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Health Services (West London)

Volume 459: debated on Tuesday 1 May 2007

Motion made, and Question proposed, That the sitting be now adjourned.—[Jonathan Shaw.]

May I say what a pleasure it is to serve under your chairmanship this morning, Mr. Cummings?

Few institutions have the need to manage as much change as the national health service. Sometimes it feels like it has spent the past 25 years in a culture of permanent revolution. This debate is a chance to talk about some of the changes under way to health services in west London and the impact that they will have on patients and communities. I wish to limit my remarks to the future of two specialist hospitals that enjoy extraordinary support in the communities that I represent, but whose futures remain uncertain, as the cards get shuffled again in the game of power politics within the health economy of west London—a game that has so far benefited management consultants far more than patients.

Harefield hospital ought to be the jewel in the crown of the NHS. Benefiting from its long association with Sir Magdi Yacoub, Harefield is one of the best known heart hospitals and heart science centres in the world. In fact, I would argue that very few hospitals in the NHS system enjoy the same international reputation as Harefield. The heart science centre is recognised for groundbreaking advances in the regeneration of the heart in last chance cardiac patients and in the generation of human heart tissue. Surgeons in the hospital there continue to pioneer groundbreaking treatments to save lives at minimum disruption and pain to patients. Instead of building on that centre of excellence, however, the NHS has mucked it around. The Minister is aware of the story, because he was good enough to meet all three Hillingdon MPs—my hon. Friend the Member for Uxbridge (Mr. Randall), the hon. Member for Hayes and Harlington (John McDonnell) and me—and Mrs. Brett, the chair of Heart of Harefield, which is well represented here today.

Now is not the time to revisit the horrors of the Paddington health campus fiasco. The Chairman of the Select Committee on Public Accounts put it well, in his characteristically understated way, when he said in January:

“The collapse of the ambitious Paddington Health Campus project after five years was the direct result of appalling planning and forecasting of costs by the NHS Trust partners”.

Of course, this being the NHS, the partners did not pay the price; in fact, the individuals involved all got promotions. The price has been paid by the taxpayer, who will have to pay more for future refurbishments, by patients, who could have had better facilities by now, and by staff, who had to live with such uncertainty for so long.

Thanks in large part to Heart of Harefield and the clear-headed leadership of Bob Bell, the chief executive of the Royal Brompton and Harefield NHS Trust, the emperor was finally revealed as wearing no clothes and the plan collapsed. The board of the Royal Brompton and Harefield knew how it wanted to respond. It wanted greater freedom to run its own affairs, aspired to achieve what the Government say they want all trusts to achieve—foundation trust status—and received tremendous support in the community for that aim.

The Royal Brompton and Harefield had been a three-star specialist trust for two years running, with an outstanding clinical record and a strong financial position, so its application for foundation trust status should have been plain sailing. So everyone was puzzled in August 2006, when the Department of Health did not support the application. Puzzlement turned to anger when the Department had to admit that the cause of not proceeding was the need to respond to vehement, personal objections by the outgoing chief executive of the strategic health authority for north-west London, one of the leaders of the Paddington health scheme and clearly a man with a personal axe to grind. The local community was so incensed that it was prepared to go for a judicial review. However, it was reassured by the Department’s response, which was to make it clear that it supported the trust going into the next round, which it has since done, with the full support of the London strategic health authority.

We now find, however, that another rock has been laid in the road, obstructing progress towards foundation trust status. Monitor has let it be known verbally that it intends to block the application. Indeed, it took the unusual step of asking the Royal Brompton and Harefield to withdraw it, which, quite sensibly, it has refused to do. Why has Monitor taken that position? It has said that it is a result of Government reforms to the allocation of research grants, under the “Best Research for Best Health” strategy. In Monitor’s view, the Royal Brompton and Harefield is assumed to be a loser and will stay a loser—to the tune of approximately £20 million over three years.

Monitor has also taken the strangely dogmatic position that the Royal Brompton and Harefield will not recover that money in a more competitive research market, despite the fact that the trust’s research programmes are all rated as strong by the Department, most recently in January this year. Even the chief executive of the NHS has written to the chief executives of London hospitals—I have a copy of the letter with me—who had written to him expressing concerns about the new process and the plans for adjustments and transition. He wrote back robustly, saying that they should not assume that they would be net losers from the process, and that everything depended on the quality of research and competition in a more transparent market.

Monitor has continued to adopt a doomsday scenario, however. Moreover, it has refused to believe that a trust with a strong financial position operating in cardiology, which I understand to be one of the most lucrative fields in the market, will have the financial wherewithal or nous to adjust its business plan in the unlikely event of failing to win research grants. The absurdity of that position has reached new heights, as the chief executive of the Royal Brompton and Harefield has revealed that he now expects to have around £250,000 of taxpayers’ money to spend on paying consultants to help him draw up a contingency plan that he knows is not needed.

More alarming for the community that I represent is the fact that the chief executive will be forced to freeze development plans at Harefield hospital, where we had been extremely excited about his commitment to investing £20 million in refitting the hospital to make it even more fit for purpose and safeguard its future in the community. As a consequence of Monitor’s position, all those development plans will have to be put on ice. The chief executive, who has performed heroics in raising the morale and sense of permanency in a trust that had to live through five years of uncertainty about its future, now has to go through that management challenge all over again.

That all seems very strange, and must be worrying for Great Ormond Street hospital, another prestigious hospital and similarly emotive institution a little further down the track that is now in a similar situation. Surely it was not the Government’s intention to undermine those great hospitals. What is going on? A clue lies in a comment from Monitor to the Royal Brompton and Harefield. Monitor said that the trust had

“no future as a standalone Trust”.

If reported accurately, that raises concerns that Monitor may be exceeding its remit and taking views on the configuration of assets in London, at a time when it is known that both University College London and Imperial college are locked in a power game to secure a marriage with the Royal Brompton and Harefield.

In that dialogue and courtship, many compelling clinical reasons will be trotted out for such a marriage, and some of the vows may be true. But at the heart of the issue, as everyone acknowledges, is land—the Brompton site, which is valued at up to £1 billion and a source of cash for grand plans; land that the Royal Brompton and Harefield would control if it achieved foundation trust status and that it could use to fund ambitious plans to redevelop and improve services.

The consequence, intended or otherwise, of Monitor’s intransigence will be to condemn the Royal Brompton and Harefield to being stuck in a less ambitious rut and, in effect, to force it into the arms of a suitor. I am sure that the Minister shares my concern that Monitor’s activities and decisions should be entirely divorced from any commercial interest or power play within the NHS, and should be seen to be so. Will he therefore reassure me that the strict remit of Monitor is to assess applications for foundation trust status and to regulate those trusts, and not to make judgments on the future configuration of services? Will he reassure me, either today or in writing, that no person at Monitor has any formal or informal interest in the negotiations on the future of UCL, Imperial or the Royal Brompton and Harefield?

