HC Deb 20 March 1972 vol 833 cc1266-83

1.35 a.m.

Mr. John Farr (Harborough)

I make no excuse for once again calling the attention of the House to the abysmally poor service for hospital patients in Leicestershire and Rutland. I have initiated four or five debates on this topic in recent years and the fact that it is necessary to air fresh complaints about this service is distressing. I hope that tonight I shall get a more forthright and hopeful answer than I have had from my hon. Friend the Under-Secretary of State for Health and Social Security or previous Ministers who have occupied his illustrious position.

In Leicestershire complaints about the hospital service can be channelled into three outlets, all of which I have raised in debates or Questions. The first is related to the service provided by casualty departments at some of the hospitals, particularly at the Leicester Royal Infirmary. It should not be necessary for me to provide for the Minister the example of a recent meeting of Blaby Rural District Council in my constituency. During a discussion about complaints of waiting time and treatment at Leicester Royal Infirmary casualty department, Councillor Mrs. Hall said that she had waited eight and a half hours. She complained not so much for herself as for children who waited for hours without attention. Another councillor said she waited from very early in the morning until late afternoon for treatment. She too was concerned about the number of children who had to wait and the effect that delay had on them.

The second point in my three-pronged argument is in relation to waiting time for consultations in the district. My hon. Friend will be aware that in Leicester one has to wait an average of three or four months for a National Health Service consultation. When I brought this matter before him in December, 1971, I gave my hon. Friend examples of the very long wait that some of my constituents and others had for such consultations. In some cases it was necessary to obtain a private consultation rather than suffer the anguish and uncertainty of waiting for a National Health Service consultation.

The third point is in relation to waiting for a National Health Service operation. When I last raised this point with my hon. Friend's Department in debate a year or two ago it was appalling. Since then, despite what I know to be his good intentions and his sincere concern about the situation, things have not improved. Just over a year ago I gave my hon. Friend examples of people who waited three and four years for a National Health Service operation. One or two had to go privately. Since I last raised the matter in debate I had the example of a lady whom I shall call Mrs. P., who waited for three years and found the long wait so distressing that she felt constrained to raise the money to have the operation privately.

Other examples have come to light and I can quote to my hon. Friend a report from the local newspaper dealing with conditions in Leicestershire, relating to a lady whom I shall call Mrs. K. She first saw her doctor on 12th September last year after haemorrhaging at work. The report says: Leicester Royal Infirmary could not give her an appointment until January 13"— That was for a consultation— so Mrs. K. paid £5 for a private appointment which was made for October. In her own words, Mrs. K … felt so 'bitter and twisted' about the fact that the only way she could obtain an appointment with a specialist being on the payment of a fee that she decided to see her Member of Parliament. It was when she saw the specialist that Mrs. K … was told: 'If I could pay I could get into Fielding Johnson within a fortnight or St. Francis by December'. 'I would not give an answer there and then because there was a fear that my husband, an engineer, might be out of work as a result of a strike and we also had the possibility of £300 road-making bill over us.'". Eventually her family doctor advised her against the operation saying she had paid enough through her full national insurance stamp and he believed that it would cost more than the £150–£170 quoted. In October of last year she went on the waiting list and was told by the specialist that she would have to wait up to four years for a National Health Service operation.

Those are a few examples I have of constituents who have already waited a long time for a Health Service operation. It is apparent to me, and has been for some time, that in a district such as Leicester and Rutland there is something wrong with our hospital services. As long ago as March, 1966, one of my hon. Friend's predecessors, the then Parliamentary Secretary, said in answer to my complaint that he was determined to introduce improvements as rapidly as the country's resources permitted.

