We will carefully consider the proposals put forward by Sir Bernard Tomlinson and his team. No decisions will be taken without full consultation with those institutions that are affected. We shall set out our detailed proposals for change in the new year.
Will the Health Secretary confirm the report in "London Health Emergency" that in the past six months the four regional health authorities covering London have drawn up plans to axe 9,000 beds over the next five years? Is not the presupposition in Tomlinson's and the Government's thinking that London has too many hospital beds an absolute myth? Has there not been a cut of 8,000 beds in the past decade and have not hospital waiting lists in the capital increased 30 per cent. in the same period?
If the hon. Gentleman studies the Tomlinson report, he will see that London already has many more beds than other parts of the country. It has 3·9 per thousand compared with 2·5 per thousand elsewhere. The waiting lists in London have come down by 10 per cent. over the past year and that is an achievement.
The real point is that Tomlinson has identified a problem of long standing which has been recognised by 20 reports in the past 100 years. With 45 hospitals, 12 teaching hospitals and eight postgraduate hospitals, London must have an enormous overhead infrastructure, but does not provide the proper primary care services that are needed. It is time for us to take those decisions, which we shall do on the basis of improving health care for Londoners while safeguarding research and teaching.
Has my right hon. Friend seen the report in last Friday's Evening Standard of a study conducted by two health experts which concluded that general practitioners in London tend to be elderly with large practice lists and often without adequate back-up staff? Does not that report clearly make the point that action and change are needed to improve primary health care services in the capital?
I saw the report that my hon. Friend mentions. It comes from a report in the British Medical Journal. It recognises the point stressed by Tomlinson that London has poorer primary health care services than other parts of the country. It is absolutely vital that we invest in primary health care in London as we take forward proposals.
I give an absolute assurance that no decisions will be made until careful consideration has been given and until it is possible to guarantee the improvements in primary care that were so clearly identified by Professor Tomlinson.
While the Secretary of State is considering implementation of the Tomlinson report, will she assure the House that members of staff who stand to lose their jobs if hospitals are closed will he redeployed, given that we have a waiting list of approximately 139,000 in London?
I thank the hon. Lady for giving me an opportunity to say that some of the suggestions about the number of staff who would lose or change their jobs are ridiculous, irresponsible and scaremongering.
It is untrue and devoid of explanation that figures of the kind quoted by the Confederation of Health Service Employees could seriously be considered. The figures that have been quoted are enough to alarm and worry people in the health service in London at a time when most people want to explain and reassure.
The hon. Member for Sheffield, Brightside (Mr. Blunkett)—I give him credit—said that the status quo could not continue in London. Editorials in The Guardian, The Times, The Independent and New Statesman and Society have said that change must come. Of course, the needs and interests of staff will be very much in our minds so that we can find ways to redeploy them and make the changes as easy as possible.
I can give my hon. Friend that absolute assurance. As has been said in many independent reports, the problems in London are of long standing and complex. Increasingly, patients now wish to be treated in their home communities. As I have made clear, a great number of specialist services need to be rationalised. We need improvements in primary care and community services. There will be no question of decisions being taken before we can be sure that they will lead to improvements in care, better use of resources and a strengthened national health service.
Will the Secretary of State give an undertaking that she will conduct full public consultation with Londoners on the future of their hospitals? Will she guarantee that she has secured the additional funding that is necessary for primary and community care before she gives any further consideration to implementing the Tomlinson report?
The House will know that my hon. Friend the Minister for Health is having discussions with the different institutions in London on the basis of the recommendations in the Tomlinson report. As I made clear at the time of the statement, it is advice to the Government and not Government policy. We shall discuss with all interested groups how we can take forward those changes to improve health care for Londoners. I give the hon. Lady and others a clear commitment that those changes are about improving health care for Londoners. That is the message from all the professional journals—from the Nursing Times and Nursing Mirror, General Practitioner, House, and the Health Service Journal. As far as money is concerned, in answer to an earlier statement, I seem to remember that the hon. Member for Wakefield (Mr. Hinchliffe) was busy telling people at a social services conference that money for community care would not be ring-fenced—the day before I was able to announce community care resources. People should take prophecies of doom from the Labour party with a pinch of salt.
Will my right hon. Friend accept, from a Kent Member of Parliament who represents an area which historically has long been underfunded and whose patients have had to travel well over 50 miles for hospital treatment in London, that his constituents are exceedingly grateful that she is showing her determination to reorganise the London hospital service, so that services that have been overfunded there can follow patients out of London to areas like ours?
I think that my hon. Friend speaks for many hon. Members. In the past year, the rest of the country supported London health care to the tune of £50 million. Sensibly, 20 per cent. of the money in the national health service cannot continue to cover 15 per cent. of the people. I am well aware that there is great pressure outside London for us to move swiftly. We shall move only as fast as we are able to safeguard health care for Londoners, but we shall do so on the basis of the long-term interests of the national health service.