In relation to the flows of research funding, can the Minister say what impact analysis was conducted on the London hospitals affected by the changes? Can he confirm that it is not the Department’s intention to destabilise those institutions? Will he also take this opportunity to echo David Nicholson’s view that there is no reason in theory why trusts with strong research programmes, such as the Royal Brompton and Harefield, should not continue to win research grants under the new system? Can the Minister confirm whether the three-year phasing-out timetable is set in stone? If not, I urge the Department to consider a phasing period of five years. That would certainly help the Royal Brompton and Harefield to meet Monitor’s objections, but this is not just about one hospital or one trust.

I should say that there appears to be no objection to the principle and the objectives of the proposed reforms to research grant. The concerns appear to be about the timing and the thinking through of the consequences of changes that are a systematic challenge to all hospitals involved. It is not clear that the consequences have been thought through carefully enough. I am sure that the intention was not to destabilise trusts such as the Royal Brompton and Harefield and Great Ormond Street, but that seems to be the consequence.

Moving to five years would give those hospitals more time to adjust and adapt. It would also allow more time for high-class research capacity to be built up outside London. As was said to me, we should not underestimate the fact that it took 20 years for trusts and institutions such as the Royal Brompton and Harefield to build up the centres of excellence that they have developed. It would be a shame if financial pressures forced high-quality research capacity to be cut in London before appropriate capacity had been built up outside. People would not see the sense in that. A move from three to five years would not dilute the principles or direction of travel of reform, just the pace of the journey. I hope that the Minister will give it serious consideration and give us a meaningful answer in his response, either in this debate or in a follow-up letter.

Let me close with some brief comments on another specialist hospital suffering similar uncertainties. Mount Vernon is a wonderful cancer centre that is clearly the most convenient location for a universe of about 2 million potential patients in the west London cancer network. The Minister will be aware that the very controversial decision was taken to move it to a shiny new hospital in Hatfield in 2013. The community was fobbed off with the promise of some walk-in radiotherapy capacity being kept on the site. However, that option faded away as it became clear that it was a second-class service with some risks attached to it. The local community then faced the choice of going to Hammersmith or Hatfield for regular radiotherapy, involving a journey of at least 45 minutes in a car, assuming moderate traffic. That is not a distance or an imposition on a patient that I would care to choose for my family and I am sure that the Minister would not, either. It was unacceptable to the local community.

Now we know that the Hatfield project has collapsed—it was considered unaffordable—we now face a vacuum of decision making and uncertainty about the future of a Mount Vernon cancer centre. The local community’s view is clear. They ask, “Why move it? Why move it if you have just invested £23 million of taxpayers’ money in new radiotherapy bunkers? Why move it when you clearly have superb people on-site, offering brilliant treatment? Why move it if you have Hillingdon hospital, as the landlord of the site, now committed to the site, committed to turning it into a health village and providing there the adjacent specialisms that are required to complement a modern cancer centre? Why move it if you have such strong local support for the centre and the extraordinary charities that feed off it and support it? What could be more affordable than building on the excellence on the site? What could be more affordable than keeping cancer services at Mount Vernon?”

We keep being told that a heat map exists in the Department of Health. Personally, I do not believe that, but if it does exist, I urge the Minister to go back and put a large red sticker over Mount Vernon cancer centre, because the people are on the move and petitions are being signed. We are determined to send the strongest possible signal into the system that we want to keep cancer services at Mount Vernon.

I have spoken about two hospitals, but the same message. They are excellent hospitals. The message to the Department is: please support them in the same way the local communities do. Give them some stability—that is what they are crying out for—not in the interests of complacency or a quiet life, but in the name of progress, ambition and a desire to build on acknowledged excellence.

There is a slight “Groundhog Day” feel to this debate. I note from Hansard that, on 8 February 2006, the hon. Member for Ruislip-Northwood (Mr. Hurd) initiated a similar debate, in which I spoke, as did the hon. Member for Uxbridge (Mr. Randall). Indeed, I think that all the suspects are here again, save for my hon. Friend the Member for Hayes and Harlington (John McDonnell), who perhaps has other business detaining him at the moment. I am sure that the hon. Member for Richmond Park (Susan Kramer) will fill in the gap for her party in a similar fashion.

I hope that the fact that 15 months later we are in the same Chamber for the same debate does not mean that things have not moved on. Despite the comments that we have just heard, things have moved on in some respects for the better. It was reported in that debate, wrongly, that one of my local hospital trusts—Hammersmith—had a very considerable deficit, although it is true that it had a deficit. It now runs on a year-to-year basis, with a balanced budget and, occasionally, a surplus. More to do with NHS finance regulations than the efficiency of that organisation, there is still an underlying deficit of some £11 million, which is to be eliminated over the next three years. That is an improved situation.

There were rumours, which had persisted even then for a year or more, that services would be closed at Charing Cross hospital, which many of my constituents use as their regular district general hospital. Those rumours were always unfounded, but they persist, although they have become more muted, as the evidence does not support them. I note that there is a statement on the issue even today:

“There are currently no plans to close any A&E department, Charing Cross Hospital or any other site. In fact significant investment continues to be made at Charing Cross, with new mental health services; a new 72-hour day-and-stay surgery unit”—

costing £3.5m—

“four new linear accelerators…£6.5m…new research facilities; and a Maggie’s Cancer support centre due to open…later in 2007, £2.5m.”

The evidence of one’s eyes, as one drives down the Fulham Palace road, is that Charing Cross is a hospital that is thriving and into which more and more investment is going.

There is perhaps slightly less good news on the progress of the White City collaborative care centre. That is an innovative LIFT—local improvement finance trust—scheme, a £50 million project, organised between the previous Labour council and the local primary care trust. I said when I spoke in the debate 15 months ago that I had great hopes for that project pushing on quickly. So far, not a brick has been laid; indeed, planning consent has not been granted. That is a great concern for me, as the centre will lie—I am still convinced that it will happen—in the White City ward, one of the most deprived wards in London or, indeed, the country. That flagship project, a building designed by the Richard Rogers Partnership, is much needed to bring not only health care but other facilities to the area.

The business case has now been approved, and I am given some assurance that we will see bulldozers on-site by the end of the year, but it is not a satisfactory situation and a good deal of the blame must lie at the door of the new Conservative-controlled council in Hammersmith and Fulham. One appreciates that, when there is a change of power, matters can be delayed, but the persistent renegotiation of the development for no good reason—in fact, for only bad reasons: to reduce the investment by the local authority in social care and to diminish the proportion of social housing on the site—has not only caused delay, but will mean that the development, when it does go ahead, will not be as good as originally planned.