The former Parliamentary Secretary went on to say, dealing with the Leicester situation: I want, if I may, very quickly to deal with the Leicester situation in particular, but I want to make it absolutely clear that it is for the board to assess priorities for development of the service within its region or between one locality and another. He said a few more words and concluded that paragraph by saying: Nevertheless, there has already been development at Leicester, and about 11 per cent. of the board's investment in the first 17 years of the Health Service has been spent in the area."—[Official Report. 7th March, 1966; Vol. 725, c. 1871.] That may sound a lot but we have to take into account that nearly 20 per cent. of the Sheffield Regional Hospital Board population live in the Leicestershire area. Area No. 21.

The concern of the medical practitioners can be illustrated by an extract from a letter from Dr. Whowell, the Leicestershire and Rutland Local Medical Committee Honorary Secretary, who wrote to the Leicestershire No. 1 Hospital Management Committee in December, saying: At the meeting of the Local Medical Committee held last Wednesday, the hardy annual of hospital waiting lists came up—particularly those for out-patients. While it was realised that the present situation was not the direct fault of the Hospital Management Committee, I was instructed to write to you to put forward a suggestion—that the attention of the general public should be drawn to the fact that dissatisfaction with the local services in this respect is beyond the control of the Hospital Management Committee and that it stems from an intrinsic lack of capital to expand the out patient department and also to increase the number of consultants. From answers given by my hon. Friend to recent Questions on this issue, it seems that lack of capital is the basis of all our complaints.

I have had many soothing replies from my hon. Friend about hospital services in my county. Seven or eight years ago I was told by one of his predecessors that everything would be all right soon, we only had to wait for present plans to mature. The nub of my criticism lies in the woefully inadequate proportion of money available to the Sheffield Regional Hospital Board for expenditure on medical services in Leicestershire and Rutland.

Only six days ago my hon. Friend gave an answer which I find most illuminating and which reveals the true basis of my complaint. I asked: what was the average annual expenditure on hospital services in Leicestershire per head of population in the last three years; and what was the comparable figure nationally". My hon. Friend replied: Hospital service current expenditure per head of population in Leicestershire and Rutland in 1968–69 was £9.6; in 1969–70 it was £10.2 and in 1970–71 £12.2. The corresponding figures nationally are £12.9, £14.0 and £16/".—[Official Report, 14th March, 1972; Vol. 833, c. 49.] In every case those national figures are 25 per cent. more than the amount expended in Leicestershire and Rutland.

In this situation, which has occurred year after year, with 25 per cent. below the average national per capita expenditure on hospital services and a per capitaexpenditure well below that of the neighbouring counties, the medical services of Leicestershire and Rutland are bound to deteriorate and suffer markedly. This below-average expenditure is the prime cause of the deplorable services which still exist.

I suggest, first, that no longer should Leicestershire and Rutland be starved of a proper share of moneys available for hospital services. It is no wonder that this part of the country has a reputation for woefully inadequate service in many spheres when less money is consistently spent on it. I look to my hon. Friend, instead of promising me that in a few years' time things shall be better, to see at least that a fair and equitable amount in proportion to the national expenditure per head is expended on National Health Services in the district.

Secondly, I ask whether my hon. Friend is satisfied with the present structure of the Sheffield Regional Hospital Board within which area Leicestershire and Rutland fall. It is a strange anomaly, and has been to me a source of wonder, that Leicestershire and Rutland should fall under the control of a regional hospital authority centred 60 or 70 miles to the north in south Yorkshire. I have no doubt my hon. Friend will be able to explain this anomaly to the House if only by saying that this has always been the case and there is no reason why it should be changed.

I suggest two alternatives which would far better meet the needs of those in Leicestershire. First, I suggest a possibility which my hon. Friend may not yet have considered, namely, that there should be a new regional health area based on the new medical school in Leicester. This new regional health area would serve Leicestershire, Rutland and Northamptonshire and would have a population of about 1¼ million people. The main advantage of such a proposal is that it would mean that the new Leicester teaching hospital would be the centre of its own region in accordance with the pattern outside the metropolitan area. It may be thought that 1¼ million is on the small side for a regional hospital area and that this would mean divorcing Northampton from the Oxford region, but this is a suggestion I put to my hon. Friend.

