Bottomley insists change is best medicine

Inside Parliament Health Secretary faces up to barrage of criticism in fiery debate on future of London's hospital services

It was clear that Government business managers had left little to chance in the predictably fiery debate on London's hospitals - successive backbench Tories from outside the capital intervened at an early stage to support Virginia Bottomley.

Even Sir George Gardiner, the right-wing MP for Reigate and not one of the Secretary of State for Health's natural supporters, rose to repeat a constant theme from the Conservative benches: that people in the provinces did not want to travel to the capital for specialist treatment, but wanted services - provided, the MPs said, in generous measure by the Government - of their own. "Resign," cried Labour MPs as Mrs Bottomley rose to her feet.

The Secretary of State, of course, was well prepared for the interventions of the small group of north London Tories who have campaigned against the closure of the accident and emergency department at Edgware General Hospital - so much so that it took Hugh Dykes, MP for Harrow East, four attempts to get Mrs Bottomley to give way.

But it was Sir John Gorst, MP for Hendon North and fellow Edgware campaigner, who sought to wind both Mrs Bottomley and Margaret Beckett, her Labour shadow, as the latter opened the Labour- initiated debate.

The thrust of the Opposition motion was for the slowing down of the pace of change to Bart's, Edgware, Guy's and the Brook hospitals, and a re- examination of the case for it. The logic of Mrs Beckett's argument, Sir John declared, was "not that there should a pause or a review, but that these closures should be reversed completely - and in my view, for all time".

Mrs Bottomley, too, told the House that Labour's call for a moratorium on closures was a "cop-out". But one of her principal weapons was the charge that Labour's staging of the debate was "cynical opportunism with this piece of parliamentary gamesmanship" at a time when Labour constituents had so benefited from hospital improvements in their areas.

It took Sir John three attempts to intervene and register a protest at the cynicism charge, telling Mrs Bottomley that he too had sought an opportunity for a debate - and that he wished to register a vote against the proposals.

In increasingly heated exchanges between Mrs Beckett and Mrs Bottomley, and near-derision from Labour backbenchers, Mrs Beckett said: "What nobody can doubt is that the public has lost confidence in the Government's handling of the NHS, something over which the Secretary of State blames everybody but herself." Mrs Bottomley's outstanding political characteristic was that she heard only what she wanted to hear.

Mrs Beckett had opened her remarks with a reminder to Mrs Bottomley about the closure of the casualty department at Homerton hospital in east London for 39 hours at the end of the bank holiday. The unit, which must absorb accident and emergency cases that would previously have gone to Bart's, was still closed because all wards were full as Mrs Bottomley was praising the world-class hospital on radio.

Mrs Beckett said MPs on both sides were "deeply uneasy" about whether the Government was pursuing the right course, and many Tories would be "secretly relieved if there were some way to halt the juggernault that may be carrying them to destruction along with London's health service."

Mrs Bottomley insisted there was no going back. She promised, however, that there would be improvements in the London Ambulance Service and the opening date of the minor accident treatment service at Edgware Hospital would be brought forward to the earliest opportunity. The Regional Health Authority had also decided to provide an additional £2m for improvements in family doctor and community services in Edgware catchment area, she added. The concessions were enough to placate another intending rebel, John Marshall, the MP for Hendon South, who would have lost his PPS job for failing to support the Government.

"The price of doing nothing ... would be to let our hospitals and services slip into decline - to fail London and Londoners," Mrs Bottomley said. Amid Opposition uproar, she protested: "There are no instant answers or scratch-card solutions." It was time for a better balance, as London had for too long suffered from "duplicated and fragmented" specialist services.

Simon Hughes, Liberal Democrat MP for Southwark & Bermondsey, who has spearheaded the campaign to save Guy's, said it may have been argued in the past that London got more than its fair share of resources. "That isn't the case any more. Indeed, there is clear evidence that there is a rising population in inner and outer London." In a reference to Mrs Bottomley's "seven-point plan" to reassure MPs, Mr Hughes characterised the end of her speech as "a pledge made by a Snow White of the health service with seven dwarf pledges following behind."

Peter Brooke, a former Cabinet minister and one of the foremost campaigners against the closure of Bart's, accused the Secretary of State of "moral cowardice" last month in not making a Commons statement on the changes. Last night he followed that through by giving Mrs Bottomley notice that he would rebel on the vote. Of colleagues prepared to give the minister the benefit of the doubt, the MP for City of London and Westminster South suggested that perhaps they could give that to Bart's instead, and abstain.