I mention those matters because they deserve to be updated and to be put on the record, but the general pattern in health care, certainly in my part of west London, is of an improving situation, driven by the record investment that is going into the health service there. I could say a great deal more about each of these issues, but I want to speak only briefly today and to concentrate on one particular issue. It is appropriate that I do so today, because today marks the launch of what is an innovative and exciting project not only for my constituency and, indeed, the whole of west London, but for the country. I hope that my hon. Friend the Minister will confirm that when he responds to the debate, because consultation documents on the proposal for an AHSC are sitting in envelopes waiting to go out to all and sundry across west London as we speak.

The consultation period will run for three months, and I am confident, given the soundings that I have taken in the area over the past year, that the response will be resoundingly positive. The basic proposal for the AHSC will go to the Secretary of State in August and, if approved, will hopefully lead to the merger in October of three already excellent institutions—St. Mary’s NHS Trust, the Hammersmith Hospitals NHS Trust and Imperial college. That will result, in the first instance, in the first AHSC and, in due course, in the first academic NHS trust. As I said, that is an exciting prospect, and it comes, as I think everyone will acknowledge, after some uncertainty about the organisation of health care in west London.

Other projects are under way to ensure that the standard and configuration of health services are improved, but I hope that the AHSC will take us to a new level of excellence. That is not to say, however, that the existing institutions are not in good shape. Indeed, the “Good Hospital Guide” for 2006 ranked Hammersmith Hospitals NHS Trust and St. Mary’s NHS Trust as the second and third best in the country respectively for clinical excellence, quality and safety. It goes without saying that Imperial college is one of the largest medical institutions in Europe, and its world-class reputation was recently confirmed in The Times Higher Educational Supplement, which placed the university fourth in the world for biomedicine and ninth overall. Perhaps that is a clue that we already have world-class excellence in research, particularly at Imperial, which is already based at the Hammersmith and St. Mary’s sites. However, the new configuration and single management under an academic trust are designed to set a new standard for health care in the UK.

I hope that the AHSC goes ahead. I am conscious that it would do so against the background of the review by the eight PCTs of health care in north-west London and Professor Ara Darzi’s review of health care in London—his “The Case for Change” document, which was published last month, and his framework for action, which is due at the end of this month. All those matters are taken into consideration in the proposal that is going forward today. I have read the consultation document, and it is very good; it deals with all the bureaucratic matters and shows how the AHSC will not only provide improved research and health care for my constituents, but use the NHS network to give people across west London and beyond access to higher quality, world-class health care.

We will all, I am sure, be greatly embroiled in discussions about the process and about who will take the AHSC forward. I recently met Lord Tugendhat and Steve Smith of Imperial, who are taking the lead on the issue at present. I am extremely impressed by their proposals and, indeed, by Professor Darzi’s proposals for health care across London as a whole—this is a new beginning for west London and for London as a whole. In both cases, I am most impressed that those involved have cut through the bureaucracy that bedevils the health service—whichever party is in government—to concentrate on the outcomes for patients. I sometimes wish that health professionals would stop referring to my constituents as guinea pigs and stop rubbing their hands at the prospect of gaining access to more of them, but I know that they are well intentioned at heart.

Progress has already been made. Shortly after our previous debate last year, I visited the new renal centre at Hammersmith with the all-party kidney group, and that institution is fantastic, as are the other buildings that are going up on the Hammersmith and Charing Cross sites and, no doubt, on the St. Mary’s site. Impressive improvements have been made in care as a result simply of changes that have been made under the existing management and co-operation arrangements, but the institution of the AHSC is a once-in-a-generation opportunity to make a sea change and to improve the health care of my constituents and those across west London.

I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) on obtaining the debate. As the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) implied, this might well become an annual event, which would be a good thing because nothing matters more to our constituents than the provision of good health care.

I echo my hon. Friend’s comments about the Mount Vernon site. Although it is not in my constituency, many of my constituents use the facilities there and are concerned about any potential move to take cancer services away from the site. My hon. Friend told us about the proposal to move to a fictitious hospital in Hatfield, although the site had not even been identified and there was no planning permission. Although such things happen, we must move on. It is self-evident to anybody who knows someone who has suffered from cancer or who has suffered from it themselves that the last thing a cancer patient needs to do is to make a long journey in terms either of mileage or, in the case of west London, travel time. Public transport is available to take people into central London, although it can be unreliable, as we all know, but the last thing that somebody who is having chemotherapy or other treatment wants to do is sit on a crowded train. The joy of Mount Vernon is that although it is in west London—I would say it is in Middlesex—it looks over some wonderful countryside and has excellent facilities for patients and for the family and friends who take them there. We should not lose what we have there.

My hon. Friend did not mention Hillingdon PCT, but it is involved in a rather sorry tale of deficits. The three Members of Parliament for the area have tried hard to help successive chief executives of the PCT. I have lost count of how many we have had—I think that we have had more than one a year so far under the revolving-door policy that we seem to have at the PCT. Indeed, we have just lost Mr. Sumara, who has gone off to be the chief executive of the London strategic health authority, NHS London. However, I get the impression that although chief executives come and go, the problem of the deficit remains to some extent. I still have not had the answer that I would like on that issue and I do not know exactly why such a large deficit has arisen. I do not want to indulge in party politicking on the issue because it is far too important, but there is a serious problem and I doubt that the ongoing debt—that is what it is—will benefit my constituents and their health care.

My hon. Friend and I have raised the issue of orthodontics, homeopathy and other services that seem to be affected. We are always assured that they are not affected, but I am afraid that I am becoming increasingly cynical as I get older, and I am not entirely sure that I quite believe what I am told these days. There was a time when I was fresh faced, young and slim that I might have believed it, but as you see today, Mr. Cummings, things have changed somewhat.

I am afraid it will come to the Minister too; I was young and full of hope, but I must tell him that life deals a bitter blow. His will come shortly because fate has given me a lot of time to speak in this debate and there are matters that I want to raise with him.

Hillingdon hospital, which is in my constituency and is close to where I live, still manages to provide a very good service, but, as I think is recognised, the building is not quite what it should be. I remember going there as an 11-year-old, having broken my wrist playing football; even today, although there has been a little refurbishment of accident and emergency, the X-ray department is identical to what was there 40 years ago, so it is probably recognised that change is needed. We have been talking about a rebuild, and there is also talk of the private finance initiative, among other things.

It is a slight shame that the ideal location for a new Hillingdon hospital should be the RAF site. There is a very large RAF station in Uxbridge that is being sold by the Ministry of Defence, but it seems that the time scale between the departure from the site of the Ministry of Defence and the potential financing of a new build at Hillingdon hospital makes the idea impossible. It has been explored, but I have promised those involved in the Hillingdon Hospital NHS Trust and the primary care trust that I shall not keep going on about it, for fear that we shall lose the rebuilding of Hillingdon hospital, which is so sorely needed. However, it seems incredible that two Government Departments cannot get their act together sufficiently to achieve something that would provide the whole of west London with the services of a remarkable facility in the future.

