bicycle. It is all simple stuff, but it is important if we are to maintain the growth in numbers of people who cycle.
The debate is essentially about investment, and I shall quickly mention three areas where investment is needed. My hon. Friend mentioned the East London line, and I support all that he said about it. If the East London line extension is to be improved, work can go ahead quickly. The route is largely established, particularly now that the Bishopsgate goods yard issue has been resolved. The track bed is already available for running to Dalston Junction. It can then join with the North London line and run round to Highbury and Islington station, at last linking Hackney to Islington by tube. The one thing that all Hackney residents want is to be able to get a tube to Islington?then they will be able to shop more easily in Upper street, which I am sure is their main aim in life.

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I also feel strongly about the East London line extension route, which would go up to Finsbury Park station. That would enable the Finsbury Park interchange to be improved and developed. It would make a good stopping-off point, and allow many people to get on to the tube before the trains reach King's Cross. At the moment, they can get on to the Victoria and Piccadilly lines, but with the East London line there would be a link through to the City, which would be extremely welcome.
That leads me on to the vexed question of Finsbury Park station. I am sure that the Minister has been there, as has every Minister for the past 15 years. They have all said that it is appalling, and I agree with them. It is a mess. It is overcrowded, badly laid out, and on a difficult site. Transport for London has put in a great deal of effort to improve the station and the interchange. I am sure that my hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) would support the need for improvement or that station, and if possible, its complete rebuilding.
We have reached agreement on most of the things that need to be done, but Network Rail has proved difficult, and has decided that all its investment must go somewhere else. I have raised the matter with the Secretary of State and with other Ministers and I would be grateful if the Minister will confirm in his reply that his Department is fully behind the TFL proposals for Finsbury Park station, and will ensure that Network Rail plays its part in improving it.
Ms Diane Abbott: My hon. Friend will agree that the investment and rebuilding of Finsbury Park is key to the regeneration of what is a rather neglected corner of north-east London, perhaps because three boroughs meet there. So much would be done to improve the quality of life of those living there if the Government could give the scheme their full backing.
Jeremy Corbyn: I agree with my hon. Friend. In the past, we have had plans to close railway lines and turn them into roads, and to run down various lines deliberately. Fortunately, those days are now behind us, but we still have quite a lot of underused surface-level railways lines, with unimaginative train routes using them. I am thinking of the North London line system, which includes the Barking to Gospel Oak line and the North Woolwich to Richmond line. I live near the Barking to Gospel Oak line, and we have complained about it for a long time. Silverlink has improved the service and the stations are better than they used to be, but several things could be done.
First, an interchange station near Tufnell Park station on the Northern line could be constructed. The route would then not only link with the Victoria line at Blackhorse Road, but passengers could transfer to the Northern line at Tufnell Park. Secondly, there could be a more imaginative service. Why does the service have to stop at Gospel Oak? Why on earth can trains not run through to Willesden, Ealing, Richmond or the west London line? The entire basis for an outer circle surface rail link is in place, and it could be developed. Is there a complete lack of imagination, or is nothing done because several railway franchises are involved and it is just too complicated for them to get together and work something out?
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That leads me to the question of the future structure for transport in London. When this Government were elected, they did the right thing in establishing Transport for London, a Greater London authority and a Mayor who had considerable powers over transport. Unfortunately, he has only just received powers over the tube. It is time that the rail system in London was handed over to Transport for London, which could then ensure that a properly integrated system ran within London, that another ran in and out of London, and that the two were integrated.
The problem with London's transport infrastructure is largely its age. Some of it is very old. It is wonderful and historic, but expensive to maintain. New tube networks are expensive to install, particularly when we have so many different operating systems within the same network. I would be grateful if, when the Minister replies, he gives us hope on two issues. First, we want hope that Crossrail will finally go ahead. Secondly, we want him to continue to give his blessing to the development of surface-level tram lines.
The Croydon Tramlink has proved to be successful and the Mayor's proposals for tram links in west London and from Camberwell to Camden seem exciting, relatively cheap and quick to install. They are a rapid way of improving public transport in London. We have great opportunities and a wonderful city, but unless we continue to improve public transport quickly. we will end up with congestion problems that will encourage people back into their cars. All the success of the congestion charge will be lost unless we continue to invest heavily in surface-level transport links in London.
2.35 pm
Mr. Andrew Love: I congratulate my hon. Friend the Member for Battersea (Martin Linton) on securing this debate at a very apposite time, and I shall take up the theme of his contribution—the transport challenges facing London.
Three million people use the underground every day, which is about the same number as use the rail network; 5.9 million people use London buses, which is a third of the total for the whole of England and Wales; and 85 per cent. of the commuters who come into central London use public transport. On top of that, London is the fastest growing city in Europe; as the Mayor likes to put it, it will grow by the size of the Leeds conurbation about 800,000 people—by 2016. The capital city also has an enormous tourist industry; 30 million tourists visit us annually. They spend a huge amount and are very important to the London economy. However, our infrastructure has been deteriorating for years under different Governments, and there has been a failure to address the increasing need for good-quality 21st–century transport.
I welcome the new powers, agreed by the Treasury, to allow Transport for London to borrow for capital expenditure. That can be done because of the fees that arise from the fare structures in London transport. However, that does not go far enough; it does not fund all the needs of London transport.
We must ask: why should we invest in the capital? There are many reasons. I do not think that one of them is that London is a net tax contributor to the rest of the country; in my view, that is right and proper. However,

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it must be recognised that London is the engine of the UK economy and that, economically, it faces not inwards but, in many ways, outwards. It competes internationally with cities in other countries rather than with other cities in this country.
The vast bulk of the investment that goes into London comes from abroad. The state of London's transport is critical to such decisions about whether to invest in London rather than other cities. That is critical to a wider area than London alone; all the evidence shows that that investment ripples out into the rest of the south-east and the entire country. If we lose that inward investment in London, not only will London suffer, so will the rest of the country. London has higher productivity than the rest of the country. Its competitive edge not only works internationally, it helps the rest of the south-east, and the country, to raise its game by improving its ability to attract investment.
Investment in London is good value for money. There has been a study that shows that the benefits will be two and a half times greater if investment is made along the lines that Transport for London suggests, rather than if the absolute minimum is done. The Transport for London plan shows that there will be a 7.5 per cent. increase in capacity if we invest the sums suggested. Those are just the benefits in transport terms; there are also the knock-on benefits of reducing social exclusion and regenerating parts of London that are exceptionally deprived.
Having made that case, I shall now look at two areas where investment is urgent. First I will take up the themes of previous speakers, and talk about London buses. They promote social inclusion. Who uses London buses? Bus passengers are the elderly, people on low incomes, people without cars, minority ethnic groups and women—all the groups that are most excluded within the London economy. If we are to reduce that exclusion, buses will have to be the primary transport mode that we use.
Transport for London, the Mayor and the Greater London authority have had some success on this issue, and I pay tribute to them for what they have achieved over the past four years. Bus use has gone up by 30 per cent., although it is stagnant in most of the rest of the country. There has been a 15 per cent. rise in the average number of passengers travelling on each bus, so buses are giving better value for money.
From the vantage point of my constituency, I can see that buses have made a major contribution to public transport in outer London, which does not generally enjoy the benefits of the underground or a good rail service. Buses therefore make a critical contribution to outer London, and that has been important over the past four years.
The second issue, however, is critical. We want to invest in the tube, the rail system and the other things that hon. Members have mentioned, but it will be some time—perhaps 10, 15 or 20 years—before we see the major benefits of that investment. Investment in buses, however, is ideal because it can be delivered in the short term and can increase capacity now. That is why we need to fund the plan to increase bus capacity throughout London, particularly in outer London.
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Two issues are critical to my constituents. First, Edmonton Green bus terminus is among the top 10 in terms of daily bus movements, so it is critical to the whole of that part of north London. However, negotiations over the delivery of a new terminus are mired in complex issues and never seem to end. I make a plea to the Minister, and in particular to Transport for London and the developer, to sort things out. They desperately need to do so if the service to my constituents is to be improved.
Secondly, I am interested in the school bus service, which the Department has been carefully studying. I have corresponded with local schools, one of which said:

"What a much needed service! Like many schools in Edmonton we suffer from massive congestion at the start and end of each day. This leads to real issues of road safety for our children. We would be delighted to be involved in a pilot scheme".

So, too, would the rest of my constituency. Perhaps the Minister could take that idea away and consider it for future reference.
In an intervention on my hon. Friend the Member for Battersea I mentioned that the rail service was in urgent need of upgrading, but that is an understatement. I know from the nods around the Chamber that that view is shared throughout the capital. We must create more capacity and improve performance on our railways, because commuters have suffered long enough. The train operating company on the railway line in my area has recently changed, and the transition has been relatively smooth; indeed, hardly anyone has noticed it. However, if I were to ask my constituents whether they had seen any improvement in performance or standards, they would say no to that, too, because the problems and challenges on the line are still to be addressed.
I strongly agree with my hon. Friend that we need to consider an alternative solution, and that suggested by Transport for London begins to address several of the issues. In its brief for the debate, for example, Transport for London says that it will be looking to increase capacity, to improve the integration of fares across London and to enable funds to be raised for major rail projects. Its expertise would bring real benefits to London commuters, and on that basis alone, its proposed alternative should be considered sympathetically.
The Minister will say that the commuter lines do not start in London and that London is only part of the service that they deliver. However, London commuters have suffered long enough, and there must be a positive way forward. A link-up between Transport for London, Network Rail and the train operating companies would deliver real benefits, without necessarily challenging or making things more difficult for the rest of the rail network in the south-east.
Finally, I want to raise a local issue. My local central station at Edmonton Green sits cheek by jowl with the bus station, and is in need of urgent improvement. That is set out in the plan, as are improvements to stations throughout the capital. Improvements will not happen without the plan. The use of the station by my constituents is severely limited because improvements have not taken place. They fear using the station in the evening. The multiple stairs to the station cause great problems for disabled people. Such matters should be dealt with.

