My Lords, I congratulate the noble Earl, Lord Howe, on ably introducing this important debate with his usual words of wisdom and care, which are much appreciated in the House. It is good to see my noble friend and, if I may say it, colleague on the Front Bench. That he is a colleague from Imperial College is apt to my declaring my interest in this debate. His presence here is very good news, and I hope that he will be able to improve our health service in due course.
His report is full of aspiration, which is to be commended. However, the inequalities in health care in London will not be solved by the NHS. As we well know as medics, those inequalities are solved mostly by changes in the environment, by alleviation of poverty, by better education and, to some extent, prevention of disease, on which the report focuses.
I do not have time to talk about much of what is in the report. I am a little concerned about obstetrics. Only in the past week, two opposing positions on the value or safety of home delivery have been argued in the British Medical Journal. There is no clearly stated evidence yet that it is truly safe. The health service faces massive legal costs for babies which are seen by the courts to be damaged. I am concerned also that continuity of care may not be offered to obstetric patients who may be treated first for their gynaecological condition or their fertility problem and have to go to different health authorities for their treatment. That is certainly a problem at Hammersmith, where I used to work.
I am concerned, too, by mental healthcare. A key issue in London on which the report does not focus is the environment for mental health patients who are inpatients. It is desperately depressing to visit a mental health ward. Many patients are probably made worse by that environment.
As the report states, London is a major city: it is one of the great cities of the world. It is also one of the greatest cities, unparalleled in Europe, for medical education. It is an extraordinary centre for research, teaching and training. Imperial College is probably the biggest medical school in Europe, and it is highly successful. We have University College, King's College, Queen Mary College and St George's at Tooting—it is an extraordinary line-up. We must recognise in London the failure to translate much of the research that takes place from the basic area. It needs to be much more focused in the future if we are to go forward with healthcare. The report had trouble mentioning translating research; it mentions MRI and penicillin. Huge gaps need to be addressed.
There is a crisis in the confidence of people going into academic medicine, which is severely threatened. Listening to this debate is a medical student from Imperial College who, like so many of her colleagues, is thinking of doing her PhD not in London, but in the United States, because she is so disenchanted by her prospects.
We might be well advised to consider bringing back the old method of training junior hospital doctors. Perhaps my noble friend will think about it. The FIRM system had a lot to recommend it. I understand that appointments to it were likely to be biased and subject to misplacement, but it would be unwise to give up completely the advantage of working in a unit where doctors covered for each other and had a team responsibility. It was deeply important when I was training, and it still is.