There is one matter concerning Hillingdon hospital for which, to be charitable, I probably cannot blame the Minister. It is the continuing problem going back many years of an incinerator on the site. Unfortunately, it was given planning permission many years ago, when there was Crown immunity—I think that the ruling about that has now changed. Subsequently, Hillingdon hospital sold some land and made an application for residential development. The local authority turned it down, but its decision was overturned on appeal. Anyone familiar with the area would have known that the new houses would be situated right up against the incinerator, although from talking to the residents it seems to me that they were given some sort of assurance by the people selling them the properties that there was nothing to worry about and it would soon go away. Sadly, that does not seem to be true.

I am greatly concerned about the matter. I have heard recently from residents about police escorting the waste lorries as they come in. One begins to wonder exactly what is being incinerated there. We have had meetings and I am assured that everything perfectly okay and there is nothing to worry about. None the less, there is a great deal of noise and a certain degree of pollution, and I am not convinced that what people in that area are breathing in is beneficial to their health. It is ironic that such an operation is on the hospital grounds and, although not run by the hospital—it has been put out to a company—is an integral part of it. We should think about that, because when we want public support for hospitals and the health economy it is important to deal with both sides of an issue.

My hon. Friend the Member for Ruislip-Northwood mentioned Harefield hospital, which, although it is not now in my constituency, was historically in the Uxbridge constituency. It does not only serve our constituents; it is world-renowned. I should say that Harefield has a healthy future. It has been refurbished and improved and has lately benefited from a most up-to-date 64-slice scanner, which is a brilliant diagnostic aid. It cost about £700,000, which interestingly was all raised by the public. After the scandal—that is one of the mildest words that I can use—of the Paddington health campus, it is reassuring that everyone is happy to invest in the Royal Brompton and Harefield NHS Trust.

I noticed yesterday on the Hillingdon Times website that Harefield hospital had just achieved another first. Mr. Brian Everard of Stanmore was

“spared the pain and trauma of open heart surgery—to replace his heart valves—and was instead operated on through a small incision in his chest.”

Harefield hospital, as it says in the article,

“has long been at the cutting edge of heart and lung treatments and earlier this month it was announced that scientists had managed to grow heart valves from stem cells, a world first.”

It is also making incredible advances in the treatment of cystic fibrosis. I do not think that I have to make a case for what is happening at the hospital.

My hon. Friend mentioned shenanigans about trust status and said that it was not time to revisit the Paddington health campus scandal. I disagree—but only because no lessons seem to have been learned. When that project finally came to its end, all the supporters of Harefield hospital greeted the news with delight, but there was great anger about the cost to the public purse of that over-ambitious and fatally flawed project. My hon. Friend rightly mentioned a voluntary organisation that has been mentioned before in such debates: Heart of Harefield. Its members are ordinary men and women led by a very energetic person, Mrs. Jean Brett, who has shown what determination, knowledge and great skill can do. I am not sure that the scandal would have been exposed without Heart of Harefield and Mrs. Brett. We might even have reached the point of having a white elephant that would have cost the public purse millions for years to come.

Unfortunately, the public anger remains. My hon. Friend referred to a meeting about this some time ago with the Minister, who was very generous with his time. One reason for the anger is that the chief executives who were involved remain unaccountable and the Royal Brompton and Harefield NHS trust is perceived as having been unjustly denied foundation trust status. I hope that hon. Members know that I do not engage lightly in polemics—I am a great believer in a consensual style of debate in this Chamber. However, much of what has happened seems to me to be down to the actions of one of those NHS chief executives, Gareth Goodier. I believe that he has been vindictive.

The chief executive of the North West London strategic health authority was humiliated at being proved wrong on the Paddington issue. The strongest contributing factor was the withdrawal from the project of the Royal Brompton and Harefield NHS Trust, under the leadership of its new chief executive, Mr. Bob Bell, for whom I have the highest regard. Shortly after his appointment, Mr. Bell, who had experience of planning and completing a new hospital, realised that the Paddington project lacked sufficient land to make it viable. There is an obvious contrast with the inability of his supposedly senior colleague to grasp that point over a lengthy period of time.

I do not expect this place to be like a business, because they are different worlds, but I remember discussing the Paddington project in this Chamber in May 2004, when I set out, in what I thought was a calm and collected way, why the business arguments for continuing the Paddington health campus were flawed. The Minister who responded to that debate, who is now a little more senior—the Secretary of State for Work and Pensions—turned on me with a degree of unkindness and accused me of opportunism. He also accused the people who had helped and advised me and given me information of being vindictive and simply wanting to stop something that was going to be the most marvellous thing in the world. I protested that that was not the case and that I was using the little knowledge that I had acquired from 20 years in business to show that the project was a waste of public money, but I was not able to get a word in. I remember trying to make an intervention at the end but not being allowed to make it. However, but that is how things work in this place—let us be grown up about it.

Since that debate, the people who were responsible—NHS executives and Government Ministers—have never acknowledged that a mistake was made. No one has said, “Actually, you were right, and so were the people with you. A great deal of money has been saved for this country and the taxpayer, and we regret the waste beforehand.”

My hon. Friend makes an important point about learning lessons from the collapse of the Paddington health campus scheme. I recall the debate that he secured back in May 2004, in which I was the Conservative Front-Bench spokesman. The responding Minister in that debate was indeed the present Secretary of State for Work and Pensions, who subsequently repeatedly refused ever to give direct evidence to the inquiries of the National Audit Office and the Select Committee on Public Accounts into why the Paddington health scheme collapsed. That was one of the more disgraceful episodes of Labour Ministers’ stewardship of the Department of Health.

I agree with my hon. Friend. Indeed, I was going to make that point. It was not only Ministers who acted in that way: NHS chief executives did not give evidence to the inquiries by the NHS and the Public Accounts Committee. If there had been a genuine desire to ensure that the same thing did not happen again, they would have given evidence. I should like to know what reasons they gave for not giving evidence. Were they trying to hide something? I shall give them the benefit of the doubt, but there is a strange smell about people refusing to give evidence to inquiries that are intended to sort out problems and ensure that they do not recur.

The North West London SHA chief executive, Mr. Goodier, was one of the strongest supporters of the Paddington project. I remember discussing it with him. His support continued even after he was sent a letter by the Department of Health in January 2006 advising him in the strongest possible terms to write back disproving the points made in the letter. Again, nothing was forthcoming.

The Royal Brompton and Harefield NHS Trust has benefited greatly in the past six months from its association with Sir Magdi Yacoub, of whom the whole House and a great many of the public have heard. The Sir Magdi Yacoub heart science centre, which is on the Harefield site, has made groundbreaking, successful advances in the regeneration of the heart in last-chance cardiac patients using a combination of drug treatment and a ventricular-assist device. We have already heard something about what is being done at that centre. Its breakthrough in April in generating human heart tissue opened up a field that is so large in its scope to benefit patients that it is impossible for any of us to quantify.