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I make a final plea to the Minister. Transport for London is doing all that it can to develop the transport network, but it needs the support of the Department to achieve all that it wants. The benefits will come primarily to London commuters and to people in constituencies such as mine, but benefits will also be delivered to the rest of the south-east and throughout the country. On that basis alone, I commend the plan to the Minister.
Several hon. Members rose—
Mr. Deputy Speaker (Mr. Edward O'Hara): Order. Before we continue, I remind hon. Members who wish to contribute to the debate that winding-up speeches should start not later than 3 pm.
2.46 pm
Clive Efford: I, too, congratulate my hon. Friend the Member for Battersea (Martin Linton) on securing the debate. As has been said, it is timely not only because of the elections for Mayor and the comprehensive spending review, but the fact that a debate about London's transport system has begun as a result of our being shortlisted for the Olympic bid—an issue to which I shall return. Reference has been made to many projects, such as the East London line, Crossrail, Thameslink, the extension of the Docklands light railway in the Thames gateway area and the Woolwich rapid transport link along the river front. However, alongside those issues we must consider how we bring the benefits of those schemes to the wider community, and how people who do not live or work in the immediate areas that will see major improvements in their infrastructure can link into them and reap the benefits of that investment.
We must appreciate the successes. It is easy to slip into a debate about London's transport network and be only negative, not positive, about it. That reflects the level of use of public transport in London. We should not forget that there is a high dependency on public transport in London, which to some degree is a reflection of its success. Over the past few years, several successes have come from the office of the Mayor—
2.47 pm
Sitting suspended for a Division in the House.
3.3 pm
On resuming—
Mr. Deputy Speaker: I remind hon. Members that the winding-up speeches will now start at 3.15 pm.
Clive Efford: Thank you, Mr. Deputy Speaker.
TFL's research shows a 30 per cent. modal shift from cars to other forms of transport between 1999 and 2003. There are many other figures relating to increased bus usage and so on, but I shall not go through those now, as other hon. Members want to speak.
London is essential to the economic well-being of our country. It supports 4 million jobs, 1.4 million of which are in central London. Five local authorities in London have employment densities of 5,000 workers per square
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kilometre, and in the City of London the figure goes up to 130,000 jobs per square kilometre. More than 90 per cent. of those people travel to work by public transport. Two thirds of all UK rail journeys begin and end in London, and Londoners account for 50 per cent. of all UK rail journeys. That demonstrates that it is essential for London to have an effective voice in how not only our rail services but all our transport services are integrated. London will need more money to invest in public transport networks.
I heard my hon. Friend the Member for Battersea support the East London line, which he rightly called the orbital route. I support it too, but coming from southeast London, I must ask what happens to my constituents who are outside its orbit. How do we ensure that our train services link into it? Is it possible to make it turn east, so that it really is an East London line, linking with communities in south-east London who do not have direct access to the London underground? They, too, will then benefit directly from the new rail service.
Crossrail is another essential development, particularly for south-east London. It is crucial that there is a station at Woolwich, and that Woolwich becomes a major transport hub, linking with other modes of transport and allowing the wider community in south-east London to use the road network. We must develop a bus network on those roads to link with the other new transport developments.
We seem to be approaching the end of the difficulties with Thameslink 2000—perhaps we should stop using that name, because it sounds like the number of years that it is taking to get off the ground; a new name may be needed. That extension to the rail service is needed in my part of London. We need to plan and ensure that we integrate our network. One example of such planning is the development of the Jubilee line, which has made its way to North Greenwich station in the north of my borough. One bus service goes direct to that tube station from the south of Greenwich, through my constituency, but in the rush hour it takes 45 minutes to get there, and is not an option for commuters.
As my hon. Friend the Member for Edmonton (Mr. Love) said earlier, we need express bus routes to take people from outlying areas, link them rapidly with the new transport developments and give them an alternative method of getting to and from work each day. We need to develop such strategies if we are to address the growth in demand that we all know will happen in London's transport system and reduce car use, which is increasing. We cannot afford the Mayor of London's voice not to be heard in those debates, including on the development of transport and train services.
I should like to dwell for a moment on train services. The 12-car strategy for the network in south-east London seems to be disappearing completely from the agenda. If we are to develop a transport network to meet the growing demands, particularly in north Kent and the Thames gateway, we need to increase the capacity of the existing rail network. We cannot continue with a train system that has an inadequate electricity supply and cannot grow as required to meet future demand. In the absence of any other form of public transport, failure to increase that capacity means that our road network, which is already overloaded, will become even

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more congested. We must ensure that London's needs—particularly those of south-east London, where there is no direct access to the London underground—are heard in that debate.
Finally, there is the discussion of London's transport network in relation to the Olympic bid. A lot has been said about our transport network creaking at the seams, the infrastructure needing repair and improvement and the fact that we desperately need to develop new schemes to meet future demand. In a sense, that is a private debate among ourselves. For those outside looking in, it may seem that our transport infrastructure could not support a scheme such as the Olympics. However, the truth is that we have an effective transport network. but we are so concerned about it because of the heavy demand on the rail network, and the value that we accord it. A debate about the need to improve and develop that network should not be mistaken for a debate about a system that is incapable of supporting London's needs in the future, or the needs of a major event such as the Olympics.
3.9 pm
Ms Diane Abbott: I am glad to have the opportunity to speak in this important debate on London's transport needs. Colleagues have gone through the range of transport issues, and I want to focus on a few key infrastructure projects and the importance of transport for regeneration.
We cannot talk about transport in London without congratulating the Mayor, Ken Livingstone, on his visionary leadership in transport issues, particularly the introduction of the successful congestion charge and the massive improvements in buses. However, I want to focus on transport and regeneration.
We have heard a lot about transport for commuters and for people wanting to go through London to somewhere else, but we cannot overstress the importance of transport links for regeneration in inner London. There is sometimes a tendency to talk about London as if it were very wealthy, with lots of jobs, but in inner London—in my borough, Hackney, in Islington and in Deptford—one in two children live in poverty.
There is no more certain lever of economic regeneration than improved transport. First, it provides a Mecca for new business and retail projects. Secondly, it makes it easier for people to travel to work and enlarges their travel-to-work areas. Thirdly, investment in transport, in new stations and in developments above stations can transform the whole look of an area.
I am so keen on these infrastructure projects because of the benefits of transport improvements for people in some of the poorest areas of London. We have heard about Crossrail; what we want to hear from the Minister about Crossrail 1 is whether it will go ahead. Even if it were given the go-ahead tomorrow, its completion would still be too late for the 2012 Olympics. Nevertheless, it is still a vital project for London.
Business, the communities and the Mayor want to see Crossrail happen, and if the Minister gave the definite go-ahead in this debate, he would have the gratitude of Londoners from one end of the London underground to
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the other. Everyone inside the M25 would be singing his praises, and casting flowers on the road as he went about his daily business.
We do not hear enough about Crossrail 2, the Chelsea-Hackney line, but that is another vital infrastructure project, which would help redevelop the constituency of my hon. Friend the Member for Eltham (Clive Efford) to the south, and which would help the people of Hackney and inner London.
As for the East London line, let me remind the Minister that it was the subject of a manifesto pledge. The Government have already committed more than £100 million to it; it would link Highbury and Islington in the north, passing through Dalston, Canonbury, Haggerston, Hoxton and Shoreditch down to West Croydon. No single project would do more for the east end than the East London line would. Other Members are quick to talk about crime, deprivation and social exclusion, but such infrastructure projects could probably do more than any single one-off scheme or project to counter social exclusion and poverty in the east end and other poor areas of London.
The London elections and the elections for the Mayor and the London assembly are not too far away. I remind colleagues, and the Minister, that within the next 12 months there will almost certainly be a general election. When we are on doorsteps during that campaign, people in London will want to know what their Labour Government have done for them. I want to be able to say on the doorsteps of Hackney that, yes, we did deliver the East London line, that, yes, there is a definite go-ahead for Crossrail 1 and that, yes, Crossrail 2 is definitely going to happen. That would make sense for Londoners, for the poorest areas of London and for business. Above all, it would make sense for the Government to make the money available for those long anticipated and desperately needed infrastructure projects. On behalf of the people of Hackney, I ask the Minister to let us have a real green light for Crossrail 1, Crossrail 2 and the East London line.
3.14 pm
Siobhain McDonagh: I shall spend my one minute singing the concerns of south-west London, which, as people know, is the greatest bit of London. We recently had a visit from the Mayor. who called my office and suggested that he would like to arrive by public transport, but in that respect, in my constituency we feel that Paris is closer than north London.
From looking at the transport planner, we discovered that he would have to take three different buses plus the train to get there; it would have taken him in excess of two hours. When he finally got to Pollards Hill, he would find an area that has lots of great transport systems, but no access to any of them. The area is on the longest bit of the Brighton to Victoria rail line without a station, in spite of the fact that Eastfields station has been promised since 1936.
The Mayor would find a fantastic Croydon to Wimbledon tram line, which people in Pollards Hill cannot access unless they happen to be long-distance runners and can cross Mitcham common, because they do not have a bus to get there. He would also find that the 463 bus—a fantastic bus service provided by Quality