The second alternative lies in an amended regional hospital area but this time, instead of being confined simply to Leicestershire, Rutland and Northamptonshire, based on Nottingham and including Lincolnshire, Derbyshire, Leicestershire and Rutland. In other words, it would mean detaching from that area this portion of the Sheffield Regional Hospital Board's area and establishing a separate authority for it to form a regional base on Nottingham. Nottingham is, of course, far closer to Leicester than is Sheffield, and it is not so remote. The difficulties of access and telecommunication between Leicester and Nottingham would not be nearly as great as between Leicester and Sheffield, which is 50 or 60 miles further on into south Yorkshire.

I do not want more money to be spent on Leicestershire and Rutland, but I want to see an adequate and fair proportion of moneys available for health services to be spent on my constituents and those of my hon. Friends in Leicestershire and Rutland.

I should also like serious consideration to be given to whether the future of Leicestershire and Rutland still lies with the Sheffield Regional Hospital Board. I believe that the siting in respect of Leicestershire and Rutland is outdated and I believe that one or other of the two suggestions I have made would be preferable to my constituents.

Before I conclude, I wish to draw to my hon. Friend's attention my fears in connection with the geriatric hospital bed provision in Leicestershire and Rutland in a couple of years' time. As my hon. Friend will be aware from the correspondence which has passed between us, for which I am grateful, Hillcrest Hospital in Leicester is due to be closed in 1974. It is calculated on the best advice available that this will lead to a serious deficiency of geriatric hospital beds in 1974.

If one takes the basis that the Ministry uses, that 1 per cent. of the population aged over 65 is or will be in need of a geriatric hospital bed in this area—Area No. 21—one can calculate that the need will be for 1,023 such beds. The latest assessment, arrived at very recently, is that there will be only 735 such beds by 1st April, 1974. That will leave a deficit of 288 which, if it comes about, will be a severe additional burden on local community services. I ask my hon. Friend to bear in mind this warning in order to ensure that the district is not crippled with a large burden by being short of 200 or 300 severely needed geriatric hospital beds.

In conclusion, I repeat a view that I expressed to my hon. Friend in the House some time ago. It is one that I still hold. I want to see a first-class National Health Service, as I am sure my hon. Friend does. I know that both he and my right hon. Friend the Secretary of State are endeavouring to provide a first-class service. It distresses me to know that my constituents are saying that we have not got that in Leicester. We have doctors telling people that the only way they will get much-needed operations within three or four years is by going privately. We have a hospital service which does not live up to the ideals and standards that we need.

1.57 a.m.

Mr. Tom Boardman (Leicester, South-West)

I am happy that my hon. Friend the Member for Harborough (Mr. Farr) has given me this opportunity to confirm his fears and concerns about the hospital service in Leicester and Leicestershire. I speak for the city itself, whereas my hon. Friend has spoken for the county. The hospitals to which he referred, however, serve the constituents of both of us, although the Leicester Royal Infirmary is in my constituency.

I know that my hon. Friend the Undersecretary will be able to refer to the progress which will be achieved at the Leicester Royal Infirmary. We welcome its designation as a teaching hospital. We know that we can look forward to great improvements towards the end of this decade.

Like my hon. Friend the Member for Harborough, however, I am gravely concerned about conditions as they are today. My hon. Friend's analysis of the problem and his suggestion that the Sheffield Hospital Board may be too remote is one which, though I have not discussed it with him, strikes me as having a sound ring of truth to it.

One of the problems about the hospital service as a whole which applies particularly in Leicester is that since 1948, when local responsibility was passed over to regional boards, those hospitals which were well advanced and progressive have been held back so that the others might catch up. In 1948, for example, I understand that the Leicester Royal Infirmary was extremely progressive and well ahead of other hospitals which are now in the Sheffield Board's region. Since then, the board has tended to mark time with expenditure on hospitals which were well ahead and has concentrated on enabling the others to catch up. It is a deplorable state of affairs that hospitals in the Leicester area are having spent on them 25 per cent. less than the national average and 25 per cent. less than hospitals in Nottingham. As my hon. Friend said, one-third more is being spent on other hospitals than on those in the City of Leicester.

