HC Deb 31 March 1952 vol 498 cc1371-80

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Vosper.]

1.15 a.m.

Miss Irene Ward (Tynemouth)

Before I come to the substance of the case I wish to make tonight, I should like to express my appreciation of the steps that the Minister has taken to try to deal with the financial position of the Newcastle-upon-Tyne Regional Hospital Board, and I am sure this appreciation will be shared not only by members of the Hospital Board, but by all those who share the amenities in the parts of the world covered by the Regional Board.

I am sorry in the comments that I have to make tonight I shall have to quote from a series of documents, but I am anxious to place on record the unfortunate position in which this Regional Hospital Board finds itself owing to the regional basic allocation made to it at the time when the hospital services were brought into operation. First of all, I want to quote from the last available Annual Report of the Newcastle-upon-Tyne Regional Hospital Board issued in March, 1951, and it is on the quotation from this report that I really base the case that I want to put tonight.

The position, according to the senior medical officer, Mr. W. G. Patterson, is that the 1951 census figures give a population of Newcastle-upon-Tyne Hospital Region as 2,911,922—that is approximately 6.64 per cent. of the total population of England and Wales. The amount of money, running costs and capital allotted to the hospital service in Newcastle Region for the year 1951–52 was £11,266,000 for Regional Hospital Board hospitals and £1,156,567 for the teaching hospitals, a total of £12,422,567. That is approximately 5.1 per cent. of the £243 million allotted for the hospital service during 1951–52 for the whole of England and Wales.

It is apparent that the population of the Newcastle Hospital Region is getting about 23 per cent. less than its proper share of the nation's expenditure of the hospital service, if it is accepted that the hospital needs of the population of the Newcastle Region are not materially less than the needs of the population in other parts of the country.

Whatever may be the reasons, good or bad, that existed prior to July, 1948, and which have left some parts of the country with a good hospital service and some parts with a bad one, there can be no justification in the National Health Service for maintaining grossly different standards of hospital service in different parts of the country. On the population basis and with the country's present expenditure on the hospital service, the Newcastle Region should be getting approximately £16 million per annum instead of £12,422,000. That was to combine expenditure on the amount provided by the Board of Governors and the Regional Board.

The Report states: Even allowing for high wage rates in some areas, Newcastle and those other regions which are at present given less than their fair share of the national hospital money cost must hope that, year by year, their hospital services will be given preferential treatment in the allocation of additional money so that, over a period of ten or fifteen years, for example, they may be raised step by step to the average of the country. It would be idle to expect that such major discrepancies in the standard of hospital service throughout the country could be completely adjusted in less than ten to fifteen years. The whole case for linking hospital expenditure with population is that over areas and populations as large as those of the Newcastle region and of the other thirteen hospital regions in England and Wales, there is very little hospital service given to the population of the Newcastle region and similar regions by the Metropolitan and the other regions which, relative to populations served, receive a high proportion of the country's hospital money at present. Then, the last paragraph, which is very important in view of our financial position today, states: Should reductions be required in the total expenditure on hospital services in the country in future, there is an equally strong case that such reductions should be imposed last of all on those areas which, at present, have relatively poor hospital services. The last quotation is from the Treasurer's section, and here it is disclosed, in comparison with the global sums originally approved for 1950–51 for management committees throughout England, that of the amount allowed per bed and per head of the population the Newcastle Region was the second lowest in the country; and the Board felt that this was a factor which should be most strongly brought to the notice of the Minister.

This really places on record the views held by the Regional Board, namely, that the attention of the Minister should be drawn to our unfavourable position; and it is for that reason that I am raising this matter tonight.

I am glad to see that the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), who was Parliamentary Secretary to the Ministry of Health in the last Government, is present, because I am somewhat surprised that, having regard to his position, he was not able to safeguard the interests of the Region in which his constituency is situate.

When I had my attention directed to this latest report of the Newcastle Regional Hospital Board, I immediately got into touch with the Minister of Health, and I also, on receiving his letter, with which I shall deal in a moment, got in touch with the Chairman of the Newcastle Regional Hospital Board. I then found that a deputation had already gone to the Ministry of Health to draw attention to the unfavourable position in which we find ourselves.

I should now like to quote one or two lines from the letter of the Chairman of our Regional Board. On 29th February he said: We had a deputation at the Ministry at the end of January and on the whole we were satisfied with their outlook and with the assistance that they gave us there and then. This was an immediate grant of £15,000 to be spent in the current financial year and an additional £200,000 for next year as mentioned by the Minister. I agree with you, however, that although we are happy to receive monies which other regions are unable to spend and although that indicates that the Ministry are sympathetic with our problem, the basic trouble is the original allocation of the funds amongst the regions. I would, however, like to stress that we have put our case to the Minister on a long term basis, because we realise that both money and material are at present in short supply. What we are aiming at is to obtain a larger allocation of capital monies over the next ten to fifteen years in order to catch up with the better areas of the country, bearing in mind also that additional building and expansion carries with it the need for additional monies on revenue account. I am interested to see that the Minister is sympathetic to our view, but we must keep on pressing the Ministry year by year in order to get a fair crack of the whip. I am bound to say that, over a wide variety of subjects, during the last few years the North of England has felt that it has had one or two very raw deals.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

I think the hon. Lady would agree that on what is perhaps the most important consideration it has had an exceedingly good deal in that the people today are fully employed.

