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Page 2, line 14, at end insert:

("Strategic Health Planning Authority for London.

"8A.—(1) It shall be the duty of the Secretary of State by order to establish a Strategic Health Planning Authority for London.
(2) The membership of the Authority shall be established in accordance with Part I of Schedule 5 to this Act."").

The noble Lord said: My Lords, in moving this amendment, which is very similar to Amendment No. 8, debated in Committee in this House, I make no apology. Some confusion prevailed last time. The amendment defined the region of London as,


    "the area of the London Boroughs".—[Official Report, 28/3/95; col. 1552.]

As several noble Lords pointed out, inner and outer London boroughs differ greatly in their socio-economic make-up. The inner London boroughs have much greater social and health needs due to their high levels of social deprivation. It is possible to consider a strategic authority covering entirely or mainly the health authorities which cover the inner London boroughs. That is the spirit in which I want to consider the proposal in this amendment.

The inner London boroughs have, on the whole, quite similar needs. They have quite high levels of unemployment; not very good housing; high levels of immigration; and degrees of poverty that we do not see so much in the outer London boroughs, whose make-up is rather similar to that of the Home Counties, which have a more affluent population in better housing, for example.

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There is a need for close co-operation among inner London health authorities. Their populations are concentrated. As the Tomlinson Report, Making London Better and the London Implementation Group task force have pointed out, there is opportunity for the rational siting and sharing of specialist care units.

Primary care is relatively poorly developed in all the inner London boroughs. It will be best helped by co-ordinated action to raise standards. That is shown, for example, by action on the London Implementation Zone. Co-operation between health authorities and local authority social services departments is a crucial element in making care in the community efficient. In fact, the concept of a primary care led health service depends on that.

The noble Baroness Lady Miller, said in Committee that the work of the London Implementation Group was now complete. I suggest that there is still plenty of ongoing work for such a body, as there is for the London Implementation Zone, which relates to primary care. This amendment would allow the work of those two task forces to be built upon in a constructive way.

Finally, it is worth pointing out that the population of London—its size, depending on whether you take the population of the inner London boroughs or include Greater London—would be comparable to that of each of the eight existing regions, which are to be succeeded by the regional offices of the NHS Executive.

This amendment is reasonable. This is a very good opportunity, while changes are being made in the structure of the health service, seriously to consider setting up a suitable strategic authority for London as described in this amendment. I beg to move.

4.15 p.m.

Lord Addington: My Lords, very briefly, I support this amendment. The same issue was raised from these Benches in Committee. London is a very large and diverse area. Strategic planning in virtually all fields would be beneficial for so large an area. Health provision is certainly no exception.

Lord Desai: My Lords, perhaps I may be allowed to speak at this stage, even though I did not speak in Committee. I shall refer only to the concrete experience that I have. I declare an interest as chairman of a small drug intervention agency, City Roads, which deals with drug crisis problems.

Since the care in the community legislation was passed, this small group has had to deal with all the various boroughs of London separately. When it comes to issues such as drug and alcohol abuse, it is quite clear that there will need to be some sort of co-ordinating agency for different drug intervention agencies. Although these have to deal legally and contractually with individual boroughs, the problem is London-wide, if not larger. In the absence of an authority such as that proposed in the amendment before us, ad hoc co-ordinating committees are liable to be set up separately for different topics. Then there will be the

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problem of setting up co-ordination across those different co-ordinating bodies, be it for drugs, mental health, alcohol abuse or whatever.

It would make much more sense at present initially to set up a strategic health authority that can deal with all those problems. They will not go away. While some matters can be dealt with at individual health authority level and individual trust level, there will be cross-authority problems. The amendment deals with that issue; therefore I support it.

Baroness Jay of Paddington: My Lords, before the Minister replies, perhaps I may speak briefly in support of my noble friend Lord Rea. As we all know, the position in London moves very rapidly and changes very often. I was extremely interested to hear the remarks on London that the Secretary of State for Health made on television yesterday afternoon. Among other things, she said that London has had entrenched problems over many years. I believe that we would all concur with that point. She also said that the London health service is not good enough now, and that some health authorities have not planned well enough and not done well enough to meet the various problems with which London deals. All of that speaks to the argument for having some kind of strategic authority which can enable the Government, the Department of Health and the Secretary of State, to have some influence of a more direct kind so that future Secretaries of State will not need to say that the London authorities have not done well enough and feel that that is something that they can only remotely influence.

In introducing the amendment, my noble friend Lord Rea spoke about the London Implementation Group. He mentioned that it was a task force which the noble Baroness, Lady Miller, told us in Committee had completed its work.

Obviously the task force has completed its work, but the measures, the problems and the issues that it was set up to deal with have certainly not been solved. It would be useful to translate the London Implementation Group, with its various task force functions, into something with a longer life and a more strategic overview.

I was invited by the Minister, when we talked last week in your Lordships' House about the end of term report on the London Implementation Group, to visit with her the various projects in primary care which have been developed under that initiative and which she felt were very suitable examples of its success. But, without wishing to lend coin or credence to what is an unattractive word, I think that is what is described in the jargon as "projectitis". There is very little strategy attached to what the London Implementation Group has achieved and, in terms of the end of its life this month, a lack of evaluation.

If I look at some of the issues which have arisen during its life—and which have risen again, acutely, in the past few weeks—I can mention, among others, the pace of change in London. How quickly are we to implement the moves towards making primary care the most important method of delivering care to Londoners and weaning—if that is the appropriate word—them away from using the acute services for primary care?

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How quickly should we engage in more bed closures in the London area? How can we effectively improve primary care in a population which has little understanding of the necessity to register with GPs? I described in Committee how many local health authorities in London have had a reduction in numbers of the population registered with GP fund holders. How do we deal with improving primary care in a floating population, with all the great social distress and deprivation, which, as people know—the noble Lord, Lord Rea, referred to it again this afternoon—is particularly acute in the London boroughs? How do we organise the specialties which have been reviewed following Professor Tomlinson's report?

All of these are issues which need to be dealt with strategically. They are not susceptible to the task force "projectitis" approach of the London Implementation Group.

I was interested in the February report of the inner London chief executives on hospital services for London. It was obviously an informal group of people which got together, I believe, in response to the special lecture given by Professor Jarman about inner London health needs. The chief executives' report said:


    "the broad strategic direction that has been set for London is correct, but at a number of points clear and strong management action is required by our Authorities if it is to be achieved in a manner which is clearly seen to benefit patients".

It goes on to say:


    "We also believe that action needs to be taken at Regional and/or national level in relation to a number of the findings in the studies".

It cited, for example, the questions of management of admissions and discharges, of calculating bed requirements and whether or not trusts were in a position to make the appropriate calculations on the basis of their business cases. It also said that there should be an overall review of the yellow and red alert mechanisms across London, and of the role that the emergency bed service should play in the future.

Those are just some of the issues which the inner London chief executives clearly felt were appropriate for collective working and a strategic view.

Of course we can continue to have ad hoc committees working on these matters—as indeed the chief executives did on this particular subject—but it would be much more sensible if we had in place a strategic health authority with the additional authority and status necessary to achieve solutions to so many of the medium and long-term problems of London. I support my noble friend.


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