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Line—does not yet reach Pollards Hill, although that has been promised for years. We need to be able to access the systems that already exist. That would be quite simple; it just needs a little attention.
3.15 pm
Tom Brake: I congratulate the hon. Member for Battersea (Martin Linton) on securing the debate. I wholeheartedly agree with much that has been said today, but one aspect of the debate has surprised me—the difference that the Mayor's Labour party card has made to the plaudits given to him. Admittedly, several hon. Members in the Chamber have regularly congratulated him, but others have not been so forthcoming.
Ms Abbott: I hope that the hon. Gentleman acknowledges that I have consistently supported Ken Livingstone.
Tom Brake: I was looking directly at the hon. Lady when I commented on the fact that some Members have been consistent in their plaudits.
Another aspect of the debate that surprises me is the fact that, a couple of weeks away from elections, the Conservative mayoral candidate, Steve Norris, has not been mentioned. I would have thought it appropriate to mention him during the debate and to highlight some of the problems that his candidacy presents.[Interruption.] At least now many hon. Members are commenting, if only from a sedentary position, on the lack of suitability of such a candidate in the forthcoming mayoral elections.
London's transport needs are great, and are growing. If the Mayor's projections that an extra 800,000 people will arrive in London by 2016 are accurate, the demand will greatly increase. Clearly, transport funding needs are not being met. That was always going to be the case, given that when the legislation was passed, there were no means, with the exception of the congestion charge, by which the Mayor could raise funds for transport in London. The mayor, whether aspiring Labour, independent, or—as it now appears—independent
Labour, was always going to have to go cap in hand to the Government to seek funds for transport in London. As several Members have pointed out, the framework within which funding is obtained, particularly for rail, is not fit for purpose.
It is regrettable that, seven years on, we are only now discussing the fact that rail is not included in the Mayor's portfolio, when four or five years ago there was an opportunity to ensure that it was. That was a missed opportunity. Four or five years ago there was a need for the Mayor to be given much greater powers over rail in London to ensure better integration. However, we are where we are. How do we get a transport system that Londoners can be proud of, and that tourists, businessmen, and perhaps visitors o the Olympics, will believe is appropriate for their needs?
Several Members have commented, entirely correctly, on very large schemes such as the Fast London line and Crossrail. It is, however, important to concentrate on the much smaller schemes too. At least one hon. Member focused, rightly, on the need to improve walking and cycling facilities. The Government are
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rightly focusing on improving people's health and trying to encourage people to take 10,000 steps a day, which by my reckoning means the average person walking about 5 km a day. Walking and cycling are key to improving people's health. Anyone who walks and cycles is taking some of the pressure off public transport in London. The focus on walking and cycling should therefore be greater, and some relatively low-cost schemes could be introduced to improve them.
The big schemes for the tube need to be tackled. The tube should be run much later to make it much more appropriate for London's needs, particularly at weekends. We also need simplified ways of measuring performance on the tube. I see from the glossy magazine sent me by Metronet that mystery shoppers have been examining the worst square metre of carriages and noting every piece of rubbish larger than 5 cm in width. That is one way to measure the cleanliness of trains, but I am not convinced that it is the best; nor it is necessarily the cheapest way, given the overheads involved in such schemes.
I agree entirely with the hon. Members who spoke of the need for a rail authority—a body that can integrate rail services with other transport providers. Several Members commented on bus improvements. Improvements have certainly been made, although I doubt whether it is prudent to build in improvements only to run out of money and find that a huge new injection of Government cash is needed.
No one has yet mentioned something that could make a significant difference to those who use buses, especially the socially excluded, to whom some have referred, but others as well. I am thinking of Countdown. If people are to use the buses, they need to know reliably when they are due to arrive. At the moment that does not happen. Until that issue is addressed, we cannot expect commuters, particularly those who now use their cars, to use buses, and those who now use the buses will still not receive a proper service. That has to be a priority.
I, too, welcome the fact that no one has proposed major road schemes as a solution. We can improve the road network by much tougher enforcement of bus lanes. So that we are not perceived as anti-car, there needs to be some sort of pan-London co-ordination on parking enforcement. People need to know that they are being dealt with firmly but fairly. They should understand that the system is fair, and has consistency across London.
Finally, the River Thames, which is only a few yards away from us, is severely underused. That is regrettable. I hope that the development of the Thames gateway will result in the provision of additional river services, and that we can use that main artery to great effect, which would reduce congestion on the roads.
We need to make progress on many relatively low-cost schemes, to improve the roads for walkers and cyclists, to improve bus lane enforcement and so on. However, we need also to make progress on the much larger schemes. Many hon. Members have made a case for Crossrail and the East London line extension. It is time that the Montague report was published; we need to see its it recommendations and get some of the projects under way, and we need to see progress before the International Olympic Committee returns. If we have not made progress, I suspect that the committee need not even bother to get off the plane.
3.23 pm
Mr. Mark Field: London's transport needs—and, accordingly, the outcome of the Government's forthcoming spending review—crucially affect the residential population. As one or two hon. Members have pointed out, they affect also commuters, tourists and businesses. As has already been said, the lifeblood of our nation lies in London. It is the economic powerhouse not only of the nation but, to a large extent, of Europe. The hon. Member for Edmonton (Mr. Love) rightly pointed out that a loss to London is a loss to the UK. Jobs lost in London will not necessarily go to Birmingham or Manchester—or even, dare I say it, to Glasgow or Edinburgh—but may leave our shores entirely.
I congratulate the hon. Member for Battersea (Martin Linton) on securing this important and overdue debate. He is critical of my party's record, but I take that on the chin—although I could argue that his party has been in Government for the past seven years. However, as he rightly says, the East London line is the key. I will be interested, as he will, to hear the Minister's copper-bottomed commitment and guarantee to fund the line.
London's transport is—perhaps wrongly—widely regarded as being in something of a mess. I take on board the comments of the hon. Member for Eltham (Clive Efford); he is absolutely right to say that the transport system undertakes an enormous task daily. We have all had, and know constituents who have had, negative experiences of commuting to and from and moving around London, but to a large extent London's transport is a great success. It does its job, albeit with certain glitches. We cannot deny what was said in the International Olympic Committee's report on the Olympic bid. That report raised the profile of the issue, and will continue to do so in the months ahead.
I have repeatedly said that our Olympic bid will be in great difficulty unless there is a commitment to Crossrail and the East London line. There is little doubt that we will have great difficulty putting forward a coherent case in July next year unless that case is turbo-charged by a Government commitment to the funding needed for the transport system.
I appreciate the concerns about the reliability of the tube felt by the constituents of my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson). He mentioned that he has eight stations in his constituency at the moment; I am sure that he is hoping for nine or 10 when the Croxley link is in place. He rightly identified the need for better leadership on transport. That lies at the core of this debate. Where do we want our transport system to be, not just in the next few years, or in the run-up to the next mayoral or other elections, but in 20 or 30 years' time?
We need a strategic vision. To that extent, I have some—very limited—sympathy with Ken Livingstone. I agree with the hon. Member for Hackney, North and Stoke Newington (Ms Abbott) that he has been visionary. I do not agree with much of what he has done, but at least he has driven the agenda forward on the congestion charge and the buses—and I am a more regular bus user than I was in the past. There have been great successes with buses, and I am the first to admit it.
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However, what is the cost? There is a colossal cost, which will affect all London council tax payers in years ahead unless we get investment from the Government, and unless some economic sense is put in place.
Clive Efford: On the economics of London's transport network, the Conservative party's candidate for Mayor— [HON. MEMBERS: "Jarvis."] Yes, Mr. Jarvis; he said that he would scrap the congestion charge on day one. At the moment, the estimate is that the congestion charge will increase our income per annum by about £60 million. What would the hon. Gentleman cut to finance the abolition of the congestion charge?
Mr. Field: Obviously, I have to bow to the hon. Gentleman's knowledge, bearing in mind his taxi-driving interests. Perhaps scrapping the congestion charge would be good for those with such interests.
It is fair to say that, economically, the congestion charge has been something of a disaster. The hon. Gentleman points out that it will apparently raise £60 million a year, but he will remember, as I do, that 18 months or two years ago, when it was evident that the congestion charge would be introduced, people were talking about its raising £200 million a year, which was to be securitised into an enormous number of transport projects. That has not happened; in fact, the congestion charge may well be one of the few taxes that lose money. That cannot be a sensible way forward. I entirely support my candidate, Mr. Norris, in his plan to scrap the congestion charge.
However, although the congestion charge has not proved its worth economically, not least because many businesses in central London have suffered, at least the idea showed a sense of leadership and the vision to take the issue forward.
Tom Brake: The hon. Gentleman has not answered the question: how do the Conservatives propose to fund the shortfall of £60 million a year?
Mr. Field: The hon. Gentleman will appreciate that such issues are, rightly, in the hands of the Mayor and the Greater London assembly. However, there is no question of a £60 million shortfall. There will be no shortfall this year, and it is questionable whether there will be a shortfall in future.
Time is pressing, and I should like to mention a few specifics. Inevitably, we have not had much discussion about aircraft noise, apart from the contribution of my hon. Friend the Member for Ruislip-Northwood. I have not said, and will not say. much about pedestrianisation, although I entirely agree with what the hon. Member for Carshalton and Wallington (Tom Brake) had to say about it. We need to look at such matters in an integrated way. I should like more aesthetic design, for example, to make pedestrianisation more attractive, particularly in central London.
Where is the Government strategy? There was a 10-year plan in 1999, which is now defunct. We encountered a refusal to commit to Crossrail. Inevitably there has been a plan, which will no doubt come to fruition now, to delay any announcement until after 10 June, when the mayoral and GLA elections will have come and gone. I am concerned that the

