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Viscount Goschen: My Lords, indeed, Morocco is not bound by Council regulations. The important point on the airport agreement side is that the ball is in Gibraltar's court. The Gibraltarian administration refuses to implement the agreement because it believes that it cedes important concessions on the issue of sovereignty to the Spanish. This is not the position of Her Majesty's Government. We continue to press the Government of Gibraltar to act in this area. The emphasis is on the Gibraltarians; we will continue to press them to make progress on this important issue.

Lord Clinton-Davis: My Lords, while thanking the Minister for that reply with which I wholly concur—maybe uncharacteristically—can he confirm that this specific Question has absolutely nothing to do with the issue of the sensitive Gibraltarian/Spanish relationship? Is he further aware that the Opposition support the view that he has taken? There was of course a deal struck in 1986-87, in which I had some part to play, which concluded a not wholly satisfactory arrangement between Britain and Spain on the issue. It is a sensitive matter and it does not help if rather irrelevant questions are imposed on it.

Viscount Goschen: My Lords, it is difficult to separate out the issues. We believe that coming to an agreement on the airport is important for a number of reasons. I wholly agree with the noble Lord that this is a sensitive point. We continue to press for progress.

National Hospital for Neurology

2.51 p.m.

Lord Walton of Detchant asked Her Majesty's Government:

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege:): My Lords, we believe that the National Hospital will benefit from trust status but, after careful consideration, my

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right honourable friend the Secretary of State has decided that the hospital's interests will be best served by joining with another hospital that is equally committed to research and teaching, rather than operating independently.

Lord Walton of Detchant: My Lords, in thanking the Minister for that reply, I first declare an interest as the current president of the World Federation of Neurology—a federation of some 75 neurological associations across the world. Does the Minister agree that this hospital has an exceptionally proud record of patient care and service to the community; that it is at the moment financially viable; and that its associated institute of neurology has obtained one of the highest ratings in the HEFC national assessment exercise for the quality of its research? Can we be assured that if it were to merge with another hospital to form a trust its identity would be confirmed?

Baroness Cumberlege: My Lords, I am very pleased to be able to agree with the president of the world federation of neurological associations and I congratulate him on that very distinguished position. This particular hospital and its institute have a very proud record. The hospital is, we believe, of world standing but we do not believe that its future is necessarily viable. That is why we are looking ahead. If it joins a trust—as we are recommending it should—with another hospital, we would want to keep the excellence and the worldwide reputation and expertise embodied in Queens Square.

Baroness Jay of Paddington: My Lords, the noble Lord, Lord Walton, rightly refers to the concern in the international neurological community about a possible merger. Is the Minister also aware of the great concern felt in the National Health Service because of the potential threat to the number of intensive care beds in this specialty which may be threatened by the merger? Have the Government taken into consideration the cases of, for example, the patient who had to be flown from the south of England to Leeds for intensive care, and of the surgeon—a matter raised in your Lordships' House by the noble Lord, Lord Smith—who unfortunately died as a result of a lack of beds? Have the Government considered these service concerns when considering the merger?

Baroness Cumberlege: My Lords, we have considered all these aspects; indeed, we commissioned an independent inquiry, a review of neuro-sciences within the London area. The review was undertaken by some very distinguished consultants and professors in neuro-sciences. Their verdict was unequivocal. They said that the historical pattern of service provision is not fully geared to meet current population needs. Changes in demography mean that service sitings are no longer relevant as we move into the 21st century. As to the expertise in tertiary neuro-sciences centres such as that at Queens Square, the review recommended that such centres should be sited within a multi-specialty general teaching hospital and should have formal research and training links with medical schools and higher education institutes. We have accepted those recommendations,

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but we have suggested to the National Hospital that it should choose its partner rather than be pushed into a gunshot wedding.

Lord Peyton of Yeovil: My Lords, is my noble friend aware that her answer is reassuring in referring specifically to the excellence of this hospital? I hope that I can ask her now to redouble the assurance. Is she quite confident that the excellence of this institution will not be diluted by being spread?

Baroness Cumberlege: My Lords, it is our intention not only to protect and maintain the expertise within this hospital and within the institute, but also to promote its excellence. We believe it is a remarkable institution and we want to see it strengthened.

Lord Stallard: My Lords, can the noble Baroness say which other hospital she has in mind for the merger?

Baroness Cumberlege: My Lords, it really is up to the National to choose its partner. Clearly, it is considering a number of options. As the institute is already looking at University College London, perhaps that may influence its final decision. But the choice is the National's.

Baroness Masham of Ilton: My Lords, will the decision be made quickly? As the Minister knows, committee meetings and consultations take doctors away from patients. Is she aware that some patients are suffering from long waiting times in that hospital?

Baroness Cumberlege: My Lords, we have the support of both the chairman and the medical director of the National Hospital. They are preparing to bring forward a recommendation next month.

Lord Dean of Beswick: My Lords, the noble Lord, Lord Walton, says that the hospital is financially viable. The Minister in her reply says that the decision is based on the fact that it may not necessarily be viable in the future. What evidence has the Minister to substantiate that course of action? What proof is there that the hospital will not be viable? It may well be viable if the case is not proved. Have the Government taken any soundings of the highly qualified professional staff who man the hospital as to whether the service may deteriorate if there is a merger with another hospital?

Baroness Cumberlege: My Lords, we always consult with staff whenever there is a proposal. The evidence is that 13 district health authorities who commissioned services have indicated that next year they will reduce work to be done by this hospital. Indeed, the hospital itself is planning to handle up to 15 per cent. less work over the next three years.

Lord Stoddart of Swindon: My Lords, do the Minister's previous answers imply that there will be no reduction in the number of beds for this particular speciality?

Baroness Cumberlege: My Lords, I cannot give that undertaking. It depends what happens in terms not only of the number of contracts that are placed with this hospital but also movements in clinical activity in the way that medical science is changing. Your Lordships

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will be aware that, because things are done very differently today, over the years we have seen a remarkable decrease in the number of beds as more and more activity takes place on a day case basis.

Lord Walton of Detchant: My Lords, will the Minister accept that there is a major multi-million pound development of a new building going on at the Queens Square site at the moment? If, as she very properly suggests, a merger with another major hospital does take place, may we be assured that the existing site will nevertheless be retained?

Baroness Cumberlege: My Lords, that is really for the trust to decide once it is formed. I am aware that in the National Health Service it is a very dangerous thing to say, "Never, never, ever".

Turkey and Northern Iraq

2.59 p.m.

Lord Avebury asked Her Majesty's Government:

    Whether they will ask the Office of Democratic Institutions and Human Rights to refer the military operations by Turkey in northern Iraq to the Chairman in Office of the OSCE with a view to laying the matter before the Permanent Committee as a violation of Articles 34 to 37 of the OSCE's Budapest Declaration.

Lord Inglewood: My Lords, the matter is likely to be discussed within the OSCE later this week. We would expect Turkey to act in accordance with all the commitments of the Budapest Declaration, including those relating to the code of conduct and the human dimension.

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