My hon. Friends the Members for Romford (Sir M. Neubert) and for Hornchurch (Mr. Squire) are to be congratulated on raising this subject this evening on behalf of their constituents, and on delivering to the House a clear message that no one reading this debate could have any reason to misunderstand. It is no more than I would have expected from my hon. Friends, both of whom have been colleagues for a long time and co-campaigners in various campaigns.

My hon. Friend the Member for Romford was a senior, experienced and distinguished Whip when I first joined the Whips Office three and a half years ago. He used to have a notice by his desk which said, "This year Romford, next year the world," or words to that effect. This evening, he has given the House a demonstration of the effectiveness of his thinking on behalf of his constituents and of his campaign over 17 years to ensure that the importance of Oldchurch hospital in the health care of his constituents is understood by those who need to know.

I am grateful to my hon. Friend for raising the subject today, because not only has that allowed him to celebrate his 17 years in Parliament by continuing to campaign on behalf of his constituents; it has also allowed him to ensure that the members of the health authority go to their meeting tomorrow with his words and those of our hon. Friend the Member for Hornchurch ringing in their ears.

They thought that the consultation process ended on 31 January, and this will come as a reminder of the views of my hon. Friends, both of whom have written to the health authority to express their views formally. Their speeches this evening should have served to dispel any remaining doubt in the minds of members of the health authority.

This evening's debate allows me to say that I am sorry that I was unable to fulfil the engagement that I had a few weeks ago in my hon. Friend's constituency, I think at the hospital. I hope that it will be possible to reinstate that. I have no doubt that if it is reinstated the message that my hon. Friends have brought to the House this evening will once again be reinforced.

My hon. Friend the Member for Hornchurch suggested that I could spend some time tomorrow morning on the telephone communicating further the messages of my hon. Friends and adding to it a message of my own that the health authority should not proceed tomorrow with the proposal that we are discussing. I hope that my hon. Friend will understand that I shall not be doing that, not because there are no circumstances in which I might find it in myself to agree with my hon. Friend but because—this is an important principle—the only good way to manage an organisation which employs a million people and absorbs £30 billion of public expenditure is through a management structure, within which we encourage management decisions to be taken as far down the line as is practicable.

We run a delegated system of management, and if that policy is to have real effect, it is important that managers are encouraged to make real decisions and to carry responsibility for them without feeling that their every decision is subject to Ministers looking over their shoulder and jogging their elbows. Therefore, I shall not be ringing the health authority tomorrow morning to communicate the message that my hon. Friends would understandably wish me to.

Nor am I in a position this evening to be able to make clear what the Government's attitude would be if in certain circumstances the proposal ended on a Minister's desk. I will explain briefly why that is. I have explained the importance that we attach to the system of delegated management: the result of that is that a decision of this nature ends up on a Minister's desk only if it has proved impossible for the different agencies within the health authority locally to reach agreement on how the proposal should proceed.

If, therefore, the health authority were to confirm its proposal to concentrate health care on the Harold Wood site, it would be for the CHC to decide whether it wished to lodge its firm opposition to that proposal. If the CHC were to take that course, the disagreement between the health authority and the CHC would go to the regional health authority for a further opinion. If the regional health authority were to support the district health authority but the CHC maintained its opposition to the united view of the regional and district authorities, the proposal would come to a Minister for a decision.

I am sure that my hon. Friends will understand that, if a Minister had to make a decision between the CHC proposal and the management proposal, he would want to do so without having a commitment given in the House hanging around his neck, making it impossible for him to approach the subject with an open mind, as he should.

I give my hon. Friends the clear undertaking that, if it proved impossible for the various agencies that I have described to reach a decision locally, I would go to considerable trouble to ensure that the responsible Minister fully understood the concerns of my hon. Friends' constituents as well as the arguments advanced by the health authority. Therefore, I am not able to describe precisely this evening how my right hon. Friend the Secretary of State would use his discretion if the proposal came before him for a decision.

I can comment on one or two of my hon. Friends' comments. My hon. Friend the Member for Romford was particularly concerned that the convenience and accessibility of health care is considered a relevant consideration and that the creation of ivory towers is not a sufficient argument by itself to support a particular policy. I give my hon. Friend an assurance that we agree. We run the health service for the benefit of its patients, not for that of its doctors—still less for the benefit of the academicians. Convenience and accessibility are important factors in deciding the pattern of health care in any locality.

My hon. Friend stressed the dangers that are attached to grandiose ambitions, as opposed to the more humdrum development of health care in a particular locality. It is one of the sins of traditional health service management that it has regarded capital as a free good. It is to address the problem of excessively grandiose schemes not firmly based in local needs that we are introducing from 1 April the principle of capital charging, which will ensure that any addition to the capital stock of a particular district is recognised to be the cost that it is, so that any authority planning to absorb more capital in the provision of health care will take account of the capital, as well as revenue cost, that it incurs from its investment decisions. I hope that will reduce the attractiveness of highly capital-intensive solutions to particular local problems.

My hon. Friend the Member for Hornchurch stressed the importance that he attaches to a firmly based local assessment of health needs in planning for the future. He quoted in support the views of the local FHSA. Again, not only do I agree, but that is one of the basic propositions on which the Government's reforms from 1 April are founded. My hon. Friends should need no reassurance from me, because the definition of local health need and the use of the contracting system to design a pattern of provision that will meet identified local health needs is written into the statute for which all three of us voted last year. Those are the criteria that management will increasingly use in their areas.

I will enter a caveat by way of balance, and stress that, as we think about the development of provision over the health service as a whole, we must acknowledge that a constant factor is the declining need for acute beds. Modern medicine allows us to treat more patients, more quickly, with fewer acute beds. Merely because traditional medicine needed 500 or 600 beds in a particular locality, that does not mean that, in the next 10 years, we shall continue to need the same level of acute bed provision. Many conditions that once required three weeks' hospital stay can now be treated either on a day case basis, or without the need for surgery or hospitalisation at all. That must be borne in mind, particularly when considering major capital investment that will commit the health service to capital costs for a generation ahead.

Another factor that makes more complex the situation in which my hon. Friends' constituents find themselves is that both Old Church and Harold Wood hospitals are preparing applications for trust status. They are expected by the end of April, and I should emphasise that nothing that is happening as a result of the consultation process launched by the district health authority can limit the discretion of my right hon. Friend the Secretary of State to accept either or both those applications or——