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Secretary of State for Transport is a man who, as a Scottish Member of Parliament, represents nothing and no one on transport matters in the House—yet he is making decisions that will affect all Londoners, as well as tourists and businesses.
We now face the prospect of prolonged strikes, courtesy of the RMT, affecting the tube and the rail network in London during the hot summer months ahead. We are long overdue for an agreement that will, it is to be hoped, lead to a no-strike deal, if we are to get the requisite level of investment.
Where has Mr. Livingstone, Labour's hand-picked candidate, taken us on transport matters? In the first three years of his mayoralty he spent millions of pounds of Londoners' money suing the Government in a futile attempt to block the public-private partnership on the tube. Indeed, things have got markedly worse on the underground system in the past seven years. They will get worse still in the next five years, I suspect, even with the investment promised under the PPP scheme, and I believe that there is a financial night mare ahead for the buses. The optimism that has been shown about the congestion charge is also unlikely to come to fruition.
Several hon. Members made interesting contributions; one was the hon. Member for Islington, North (Jeremy Corbyn). Having been a Finsbury Park resident and one of his constituents, I suspect I am solving one of the longest-standing mysteries troubling him. He wanted to know who the one Tory voter in Tollington ward was during the early 1990s. It was me. However, I endorse what he said about Finsbury Park station. It could and should be an important hub, just as, as the hon. Member for Battersea (Martin Linton) would say, Clapham Junction could be an important hub outside the central area. It is such an unattractive place at the moment that it needs fundamental redesign.
Jeremy Corbyn: That is the nicest thing that has ever been said about it.
Mr. Field: That is also the nicest thing that I have said to the hon. Gentleman.
The hon. Member for Edmonton (Mr. Love) rightly identified the failure to deal with the expanding need for new transport. We must have more vision on this matter. The Conservative party, too, failed, when in government, to achieve a visionary outlook. However, it is important, just as it is to get the transport issue right in the context of London governance. If London's economy fails, the UK will fail. I cannot overstress the importance of that. Yet although the Mayor has been given power over Transport for London, he does not control the financial aspects that he needs to control if he is to be able to drive forward an agenda.
I have some sympathy with the Mayor of London, however financially illiterate I believe him to be, because he cannot influence the development of tramways and other projects, on which some detailed feasibility studies have been done. I have great sympathy, too, for the Transport for London staff in Windsor house, who are working on many of the relevant schemes. They know that those schemes will never leave the drawing board, because of the Treasury's financial control-freakery.
We need to break the logjam. The true congestion in London's transport lies in the failure to see through imaginative projects, because of the Treasury's
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reluctance to invest in our capital. I hope that the Minister will have something sensible to say about that, because otherwise all Londoners, all tourists and all London's businesses will continue to be let down by the Government.
3.34 pm
The Parliamentary Under-Secretary of State for Transport (Mr. Tony McNulty): As I have said in the previous couple of one-and-a-half-hour debates that I have replied to in Westminster Hall, the substantive, informative and intelligent Back-Bench contributions have been marred only by substandard contributions from the two Opposition Front-Bench spokesmen. If they were really detailing the substance of what each party would provide for London, God help us if they ever got near power at mayoral level or in a general election.
Tom Brake: That is so offensive.
Mr. McNulty: I shall come back later to the Liberal Democrats' press release, which is so misleading and does London such a disfavour that it is unworthy of the most fifth or sixth-rate mayoral candidate.
I am grateful that many of my colleagues started their contributions by saying that London's transport system had much to commend it. Of course improvements are needed—I shall come to those in a moment—but it is worth repeating that every day, Transport for London and the rail network move phenomenal numbers of people in and out of the capital, and around it. All concerned are to be commended—TFL, those involved on the railways and on the buses and the local boroughs whose input helps everything to flow smoothly.
Last year there were 947 million passenger journeys on the underground. Every day there are more than 1.5 million trips by rail, 3 million by tube and 5.5 million on the buses. Increasingly, unsung, more than 100,000 people travel in and out of Docklands on the Docklands light railway. Are there problems? Yes, of course there are. Do the Government have the vision and leadership to deal with them, working with TFL and the Mayor, before and after 10 June? We do. Am I going to stand here and give the green light to all sorts of major projects? No. This close to the spending review, of course I am not. However, it is important to understand that the leadership, the plans and the vision for London's transport system are in place, and the doom and gloom merchants, the collective Victor Meldrews, do their constituents and their parties no favours if they suggest otherwise.
We hear from the Opposition that we need better leadership for London's transport. What leadership at all was there for meeting London's transport needs prior to 1997? If that was leadership, again I say God help us. We are told that we have no vision. The Mayor, through TFL, has issued a business plan update, and I commend that document to anyone who wants an example of vision for London's transport system. Read it in conjunction with the London plan and see the options that London has to meet its transport needs.
The vision is clearly there. I have no problem with that, nor did I in the past. At the last party conference I was told off for saying that, at least in terms of transport,

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we have had a new Labour Mayor for the past four years. I said it then, I have said it before, and I will keep on saying it. Heaven help London if any of those other clowns is elected on 10 June. The cheerful fact is that they will not be.
Let me try, in the limited time that I have, to address some of the specific points made by my hon. Friends on the Back Benches before dealing with—if I have time—the minor and rather substandard comments from those on the Opposition Front Benches.
My hon. Friend the Member for Battersea (Martin Linton) outlined good reasons for the East London line extension. In reality, procurement strategy and everything else has to be considered by the Department. We are assessing it. We are not like the previous Government, who willy-nilly said yes or no to things, and then they collapsed three months later—Crossrail or anything else.
The case has been made, and well made. TFL now has an alternative procurement strategy and we need to consider that seriously in the same context. The East London line extension is an important project, for all the reasons that have been suggested. This is grown-up government. It is not to do with standing up and spending £11 billion, as Opposition Members have said that they would do. Like all the projects that have been mentioned, it is a serious matter.
In passing, I shall have to take issue with my hon. Friend the Member for Lewisham, Deptford (Joan Ruddock)—I am sorry that she is no longer here—and her notion that over the horizon of the spending review, not a lot of money would be spent on the East London line extension. We could say yes, and hope and pray that by the next review the money was still there, but that is a silly way to go about public procurement or public accounting.
I am going to disappoint my hon. Friend the Member for Edmonton (Mr. Love), who put words in my mouth. Talking about TFL's suggestion of a seat at the table, if not more, for London's rail services, he said, "The Minister will say that commuter lines do not start in London. so they should not have one." I am not going to say that. I am going to say, very seriously, that TFL's refined suggestion—it made two or three—is in the mix with the rail review. It is a serious proposition, suggesting a range of savings via fare structures, Oyster cards and wider procurement models, and we would be foolish not to take it seriously, as part of the comprehensive rail review.
My hon. Friend also said that TFL needed support from the Department for Transport. I hope that TFL would say that, in the past year if not previously, its relationship with the Government, through the Mayor and his officers, has been robust and productive. We shall continue in that way when, in a few weeks, we come to a decision on the rail review and on any number of other projects. I understand, and would not demur from, any of the comments that my hon. Friends made about their importance to their respective areas.
I have never lived in Islington, but I worked there for 14 years and I know Finsbury Park very well. Sadly, I know the Holloway road even better, and I agree with my hon. Friend the Member for Islington, North
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(Jeremy Corbyn) about that. I shall take up the detail with him later. However, I must say emphatically that the Government do not approve cycle lanes. The notion that the Department for Transport was somehow associated with the one on Blackfriars bridge is erroneous. However, my hon. Friend is right about the fact that cycle lanes are not about putting paint on roads, but about safe cycling. I have already dealt with the East London line.
I was interested to hear the hon. Member for Ruislip-Northwood (Mr. Wilkinson) stand up for some six minutes and offer to spend at least £11 billion. I agree with him in principle, because it is a constituency interest of mine. The Croxley link is important. It was reviewed thoroughly last year as part of the local transport plan because, although it benefits London, it sits outside London. We said reasonably to TFL, which was a partner, along with Hertfordshire county council and those with an interest in Watford, that if it were to proceed, TFL should stump up some money. Clearly the rail network would benefit. However, the money is not yet forthcoming; discussions and assessments are going on. With my constituency hat on, I think that that should happen.
My time is running out, but I shall try to address some of the other points that have been made, especially about access for the disabled. Wherever the tube has got to, the story is far better on trains, on buses, on taxis and on the Docklands light railway. We need to tell the whole story, across the transport system, rather than focusing on the negative. Let me put some canards to bed—if that is not too mixed a metaphor. I agree with the Mayor that in broad planning terms, the central area is now well served by buses. However, the points about inter-suburban links and express buses were well made, and he is exploring those issues.
The notion still put about by mischievous and irresponsible parties that Crossrail was ever part of the Olympic bid is nonsense, and it always was. The very people who put the Crossrail bid together, Cross London Rail Links, which is a combination of the Strategic Rail Authority and Transport for London, say clearly in their business case that, even on the most optimistic of estimates, it will be 2013 or 2014 before it becomes operative.
I have seen silly little press releases from the Liberal Democrats, in which someone called Simon Hughes—or perhaps I should say the hon. Member for Southwark, North and Bermondsey—claims that the delay in Crossrail could prevent London from winning the Olympics. How dare he talk down our Olympic bid in those terms? His argument is fundamentally wrong. He should go and read the business case. I sat through the proceedings on the Greater London Authority Act 1999, and I do not profess to have committed each of the 1,500 amendments made to it to memory, but I am sure that there were none on rail services in London, or on what should and should not be part of the GLA structure in that respect.
Tom Brake: Go and look.
Mr. McNulty: I shall look, because I know that to be the case.
I have one last point, with which I hope hon. Members will agree—funnily enough, it is non-partisan. Is it really beyond the wit of our only substantive serious

