§ 2.53 p.m.
§ Lord EnnalsMy Lords, I beg leave to ask the Question standing in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government how many hospital beds in the National Health Service have been closed since May 1979, and how many new beds have been provided.
§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)My Lords, up to the end of March this year 17,220 beds have been approved for permanent closure and 12,035 new beds have been provided in major schemes, plus others in many small schemes, on which we do not have information centrally on the numbers of beds involved.
§ Lord EnnalsMy Lords, I do not fully understand whether the noble Baroness answered the second part of my Question relating to the number of beds that have been closed. Will she confirm that the figures given by the Minister of State, Mr. Kenneth Clarke, show that, on balance, there has been a reduction of 2,486 over the past six years? Does this significant reduction in the number of beds partly explain the very substantial increase in the waiting lists which were reported by the noble Baroness on Monday?
§ Baroness TrumpingtonMy Lords, I repeat that 17,220 beds have been approved for permanent closure and 12,035 new beds have been provided in major schemes, which does not take account of the smaller ones. The fact that beds have closed is not the point; it is the number of patients who are treated. For example, in the acute sector, as I said earlier this week, 650,000 more cases were treated in 1983 than in 1978, though 10,000 fewer beds were available.
§ Lord RentonMy Lords, is my noble friend aware that it is often alleged that beds are not available in some hospitals due to financial stringency? What truth, if any, is there in that allegation?
§ Baroness TrumpingtonMy Lords, there is no truth in that. Health Service expenditure has increased by about 16 per cent. over and above general inflation since 1979. No closure is approved by Ministers purely 1230 on financial grounds; nor unless we are satisfied that it will produce an improved service for patients. We will approve closures which allow resources to be put to better use elsewhere, but these must be part of a sensible rationalisation of facilities.
Lord WinstanleyMy Lords, does the noble Baroness agree that every bit as important as the number of beds available in any hospital, or in the National Health Service as a whole, is the number of beds actually occupied? Is she aware that in the past beds were too rigidly demarcated as surgical beds, medical beds or whatever, as if they were of different shapes? That sometimes led to wastefully low occupation rates and to the point raised by the noble Lord, Lord Renton—that there were no beds when, in fact, there were. Has that problem been overcome? Can the noble Baroness tell us what is the bed occupancy rate in the National Health Service as a whole, as a percentage of the total? Is she aware of any regions, or individual hospitals, where bed occupancy rates are low?
§ Baroness TrumpingtonMy Lords, I am very grateful for most of the remarks made by the noble Lord, Lord Winstanley. The only figure I am able to give him is that in England in 1983 the average daily number of National Health Service beds available was 343,000.
§ Baroness Gardner of ParkesMy Lords, can my noble friend confirm that the building of new hospitals now in London—at St. Mary's, Paddington, and the new national heart hospital—will improve the situation referred to by the noble Lord, Lord Ennals, where the types of beds available were not necessarily the types needed, and that where new hospitals are built that situation will be taken into account?
§ Baroness TrumpingtonMy Lords, I am grateful to my noble friend. Up to March of this year 38 major hospital schemes had been completed and nine more are expected to be completed this year. In addition, many smaller schemes have been completed for which we do not collect, centrally, information on the number of beds involved. I have to add that I cannot personally be responsible for whether the beds are in use or are empty.
Lord Wallace of CoslanyMy Lords, the noble Baroness gave the impression that everything was okay and in order in the National Health Service. Why, then, is it that periodically in many areas—and this has been going on for some time—emergency and out-patient departments are closed, putting pressure on other hospitals that are struggling to remain open?
§ Baroness TrumpingtonMy Lords, if the noble Lord is referring to regional variations, I would point out that there are many factors that lead to variations in the number of available beds in different Health Service regions. Largely, these are historical, but they also include the use made of day care, community care, efficiency in bed use, differences in population profile or differences in patterns of referral.
§ Lord Orr-EwingMy Lords, is it not a fact that more beds were closed during the period of Labour rule, when the noble Lord, Lord Ennals, was a permanent Minister, than during the Conservative Government's period of office?
§ Baroness TrumpingtonMy Lords, between May 1979 and March of this year 222 hospitals have been approved for closure under this Government. This compares with 270 under the previous Labour Government.
Lord TaylorMy Lords, of the 17,000 beds which I think the noble Baroness said were earmarked for closure, can she say how many are for mental patients? Is not the proportion of mental hospital beds going down rather more rapidly than the number of patients needing them?
§ Baroness TrumpingtonMy Lords, we believe that mentally disordered people should be able to lead as normal a life as possible. That can in most cases be best achieved if they can live at home or in homes which are part of the general community. Even when continuous health care is needed it can often be provided in a small local NHS unit rather than in a large hospital.
§ Lord KilmarnockMy Lords, can the noble Baroness confirm that the decision to close St. David's Hospital in Brecon, which is a geriatric unit, has been reversed, and can she say whether that reprieve has anything to do with an impending by-election in the Brecon and Radnor constituency?
§ Baroness TrumpingtonMy Lords, if the noble Lord would care to write to me on that matter, I should be delighted to give him an answer.
Lord MorrisMy Lords, I know how to make a bed and how to sleep on one but not how to close one. Am I missing something?
§ Lord StallardMy Lords, does the noble Baroness accept that the availability or occupation of beds cannot be separated from the availability of doctors, nurses, ancillary staff and administrators in hospitals? Does she further accept that those people are not available to man and staff the beds that we need as a direct result of Government policy?
§ Baroness TrumpingtonNo, my Lords, I certainly do not accept that. We have more doctors and nurses now than there were under a Labour Government.
§ Lord EnnalsMy Lords, as we have now established that finance is not the cause of the 5,000-bed reduction, may I ask whether it was the reduction in the number of nurses? Is the noble Baroness aware that 1984 was the first year since the creation of the NHS in which there were fewer nurses employed in the service than in previous years? For the first time there was an actual reduction in the number of nurses. Is not that part of the explanation?
§ Baroness TrumpingtonNo, my Lords. The closures are necessary because of the need to replace outdated 1232 buildings and in response to changes in population and new policies for health care, with particular emphasis on care in the community.
§ Lord EnnalsMy Lords, what about the reduction in the number of nurses?
§ The Countess of MarMy Lords, in view of the recent report by the National Council for Women on women in the health service, can the noble Baroness please say what proposals Her Majesty's Government have in order to increase the number of beds for the treatment of women by women in the Health Service?
§ Baroness TrumpingtonMy Lords, that is a little outside the Question, but I know that if it is their wish wherever possible women are treated by women.