The Heart of Harefield campaign has been mentioned a lot in this and previous debates. Before Jean Brett agreed to lead that campaign back in 2000, she had to be convinced that maintaining the bed-and-bench situation at Harefield hospital, in which the patient and research are in proximity, was of such importance that destroying that affinity would result in a loss of benefit to patients both nationally and internationally. Recent events have proved her decision to have been absolutely correct.

The trust is the UK’s largest cardio-respiratory centre. Due to its expertise and eminence it has been the largest recipient of NHS research and development funds, but recent Government changes in the allocation of such funds have caused problems. Monitor has suggested that all research funding might dry up after 2009 and has claimed that the trust’s strong financial position could therefore be jeopardised. That is a rather worrying thing for Monitor to say. The public, and probably the trust’s board, have had a surfeit of NHS organisations throwing spanners in the works while pontificating on matters that are beyond their remit. I am afraid that I hear echoes of the whole Paddington fiasco coming back to haunt us.

It is highly unlikely that the Royal Brompton and Harefield Trust or other specialist trusts will be so radically disadvantaged in respect of research moneys by the Government that all specialist trusts will therefore cease to be financially viable. It is rather more likely that the possible side effects of introducing a new research and development system were not thought through, but it is not acceptable for Monitor to take a disaster scenario approach when assessing the trust for foundation status.

In the most recent round of applications, 17 trusts applied for foundation status, of which only three were successful. Given that one of the trusts was the Royal Brompton and Harefield Trust, which is regarded by the chief executive of the SHA for London as one of the most successful, there are doubts about the efficiency of the system. The press releases at the end of March suggested that the decision had been taken some time before. The application was supposed to be under consideration at that time and the decision was to be made by 26 April, but it seemed to be a foregone conclusion. I want some openness about that decision, and Members of Parliament, members of the public and members of the trust need answers about it.

Specialist trusts should not be unilaterally disadvantaged by Monitor as a result of Government policy on cuts in R and D moneys, particularly given that decisions remain in a state of flux. There is no objection to changing the system nationally so that R and D moneys are shared more equitably throughout the country and are monitored more strictly so that they do not leak into supporting deficits, but it is not acceptable for any organisation to use the change in Government policy as an axe to disadvantage specialist trusts. The improvement of patient care and the reputation of this country both nationally and internationally depend on the fruits of specialist trusts’ research.

I raise this matter because I am genuinely angry about what has happened, and not only because one of the best NHS trusts in the country—a real jewel of the NHS—has been affected. I am angry about the lack of openness, the twists and turns and the political manoeuvring. Things have gone on that would make a senior Whip blush—the sort of strange things that go on behind closed doors about which I can only dream. At least, that is how things seem to me, a young innocent out here. All that is bad for the NHS.

If we want to improve the NHS and its systems, as I believe everyone does, we cannot have the current system of NHS executives running roughshod over common sense and the evidence and then indulging in a vindictive war against those who have dared to cross them. I dare say that I shall have to watch out if I go to hospital in the next few months, certainly in some areas, but I lay down the marker now: I know where they are, I know where they live and they know where I live.

I am conscious of the fact that my constituency is in south-west London, so I shall attempt to impose a self-restraining ordinance not to drift into that territory, because south-west London deserves a health debate of its own. I shall try to focus instead on west London issues, although as the two areas sit side by side and the boundaries are terribly unclear to most constituents anyway, many of the experiences and issues are inevitably shared.

This has been an incredibly high-quality debate, involving hon. Members who are able to talk in great detail about the particular circumstances of local trusts and hospitals. I shall therefore try to take a small step back, because lying behind our discussion is an absence of any sense of sustainable direction within the national health service. That has been the character of the past and we are all afraid that the situation may not be resolved in the future.

Many of us have been in conversation with a strategic health authority—I imagine that that is the case for all hon. Members present. I suspect that they have been excited by the basic work in Sir Ara Darzi’s “Healthcare for London: A Framework for Action”. There is a sense that perhaps there is now the possibility that someone is coherently examining the future situation across London. We are conscious of the fact that the work is being undertaken in the context of a national health service that does not meet Londoners’ or west Londoners’ expectations. In addition, productivity levels in the NHS are lower in London than elsewhere in the country—for example, doctors in its acute hospitals see 24 per cent. fewer patients than those elsewhere. We are also conscious of the fact that London is perhaps in the almost unique situation of having overcapacity in many areas and the wrong capacity in many areas. We are concerned about how all this will be resolved.

May I say, because this is shared by people of west London and south-west London, that as we examined “Healthcare for London” and the core consultation document, we saw a worrying red flag? The consultation document talked constantly about the needs of north and east London, as if those areas were in competition with west and south London. On the distribution of GPs, the document said:

“There are overall fewer GPs per head of weighted population in the east and north of London (where health need is greatest), compared to the south and west”.

I would not dispute the fact that that may be true, although the situation in areas such as Ealing probably does not look as good as elsewhere in west and south London. We are desperate for a strategy that will build all of London, not one that will siphon resources out of the west and south, where need is great, even though there might be a greater need in the north and east.

We look at this issue in the context of Mayor Livingstone’s focus, which seems constant, on pouring resources into north and east London—it is partly driven by Olympic fever, but it is also a fundamental view—while the population insists on coming to the west and south and building their homes there, no matter what the authorities would like to do to direct them elsewhere. The need of, and the resources that have to be put into, health services in west London should not be discounted by an institutional wish for a population shift. I suspect that such a shift will not occur—there is certainly no evidence of it occurring.

The Government’s response to west London’s health issues has been one of chaos. Others have talked in great detail about the Paddington health campus scheme, and I echo the comments made, although I shall not reiterate them. One would have thought that after putting hospitals such as the Royal Brompton and the Harefield into a period of such uncertainty, stress and concern, the response after the Paddington scheme fell through would have been carefully to provide genuine certainty to overcome the damage that had been done by what most people now regard as an idiotic scheme. That has not happened. We see the same thing repeated in the case of the Mount Vernon hospital cancer specialty unit. Proposals to take everything to Hatfield were abandoned and nobody knows where the programmes will be taken. That does not help the health service at all.

That kind of chaos is being increased and intensified yet again by a policy that I wish the Minister would address, because I cannot get to the bottom of it. As I understand it, there is a requirement for about 15 per cent. of health services in the London area to be provided by the private sector, with the result that the strategic health authorities have been building up independent sector treatment centres—in other words, private centres—at a time when there is overcapacity in the system and when we need such additional facilities like we need a hole in the head. We need improved, regenerated and modern facilities. The notion that we need increased facilities for increased competition in London misunderstands the whole London health environment. That is aggravated by the fact that none of us has been able to see the underlying contracts that go with these independent sector treatment centres. We are suspicious that they contain language that essentially gives guarantees of minimum numbers of patients, which translate into financial security for those private centres, while the NHS facilities face constant uncertainty and risk.

