"I will never again vote Conservative" may be the most telling point to be made in this debate, and it has been endorsed by hon. Members from both sides of the House. Apart from the Secretary of State, only one hon. Member has spoken passionately and wholeheartedly in favour of the Government's current stewardship of health care in London. Every other speaker, with differing degrees of emphasis, has referred to his or her fears and concerns and, in the case of Opposition Members, expressed the belief that London's health care is in crisis.
There is a financial crisis and a crisis in secondary care and in accident and emergency services. The promised shift to primary care simply is not happening. There is continuing underdevelopment of community health services, community care and services for the mentally ill. As my hon. Friend the Member for Woolwich (Mr. Austin-Walker) rightly said, the London ambulance service remains a cause for concern, three years after the Secretary of State first said that she would make it her personal priority. My hon. Friend the Member for Lewisham, East (Mrs. Prentice) rightly pointed out—the theme has been echoed by other hon. Members in the debate—that there is neither an overview of services in London nor a recognition of the special and important features that affect health care in the capital.
Condemning the Government's stewardship of the capital's health care services is no reflection on the hard-working public servants in the health service, from consultants to those who clean the hospitals. We do not condemn the work, heart and energy that they put into providing health care in the capital. If they had the Government's support and the necessary resources, they could do a first-rate job, but they have neither the Government's support nor the resources.
I understand that Mr. Roy Lilley has just appeared on the early evening media speaking for the Conservative party about the nurses' pay rise and said:
The money is there for the nurses local pay rise; but not for just turning up"—
which cannot be compared with Tory Members Parliament. That is not a fair way to deal with nursing staff, whose dedication is much admired on both sides of the House. I understand that the Secretary of State is hinting this evening that she is considering abolishing the pay review body if the nurses do not agree to a 1 per cent. national rise. If the Secretary of State is hinting at that, it is a complete disgrace. If she is not, although time is short, I will happily give way to her now to put all our minds at rest. Frankly, I will happily give way to anyone who can put our minds at rest, but I see that nobody is rising to do so.
I return to the theme of today's debate: the health care crisis in London. At the bottom of the crisis is funding. The allocation of funds to the capital's health authorities, as my hon. Friends have pointed out, has recently been recalculated. The new Government formula appears to benefit outer London at the expense of the inner-city areas. I wonder why. One does not have to think very hard about it. It is quite instructive to place a map of Conservative-held constituencies over one showing the just-losers in the redistribution formula compared with the heavy losers. I have no doubt that it is politically driven and that people who live in the inner cities will lose out. London's 16 health authorities stand to lose £111 million from their budgets over the next five years. That is a cut. As has been pointed out, the biggest losers are in the inner-city areas, with Camden and Islington the hardest hit with a loss of some 14.6 per cent. in purchasing power.
Spending on health care in London as a proportion of total NHS spending has fallen from 20 per cent. in 1988–89 to some 15 per cent. in 1995–96. London has about 15 per cent. of the population, so the Government will no doubt argue that the figures are commensurate, but that is not so, as I hope to show in a moment. The Conservatives do not make the same argument when talking about spending on London's police force. Although the population is the same, spending is 29 per cent. of the national total. Average health authority spending per head for 1994–95 shows London lagging behind Liverpool, Newcastle, Manchester—the other major metropolitan centres. There is also a shortfall in the spending per head on the family health services authorities.
London is a special case, not just because it is the nation's capital, but because it has the nation's largest concentration of inner-city deprivation. Half the entire United Kingdom population of drug abusers is in London. London has 60 per cent. of the homeless population and 75 per cent. of all known AIDS cases. The unemployment rate in inner London is double the English rate. Inner London has three times the English proportion of poor housing and overcrowding. Some 25 per cent. of London's school children qualify for free school meals. Although Conservative Members try to resist the argument, there is a direct link between poverty and health. London boroughs account for seven of the 10 most deprived districts in the UK, as measured by the "Breadline Britain in the 1990s" survey. London boroughs account for 11 out of the 12 of the most deprived districts in the UK, using the Townsend deprivation index.
That has an impact on health. Inner London mortality rates are 25 per cent. above the English average. So London is a special case. The Government's claim to be redistributing resources from secondary to primary care is just not borne out by the facts. They are cutting the budget. The Labour party is calling for a moratorium, a chance to examine again the conclusions of the Tomlinson report. I know that the Minister of State will argue that it is a call for a review of a review, that it is, therefore, time wasting and that we should get on. That is what we are calling for. It is important. If the nation is marching in the wrong direction, it would be better to stop and think again rather than continue marching in that direction, which is the case that the Minister is about to advance on us.
It is our view that the Tomlinson report is flawed. In fairness to Tomlinson, however, he was not asked to examine provision for health care in the whole of London—he should have been—and his report deals only with inner London, and mainly with acute beds. He concluded that London is over-bedded. On that he is wrong. The most realistic figure that I can get—it is substantiated by the House of Commons Library—is that London has 2.5 acute beds per 1,000 of the population. I know that when the Minister responds he will quote a figure of more than four beds per 1,000 of the population, but to get that figure he is including every bed he can possibly find—no doubt including those in the private houses of Conservative Members. It is an exaggeration.
The other argument that Tomlinson addressed is that London has 15 per cent. of the population but 20 per cent. of the expenditure. When one excludes the London allowance and the extra costs involved in the teaching functions of secondary care in London, the comparison is 15 per cent. of the population and 15 per cent. of the resources. There are other reasons why the Tomlinson report is flawed, but time prohibits me from going through them.
In summary, however, the report tries to treat inner London like an "average" English district, which of course it is not. It tries to suggest that increased primary care means fewer hospital patients whereas it may well not. One might well stimulate demand for secondary services by providing primary services. Tomlinson believed that patients from outer London did not use inner London hospitals. That, too, is wrong. Research by the King's Fund has shown that, of half a million in-patients treated in inner London, 150,000 came from outer London or other parts of the country. Tomlinson's calculations also failed to distinguish between the different types of beds—surgical and medical. The crisis is not just one of secondary care, but primary care as well. If the present rate of closure of London's psychiatric beds continues, there will be none left by the year 2000. That cannot be the Government's objective, or the Secretary of State would never be out of the courts.
My hon. Friend the Member for Woolwich (Mr. Austin-Walker) referred to the London ambulance service. Some 37.8 per cent. of ambulances failed to arrive within the patients charter standard time of 14 minutes in London. What on earth is the point of having a charter if the service that is supposed to be supervised by it cannot live up to the results? The London ambulance service is long overdue for a thorough management review, as promised by the Secretary of State three years ago. She told me that it was to become a trust. The trust institutions are the Government's remedy for the problems in the NHS. If that is their preferred remedy, why has it taken so long for it to be put in place in the London ambulance service, where the problems are the most acute?