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paper in London, the Evening Stanaard, to get behind our Olympic bid, as the Manchester Evening News and other media in Manchester did for the Commonwealth games? Can it not engage with the debate? The International Olympic Committee has, of course, sent a shot across our bows—we have been well aware of that, as is reflected in the bid and the plans for the future. We will win that bid, and Londoners' transport needs will be served.

Medicines
3.45 pm
Paul Flynn: The discovery of medicines and the work of scientists in pharmacy over the past 150 years have been and continue to be a triumph. My purpose today is not to attack the work of those scientists, but to concentrate on how it has been used, subverted and perverted by the pharmaceutical industry in pursuit of greed.
Often, the only purpose of the pharmaceutical giants seems to be maximising their profits. They do so in an age when we in the western world have conquered most of the major diseases that assailed us in the past. The pharmaceutical industry pursues its goals by disease-mongering—trying to invent new diseases and exaggerating existing ones. Its activities have a huge impact on human health, public consciousness, medical practice and the ballooning burden of health service finances.
Those in the industry engage in such practices by inventing new illnesses, and billions of pounds have been spent on attempts to convince healthy people that they are sick. Such new illnesses include social phobia, attention deficit and hyperactivity syndrome and compulsive shopping disorder—it is hard to believe that the latter is not a joke, but it appears to be genuine. Social phobia is a new invention by the drug firm Roche. In order to promote and create a market for its anti-depressant, the company decided that people who occasionally feel shy or intimidated by society actually suffer from a psychiatric disorder.
Firms do such things by exaggeration and claiming that diseases that affect a small minority actually affect many millions. We know that depression or chronic obesity are life-threatening, but when a definition of obesity includes Russell Crowe, Brad Pitt and George Clooney, one may presume that it is almost certainly drawn so widely in the self-interests of the company that hopes to extend that view. GlaxoSmithKline tells me that it believes that 25 million people in Britain should be on anti-depressants. That is a vast exaggeration to promote the use of substances that are of little utility and can lead to dependence.
The companies define inevitable features of normal lives—sadness, grief, ageing and even baldness—as illnesses. The British Medical Journal had a competition to put together a list of 20 non-diseases in descending order of non-diseaseness, and came up with: ageing, work, boredom, bags under the eyes, ignorance, baldness, freckles, big ears, grey or white hair, ugliness, childbirth, allergy to the 21st century, jet lag, unhappiness, cellulite, hangovers, anxiety about penis size or penis envy, pregnancy, road rage and loneliness. The drug companies have attempted to reclassify each of those things as illnesses that require medical intervention. Baldness is an interesting one. When the firm Merck produced a new hair growth drug, it planted stories in newspapers suggesting that bald people suffered from emotional trauma and that hair loss led to panic and emotional difficulties. There are similar stories in dozens of other cases.
Such tactics are not deeply serious, in that they only involve emptying the pockets of gullible people. However, there is a terrible side to such practices,

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because the drive for profits has led to something that I, with my scientific background, find deeply shocking. I have always respected the integrity of trials, and particularly double-blind trials. All scientific evidence is based on them. We now know that there is severe criticism of the veracity of the trials that are carried out.
One such case involved an antiarrhythmic drug called Lorcarnaid. Ninety-five people with heart problems were involved in a trial in Nottingham in 1980, and the tests went on for many months. During the test, one of the people on the placebo died, but nine of the people taking Lorcarnaid died. The report was not published through the whole of the 1980s, but it was eventually published 13 years later. In the intervening period, the drug directly caused the death of between 20,000 and 70,000 Americans per year. More American males died from the use of Lorcarnaid than died in Vietnam.
We now know from the recent evidence—from an article in The Lancet and another in the British Medical Journal—that the trials of the drug Seroxat on children were misreported, that the data collected did not match the published conclusions and that the advantages of the drug were exaggerated and the disadvantages downplayed. The result of that trial was fixed. There were two other trials whose results were not published for 12 years. That is a shocking indictment of a drug. According to the Department of Health, that group of anti-depressants—selective serotonin reuptake inhibitors or SSRIs—are at present prescribed to 100,000 children in Britain. They have never been recommended or approved for children, but that is the situation today—a slightly happier situation than that in America, where 10 million children are prescribed those drugs.
We have been conditioned to believe that there is a pill for every ill. Let us again take the example of what has happened with anti-depressants in this country. In 1994, there were 2.6 million prescriptions; in 2003, there were 14 million. If those drugs worked and were successful, we would have seen a corresponding reduction in the incidence of self-harm or suicide. We have seen no such thing.
A typical example of how such drugs are marketed—it applies to dozens of examples, although we will take just one, in which the marketing strategy was leaked—again involves GlaxoSmithKline. The publicity firm involved was In Vivo Communications. The firms decided to raise the awareness, in their words, of the condition known as irritable bowel syndrome. It is rarely a disabling condition, so they gave it a makeover and it was remarketed as a serious mass scourge. For many people, it is a mild functional disorder, but a three-year medical education campaign was launched as the strategy for the drug Lotronex. The aim was to establish irritable bowel syndrome in the minds of doctors as a significant and discrete disease state and to convince patients that IBS is a common and recognised medical disorder. That was not the case before that campaign. In such cases, the idea of the disease is established and built up, so that fear-mongering about the latest illness is accompanied by news of the latest wonder drug.
Articles were planted in the medical journals; the health correspondents were recruited to write about Lotronex. Medical opinion had to be shaped so that
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there would be a reception for the drug, and groups were formed to maximise its sale. There were plans to establish patient groups. In the event, the drug was withdrawn after serious and fatal adverse side effects. The food and drug administration in the United States said that using the drug to treat patients in whom the condition was not serious—95 per cent. of them—could do more harm than good. That is one example of the irresponsible way in which those companies behave.
Part of that irresponsible behaviour was the creation of patient groups. As our stricter regulations make it difficult for companies to advertise new medicines, some of which are useless or damaging, a favourite way of getting their message across is to infiltrate existing patient groups or to set up new groups. Again, that is in their literature. We all know how many patient groups we are in contact with in our daily lives. There are hundreds in this country, many of which do splendid work, but we must look at patient groups that are formed alongside campaigns for new drugs. We want more openness with patient groups.
The splendid Mind organisation has played a valuable role in exposing the dangers of anti-depressants. Its chief executive made a principled resignation from the Medicines and Healthcare products Regulatory Agency because he thought that reports on the dangers of anti-depressants were being suppressed. Mind takes not one single penny in funding from drug companies.
The Depression Alliance, however, which admits to taking 80 per cent. of its funding from drug companies, has not uttered a word of criticism about antidepressants. I have had much correspondence with the Depression Alliance. I have met its representative and accused it of acting as a stooge to pharmaceutical companies. That accusation could be made about many patients associations. They are put in a position in which they have to ask whether they should attack the people who fund them and put the jobs of a quarter of their staff at risk—in the case of the Depression Alliance, it would be three quarters of the staff—or continue to say nothing.
There is a serious danger that we politicians listen to patient groups in our all-party groups whether they support patients or have a secret agenda as Trojan horses acting in the interests of drug companies. There are few cases of shameless promotion of drugs and drug companies, but in every case in which organisations receive substantial donations from drug companies, their mouths are bandaged when they should be criticising. I ask the Minister to support genuinely independent sources of information.
One of the Government's greatest triumphs is their establishment of the National Institute for Clinical Excellence, but it comes under attack when it releases reports, as with yesterday's preliminary report. NICE has an objective view, and it is a small voice against the might of the pharmaceutical companies.
We need a campaign of demedicalisation. We have deregulation, but more is necessary with the onslaught of companies finding new diseases and inventing new treatments. There is also the problem of "Me, too" drugs. When the patent on a drug is running out, companies tend to rework part of the drug, rename it and establish it so that they can get a new patent. That