I shall give a tiny example, although it is not particularly a south-west London example. I have talked to representatives of the breast screening services at my local hospital—those services being provided by a private group within the context of an NHS hospital—and they were naively delighted to explain to me how the patient guarantee from the NHS takes away all their financial risk. That allows them to use all their spare time to seek private patients for breast screening. They said, “It is a wonderful system because we have no financial risk at all. That is carried by the NHS, so all we have to do is build our profit opportunities on the back of it. The system works extremely well. We are a wonderful and very profitable company.” I do not think that they anticipated that my reaction might be that whoever negotiated that contract for the NHS services was not adequate or up to the job. I understood that transferring the risk from the private sector to the public sector was not supposed to be the goal.

I understand that those independent sector treatment centres will not provide training for junior doctors. This week and last week, we saw the devastating impact of all the uncertainty surrounding junior doctors, yet the programme in London seems to aggravating the situation, rather than diminishing it. That brings me to the financial crisis in the NHS, whether in west London or in all of London.

The NHS deficit in London in 2005-06 was £174 million, which is proudly said to have reduced to £55 million in 2006-07. The sum is huge, and it has largely been reduced by top-slicing from the financially successful trusts, to support the ones with deficits. Much of the price has been paid by cutting NHS jobs—for example, the 900 jobs in London, plenty of which are on the front line, and we are all aware of them. People tell me that such cuts do not impact on service, but I suspect that some hon. Members present would be able to give many examples of where service has been severely damaged.

One issue that is often not flagged up is that primary care trusts, whether in west London or elsewhere, have been reluctant to move outside National Institute for Health and Clinical Excellence boundaries for the prescription of cutting-edge medication. One example of that involves the drug Temodal, which is used to treat brain cancer. As we know, NICE can be exceedingly slow in providing approvals, so we end up with a situation where we know that approval of a drug will be given, but the paperwork and the rest of the pieces take a further 12 months to roll through and be put in place. In the past, PCTs have been willing to prescribe in such circumstances, but now they are not, given the financial pressure that they face. I suspect that lives have been lost—lives have certainly been shortened—as a consequence.

Cost-shunting between PCTs and local authorities has become acute—west London suffers from that as much as anywhere else—and it is resulting in diminution of community health services in west London. One reason for the shortage of training places for junior doctors this year is that PCTs have been clawing back from their original plans and posts have effectively disappeared.

Mental health services have taken much of the brunt of such cuts, and that is as true in west London as it is elsewhere. Hon. Members will be aware of the report by the Sainsbury Centre for Mental Health in July 2006 which said that nearly two thirds of mental health trusts have been asked to cut their budgets to cover NHS overspend in other areas.

Ironically, my area is officially south-west London, such are the weird boundaries for different aspects of the national health service, and Cassel hospital in my constituency falls into the west London family of mental health services, so I can see directly in my constituency how cuts in mental services have fallen on the most vulnerable. Superb services for adolescents have been merged with adult services with the loss of 10 beds.

I suspect that part of the reason why the Royal Brompton and Harefield NHS Trust is driving so hard to obtain foundation status is that it feels that, with overcapacity, only those who can get out early and obtain foundation status early will be able to survive, and that the inevitable rationalisation, particularly from introducing more competition, will not mean that those that remain are not necessarily not the best, but that others got out first. That seems to be a nutty way of trying to resolve the issue and to obtain the best health service structure in west London.

Although there is community involvement in seeking foundation status, that creates a false feeling, because there is no democratic control of the strategic health authority. People in west London have no mechanism for making their voices heard by the Department of Health. The chaos that has arisen because local voices are not in charge of decision making will not be resolved by giving foundation status to one hospital. Real focus on genuinely devolving accountability for health services to local people is needed, and that has not happened.

London is one of the great capitals of the world, if not the greatest. It should have a first-class health service in every part of its community and, given its history, it should have cutting-edge research. That is not the picture today, and that is a failure. The Minister must give us some coherent answers.

I congratulate my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd) not only on securing this debate, but on his dogged pursuit of his constituents’ interests in relation to health services, as evidenced by this debate and his debate in February last year. He will not give up on the matter; he will ensure that the services on which they rely are supported and maintained. That is all credit to him, and to my hon. Friend the Member for Uxbridge (Mr. Randall), who did likewise during his debate back in 2004.

My hon. Friend the Member for Ruislip-Northwood concentrated on the Royal Brompton and Harefield, and Mount Vernon hospitals, and I shall follow him. On the Royal Brompton and Harefield NHS Trust, I share my hon. Friends’ anger at what happened in relation to Paddington health campus, and the delays and £14 million of directly associated costs. Significant additional opportunity costs were associated with the failure of that scheme.

The hon. Member for Richmond Park (Susan Kramer) was absolutely right about what her constituents had a right to expect after the collapse of that scheme. The trust rightly called time on a project that was never, as the National Audit Office demonstrated, properly supported and organised. A simple question that must be asked in the national health service is “Who is in charge?” No one was ever in charge of the Paddington health campus scheme. The trust called time on it and had a right thereafter to expect to be able to manage its own affairs and to determine its own future. That is the point that my hon. Friend the Member for Ruislip-Northwood made. The trust has applied for foundation trust status precisely for that purpose. It wants greater opportunity and freedom to determine its own future. The London strategic health authority put the trust forward for foundation status, but Monitor has said no for the time being, principally because of the uncertainty attaching to the trust’s future income projections derived from research funding.

I confess that the NHS research and development programme and the reorientation to a number of biomedical centres makes me happy for constituency reasons, because Addenbrookes hospital in my constituency has benefited. There are winners and losers—[Interruption.] My hon. Friend the Member for Uxbridge reminds me from a sedentary position that the chief executive of Addenbrookes hospital is Gareth Goodier, former chief executive of the North West London strategic health authority and previously of the Brompton and Harefield NHS Trust. The national health service inhabits a small world. Ministers often remind us that the NHS employs 1.3 million, but it is funny how the same people keep turning up.

It is obvious, as my hon. Friends and the trust acknowledge, that there has been cross-subsidisation from money intended for research and development into service support. The plea of my hon. Friend the Member for Ruislip-Northwood is that, if there are to be substantial changes of the sort proposed under the R and D programme, the financial consequences must be subject to a reasonable transition. There must also be significant opportunities to enable those who are losers for the time being, but have high quality research projects, to win other research projects, even if they have not secured a position as a centre of excellence or biomedical centre for the time being.

