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"Those key elements of the Government's strategy will be familiar to the House. I set them out in a Statement at the time of the publication of the Tomlinson Report and again when I announced my response. They have been frequently debated. I said on those occasions and I say again: the objectives of this strategy enjoy widespread support within the clinical and academic worlds and from independent commentators such as the King's Fund. The need for change in london is widely recognised and widely recognised as long overdue.
"I hear and understand the concerns which have been expressed. We considered very carefully the points made during the consultations including those made by right honourable and honourable Members in their meetings with me and the Minister. I was, in particular, struck by the points made about the pace of change. The extended time-scale of some of the announcements yesterday respond to those points. Let me make it absolutely clear: no accident and emergency facility, or indeed any other, will close until Ministers are satisfied that the alternative facilities are not only available but capable of providing an improved service to patients.
"My right honourable friend asks specifically about the financial implications. The changes announced yesterday will be backed by £400 million of capital investmentthat on top of the £210 million that we are already spending on improved primary care. This is substantial investment in a modern health service.
"That money will buy, among other things, a new NHS hospital for Greenwich, and an upgraded hospital in Barnet, complete with a state of the art accident and emergency department and a world-beating centre for neurosciences and neurosurgery at King's. It will support the changes at the Royal Hospitals Trust and Guy's and St. Thomas' which will develop them as centres of supreme excellence in treatment, teaching and research. In addition we are investing substantially in other hospitals such as the Homerton, Lewisham, King's and the Royal Free.
"Aside from the direct clinical benefits, we expect these changes to lead to substantial revenue savings which I estimate will be of the order of £75 million every year once the changes are complete. This is
"I say to the House that, at the moment, rather than getting £75 million out we are putting in £28 million a year, supporting the duplication and fragmentation of services around the four areas covered by my announcement. That must be a good exchange by anyone's standards. As for St. Bartholomew's and the Royal London, the capital investment will total nearly £240 million. It is expected to deliver revenue savings of some £30 million a year. This compares to the current subsidy going into the trust of £8 million a year.
"I say this, however, in conclusion to my right honourable friend. The changes which I announced yesterday, and which carry forward our strategy, are not primarily about finance. They are about improving the quality of care. They are about better specialist services where medical expertise is enhanced by bringing clinicians together to benefit from each other's ideas. They are about better teaching and researchlinking world-class hospitals to multi-faculty colleges. They are about equipping modern hospitals to respond more flexibly to the pressures they face and to harness the awesome advances in medical technology. And they are about providing more health care where Londoners most badly need itin their communities, their doctors' surgeries, and the streets where they live.
"It is on this basis that I took these decisions. Change is not easy, but it would be harder for London if we do not change. These changes will build towards a first-class health service for London, fit for the 21st century, and they deserve the support of this House".
Baroness Jay of Paddington: My Lords, I thank the Minister for repeating her right honourable friend's Statement. I am particularly pleased that she has done so because it gives your Lordships what is a rare chance to question the Government about important decisions in the NHS at the time they are made. It is somewhat ironic that the Statement has been forced out of the Government in another place on a day when yet another major NHS document has been published and circulated. It is particularly ironic that it is about openness in the NHS. However, today we are here to discuss the Statement which has been repeated by the Minister.
The Minister spoke in the context of the Tomlinson Report. Have the Government considered those reports which have been published and the inquiries which have been conducted since the Tomlinson Report and which give a rather different picture of the needs of London? I refer particularly to that which was conducted by the chief executives of the inner London health authorities, the one conducted by Professor Jarman, who considered whether London was underbedded or overbedded, and indeed the updated King's Fund report on the situation in London which does not entirely support the view of its earlier report, although it was of course that report
As regards specific matters, the Statement says that no accident and emergency facility will close until Ministers are satisfied that alternative facilities are available and capable of providing improved services. Will the Minister comment on the situation at Guy's Hospital, one of those mentioned in the Statement as being subject to change, where I understand the A&E department, which has just had £1 million spent on it, is likely to be closed by 1999 without any suggestion being made for its further use? Will the Minister comment on the point about the need for investment in primary care before acute sector beds are closed? In the past Ministers have spoken about the inappropriate useI think it has always been a rather inappropriate use of words of A&E departments by Londoners because of the lack of primary care. However, as we all know, the lack of primary care is partly because it has not received substantial investment and there was no substantial improvement in services before these radical decisions were taken.
How much is known about the shift of resources between acute care and primary care which is supposed to lead to redistribution of services? I suspect that the situation in London is probably more like that which I know to exist in the health authority of which I am a member where the number of people registered with general practitioners has fallen in the past few years. So the ability to use primary care services has obviously fallen at the same time and A&E continues to be used "inappropriately".
Have the Government also considered the work done recently on the problems of homelessness in London and the work of the London task force on mental illness which again shows a particularly acute need for special services in London? The Minister will know that, as regards mental health beds, there have been several reports of bed occupancy being at 120 or 130 per cent. How can that possibly tie in with the closure of beds suggested in this report? How many beds will be closed as a result of the changes? How do we know precisely in what way need will be met by these, I am afraid, rather mythical improvements in primary care? Is the money which is to be spent on more capital investment in this field new money oras I mentioned beforeis it the result of a possible shift in resources which we do not know enough about?
In a debate in your Lordships' House last week on an amendment to the Health Authorities Bill proposed by the noble Baroness, Lady Robson, a question was raised with regard to the need for a strategic health authority for London. The noble Baroness, Lady Miller of Hendon, who replied for the Government, said that the need for a strategic authority for London was probably redundant because a lot of the work that was needed was already being done by the London Implementation Group. She listed the particular concerns that the LIG had been looking at which included concentrating, developing and enhancing specialist healthcare services; taking action for
Can the Minister give any kind of end-of-term account of whether the London Implementation Group has been able to reveal the shift in resources and the improvements in the areas on which it has been concentrating in order to give us much greater confidence about these radical changes to acute services? I remind the Minister that although the Statement refers to the King's Fund as an authoritative source, she will know that the latest suggestion of that fund is that its judgment of the resources needed for London was greatly under-estimated. I ask the Minister to consider that these decisions are being taken in a rushed way without due concern for the long-term changes which need to occur before we can feel confident about the reduction in acute care beds in London. I echo the stance which has been taken on these Benches on many occasions. I believe there must be a moratorium on closures pending a full inquiry into all the health needs of London.
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