I am not pleased at having to raise this topic—it should not be necessary to do so. The health services in east London are in a parlous state. None the less, on 5 April, when the Secretary of State was dragged to the House, she said:
I am determined that, as a result of these changes, we shall have a health service in London that is fit for the 21st century, in which we can all take great pride." —[Official Report, 5 April 1995; Vol. 257, c. 1736.]
I invited the right hon. Lady to today's debate. The Minister, who is present and who met a deputation on the matter a week before the Secretary of State's comment, is not responsible. The Secretary of State is responsible.
A week before the Secretary of State's comment, five Members of Parliament from east London with eight women officers of the community health councils told the Secretary of State personally that it would be disaster if the changes which she had authorised were to go ahead in the area of the East London and the City health authority. That area has a population of 500,000—the size of a large city. It is organised by one authority, whose officers and members are agents appointed by the Secretary of State. Indeed, this debate may be the first-ever opportunity for the right hon. Lady, who once again has not come to the House to take responsibility, to look at what is happening in a particular area. It is only when one sees what is happening in one area that one can see the impact of the changes introduced by the present Administration.
In east London, the City of London, one of the highest-earning areas, is next to three boroughs—Hackney, Tower Hamlets and Newham—which, on statistical terms at least, are three of the most deprived in the country. It is interesting to note that today a report has been published about the connection between income deprivation and health. Indeed, I believe that my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) gave an example of that connection which was reported in the media. There is therefore a juxtaposition of some of the most privileged people, and some of the least privileged people, whom my hon. Friends and I represent; those immediately to the east of Aldgate pump and those stretching out in a segment to north-east London.
The main plans were to close hospitals. The 1,035 beds in the East London and the City health authority are to be reduced over six years to 738—a reduction of roughly 30 per cent. That takes account of the net closure resulting from St. Bartholomew's, the closure of the London Chest hospital—we all know how respiratory diseases are on the increase, especially among children—and the proposed closure of St. Andrew's by Newham Healthcare trust. So two saints in the east are going west and that is not good news for east London at all. The reason for the closures is the belief of the Secretary of State and her officers that the need for beds will go down, despite all the trolleys serving as beds in hospitals in east London, to which I shall refer in the moment.
The key to the operation is the Whitechapel site in the constituency of my right hon. Friend the Member for Bethnal Green and Stepney (Mr. Shore). Indeed, 165 additional beds are to be provided there, together with supporting services. The figures that I gave take that into account. When will that facility be built and where is the money coming from? I understand that, at current prices, £230 million has been allocated for that development, but Ministers have not given a guarantee of when, that will be available or if it will be available. Letters of comfort to the non-existent North Thames regional health authority chairman, who has now been phased out, do not provide the sort of guarantee that we want. We have heard such stories about replacement beds before and so have people all over the country. We want guarantees that the money will be available and that that facility will be built before the reciprocal numbers of beds elsewhere are reduced. Is that not a reasonable request, given that the commitment to provide them has been given?
The second area of questioning concerns secure psychiatric accommodation. A case arose in an east London magistrates court because at one time there were no proper secure beds available in east London. The Secretary of State could have attended but instead she sent somebody else. The recommended number of secure beds—of course it is more than a bed; it may be somewhere where people may be able to help their condition—is below that recommended by the royal colleges. I understand that secure places have not been found in north-east London for 63 people, and that the 63 places that have been found are scattered over the country as far away as Yorkshire and south Wales. Are those the sort of conditions in which relatives and others may help?
Two horror stories have been supplied by the Hackney and Newham community health council representatives retrospectively and I shall read them out because such stories convey the truth of what is happening much better than statistics, however much they impress those who can read them.
The first case study is of a Hackney man, whose mental state was deteriorating rapidly. He threatened a health worker with a knife, tried to pull out his own tongue, locked a GP in his room and attacked and tried to strangle an elderly woman in the street, yet there was no bed for him in Hackney. Only after the intervention of somebody from the office of the Secretary of State for Health was a bed found. Presumably, somebody was turfed out to make room for him. Such turfing out produces the curious anomaly of 120 per cent. bed occupancy, which I understand is the figure for Newham.
Case study two is of a 15-year-old Newham girl who could not be contained in local authority accommodation. She was eventually put through the courts and sent to gaol because there was no psychiatrist available to see her. Newham currently has one psychiatrist in post to cover the whole adult population of the borough—about 250,000 people.
One of the reasons why people do not fill vacancies in the borough is the extremely hard work load and the unreasonable demands made on loyal, skilled and hard-working staff. Indeed, the health of some of them suffers as a result.