At the same time, if I understand the way in which cardiac services are moving and particularly the sort of work carried out by the Royal Brompton and Harefield hospitals—it bears comparison with that at Papworth hospital in my constituency as a cardiothoracic centre—they need rapid adjustment in the payment-by-results and tariff system. There are too many instances of hospitals such as the Royal Brompton and Harefield, which have a relatively complex case mix and are likely to be tertiary referral centres, dealing with patients for whom the tariff is not well designed. The Minister will understand that the Government’s response to the turbulence caused by the introduction of the tariff has led Ministers to hold back in the latest payment-by-results consultation document. We are moving to a timetable that is a year slower than was intended.

In reality, the proper response to that turbulence is to make faster progress and to move the next iteration of the tariff. If one does not arrive at a point where there are recognised exceptions to the tariff and recognised outliers and where the cost is not better disaggregated to individual treatments—often the complex treatments provided by tertiary centres—often hospitals of a more specialist character lose out as a consequence of the roll-out of the tariff across the NHS. I am sure that the Royal Brompton and Harefield NHS Trust needs that to happen.

I am sure that it should not be Monitor’s job to seek to engage in reconfiguration as part of its authorisation process. That should not happen. It is Monitor’s job to encourage as many hospitals as possible to secure the financial status that allows them to become more independent. Configuration is much more a matter of the relative choices of commissioners. I am sure that the Royal Brompton and Harefield NHS Trust would not complain if, in the long term, it had to begin a reconfiguration of its services because of a change in demand for its services. Anyone working in cardiac services at the moment knows that they have shifted from cardiac surgery to cardiology and intervention in a way that is redesigning services. The trust knows that it must do that, but it is doing so in response to demand and changes in technology, not as a result of a top-down process.

I must confess that I remain sceptical about the benefit of the strategic health authority—through Sir Ara Darzi—engaging in trying to determine the future configuration of services before GPs and local commissioners have had the opportunity to determine where they want services to be. I suspect that access and specialist centres will be lost, which would not happen if decisions were left to local commissioners.

The hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) made a helpful speech. I do not necessarily share his immediate optimism about Sir Ara Darzi, but I share his optimism about the coming together of Imperial college and St. Mary’s, Hammersmith and Charing Cross hospitals. In the health service of the future that we all want to see, in which patients increasingly make choices and GPs and local commissioners make choices, hospitals will begin to make their way in the NHS on the basis of reputation, results and outcomes for patients.

An academic centre with the foundation status that Imperial and the two trusts—St. Mary’s NHS Trust and Hammersmith Hospitals NHS Trust—propose could be precisely the kind of major centre that attracts demand from within the NHS, makes its way in the NHS and becomes a world-class centre. We need to establish such world-class centres in this country. Cambridge is aiming for one, and west London can achieve one through such a merger.

Like the hon. Gentleman, I met Professor Steve Smith and Christopher Tugendhat, and I very much share the hon. Gentleman’s enthusiasm for their vision. However, I caution against their allowing it to become wrapped up in the strategic health authority reconfiguration proposals. Their vision stands on its own merits; it is not designed to achieve a certain reconfiguration effect throughout London. The two must be kept entirely separate.

My hon. Friends the Members for Ruislip-Northwood and for Uxbridge made a perfectly straightforward, rational and passionate case for Mount Vernon hospital to be allowed to get on with its job in a place and in circumstances that the local population, GPs and commissioners support.

We have picked on one London primary care trust, Hillingdon, but it is in serious trouble. It had an accumulated deficit of about £59 million at the end of the financial year just gone, and it clearly requires strong change. How should change be achieved? The Minister might like to tell us whether there is any prospect of the PCT taking advantage of the framework for external commissioner support, which the Department set up through its tendering process. The outsourcing of commissioning is one option. It may have some advantages, but even more importantly, responsibility must be transferred rapidly into the hands of GPs—the primary care commissioners.

Primary care trusts, of which Hillingdon is one, have demonstrated that there are serious dangers if they fail to do their job well. If we disaggregate budgets and ensure that the individual local commissioners—GPs—have greater control over them, we will bring together clinical decisions and budgetary responsibilities. The problem of Hillingdon PCT’s deficit must be tackled. It is not fair to try to transfer the deficit into the hands of commissioners under practice-based commissioning, although that is not the Department’s intention. One cannot expect commissioners to discharge their responsibilities on the basis of such a large deficit.

The Government must contemplate the transition that my hon. Friend the Member for Ruislip-Northwood discussed, involving changes throughout the system. There may be three financial years of transition ahead—not only this year, but the two beyond—for PCTs in the worst circumstances. Hillingdon may be in that position, and it would be helpful to know whether the Minister has received a request from Hillingdon for a plan that spans such a period.

I endorse what my hon. Friend said on behalf of the hospitals in his constituency. It is important that we address the issues in practical terms now. He has done so, and I very much endorse what he has said.

I, too, pay tribute to the hon. Member for Ruislip-Northwood (Mr. Hurd) for securing the debate and for the way in which he made his remarks. I have no doubt about his personal interest and commitment to ensuring that his constituents receive the highest quality health care. I include the hon. Member for Uxbridge (Mr. Randall) in that tribute, as well.

I am pleased that my hon. Friend the Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) joined us in today’s debate. It is the second time in recent history that we have debated the matter, but health care in west London arouses huge interest, perhaps because west London contains some of the most pre-eminent names, both of individuals and of institutions, in health care in the world. It is normal and natural that the subject always arouses huge interest. On a personal level, my family recently benefited hugely from the services of the Royal Marsden hospital, which is a fantastic institution. It is truly humbling to see the staff’s commitment to their jobs. All of us want to strengthen, develop and build upon such excellence in health care; there is no political difference on that point.

In many ways, our debate has touched on all those matters. Sometimes, the debate focuses on exactly how to make such changes, and although the hon. Member for Uxbridge used the word “vindictive”, as far as I can see, everybody is trying their best when they make judgments. NHS management are sometimes unfairly caricatured, and although we may not always agree about the right judgment, the vast majority of people are rowing in the same direction.

The hon. Member for Ruislip-Northwood began by saying that in west London, there had been a period of almost permanent change. In that sense, I suppose that the title of Sir Ara Darzi’s first publication, “The Case for Change: Healthcare for London”, depresses the hon. Gentleman. However, we will constantly return to such issues because there will always be a need to review and to change, particularly when we are discussing some of the leading health services in the world.

The hon. Member for Uxbridge was absolutely right to raise the profile and our awareness of the fantastic developments at Harefield hospital. Because the health economy is bringing some of the most advanced changes to us very quickly, there will need to be constant consideration of whether services are up to date and of sufficient quality.

Sir Ara Darzi’s document includes the phrase:

“Local urgent care is not good enough.”