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process is cynical, expensive and counter-productive. I want to see greater transparency with drug company donations to tackle the problem of Trojan horses.
We live in an incredible world. In the United States, 10 million children are on anti-depressants, and the third greatest cause of death after cancer and heart disease is medical intervention. The Americans are the greatest buyers of medical health—they spend almost three times what we in the UK spend on some areas of health—yet their life expectancy is lower than in the UK and most European countries.
We in the western world waste billions on drugs and medicines for trivial and non-existent complaints or complaints of doubtful value, while people in the underdeveloped world are dying from lack of simple medicine, sanitation, immunisation and clean water. Meanwhile, the scandal of the over-prescription of neuroleptic drugs to those in homes for the elderly and to women in prison continues. We are pushing people into a dependency culture. The disease-mongers gnaw away at our self-confidence by playing down the strategies of self-coping.
There is a good side, however, with a growing realisation of the harm that is being done by over-medicalisation. "Breaking the Bonds", the splendid book by Dorothy Rowe, is probably the best book on escaping from depression by the techniques of self-awareness, meditation and exercise. A new book entitled "Healing without Freud or Prozac" by Dr. David Servan Schreiber is causing a great stir. Like Dorothy Rowe's book, it supports using exercise, throwing endorphins around our bodies and serotonin around our brains, and using other non-drug remedies.
The splendid new book by Charles Medawer, "Medicines out of Control", which was published a month ago, gives a clear view of what has happened over the past few years. Instead of dishing out anti-depressants and reaching for the prescription pad—a great temptation to clear a waiting room—a GP in Cardiff prescribed self-help, self-coping books to those who suffer from such problems. Such policies will certainly not do anyone any harm. They are non-addictive and non-dangerous.
The medically celebrated writer on such matters, Ivan lllich, said:

"The medical establishment has become a major threat to health."

He said that people are conditioned to get things, not to do things. They want to be taught, moved, treated or guided rather than to learn to heal or to find their own way. The more money we spend on coping with death and pain, the further away we drift from reality. The choice is for us to continue to become more passive and dependent on ourselves or to stand on our own feet and cope in an active way with our problems.
I have the chance now only to go rapidly over an enormous subject, but it is clear that many lives have been destroyed in order to fuel the profits of the pharmaceutical companies. Many people's lives have been thrown into confusion and dependency because of their reliance on addictive drugs that have little value. I wish to finish with a quotation from The Lancet. A month ago, it concentrated on the fiddling of the research results for Seroxat, and said:

"People around the world understand the desire to achieve success and to work in a profitable environment. They will not, however, tolerate the notion that in biomedical research this could be at the expense of their children's lives."

4.3 pm
The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate my hon. Friend the Member for Newport, West (Paul Flynn) on his success in securing this debate, which is on an extremely important issue. As ever, his contribution was thoughtful and thought provoking. I am well aware that he has raised several worries, but I hope that he agrees that this debate provides an opportunity to consider the major contribution that medicines have made to health care delivery and how they have eased the burden of chronic disease on a vast number of people.
Many diseases have been eradicated by vaccination programmes, and fatalities from some diseases have been reduced. Polio disappeared from the United Kingdom, and the meningitis C vaccine, which this Government introduced, dramatically cut the rate of that terrible disease. Spending on statins is now about £230 million a year more than three years ago—an investment that has already achieved a 23 per cent. fall over five years in death rates from heart disease and strokes in people aged under 75. Vast advances and many benefits have come from medicines, but our challenge is to ensure that all developments serve the best interests of patients. If we are to achieve a society that is fully engaged in health, every aspect of health care design and delivery must focus on patients' best interests—on people, not clinicians, managers or the pharmaceutical industry.
My hon. Friend mentioned several concerns about that industry, which plays an extremely important role. We all want the development of new and potentially lifesaving treatments, and we want them to be available for patients as soon as that is safely possible. For any medicines to be licensed, however, the pharmaceutical industry must demonstrate that it can provide evidence of the safety, quality and effectiveness of any medicine. That includes evidence from clinical trials. We need fully to evaluate the risks and benefits of a medicine in the circumstances in which it will be used. The Medicines and Healthcare products Regulatory Agency monitors the safety and use of all the medicines that are on the UK market.
My hon. Friend referred to patients groups. It is true that many patients organisations not only in the mental health sector but across the board are given support by the pharmaceutical industry. I hope that he also accepts that charity law ensures that, as with all charitable donations, support can be accepted only on a no-strings-attached basis. He also referred to the medicalisation of normal everyday problems, such as grief, and their classification as diseases that seem to require drug treatment. I share his concern that we must not encourage the belief that there is a pill for every ill.
At the same time, we must recognise the burden that depressive illness places on people. It is felt at all levels of society and affects young and old, and rich and poor. We must ensure that we achieve a balance between recognising and supporting those who need some form of intervention and medicalising the emotions that we all feel from time to time.
Even when we get that balance right, we need to decide what sort of therapy will have the right outcome for the patient. whether it is talking therapy or drug therapy. I believe that all health interventions should be

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made against that background. That is one of the reasons why we tried to increase the number of bereavement services that are available. My hon. Friend was right to highlight that issue and to say that people may have been steered too readily towards drug therapy when alternatives might have been examined.
I join my hon. Friend in praising the National Institute for Clinical Excellence. It is in the sort of sector that we are discussing that NICE can come into its own. It is producing guidance on the effective management of depression and anxiety to tackle head-on the question of prescription and over-prescription in that area. It has delivered guidelines and appraisals to help clinicians and managers deliver more effective mental health services, including talking therapies. It is now examining further work, including how we deal with anxiety and related common mental disorders, the management of disturbed behaviour in acute settings and the management of self-harm.
We need to use that process to ensure that we get right the balance of treatment that is available, so that we provide talking therapies where that is most appropriate and avoid the pitfalls of over-prescribing that are associated with benzodiazepines—an issue on which I have met with representatives of various groups. At the same time, we need to recognise the testimony of those who tell of the benefits that appropriate drug therapy affords. Lives have been turned around by modern antidepressants, which are much less dangerous in terms of overdosing than older anti-depressants and have a better safety profile.
My hon. Friend also referred to the safety of selective serotonin reuptake inhibitors—SSRIs. As he knows, an expert working group of the Committee on Safety of Medicines is undertaking a comprehensive scientific assessment of the available data on the safety of SSRIs, particularly in relation to withdrawal reactions and suicide behaviour.
Paul Flynn: That study was interrupted for reasons that the Minister may know. One of the people who gave evidence was Dr. David Healy, who claimed that there was a six times increased likelihood of suicide for people on SSRIs in comparison with a group in the same condition who were on placebos. Another trial involved
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groups of children, and one group was healthy, while the other had problems. One of the healthy children, who was on Seroxat, committed suicide. Does the Minister not accept that the research on Seroxat has been fiddled? It has been corrupted; that is what The Lancet and the British Medical Journal say. Is that not a reason why the Government should act or at least give some acknowledgement that the CSM and the MHRA, which are full of people with long experience as employees with contracts for the pharmaceutical companies, could come to some objective conclusions that are rather different from what she is saying now?
Ms Winterton: I hope that my hon. Friend will allow the expert group, which is taking evidence from a wide range of sources, to come to its conclusions. Those conclusions will be placed in the Library, and there will be an opportunity for us to debate them.
On my hon. Friend's point about clinical trials in paediatrics for SSRIs, I hope that he understands that I cannot comment on the specific case that he raised, because it is the subject of an investigation. However, he knows that the MHRA has published summaries of the relevant clinical trials and that the European law governing both the industry and clinical trials has been strengthened.
I turn now to our overall approach to medicines. We are putting increasing emphasis on medication reviews, which is helping in the appropriate management of drug therapies. That has been recognised in the general medical services contract for GPs. We are also funding a taskforce, which has published a medication review guide for patients providing information about what medication reviews are and what patients can expect. We want people to understand their medicines, to be able to manage them and to have access to the maximum amount of information about them.
It has not been possible to address every issue that my hon. Friend raised, but I hope that he recognises in the light of a range of actions—the regulation of medicines, the work of the expert group, the work being taken forward by NICE, the delivery of the medicines management collaborative and the development of clinical practice through the national service frameworks—that the Government will not shrink from taking the necessary action to protect and promote public health, and to put the patient at the centre of health care delivery and design.

