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Baroness Gardner of Parkes: My Lords, will my noble friend inform me of the position regarding the Homerton Hospital? Is it a fact that the population has largely moved away from the St. Bartholomew's area towards Homerton? I understand that the two hospitals have always worked together. Is the Homerton Hospital now taking a great load of the work which would previously have been done at Bart's?

Baroness Cumberlege: Yes, my Lords, the Homerton is certainly taking some of the accident and emergency cases. However, the Royal London Hospital, which is twinned with St. Bartholomew's, will take most of the specialist services in the future.

Baroness Jay of Paddington: My Lords, what is the Minister's response to the report published last week by the inner London health authority chief executives, called Hospital services for Londoners? The report states that people in inner London are using NHS beds at a 17 per cent. higher rate than was previously expected. Does the Minister agree with the report's conclusions that:

Baroness Cumberlege: My Lords, in the report the chief executives of inner London reinforced the direction the Government are taking. They said that we should invest in primary care; that we should strengthen specialist services by concentrating expertise and patient numbers in fewer, larger centres; that we should bolster medical research in education by bringing undergraduate and postgraduate teaching together; that we should find better ways of providing care and treatment for elderly people in their own homes and neighbourhoods; and that we should provide the general

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hospital services which we need for routine medical and surgical treatment as close as possible to where people live.

Lord Strabolgi: My Lords, what is the noble Baroness doing about the shortage of emergency beds which is now reaching a dangerous level?

Baroness Cumberlege: My Lords, we are expanding considerably the number of emergency beds at the Royal London Hospital. In fact, we are investing £3 million in that in the current year; at the Homerton an extra £2 million; and at UCL £800,000.

Baroness Jay of Paddington: My Lords, I thank the Minister for her original reply to my question. But can she please respond to the point that I made about chief executives saying that it seemed that Londoners were using NHS beds at a 17 per cent. higher rate than had been expected? Does that not suggest that bed closures have been premature?

Baroness Cumberlege: No, my Lords. The chief executives were quite firm in saying that with the proposals that I have just outlined to the noble Baroness, there would be less need for inappropriate use of hospital beds in London.

Lord Molloy: My Lords, does the Minister agree that St. Bart's is famous throughout this country and the Commonwealth, not because of the building but because of the remarkable staff who work there? It appears that they will now lose their jobs and that is a great shame. Would the Minister be prepared to consider meeting a small delegation from the remarkable staff of a remarkable hospital to listen to their case?

Baroness Cumberlege: My Lords, I appreciate the very strong emotional feelings as regards this hospital, and I am grateful for the noble Lord's comments about buildings. With regard to the expertise of the people who work there, the London Implementation Group has already set up an agency to help staff find new posts. But I am very confident that with the skills and expertise of the people who are involved, the vast majority will continue to work in the National Health Service, and many of them in London.

Lord Dean of Beswick: My Lords, can the Minister give an assurance that, whatever the final outcome of the changes in this area, they will result in a better service for the people who live there?

Baroness Cumberlege: Yes, my Lords.

Lord Annan: My Lords, is the Minister aware that in 1968 the noble Lord, Lord Todd, reported that there should be an amalgamation of the medical schools of St. Bartholomew's and the London? Is she further aware that in 1980 a similar report by the noble Lord, Lord Flowers, recommended exactly the same thing? Since then there have been a multitude of reports, some initiated by members of the medical profession and some by the Minister's department; all of them pointed inescapably to the fact that St. Bartholomew's must recognise that some change in its status is bound to take place. Is it not a fact that when the forcible

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amalgamation took place of regiments in the Army, after the initial dismay the amalgamations were conducted with great expertise and with a good effect on morale?

Baroness Cumberlege: My Lords, the noble Lord, Lord Annan, is correct in every word that he says. Countless reports have said that there should be changes in London. With the changing needs of populations; with different aspirations; with clinical practice changing; with developments in science, technology and medical education; and with rising costs, we simply cannot freeze all the London services into a time warp. That would be totally wrong. We have to produce a better service for London. These changes will ensure that that happens.

Pergau Dam

2.53 p.m.

Lord Dubs asked Her Majesty's Government:

    How they propose to reimburse the overseas aid budget for the sums that have been used to finance the Pergau Dam.

Baroness Chalker of Wallasey: My Lords, as my right honourable friend the Foreign Secretary announced in another place on 13th December, the aid programme will be enhanced this year and next by amounts reflecting the expenditure on Pergau and on three other ATP projects. He made clear that we do not propose to increase public expenditure still further in respect of payments made on Pergau before the current financial year.

Lord Dubs: My Lords, does the Minister agree that those payments made in respect of Pergau before the current financial year come to some £24 million; and that many people find it unacceptable that the Government should seek to evade their legal and moral responsibilities in this way? Please will the Government reconsider their decision?

Baroness Chalker of Wallasey: My Lords, I can indeed confirm that the figure spent on Pergau is £24 million. But we cannot rewrite the past. The financial books for past years are closed. As the Foreign Secretary said in his statement, the funds spent on these projects were voted by Parliament. The Government do not believe that the taxpayer should be asked to find offsetting funds for the aid programme in the present year or in future years for which enhanced provision has recently been announced by the Chancellor because of the court's decision.

In answer to Mr. Rowlands in another place on 13th December last, the Foreign Secretary made it quite clear that he had dealt with the larger sums involved in this year's and next year's budget in an equitable way. But the clock cannot be turned back.

Lord Judd: My Lords, does the Minister agree that, while it is not possible to rewrite the past, the facts are that money which was voted for humanitarian purposes was used for other purposes; and therefore it is only proper that that money should be reimbursed to the aid

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programme? Can she give a specific undertaking that in future years there will be no question of cutting aid budgets in order to accommodate payments for Pergau and other projects, which will now have to be made from elsewhere?

Baroness Chalker of Wallasey: My Lords, first of all, unusually, the noble Lord is wrong today. No humanitarian money was spent on ATP when it was agreed. It was a project with a developmental output, because that area of Malaysia needed electricity badly. No humanitarian money was used for the project. I cannot foresee all the things that will happen in future years, but, as the noble Lord knows, it is planned that the aid programme will increase by £56 million in 1996-97 and £115 million in 1997-98. We have a very sound programme. When we allocate money for ATP, as we do on an annual basis, we will now do so in the full knowledge of the decision that was made by the court on this case. Certainly we are not legally obliged to compensate the aid programme for the previous payments.

Lord Avebury: My Lords, does the Minister agree that it is a pity that the noble Baroness, Lady Thatcher, could not be surcharged for the £24 million that was unlawfully spent, as she would have been had she been a member of a local authority?

Baroness Chalker of Wallasey: My Lords, the noble Lord's comment is very wide of the issue. It is not only that. In government—which the noble Lord has never known and never will—one has to take a whole range of issues into account. The court held that, had there been a developmental promotion purpose in Section 1 of the 1980 Overseas Development and Co-operation Act, it would have been entirely proper for the Foreign Secretary to have taken account of the impact of withdrawing the 1989 offer of support for Pergau on our political and commercial relations with Malaysia. That was the consideration that my noble friend took into account in reaching her decision.

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