Miss Ward

I do not want to be diverted to a discussion on employment, but I must answer the point. I am glad to be able to do so. For a wide variety of reasons, but largely owing to the policy of the Conservative Government elected in 1935, we have been most fortunate in balancing our industrial economy and dividing it between heavy and light industry. I am also glad to pay tribute to the fact that the hon. Gentleman and his Government carried on the admirable work which had been started by the Conservative Government in the policy which they put into legislative form in 1935.

I do not want to be diverted from the case I am trying to make. I should like to allow the hon. Gentleman a few minutes in which to speak, and I do not want to prevent my hon. Friend the Parliamentary Secretary from having sufficient time in which to answer the case. I am sure that that is also the wish of the hon. Gentleman.

I want to emphasise that I am merely trying to state the view of the Newcastle-upon-Tyne Regional Hospital Board in this matter. I am, so to speak, a post office. When I got in touch with the Minister he confirmed the facts which the chairman had already stated—that my right hon. Friend had taken steps to try to remedy our unfortunate position. I am a realist in these matters and I always like to have any representations that I may make on record. I also like to have Ministerial answers on record. I put down a Question in order that the area itself should be informed on the action taken by my right hon. Friend.

Instead of giving me an answer to the Question I had asked, my right hon. Friend wrote me a somewhat lengthy letter stating the action he had taken and the reasons for it. Therefore, there is no Parliamentary record of the action of the Minister. I want that information to be on our Parliamentary record. I want that because it shows the sympathetic approach of my right hon. Friend to this problem and also because his answer contained one or two observations which caused me some anxiety, and to which the chairman of the Newcastle-on-Tyne Regional Hospital Board referred in his letter.

Writing to him on 20th February, the Minister said: The Board's general contention is that the Ministry should adopt a policy of steadily increasing year by year the proportion granted to the region of the total funds available for capital and revenue for the hospital service. We are entirely sympathetic to the Board's desire to overtake the shortage of hospital provision in their area, and we intend gradually to effect as great an improvement as can be done without injustice to other Boards. As you know, our resources are strictly limited, and there are other regions with as strong, or nearly as strong, a claim as Newcastle for a greater rate of development. For capital expenditure the current basis of allocation of the available money already gives this Board a rather higher amount per hospital bed than the average. This means that, in proportion to the existing accommodation in their hospitals, they already have a little more available for capital developments than is available on the average to other Regional Boards (though as you know the resources which the Government have felt able to provide for the hospital service at the present time permits only limited capital development anywhere). I may add that that available capital, so to speak, affects us only in the 1950–51 year and the 1951–52 year. It makes no improvement on the previous years during which the hospital service had been running. Therefore, I emphasise the word, "current." The Minister went on: In addition they have been getting recently some supplementary allocations of capital. The additional £15,000 mentioned in the official letter followed earlier additions this year totalling £135,000; the allocation of this extra £150,000 in all was made possible because of under-spending in other areas. That is one point to which I want to draw special attention.

The Regional Hospital Board's claim is that the basic allocations left it in an unfavourable position. We see no reason why our just claims should have to be met out of under-spending in other areas. The Minister went on: Last year, for the same reason, we were able to make an additional allocation to the Board (over and above its strict allocation) of over £224,000. These are large additions and have been made available to the Board as soon as it was clear that we could do so. For next year the main allocations were fixed in accordance with the current basis some time ago, but again, if there is under-spending in some areas we would increase the allocation to Newcastle on request: but we shall have to wait until late Autumn until we know how things are going. The general basis of distribution for later years is, as we said in our letter, already under review, and we have the Board's representations well in mind; we shall of course also have to take into account the views of other Boards and it is too early to forecast what will emerge. A question I want to address to my hon. Friend tonight is whether, providing our case for review of the original basic allocation is accepted, when that review takes place we can hope to have a fair share of whatever money is available from the Exchequer.