NHS Wales (Working Time Directive)
4.15 pm
Mr. Simon Thomas: What an esoteric title this is for a Westminster Hall debate. I assure hon. Members that the working time directive will have an impact on the national health service in Wales. It is timely and appropriate that we explore that issue in an advance of the introduction of the directive in August this year. To date, Members of Parliament have had little time to consider in detail the impact of the directive, which has been negotiate I directly between the United Kingdom Government and the European Union, and its effect on the health service in Wales, which, on the whole, is a devolved issue.
I welcome the hon. Member for West Carmarthen and South Pembrokeshire (Mr. Ainger) to his place. It is unusual to hear the Whip's voice and as I am not a member of his party, I will be able to bear it, although I cannot speak for members of his party.
Let us be clear about the directive Employees should work only a 48-hour week averaged nit over a reference period. They should rest for 11 consecutive hours per day, have a rest break when the day is longer than six hours, have a minimum of one rest day per week and a statutory right to four weeks' holiday. Night working must not average out at more than eight hours at a stretch. That is all very commendable, although the Government chose an opt-out from the directive for many years. I hope that the hon. Gentleman will confirm that the Government are not seeking further opt-outs and that the directive will be introduced as planned.
It is clear what the directive's effect on the NHS will be. By August 2004, junior doctors will be able to work only 58 hours per week; by 2007, that will be 56 hours per week; and the full directive hours of 48 per week will be implemented by August 2009. Many NHS trusts in Wales are concerned that there are simply not enough doctors to cover the new arrangements. The NHS could do one of two things: hire hundreds of new doctors, which is hardly feasible given the time it takes to train them, or radically rethink the v ay in which some services are provided. I would like to examine some aspects of that issue today.
In England, the Department of Health has set up a strategic change fund to examine how we can change the service. It supports pilot projects on new ways of working. It is not clear whether anything similar will happen in Wales, so I hope that the hon. Gentleman will comment on how Wales can respond to the change.
Patients will be concerned about something much more fundamental—the impact on waiting times and on primary, secondary and tertiary care. A few days ago in The Western Mail, Mike Ponton, director of the Welsh NHS Confederation, said:

"These developments"—

recent developments in the NHS—

"and others such as the impending European Working Time directive which will affect junior doctors' hours, mean that there is no option but to think radically about the way we provide services."

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A scoping exercise on the European working time directive undertaken by the North West Wales NHS trust found the following. The adoption of a full shift system, which would be necessary under the directive, will significantly reduce the daytime availability of junior doctors. The areas that need to be addressed to achieve compliance are mainly those of human resources, reconfiguration of services, training and education. The reconfiguration of services may not be
restricted to secondary care—that is, the district general hospital—but could involve primary care and tertiary or specialist care as well, and even NHS Direct and the ambulance service. Finally, the factors that will impinge on working towards compliance with the directive will be the GP contract, which has been newly negotiated in Wales, and the consultant contract. The report concluded that the main issue with the directive is the provision of out-of-hours cover, as that is what impacts on waiting time targets and GP contracts.
We know that waiting times in Wales are worse than in England. We know that the first Assembly Government's dream to have no one waiting more than six months for out-patient treatment and no one waiting more than 18 months for in-patient treatment has never been realized; it is a promise that has never been fulfilled. Currently, 68,000 patients are awaiting out-patient treatment. The number waiting for in-patient treatment has recently fallen to 1,401, although that is of no comfort to those who are waiting or to those who are attending hospitals in England. I think of my constituent, Mr. David Duff, who contacted me recently. His appointment at Gobowen orthopaedic hospital is not for another 18 months. It seems that the English hospitals contracting with the NHS in Wales are taking the Welsh time of 18 months not as the longest time, but as the earliest possible time, because that is how they can fulfil their contract.
The situation in Wales and in the NHS was recently examined in considerable detail by the Audit Commission, which had some rather shocking things to say. It said that the health service in Wales is currently "unsustainable" and that health spending is "inefficient and ineffective", despite the funding increases. It says that the NHS in Wales applies

"the wrong resources in the wrong place for the wrong reasons."

There could be no more obvious condemnation of what has been happening. It says that too many patients are treated in the wrong setting and—I hammer home the lessons of the working directive—that Wales has fallen behind England in reconfiguring services.
Lembit Öpik: Will the hon. Gentleman give way?
Mr. Thomas: As the hon. Gentleman is about to get married, why not?
Lembit Öpik: I thank the hon. Gentleman for his congratulations. Does he support or oppose the suggestion of an opt-out from the working time directive for certain sectors?
Mr. Thomas: I do not support any opt-out from the working time directive, which I support completely. I am saying that the NHS in Wales needs to reconfigure

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its services to meet the obligations of the directive, but it is not doing that. It is rather late in the day to achieve those aims, which is a pity.
The Audit Commission report comes to the same conclusion. On the failure to implement change or reconfigure services—the hon. Gentleman might be interested in this conclusion—it states:

"The consequence may also be severe damage to community, social, and political confidence in Wales' ability to use devolution effectively to meet the challenges of change."

As a supporter of devolution, he will be as shocked as I am about that conclusion.
We know that north-east and north-west England have similar patterns of apparent comparative poor health, but they have consistently delivered more and better health care at a lower cost than in Wales. The differences between England and Wales in terms of admissions to hospitals are not caused wholly by the myth that Wales is somehow a sicker society, but by the fact that many more patients in Wales are treated in acute centres—for instance, in hospital rather than by the GP—when they could be treated elsewhere, which would be a more effective use of money.
The only reconfiguration that has taken place in Wales is the establishment last year of 54 unnecessary health quangos. As the Audit Commission said, that has resulted in

"duplication of services and complex managerial problems."

Only this week, the Secretary of State for Health announced the abolition of half the English health quangos, which has freed up £500,000. I would be delighted if the hon. Gentleman responding to the debate were to announce the same for Wales today or even say that the National Assembly will shortly be making such an announcement.
Finally, the working time directive will affect the new contract for GPs in Wales. A survey by Pulse magazine reported in January this year that 92 per cent. of GPs felt that the new contract would lead to a rise in referrals to accident and emergency departments. That is precisely what the Audit Commission report and the earlier Wanless report warned against for Wales. More pressure will be applied to A and E because, under the new system of working, as many as eight out of 10 GPs will be able to opt out of out-of-hours care. That is a huge worry. It was announced today that the first independent private GP in Wales has been appointed. I hope that the name of Joanna Longstaff will not go down, like that of Aneurin Bevan, as the signal marker of a real change in how the NHS is working in Wales.
From my perspective, general practitioners in Ceredigion have already announced that they are to close 24 branch surgeries as a result of the new out-of-hours contracts. That means that many patients who usually go to their branch surgery to meet the GP will be isolated if they have no car or cannot visit. Whether or not they are elderly, they will let their condition worsen, and they will certainly end up referring themselves to accident and emergency departments rather than going to their GP. The implications are huge.
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The 24 branch surgeries that will close include the Llanilar health centre at Ponterwyd, Pontrhydfendigaid and Pontrhydygroes—I love these names; it is great that Hansard finds a way of coping with them, and they are all in the best part of my constituency—Aberaeron surgery at Llangeitho, Llanon and Tregaron; Newcastle Emlyn surgery at Cardigan, Cilgerran, Aberporth and Velindre; and Tregaron surgery at Llanddewi Brefi and Pontrhydfendigaid Llangrannog, which is some 11 miles away from the nearest surgery, is also losing its branch surgery. I could go on, but as I said, there are 24 of them, and I shall not mention them all. One result will be more referrals to accident and emergency departments.
It is clear that the working time directive will improve the lot of many NHS staff. It is about time that that happened, and we support it. However, it is not clear whether it will improve NHS treatment. That lies in the hands of the National Assembly for Wales and the Treasury. I must say that the Treasury has done its bit. In the past three or four years, its spending on the NHS in Wales has increased by 30 per cent., and we should welcome that. However, will the hon. Gentleman who is answering on behalf of the Government say how the Government propose to grasp the nettle of reconfiguration and address the waste and inefficiency that the complex and many-layered system of the NHS in Wales has introduced? Will he also say how we can be assured of proper primary and secondary care when the working time directive is introduced in Wales in August?
4.26 pm
Hywel Williams: I thank you, Mr. Deputy Speaker, for the opportunity to speak very briefly on this important subject. I also congratulate my hon. Friend the Member for Ceredigion (Mr. Thomas) on securing this brief debate.
Plaid Cymru Members fully support the implementation of the working time directive, and have done so for a considerable period. Other parties that I could mention were not quite as committed to it as we were. My hon. Friend outlined several NHS-related issues that concern us. The arguments relating to junior doctors' hours, for example, have been well rehearsed, and he also referred to them to some extent.
The out-of-hours duty for GPs is a particular concern in my area and in other rural parts of Wales, as my hon. Friend said. The current pattern worries patients who have found services to be scarce and have had to travel considerable distances, as well as medical staff. The medical staff with whom I spoke in preparation for the debate were, rightly or wrongly, unclear about future arrangements and the effect of the working time directive on GPs' out-of-hours systems. My former GP, Dr. John Webb of Criccieth, put it succinctly when he asked how GPs would be affected by the working time directive if they were contracted in to provide out-of-hours services and were otherwise self-employed. They are both self-employed and employed, so do they count as employees only for the period during which they are contracted in for out of-hours service? What about the times when they are self-employed? Do not these hours also count?