The casualty scene is perhaps the most spectacular. Bart's had a casualty department. Its closure has meant greater pressure on adjacent casualty units—those at the London Chest hospital and the Homerton. I am told that, since January, the Homerton casualty unit has had to be temporarily closed on 20 occasions. Although it may have been for only half an hour or half a day, that means that ambulances have to go further and everybody's morale goes down. To keep the unit's head above water, beds have had to be put in the waiting room. It is not the only casualty unit affected by the closure of Bart's casualty. The closure has had a ripple effect throughout east London, including Newham general, where at the moment patients have to wait anything between four and eight hours in the casualty unit. Eleven posts for junior hospital casualty officers were advertised not long ago, but only seven could be filled, adding to the pressure on those who responded to the call.
I understand that, quite properly, the Government have reduced the pressure on junior doctors. I have also heard that, for some reason, the Royal College of Surgeons—for all I know, the Royal College of Physicians may have done the same—has reduced or eliminated the requirement for young doctors to have such experience. The supply has dwindled. Who would blame young doctors for not choosing to go into a situation in which the stress is greatest and the staff shortages are the worst, if they do not have to? There is a descending vicious spiral.
The Secretary of State—or rather the Minister, as he is here, although it should be the Secretary of State—may know about that problem and want to make inquiries. I hope that he will be able to tell me now whether what I have said is true, because if he cannot it shows that either he or his Department is not up to the job.
There was recently a scare story—or rather, not a scare story but a factual story—in The Sun about a theatre orderly being involved in an operation. That may have been medically justifiable—I do not say that it was not—but we know that the orderly had to stand in for a doctor who was called away to fill a gap in the Newham general hospital casualty department. Perhaps he was trying to save somebody who was dying. Who is to know?
A couple of weeks ago a chap came to my advice service and said, "I was driving my van down the street, Mr. Spearing, when I had pins and needles and I went numb all down one side. I drove slowly and quietly to Newham general and said, 'I think I have had a stroke.'" Two nurses, no doubt under pressure, assured him that he had not had a stroke, and told him to see his general practitioner. The next morning, having driven quietly home, the man went to see his GP, who confirmed that he had had a stroke. I have verified those facts with the community health council.
Those stories show what problems there are in the casualty departments, which are the most critical facilities of all. And those problems stem to some extent from the ripple effect of the Bart's closure. Last week, my right hon. Friend the Member for Derby, South (Mrs. Beckett), the shadow Secretary of State for Health, asked what use was to be made of the St. Bartholomew's site, and the last sentence of the written answer by the Minister for Health read:
The Royal Hospitals trust has also been in discussion with the city initiative on possible uses of the site for health-related services."—[Official Report, 18 April 1995; Vol. 258, c. 119.]
I know that the City is worried about the reduction in local emergency facilities. It does not like the disappearance of St. Bartholomew's casualty department. If I were a City financier or somebody with plenty of money and a bit of organisation, I would say, "Can't we use some of that site for a private organisation?" City firms—there are enough of them—could get together and
say, "What about some form of accident and emergency facility there?" That is possible; there is talk of it happening. Somebody from abroad might think of such a project as a good thing. It might be a paying game, and make a profit. Someone will say, "What about a market in accidents and emergencies in the City, eh, boys? Shares?"
That is the sort of development that the Government are encouraging in health. They think that there is a market in health care. Well, we do not. That is the big difference between us. It is typified, as in a sort of parable, in the contrast between the City, Aldgate and the rest of east London. I do not say that what I suggest will happen, but I suggest to the Minister that it might.
Let us suppose that a taxi driver—John Bull, one of my constituents—had a heart attack at the Bank of England. Would he be eligible for treatment at such a place? We do not know. We can think of other representative people, too. Lots of people live in that great Barbican block. Let us think of a typical name in London—John Smith, perhaps. Would a John Smith in an organisation which had no share in that accident and emergency facility, and did not pay money to it, be eligible? No.
I do not say that that will happen, but I suggest that, under the Minister's philosophy, it could happen—unless he tells us to the contrary, so that people, not only at home but abroad, can hear him. I hope that it will not happen, but there is only one way to stop it—to reopen the much-needed Bart's casualty facility for everybody, as it was designed for the national health service and as it operated until recently.
In the East London and the City health authority, we see an example of what is happening all over the country. We often hear about social and other types of problem in other parts of the country; we read about them in black and white and we see them fuzzily. But in east London, where there are all sorts of problems, we see them not fuzzily but in focus, and not in black and white but in sharp technicolour.