The casualty service is causing immense delay and concern to all local residents and to those who go there and see the conditions. I know some of the problems. My hon. Friend the Under-Secretary has been forthcoming in his replies and has given all the help he can. One of the problems has been severe shortage of staff. People who sit for a long time in the casualty waiting room wondering why nothing is being done may be unaware that there has been a serious road accident resulting in two or three casualties demanding all the medical and nursing attention available.

I pay tribute to the medical and nursing staff, who do an absolutely magnificent job. However, it is intolerable that people, young and old alike, should have to sit for hours, perhaps for the best part of a day, in the waiting room of the casualty department.

Then there is delay in dealing with non-urgent operations. A reply I have received from my hon. Friend the Undersecretary today indicates that on 16th March there were 5,098 on the waiting list for non-urgent surgical operations. The largest figure—3,254—was waiting for ear, nose and throat operations. There were 500 waiting for general surgery and 738 waiting for gynaecological operations. I accept that, as these are non-urgent cases, to that extent no medical harm will result to these people from having to wait, but a great amount of anxiety is caused to them and their families through having to wait for years.

Mr. Farr

My hon. Friend will be interested to know that the figure he has given of the number on the waiting list for non-urgent surgical operations is almost exactly the same as the total figure of those on the waiting list in 1966.

Mr. Boardman

I am grateful to my hon. Friend for underlining the point that the position has not improved. One elderly constituent of mine has been waiting for over two and a half years for a hysterectomy. In answer to her frequent inquiries she has been told that she probably will not be called for another two or three years. Such delays are intolerable. A woman with a thyroid which brought up the side of her neck to twice its normal size has been waiting for seven years. There has been an assurance that her health will not suffer, but she suffers grave inconvenience, embarrassment and discomfort. General practitioners constantly raise cases with me as matters causing anxiety to themselves and to their patients.

I believe that the national standard is 10 geriatric beds per 1,000 elderly people. My hon. Friend has reminded the House that in Leicester the figure is under 0.8 per cent., so it is substantially below the national average. It may be said that extra beds would be provided at the City General Hospital, extra beds which would make up for those beds which would be lost when Hillcrest is closed. I understand, and no doubt my hon. Friend will be able to comment on this, that a large number of the additional beds being provided at the City General Hospital are having to be allocated for surgical cases, and one can understand why. Many of them are being allocated to the ear, nose and throat department. Again one can understand that, with 3,000 waiting, but it means that instead of there being more geriatric beds by the end of 1974, there will be fewer. The figure will be even lower than it is today.

The position is getting worse. General practitioners in the city are faced with an almost unbearable task. Many of of them tell me of cases in which they do not know what to do. If a patient living on his own is taken desperately ill during the night, a doctor tries to get him a geriatric bed. One doctor told me that he spent two hours on the telephone trying to get a patient into hospital. These old people cannot live at home where there are no facilities for nursing them and where there is no other member of the family or a neighbour to look after them, even if that was sufficient. Doctors find themselves in a desperate position in their attempts to get these old people into hospital, and I ask my hon. Friend to look at this problem again to see what can be done as an urgent measure.

There is a real fear that patients who require geriatric beds will have to overflow into the welfare beds provided by the social services. That would be a double tragedy because it would mean, first, that beds required for non-sick old people would be used in the wrong way, and that would put an added strain on the staff. Social services beds are provided by the local authorities from the rates, while geriatric beds are a direct responsibility of the Minister.

I recognise the problem, and I know that my hon. Friend is much concerned about the matter. He has visited Leicester and he knows the conditions there. I appreciate what he has done and what he is doing, but I urge him to look at the matter again, because for casualties, for geriatric cases and for non-urgent surgical cases there is a desperate need for something to be done, not at the end of this decade, but now, and I hope that my hon. Friend will be able to give us some assurance about that.