That is a bold and clear statement, and I guess that all London Members of Parliament want to see changes off the back of it. Another paragraph in the document says that

“out of the thirty hospitals in London providing stroke services, only four treated over 90 per cent…in a dedicated unit, and, whilst patients should receive a CT scan within three hours, only in seven hospitals were 90 per cent of patients getting a scan within a less-than-ideal 24 hours.”

People like me are sometimes accused of always saying that everything is marvellous and fantastic, but one cannot read such figures from someone as eminent as Professor Sir Ara Darzi without agreeing that there is a case for change. There is a constant onus on us all to see whether we can do better in providing health care for our constituents.

I shall now address the issues that the hon. Member for Ruislip-Northwood put before us. The vital context of today’s debate is specialist services and the extent to which we enhance and improve them. Ara Darzi discusses his reasons for change and devotes the body of the document to the need for more specialised care. I hope that the hon. Gentleman is encouraged by that. Ara Darzi makes his assessment of health care needs in London in that context. If I were the hon. Gentleman, I would take considerable comfort from that, having raised two issues relating to institutions today. What is important is improving the excellence in the west London health economy.

I turn to the specific issues raised by the hon. Gentleman. I, too, enjoyed our meeting last year to discuss the Royal Brompton and Harefield NHS Trust, and I, too, pay tribute to Jean Brett, who has done a superb job of raising the profile of the trust and the arguments that it wants to advance in this debate. The hon. Gentleman and I are absolutely at one on that. I would go further and say something else, which I probably said at the meeting, which the hon. Member for Uxbridge also attended. I argue that the foundation trust model does provide an answer.

We had a huge and impassioned debate in the House, particularly on the Labour side, about whether the foundation trust model was right. I am trying to remember, but I think that the Liberal Democrats opposed the model. I remember debating with the hon. Member for South Cambridgeshire (Mr. Lansley) at the time, and I do not think that we disagreed. I remember that he supported the principles of the foundation trust model. For me, it is the natural fit for a trust such as the Royal Brompton and Harefield NHS Trust. I fully endorse the trust’s efforts to realise its aspiration to achieve foundation status.

The hon. Member for Ruislip-Northwood used a phrase to the effect that it was Monitor’s intention to block the application, but that is a misrepresentation of the current position. As I said, the application went forward to Monitor with the Secretary of State’s support. That brings me to the role of Monitor. First, let me say what its job is. Its job is to make a hard-headed assessment, without fear of unpopularity, of the business case that underpins foundation status.

My local trust—Wrightington, Wigan and Leigh NHS Trust, which includes a specialist hospital in Wrightington hospital—went through the process too. Monitor found out things about the trust’s financial rigour and framework that have been helpful to its planning for the future. All of us at different times call for that rigour in the finances of the national health service. If the hon. Gentleman’s call was for leniency and for us to get all the trusts through the process, that would be wrong and would not serve his constituents’ interests or the health service in general. As anybody who has been through it will testify, the process is rigorous.

Does the Minister consider that some trusts that have not been given foundation trust status would have been given it had the information about what the Government intended to do with research and development funds been available at the time?

Monitor should always base its judgment on the information available at the time. That is what it does—it takes the trusts through the process and alerts them to potential risks that it may feel have not been adequately addressed in the trust’s business plan.

The hon. Member for Ruislip-Northwood used what we might call an anonymous quote to the effect that the trust has no future as a stand-alone trust. Let me say it clearly: that is not the view of the strategic health authority, NHS London. I put it clearly on the record that NHS London says that it thoroughly supports the trust’s foundation trust application and, provided that it can work through the problems raised by the reduced R and D funding, the trust has a positive future. The Government very much share that view.

It is not for Ministers in any such situation to say, “This trust can go forward and that one can’t,” and it is not the role of Monitor to say what is the right configuration in any one area. That is properly the responsibility of the strategic health authority and local commissioners. Let us be absolutely clear about the strategic health authority’s view. I hope that we can have a period of intensive discussion about some of the potential problems that have been highlighted and then get the application back on track so that it can be considered again shortly.

The hon. Gentleman talked about the three-year phase-out of transitional funding under the new arrangements for R and D funding. It is worth putting on record that in the last financial year, the trust received £28.6 million as part of that funding. This year, it will receive £24.6 million and in 2008-09, we expect it to receive something in the region of £4.8 million, although that has yet to be fully confirmed. That transitional timetable is not to be reviewed and is set in stone. That is a fair basis on which trusts can plan for the new world of R and D funding.

A number of hon. Members commented on the R and D funding regime. It is important to say that the NHS budget for research and development for this financial year is £776 million. I hope that hon. Members accept that the Government have made a significant contribution and commitment to research and development. As in other parts of the national health service, under the new regime people will no longer be paid for historical reasons or for what they have always done. The new regime is about being transparent so that people can bid for funding on the basis of the quality of what they do. I expect an organisation of the quality of the Royal Brompton and Harefield NHS Trust to benefit under the regime like any other such trust.

I shall give way only briefly, as I want to address points made by my hon. Friend the Member for Ealing, Acton and Shepherd's Bush.

I should be grateful if the Minister explained why the phasing arrangements are set in stone, given the evidence that they are destabilising prestigious institutions such as the Royal Brompton and Harefield NHS Trust and Great Ormond Street hospital.

I do not believe that that is the case. A three-year funding phase has been agreed and, as I say, there is the opportunity to bid for new funds under the new regime.

Let me address the question of the academic health science centre. I confirm to my hon. Friend the Member for Ealing, Acton and Shepherd's Bush that today the strategic health authority has initiated a consultation on whether the three confirmed organisations will be able to go forward to create the UK’s first academic health science centre. It could be an incredibly exciting proposal and vision for health services in west London, and my hon. Friend will agree that as the clinical research translates into NHS services the benefits to his constituents could be huge. I am pleased to hear that at this stage, knowing what he does, my hon. Friend is supporting the proposal.

The hon. Member for South Cambridgeshire was right to say that the issue should not become wrapped up in debates about reconfiguration. The proposal should stand on its own merits and go forward with cross-party support so that we can see whether we can create an institution that would begin to rival the academic and health service institutions that are seen in the United States. Obviously, I encourage my hon. Friend to play a full part in the consultation. We will see whether we can turn the vision of Professors Sir Ara Darzi and Steve Smith into reality. I pay tribute to them for their personal commitment.

In the time that I have, I want to mention Mount Vernon hospital. I hope that the hon. Members for Ruislip-Northwood and for Uxbridge accept that there has been recent investment in the improvement of cancer services at Mount Vernon hospital. No one can ever say that something could never be reviewed or changed, but we should look at the reality on the ground. As a result, we see a trust whose services are being invested in and improved. That is the important thing that matters to local people.

The hon. Member for Uxbridge raised the issue of Hillingdon hospital. I believe that an outline business case is about to be put to the strategic health authority, and I hope that it will reach me soon.