In east London we have seen the closures that the Secretary of State, whose hands are not safe, announced a few weeks ago. My hon. Friends and I, who represent constituents who live in east London in the deprived boroughs, have to bring those facts out, and say that the health service there is not good enough. The Government ought not to be proud of it now, and I fear that, despite what the Secretary of State said, we shall not be able to be proud of it in the next century, either.
I congratulate my hon. Friend the Member for Newham, South (Mr. Spearing) on having secured the debate. I shall add a few brief remarks of my own, because I want to comment on the level of resources available for health services in east London. Before I do so, I shall express one note of commendation for a recent Government decision, because this is the first opportunity that I have had to do so.
I welcome the decision to have three community health service trusts, rather than the one initially proposed, in east London. My hon. Friend and others, including myself, reflecting representations made in east London, have expressed that view to the Minister in earlier debates, and I am pleased that it has been decided to go for three trusts rather than one. That will give us a better basis for the future of community health services in east London than we should otherwise have had.
However, that decision has already shown what an extraordinary disparity there is between the budgets of the three new community health service trusts. That has again thrown into relief the question of the resources made available for the health services in east London to deal with the problems that my hon. Friend has so eloquently described.
We need a funding regime to reflect the immense need created by the deprivation that we endure in east London. We have not yet got that. Of all the myriad examples that could be cited, I shall mention the formula for the funding of the psychiatric services, which contains no reference whatever to the level of unemployment in an area.
It has been well known for many years that high unemployment contributes to psychiatric problems, yet that knowledge is not reflected in the funding formula. This morning's King's Fund report, which my hon. Friend mentioned, shows that resources must reflect far more fully than they do the deprivation that leads to and accompanies poor health. If we can make sure that that happens, east London will have a much better slice of the resources than it does, and we shall be able to look forward to resolving some of the problems that my hon. Friend has described.
I thank my hon. Friend the Member for Newham, South (Mr. Spearing) for allowing me a brief intervention. I represent a constituency slightly to the east of my hon. Friend's constituency, in which, despite massive local opposition, the Government have given the go-ahead for the closure of the accident and emergency unit at Oldchurch hospital. Hon. Members on both sides of the House have long expressed our real fear that that decision marks the first nail in the coffin of Oldchurch hospital as a whole.
The people whom I represent desperately need the services provided by that hospital. They have already lost too much—Barking, Rush Green and now Oldchurch. Now they are to be expected to go to Newham general hospital—we have heard about the problems there. My constituents will be left with one hospital serving almost half a million people.
The people of Barking are more likely than average to be old, to be sick and not to have the use of a car. Yet they are now expected to travel on lousy public transport all the way to Harold Wood hospital or Newham general hospital for accident and emergency services. It will be a catastrophe.
I seek two assurances from the Minister today. Is the impact of the closure of the Oldchurch unit being monitored by his Department? If so, will he report back to the House? Is the future of Oldchurch hospital as a whole secure?
I congratulate the hon. Member for Newham, South (Mr. Spearing) on securing this debate on an extremely important, and controversial, matter. I am pleased to come to the Dispatch Box today to explain the Government's policies and the reason behind them. Rather than concentrate on the general strategy, I should like in the moments that remain to me to get into the meat of the arguments that have been raised by the hon. Members for Newham, South, for Newham, North-East (Mr. Timms) and for Barking (Ms Hodge). I shall deal with as many of the points as I can.
I shall deal first with the points about beds. A range of research published over a period suggested that general bed reductions were required in London. The debate gets off on the wrong foot if anyone suggests that there are prescriptive figures tied to a definite timetable from which no one will depart. I remind the House that health authorities are given by the Government a fundamental statutory responsibility to provide adequate services, whether that means acute beds, what are described in the language of academics as low-tech beds or long-term beds. The health authorities have to get the balance right.
I am sure that the hon. Member for Newham, South will concede that the reductions are not being done according to a strict timetable with a ratio of beds dropping according to some formula that was fixed some time ago, on which the Government are being inflexible. Nothing is further from the truth.
The figures that underpinned Tomlinson were essentially predictions of trends in bed use. Therefore, actual bed reductions are broadly in line with the predicted trend. That is what we have seen. The Government's policy in London, as in the rest of the country, is that it is for individual health authorities to plan what level of provision is appropriate in their area, taking into account all the factors of need, demand and availability, and the desirability and adequacy of other services.
An impression has emerged that the report that underpinned the reforms that are now taking place is out of date. The report is being questioned. It is important to remind everyone who is interested in the matter that the King's Fund still holds to the view that, as a result of changing medical practice and the reduction in referrals to London hospitals from outside the capital, London will need fewer acute hospital beds in the future in general terms. Most people would concede that point.