2.8 a.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

I am glad that my hon. Friend the Member for Harborough (Mr. Farr) paid a modest testimony to my interest, concern and admiration for the City of Leicester and. more broadly, for the County of Leicestershire, visiting both of which has given me great pleasure and a good deal of stimulus, intelligence and improvement in my knowledge.

Mr. Deputy Speaker (Miss Harvie Anderson)

Order. I think the Minister will recall that he needs the leave of the House to speak again in this debate.

Mr. Alison

I beg your pardon, Mr. Deputy Speaker. Perhaps I may have leave of the House to speak again. It is no doubt reluctantly granted at this late hour.

I have no hesitation, nevertheless, against the background of a personal concern, knowledge and affection for Leicester and the county in repeating what I was forced to confirm to my hon. Friend the Member for Harborough on 14th December, 1971, when we last talked about this subject, that we accept unequivocally that the Sheffield region is under-resourced and that the hospital service in some parts of the region, including Leicester and other areas in the East Midlands, are under pressure. Much remains to be done in the way of new provision and increased resources in order to enable the region to cope with the growing demand made on its hospital services.

It is true that at least to some extent, but not exclusively, the pressure on hospital services can be measured by the length of waiting lists for admission to hospital. We are certainly not complacent about the waiting list situation in Leicester or, for that matter, in other parts of the Sheffield region falling within the East Midlands conurbation. My hon. Friends have given stark and sombre illustrations of this, certainly in some specialities.

In the more critical specialties in this context, such as general surgery, trauma and orthopaedics surgery and gynaecology, the position is far from uniform. In general surgery, for example, the position at Leicester is better than both the regional and national average situation. In the other two specialties I have mentioned the reverse is the case and in comparing waiting lists with discharges and deaths the position is worse than both the regional and national situation.

Compared with population the position appears to be better in Leicester than both the regional and national situation, although one cannot completely discount the possibility that general practitioners are discouraged from referring patients to hospital because of long waiting lists. By far the largest proportion of the waiting list in Leicester is for admission to the ear, nose and throat department; this is partly due to the effects of staff absence some time ago because of illness, and the lost ground has still to be recovered. I agree that the waiting times for non-urgent cases are above average in some specialities but this position will improve as new facilities now being developed and planned are brought into operation.

So far as waiting times for consultations are concerned, patients with urgent conditions are always seen without delay and non-urgent cases can always have their appointments brought forward if their general practitioner considers that their condition has worsened during their wait for an appointment. The most protracted waiting times for non-urgent cases are in the specialties of general surgery, ophthalmic surgery and orthopaedic surgery.

At Leicester Royal Infirmary the waiting time could be 12 weeks or more. At Leicester General Hospital the waiting time for an appointment in general surgery could be up to 17 weeks. However, the position in other specialties is better and has improved in recent months. For example, the waiting time is now three weeks in E.N.T. and neurology, six weeks in urology and two weeks or less in nearly all other specialties.

As I have already said, we are not complacent about the waiting list situation in Leicester or, for that matter, about the situation nationally. A special study on the personal initiative of my right hon. Friend is in progress to determine how best to secure an improvement. Lengthy waiting lists are an indication of the need to increase hospital provision in Leicester and it must be increased both to cater for service needs and to meet the requirements of the new medical school which it has been decided to open in Leicester.

There is also a need to increase the levels of medical starring in Leicester which the Sheffield Regional Hospital Board acknowledges to be lower than average but progress cannot be as fast as we could wish until the new developments under way in Leicester provide the additional facilities which the doctors need.