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The aim of the working time directive is to improve the quality of services, as well as the conditions for people at work. What if a GP works as a self-employed GP one day, is due to work the following day and is then up all night? Will the working time directive do anything to improve the standard of service that is provided then? I should also say that Dr. Webb's practice ensures that partners who have been up and out all night have a day off. That is the best practice that can be followed.
Will the working time directive be practicable? My hon. Friend referred to the possible shortage of doctors when the hours are limited. Will it be practicable for small medical centres in rural areas that cannot recruit sufficient numbers of new doctors to give people time off when they have been up and out all Light? Furthermore, the employment status of some GPs will change when the new contracts are introduced. Presumably, there will be an effect on the number of hours hat they may work. Again, will there be sufficient staff?
I want to note the effects on GPs themselves. I am a former approved social worker who is well used to being up overnight performing one or two sections, having gone to work the previous day or being about to work on the following day. I know something of the pressure on people who do that sort of work, such as medical staff. I think that medical staff should be protected from that sort of pressure, but we need reassurance that the quality of service to the public will not decline.
4.30 pm
Mr. Nick Ainger: I congratulate to the hon. Member for Ceredigion (Mr. Thomas) on securing this important debate on the impact of the working time directive on the NHS in Wales, although at times his contribution appeared to stray away from the directive itself.
The Government are committed to delivering a world-class health service for patients while maintaining a safe working environment for all health professionals across the NHS. We share that commitment with our colleagues in the Welsh Assembly Government.
We have been investing heavily in the men and women of the NHS in Wales. As the hon. Gentleman recognised, in recent years there has been a huge increase in the number of NHS staff, although that on its own is not the answer to the working time directive issue. There are now almost 19 per cent. more NHS staff in Wales, 30 per cent. more whole-time equivalent hospital consultants and almost 16 per cent. more qualified nurses than in 1997, and there are 6 per cent. more GPs than a decade ago. In the past, there used to be cuts in the numbers of doctors and nurses being trained, but the number of medical students in Wales increased from 950 in 1998 to 1,320 in 2003. This coming academic year, that figure is projected to rise to 1,385.
By 2010, the Assembly Government plan to have 700 more consultants and GPs, 6,000 more nurses and 2,000 more other health professionals. However, we are well aware of the challenge facing the NHS as a result of the extension of the working time directive to include training grade doctors from 1 August this year.
The working time directive became law in the UK in 1998, and it fixed working hours to 48 hours in every
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seven days, but that was not applied to doctors in training. From 1 August 2004, doctors in training will be included under the working time directive and will be expected to work no more than 58 hours in every seven days, averaged over 26 weeks. From August 2007, that will change to 56 hours in every seven days, and from August 2009, it will become 48 hours in every seven days. In both cases, that will be averaged over 26 weeks.
The issue has been compounded by the SIMAP and Jaeger rulings at the European Court, which mean that all time spent on duty in the hospital will count as work. That will include time spent resting, or even asleep, while on call. In addition, any doctors who continue their residential duty period beyond 13 hours, breaking into a rest period, will be owed compensatory rest. The Jaeger ruling suggests that that compensatory rest must be taken immediately after the end of that duty period. In effect, that would prevent doctors from continuing to learn or from delivering a service the day after a night on duty.
Those judgments were not initially part of the directive, and they are making full compliance more rigorous than had originally been envisaged. Due to the potential impact on the continuity of care and junior doctor education, the Government are urgently discussing the impact of the SIMAP and Jaeger cases with their European partners.
Mr. Thomas: The hon. Gentleman has introduced an important point. It is not just about the increasing numbers, which he rightly outlined, or the response of the National Assembly Government, but about the legal framework and what will have to come into the NHS in Wales. Does he think that the answer to the working time directive is to increase the training and the numbers—an approach that I think will fail—or that some of the structural problems of the NHS in Wales should be addressed?
Mr. Ainger: I do not think that this is a matter of structural problems; it is a matter of how the health professionals work and the mix of skills that are used. The hon. Gentleman referred to the experiments and pilots that have been carried out in England. Such things are being considered, including multidisciplinary teams in which some nurses taking on duties that have traditionally been carried out by doctors. I shall deal with that point later.
The potential modification to the original directive is most keenly felt in small sub-specialties or smaller district general hospitals, such as Bronglais, in the hon. Gentleman's constituency. Bronglais highlights the issues faced by the Welsh NHS in meeting the directive while continuing to offer a high standard of care to patients and maintaining training opportunities for junior doctors.
Meeting the directive is not optional. It is a legal requirement and a failure to comply carries the possibility of significant penalties. However, there are no knee-jerk changes that will jeopardise the standard of care that is offered to Welsh patients, and neither will the education of our future general practitioners and consultants be put at risk.
Lembit Öpik: The hon. Gentleman speaks about a blanket opt-out. Is he aware that the Chairman of the European and External Affairs Committee of the National Assembly for Wales said in response to a consultation:

"We have some concerns about the blanket use of opt-outs in the UK and suggest that sector-specific opt-out arrangements might be more appropriate"?

Is he aware of that proposal, and that there was cross-party support for it? That means that Plaid Cymru agreed with it and that it supports the blanket use of opt-outs in Westminster, but opposes them in Cardiff.
Mr. Ainger: The hon. Gentleman makes an interesting point, but the Government are not seeking an opt-out. They are discussing the impact of the SIMAP and Jaeger cases with their European partners.
The Welsh Assembly Government are encouraging the local health boards and trusts in Wales to prioritise junior doctor rotas that are outside the directive, because they mean too long a working week. Assembly officials have visited trusts and health boards and are offering assistance to them on meeting the directive. About two weeks ago, from 11 to 14 May, Assembly officials visited the trust responsible for Bronglais and met the local health board. They are working with the mid and west Wales regional office to explore sustainable long-term solutions, which may involve some additional staff and the possibility of employing consultants and of GPs working differently in future. I was making that point earlier.
Assembly officials are also working with local health boards throughout Wales to advise them, as commissioning bodies, about how best to invest the 1 per cent. uplift for inflation that is included in their discretionary allocation. The £30 million a year is directed at additional support to junior medical staff to meet the dual requirements of the new deal for doctors and the working time directive.
The hon. Member for Ceredigion mentioned the problems with branch surgeries. I should like to make a couple of points about that. He may be aware that the working time directive was discussed with the general practitioners committee in Wales at its monthly negotiating meeting with the Assembly Government. It is aware of the direct and, more importantly, the indirect impact on it and its staff, and it has been planning accordingly.
The hon. Gentleman believes that the working time directive has affected branch surgeries. In fact, it is far more likely that it is the general medical services contract, which is due to come in at the end of this year, that has had the impact. The contract introduces a new set of quality standards for premises to ensure that surgery premises are fit for their purpose, and that guidance is produced on issues including information technology, patient note availability, patient privacy, infection control and clinical waste disposal, which are all important.
Mr. Thomas: I agree with what the hon. Gentleman has just said, but my point was not that the working time directive directly affected the branch closures. In fact, it was the other way around: branch closures will put more pressure on hospital accident and emergency
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departments, and particularly that of Bronglais general hospital. That will have an effect on junior doctors and others working in those hospitals.
Mr. Ainger: I understand the hon. Gentleman's point. The Welsh Assembly Government recognise the importance of branch surgery closures, particularly in rural areas. They understand that those branch surgeries form an important part of the fabric of primary care delivery in rural areas. There is a proper laid-out procedure to be followed before any branch surgery can close. There should be full consultation, and there is an appeals procedure. However, we are dealing with general practitioners; at the end of the day, they are independent contractors and cannot be directed to carry on providing particular services in particular areas.
Complying with the directive is crucial, but the directive is not the only development in the health service in Wales. It is being addressed alongside other changes in Wales, such as "Agenda for Change", the new consultant and GP contracts, NHS modernisation and the local Wales action plans. Together with the directive, those initiatives offer us an opportunity to deliver a different but better health service in Wales. The Assembly Government are dealing with those changes through NHS trusts and, on a wider basis, through their regional offices. Trusts are being encouraged to explore the possibility of sharing resources, and they are seeking sustainable long-term solutions to certain specialties on an all-Wales basis.
As I said, at the level of the Welsh trusts, we are exploring a phased implementation of more innovative systems of care, including systems that utilise available staff more effectively and efficiently. That includes many of the ideas that are being piloted in England under the hospital at night principle. In addition, the introduction of cross-cover between specialties is being looked into. The question of who needs to be on duty and whether they can be on duty from home is being examined critically as a possible means of solving the problems posed by the SIMAP and Jaeger judgments. We aim to comply with the directive through doing that, and through the addition of limited numbers of key professionals.
Concern about the issue is understandable, as it clearly needs to be addressed. There needs to be a greater integration of primary and secondary care in the out-of-hours period. That is planned by the health boards in various reports. They are trying to bring in GPs because of new developments in contracts. Obviously, radically different systems will be in place in hospitals in order to cut out the repetitive aspects of the care pathway. All tasks will be scrutinised and appropriately delegated to competently trained staff, who will operate in a multidisciplinary team. That means that many tasks originally performed by doctors will now be performed by other trained staff. The directive will require most junior doctors to adapt to shift systems. That will require some additional staff, and it will represent a cultural change for staff and patients alike, but it is necessary to meet a legal requirement.

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The working time directive and recent case law represent difficult but not insurmountable challenges to the health service in Wales. We must apply simple, logical principles. We will add innovative systems of care and expand staffing where necessary. Whenever possible, we will maintain the current shape of the service. The Welsh Assembly Government are
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addressing that important issue, and are working with local health boards, trusts, GPs and others to ensure excellence in health care while striving for compliance with the directive.
Question put and agreed to.
Adjourned accordingly at sixteen minutes to Five o'clock.