I understand that those who represent London constituencies wish to make their points in their own way, but the principle is that the number of beds must be adequate. There is an overview. Restructuring will mean that, in time, a different pattern will emerge in London. That is something with which the House is familiar. It is broadly accepted outside London, especially in areas which previously referred to London hospitals to a great extent, but now find that they do not do so as much. The pattern has changed and the demand from the local area is that the hospitals that serve local people should take much more of the case load than in the past.
On a point referred to in passing by the hon. Member for Newham, South, there is one saint in the east which is not going west. St. Andrew's hospital will not close. In-patient services will be transferred to Newham, with concentration of day care and out-patient services at St. Andrew's. That proposal is subject to public consultation, as are all the changes proposed.
The hon. Gentleman asked how we were to guarantee that changes would take place smoothly and services would be preserved. It was a fair point. As he knows, it is impossible for any Minister to give specific guarantees from the Dispatch Box of funding other than on a year-to-year basis from committed funds. I ask the hon. Gentleman to consider, first, the level of capital investment that has already been committed in London and secondly, the capital and running investment provided through the London initiative zone for primary care. I suggest that if he is looking for an earnest of the Government's intentions, the flourishing of primary care schemes, not least in his constituency, is the clearest possible evidence.
If the hon. Lady does not mind, I will not give way. I agreed to allow three hon. Members to speak in the debate, and I have only a short time to make my speech. I must answer the points that have been made. I apologise to her. Perhaps, on some other occasion, I could respond to her points. I understand that we may be offered an occasion at some point in the future.
The hon. Member for Newham, South should bear in mind the pledge that my right hon. Friend the Secretary of State and my predecessor gave to the House about casualty departments, to which he specifically referred. My remarks on this subject are also directed at the hon. Member for Barking. No facility shall close unless there is an equivalent, if not better, facility in place. The hon. Gentleman talked at some length in a rather dramatic way about unlikely scenarios for the future of the site at Bart's. I ask him to bear in mind the views of a great body of professional opinion. It is not me or even great academics who are telling him this. If the hon. Gentleman talks to a casualty surgeon—a specialist consultant in a new field—he will be told that there needs to be a critical mass and there needs to be reorganisation. I understand that reorganisation is painful, but on the Bart's site there is now an excellent minor injuries unit to deal with the everyday needs of the local population. Those developments across London are highly welcome.
The hon. Member for Newham, South also referred to mental health. Mental health services are a high priority in east London. There is a pressing need for better services. The health authority has set up an action research project to consider how best to meet those needs. There are 109 mental health beds in Hackney, including 15 psychiatric intensive care and 15 low secure beds. There are 91 beds in Newham and 101 in Tower Hamlets. That is a total of 301 beds.
The demand for psychiatric beds greatly fluctuates. As the hon. Member for Newham, South rightly said, there are pressures. On occasions, in order to meet demand, placements have been made outside the district. That is why the district health authority is working to provide a further 15 intensive care beds in Newham to meet need in that part of the district.
On the point about pressures and over-occupation, much of what appears in the statistics of over-occupation is cases in which people are released into the community, in the care of their family, for a fixed period. That person's bed then becomes available and is used in the interim. No one would suggest that the corollary which the hon. Gentleman implies is that the bed should lie vacant in the meantime. Proper use is important.
The hon. Member for Newham, North-East raised the general question of resources. With the new formula, which concentrates more on capitation than before, resources are moving exactly in the direction in which the hon. Gentleman suggests he wants to go. Deprivation and problems in east London have been recognised in other ways as well—in primary care, not least through the London initiative zone and through the fact that deprivation payments are now well established. Those are important ways to get into what I would describe as the "front line" of care. The hon. Gentleman will agree that this year's increase of 4 per cent., or £322 million, which the East London and the City health authority will receive, is welcome.
The hon. Member for Newham, South asked a specific question about the future of the Bart's site. The Government welcome the trust's intention to explore the possibilities of a continuation of medical care on the most historic part of the Smithfield site. The contribution that will be made by the project team, led by Sir Ronald Grierson, will be welcomed. The team will look at the practical options involved, which are likely to be at the less spectacular end of the spectrum that he painted to the House today.
The policy that the Government have put in place will bring better health care to Londoners in the future. It will bring to London's health care a 21st century standard, which is now met in many other parts of the country. That is broadly welcomed by those close to providing the service. Ultimately, to shirk from making change where it is necessary is an abrogation of responsibility, not just by the Government but, if she failed to take the challenge, by my right hon. Friend the Secretary of State.