---

Health Care in London

I am sure that many people watching the debate will think that that time could have been better spent focused on what Members from all parties were saying. Indeed, as we have heard over the past few hours, concern has been expressed from both sides of the House about the process that is unfolding and about how our NHS services in London will be reconfigured over the coming months unless we halt this process. I hope that tonight's debate has given Ministers some cause for concern, because residents across London are absolutely furious that they are not being involved in this process in the way that they want to be. We all know that London is a diverse and vibrant city. Residents are very mobile. Migration and demographic patterns mean that we have an every-changing population. That is a key part of London's identity, but we know that when it comes to providing health care in the capital, it means that we face some unique challenges. Even the Minister of State, Department of Health, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), when he was introducing the debate on behalf of the Government, admitted that Londoners put up with a worse health service than other parts of the country, in spite of the tireless work of NHS staff in our primary care trusts, GP surgeries and hospitals. I hope that at the end of this debate Ministers will address some of the concerns that have been raised. Although in London we have some of the best hospitals in the country—and, indeed, even in the world—we also have, as we have heard, some of the worst health outcomes, with stroke, heart disease and cancer being particular causes of concern. Health inequalities in London are complex. The London poverty profile shows that three quarters of the London boroughs with the highest rates of premature death are in inner London. The risk of premature death in Newham and Lambeth is 250 per 100,000 people, which is twice that in Kensington and Chelsea. There are also unequal levels of long-term illness, with east London disproportionately affected. The last census revealed that 15 per cent. of adults in Islington, Hackney, Newham and Barking and Dagenham suffered a long-standing illness—twice the level of such illness in Richmond and Kingston. It is perhaps no wonder that some of the Members representing those constituencies have taken the opportunity to flag up their concerns about the changes in health care provision that could be coming down the track for their constituents. What have we had in response to that complex series of health care needs? We have a city-wide strategy from NHS London and now, as we have heard today, some specific plans are being worked up, apparently behind closed doors, by individual so-called NHS sectors. NHS London has predicted that its funding shortfall by 2017 could be £5 billion. On the back of that assessment have come some serious unfolding plans to reorganise services, shifting care away from acute hospital provision to community services and centralisation of specialist services. Those far-reaching changes have raised the prospect that behind closed doors we could have plans for some of London's hospitals to be downgraded and even closed down. In all the proposals that seem to be being worked up, it is interesting to see that there does not seem to be much mention of the fact that management costs in the NHS have skyrocketed. There does not seem to be much mention of the fact that 15 per cent. of the estates owned by the NHS in London are either unoccupied or underutilised. I know that from personal experience, as the Putney hospital site in my constituency has been derelict for the past decade. The local primary care trust apparently has no ability to bring it into use for our local health care provision.