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Lord Marsh: My Lords, I speak as one who would certainly not agree with the Minister's view that the changes in some areas are moving at a fast pace. Does she accept that the Statement is of positive help? One hopes that it will enable those organisations which were reluctantly forced to block large payments in relation to Guy's rebuilding—in the case of my own organisation the amount was more than £9 million; and there were other large sums involved—to reconsider their position with a view to releasing those moneys and therefore ending at least some of the destructive uncertainty which surrounds the reorganisation at present.

Does the Minister also accept that there is an urgent need for the Government to announce a firm, clear policy and to stick to it? All the issues in this controversial area have been well argued and are well known to anyone interested in the subject. The possibility of the Minister and the Government finding

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total agreement with their proposals is limited, to say the least. The key factor now is to get on with the policy and to stick to it.

Baroness Cumberlege: My Lords, I agree very much with the noble Lord. Perhaps I may pay tribute to the work that he has done through the trustees chairing that body at Guy's Hospital.

The noble Lord is completely right. Uncertainty is very damaging not only to institutions but also to the staff who work within them and others who are in academic or research positions. I agree with the noble Lord that the case has been well argued, well reasoned and well debated. Indeed, we have had 20 reports in the past 80 years all saying roughly the same. I have to say that there has been no Secretary of State more courageous than the present Secretary of State. She has grasped the nettle and is determined to continue. We are firm. We are clear. We have a policy which we believe will improve the services for the people of London.

Lord Jenkin of Roding: My Lords, does my noble friend accept that many noble Lords on this side of the Chamber totally support my noble friend's remarks concerning her right honourable friend the Secretary of State who has shown enormous courage and constancy in seeing through what we always recognised would be a difficult and in some cases a stormy process? However, is not my noble friend absolutely right to concentrate on the need to improve the primary care and community care services? Was it not astonishing to hear the noble Baroness, Lady Jay of Paddington, refer to mythical investment in primary care? I wrote down her words.

There are a thousand projects; my area of east London—it includes Walthamstow and Waltham Forest—has the highest concentration of single-handed practitioners in the entire country. Is my noble friend aware that many projects are financed through the London Implementation Group programme—

Baroness Jay of Paddington: Perhaps I may—

Lord Jenkin of Roding: The noble Baroness must learn to sit and take criticism and not to jump up every time someone criticises her.

Lord Richard: The noble Lord is supposed to ask a question.

Lord Jenkin of Roding: I was asking this question. Is my noble friend aware that in that area of London a great many projects are going ahead which will realise the ambition of a primary healthcare-led service? Is such a service not at the heart of the whole reform? It is what doctors and other professionals in the health service, including the chief executives of the inner London health authorities to which the noble Baroness, Lady Jay, referred, have been demanding for years. My right honourable friend the Secretary of State is now delivering that service. Is it not right that she should be allowed to provide it?

Baroness Jay of Paddington: My Lords, I apologise for interrupting the noble Lord. I had thought that he was sitting down; I misunderstood. As I am sure he

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knows, I am perfectly capable of taking criticism. I wish to ask a supplementary question. The Minister did not respond to my original question. If there has been such successful investment in primary care where is the end-of-term report of the LIG?

Baroness Cumberlege: My Lords, it is on the ground. The noble Baroness has only to come with me to visit some of the remarkable schemes that are now taking place. I do not refer to all the schemes because it takes time to appoint people and to build new health centres, and so on. But we are seeing a tremendous improvement, as my noble friend said.

There certainly is room for improvement. We know that in inner London there are 25 per cent. fewer practice nurses helping GPs than there are practices; that 80 per cent. of GPs nationally offer minor surgery but in inner London the figure is only 46 per cent., and that that accounts for some of the accident and emergency overload that we have experienced; that almost twice as many GPs work alone in London compared with the national average; and that in London twice the national average of GPs are over 65 years old.

Noble Lords will know that the noble Lord, Lord Rea, is a GP working in London. When we have had debates in this House, he has often spoken of primary care. Indeed, he asked me for the list of the 1,000 projects. I have given him that list. If the noble Baroness would like to accompany me, we shall go round London and see what is happening on the ground.

Lord Butterfield: My Lords, perhaps I may slightly shift the thrust of the questions and observations towards education and research. Can the noble Baroness give a reassurance—I know that it will be widely appreciated among the academic and research communities—that there is full support for the key objectives that she mentioned? The shift in the pace of change will be widely appreciated. It will give people the opportunity to think through their research applications and plans.

However, I am sure that the noble Baroness knows that there is a widespread hope in Guy's that a suitable division of specialist services and specialist beds between Guy's and St. Thomas' can be worked out. It is greatly hoped that there will be opportunities to improve the training of the undergraduates in primary care activities. It is hoped that such educational development, and a service bridging the gaps while primary care is built up, can be established on the Guy's site. It is very much hoped that the shift towards home treatment and outpatient services can be developed at London Bridge because of the wonderful transport connections. Indeed, some of us cast our eyes over to that remarkable polyclinic which is to be found in Leiden. The circumstance is similar to the relationship between the new hospital being constructed at Guy's and London Bridge Station. It allows people from a wide area to come to a centre where the research people are in a strong position to give what so many patients demand. Indeed they demand it in primary care. It is real reassurance about the diagnosis that they receive. That reassurance comes from a research, knowledge-orientated, teaching hospital environment.

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Perhaps the noble Baroness will give reassurances that research in surgical, dental and psychiatric subjects will be cosseted and will make its contribution to the London scene. It is such a strong scene that we all realise that we can play only a part in it. I should be most grateful if the noble Baroness will give me some reassurances to take back to my young men and women.

Baroness Cumberlege: My Lords, I know that the noble Lord, Lord Butterfield, has a long-standing interest in medical education and research and has worked tirelessly to improve it. I am sure that he will be reassured to know that today the provost of University College London, Dr. Derek Roberts, has announced that University College London has been given £11.5 million by the Wellcome Trust and £14.5 by the Higher Education Funding Council for England to fund a new teaching centre for medical students and a major new medical research centre at University College Hospital.

I know that the noble Lord's particular interest is in Guy's Hospital. I hope that I reassure him that our vision for the future is for Guy's to be the centre of excellence in terms of teaching and research. We have much support from the Vice-Chancellor of the University of London. We believe that the linking now of medical schools with multi-faculty colleges will strengthen them, as indeed they have been strengthened in other parts of the country, for example, in Oxford.

We are concerned that our teaching and research should not fall behind. We want to be a world leader and a world beater. We want to attract students from all over the world to benefit from our medical education, which we believe is the best but which has to struggle very hard to maintain that position.

Lord Stoddart of Swindon: My Lords, the noble Baroness says that there had been a lot of consultation. Was there consultation between the Secretary of State and her right honourable friend Peter Brooke? He does not seem to believe that there was proper consultation with somebody who had a real interest in that area and in Bart's in particular. Has there been proper consultation with all the staff of St. Bartholomew's? My information is that there has not been proper consultation and that they will by no means be satisfied with the Statement which the noble Baroness repeated today.

Can the Minister also explain why the Secretary of State for Wales seems to take a completely different line on reorganisation from that taken by the Secretary of State for Health? Apparently, he believes that many of the older buildings are perfectly suited to modern methods and that much of the reorganisation is for administrative and financial convenience. I wonder whether the noble Baroness would comment on that.

Finally, can she say whether the £210 million for primary care to which she referred is new money or is it to be transferred from elsewhere to somebody else's detriment?


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