Then my right hon. Friend went on to say: On maintenance expenditure, the Board asked for an additional £200,000 for next year, and we were fortunately in the position of being able to make a supplementary allocation of this amount, which brings the total for the year to £12,359,000. That, of course, is still short of the £16 million which we make out to be our allocation. The Minister added: This represents an increase of 14.6 per cent. over the amount approved for this year, and this percentage increase is the highest in the country. That is a very nice way of putting it, but I assume my right hon. Friend would not have given us this percentage increase unless it was justified. Therefore, I feel I am entitled to say once again how very unfavourable was the original basic allocation made to the region I represent. The Minister went on: Again we shall bear in mind the Board's representations when we come to consider the allocations for maintenance purposes for later years. I am very grateful to my right hon. Friend for the action he has taken. I have a very shrewd suspicion that when my hon. Friend the Parliamentary Secretary comes to reply she will be able to give me a number of figures proving that we are now in a reasonable position and that our situation has been greatly improved. But, nevertheless, it could not have been improved unless the Newcastle-upon-Tyne Regional Board had been in a position to emphasise its claim, and unless other regions had had money which they had underspent, which was available to put into the regional pool. I consider that that discloses a very unfortunate position.

I should also like to draw the attention of my hon. Friend to another point which I think accords with what was pointed out by the hon. Member for Newcastle-upon-Tyne, East. Industrially we are an expanding area. We are expanding our iron and steel industry and we are embarking upon additional chemical works. We have taken over a good deal of light industry. In other words, we are a vigorous and expanding area. We look to my right hon. Friend and my hon. Friend to see to it that the Newcastle-upon-Tyne Regional Board has its fair share of the national moneys.

I quite agree with the way in which the case has been presented and with the way in which the increased allocations have been decided upon, but I want a specific assurance that we shall not be dependent purely upon underspending in other areas, and that when the reviews take place we shall indeed have the fair basic allocation for our hospital services which we believe undoubtedly is our due.

1.39 a.m.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

There is very little time left, and I only want to say we in the North-Fast are all agreed that the Newcastle region is in a very difficult position and also that it must take considerable time before that position can be put right. We worked on the problem for a considerable period. We know that supplementary allocations were made on 7th July and 9th October last year, as well as the additional sums referred to by the hon. Lady the Member for Tynemouth (Miss Ward).

I expect that the Parliamentary Secretary will be able to point out that over a considerable period there has been close attention paid to the problem of the Newcastle region, as there has been to other regions as well, because of the very real and urgent need in that region as elsewhere.

1.41 a.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

It would be difficult to answer all the points raised by my hon. Friend the Member for Tynemouth (Miss Ward) in the three minutes left to me, but I would emphasise the confusion of thought which obviously exists in her mind about two entirely different aspects of expenditure in the gross sum which is allocated to regional hospital boards.

There is, on the one hand, the major part, which is used for revenue and maintenance, and the other part, which is used for capital improvements and new capital expenditure. The revenue for maintaining existing resources for staffing, wages, laundry, food and the like within a hospital must be related to the existing hospital resources, and not to the population. If there are not the nursing staff and the hospitals there, one cannot expect grants for maintenance.

The figure of £16 million is unrealistic when considered in relation to the number of hospitals in the Newcastle Regional Hospital Board area. The greater part of the £12 million-odd they receive is used for maintaining existing hospital services. I would point out, though, that this year's allocation of £12,359,000 to the Board includes an amount for developments and improvements which is the second highest in the country. Also, in that allocation is an additional £200,000 which will enable the region to refrain from closing four maternity hospitals with 63 beds and an infectious diseases hospital with 30 beds, and will give them a chance to open the greater proportion of 546 beds many of which are for tuberculosis patients.

As far as the capital side is concerned—my hon. Friend will appreciate that this is limited severely by the amount available for capital investment programmes at present—the decision as to the amount of money we can use for this purpose is taken at Cabinet level, and when we get our modest share for hospital purposes it must be divided as fairly as possible among the regions. For the year 1950–51 the Newcastle Regional Hospital Board received £738,000, which included an additional allocation of £224,000; in 1951–52 they had, with an additional grant of £150,000, a total of £630,000; in 1952–53, with the programme drastically curtailed, they will receive a basic allowance of £384,000.

It is estimated that the Newcastle Region has 6.64 per cent. of the total population of England and Wales. They have 6 per cent. of the staffed beds in England and Wales, and the share of capital allocation given to them this year will be 6.8 per cent. of the available capital we have at our disposal for regional boards.

Another point of complaint of my hon. Friend was that we appeared to have supplementary moneys which we could allocate later in the year. We allocate as fairly as we can to all regional boards, but occasions do arise when money which has been allocated cannot be used—perhaps, for the installation of a new boiler which does not arrive, or for building that cannot be started on a site, which, through long legal negotiations, does not become available within the capital year—and this gives us an opportunity to use and transfer capital which it would not be possible to use in that current year for other priority purposes elsewhere. We regard that as sensible flexibility and an eminently desirable arrangement so that we can switch, as circumstances change, from one area to another.

I hope that, in the short time available to me, I have been able to deal at least with the major points which my hon. Friend raised.

Adjourned at Sixteen Minutes to Two o'Clock a.m.