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Health Care in London

The hon. Lady should listen. I am not justifying it at all. I am simply saying that what happens in one part of London has serious ramifications in another part of London that is apparently not particularly close to it. The key question is "If not this, then what?" Does there need to be a strategy review and overhaul of what is going on in London? I think that everyone would answer "Yes", but anyone who answers "No" is living in the past, because the real world moves on. However, when it comes to the question of whether the bureaucracy has the capacity and is properly equipped to deal with such an overhaul, I hesitate. Let me give an example. When the maternity service at Northwick Park hospital was reconfigured 10 or 12 years ago, it could not have been known that more than half the cases presenting to the service would be in the high-risk category, because that particular part of the population was not there then. Where are the flexibility and responsiveness that would make it possible to deal with the dynamics of what is going on in London? Local needs cannot just mean PCTs. Unlike the hon. Member for Orpington (Mr. Horam), who has represented about three dozen parties and four constituencies—he is not in Chamber at present—I do not argue that there should be far fewer PCTs. There should be co-operation between PCTs. I believe—and here again I agree with the hon. Member for South Cambridgeshire—that there are local dimensions in which public and preventive health should be provided all the more. Over the past 20 or 30 years, a collective failure of public policy has meant that preventive medicine and primary care have not developed as they should have. Anyone who visits any other European country will find that most of the cases that present to A and E encounter nothing resembling the provision here, because people in such countries as Germany and Sweden are much more aware and much more educated. If various different organisations such as trusts and PCTs are to deal with local health provision in this country, my one plea is that they should talk to each other. Apart from the Royal National Orthopaedic hospital, whose trust is separate from the PCT, there are no hospitals in my constituency. Edgware community hospital, 10 yards away on the other side of the Edgware road, is hugely important, but is run by Barnet. Just the other side of the Northwick Park roundabout is Northwick Park hospital, in the constituency of my hon. Friend the Member for Brent, North (Barry Gardiner), which is run by Brent. In the middle is Harrow PCT. At present the PCT is doing some very good work looking into the possibility of a polyclinic and the reconfiguration of GP services in the east of the borough, which is long overdue. Barnet, meanwhile, is considering what provision for Edgware community hospital should be over the next 10 years. Are they talking to each other? Not enough. It is true that Northwick Park, to which my hon. Friend the Member for Brent, North will no doubt refer, has been given "stroke status"—if that is the right phrase—and is developing its acute facilities, while also dealing with serious financial consequences; but is it talking to Barnet about what will be provided at Edgware? Is it talking to Harrow PCT about the configuration of GPs in the east of Harrow? Can the three together come up with a solution that has a degree of synergy? That is almost sub-strategic, but it is certainly supra-local. Simply talking about things being driven by local needs is bunkum. Simply talking—as I know Ministers are not—about things being driven top-down is equal bunkum. Where are the mechanisms that could get things right in the middle? I fear that they have not yet been developed. I think that the concern about sector-based and sometimes secretive solutions is partly due to the fact that no one in one part knows what those in the other part are doing. Of course there should be more openness, but there must also be a strategic review that takes local dimensions fully into account.