In the Sheffield Region as a whole the numbers of medical staff are increasing; as I said in reply to a Question by the hon. Member for Dearne Valley (Mr. Edwin Wainwright) on 29th February, the provisional figures for 30th September, 1971, show an increase of 5 per cent. compared with a year earlier. But there is still a very long way to go before the region catches up with the levels of staffing prevailing over the country as a whole. The developments in hospital building which I am about to describe, and the development of the new teaching hospital in Leicester, will all stimulate growth in medical staffing.

The problems of maldistribution of hospital staff will be urgently studied by the new Central Manpower Committee (Medical and Dental) which has been set up to advise the Secretary of State and which held its first meeting earlier this month. I hope that it will be able to make recommendations which will help the understaffed regions.

The deficiencies in the hospital services in Leicester, which must be rectified to achieve a permanent solution to the problem of waiting times, can be rectified only by capital development. My hon. Friend the Member for Harborough pinpointed this aspect. This is being planned by the Sheffield Regional Hospital Board at the present time.

In the Sheffield Region the demand for hospital services has increased in common with the rest of the country, but due to an inherited shortage of beds and resources it has been difficult up till now to make good the backlog while at the same time meeting increased needs. Although I can understand my hon. Friends' concern for Leicestershire, its situation, recognisably below desirable levels, has nevertheless been better than the situation in other parts of the region. It is a question of priorities, and the regional hospital board has undoubtedly had to face a difficult task.

In its development planning for the area the Sheffield Board is aiming to concentrate its district general hospital services in Leicester, which is the natural centre for the area. The service needs will be met initially by the Leicester Royal Infirmary, which is being developed as the major teaching hospital, and the Leicester General Hospital, Plans are being considered for a further district general hospital also to be located in Leicester.

It should not be thought that there have been no developments in Leicester. To date nearly £6 million has been spent in capital developments, including new X-ray and maternity departments, extension of the pathology departments, a group pharmacy and a new maternity unit at the Leicester Royal Infirmary and a new operating suite, new out patient department and new pathology department at the Leicester General Hospital. Work is in progress amounting to £1.3 million to provide 240 geriatric beds and other improved facilities at the Leicester General Hospital. Work is programmed to start in 1973–74 on Phase II of the redevelopment of Leicester Royal Infirmary, at an estimated cost of £6.6 million, to include 431 beds, 12 operating threatres, four diagnostic X-ray rooms, a new out-patient department and an accident and emergency centre.

On this point I should like to refer to the severe criticisms which my hon. Friends have made about the accident and emergency departments. There is one department serving Leicester and Leicestershire, and it is the largest in the country with 80,000 patients per year. The present department is too small. I admit this unequivocally. There have also been staffing difficulties. Both my hon. Friends know something of the real difficulties which we face nationally in persuading doctors to work in accident and emergency departments. The regional hospital board is looking for ways of reorganising this department in the interim until the new department is opened in Phase II. Meanwhile, I share my hon. Friends' real dismay when long delays occur. A later phase of the Royal Infimary is planned at an estimated cost of £9 million.

Although the establishment of the new medical school in Leicester has presented the board with major problems in planning the disposition of its resources, it will help to augment the hospital services earlier than would otherwise have been the case. For example, the board is planning interim improvements at the Leicester General Hospital amounting to £2 million, including an extension to the out-patient department, for use by teaching staff expected to be appointed by 1973–74. These major capital developments are, I emphasise, under way and compare not unfavourably with the scale of capital development in other parts of the country.

As to the provision of finance, we recognise that the Sheffield Region as a whole has a below-average share of the total moneys available for recurrent expenditure on hospital services. This is being rectified progressively over a period of 10 years, and while it may seem to be a long time before Sheffield achieves parity there are nevertheless compelling reasons why this cannot be done more quickly.

When the National Health Service was set up, regional boards inherited wide disparities in resources both financial and physical, and standards of service varied appreciably between regions. Since 1948 it has been the aim to reduce these disparities and this has met with a fair measure of success; but progress has been slow and somewhat uncertain. For a long time the annual development addition in real terms to hospital revenue expenditure was too small to allow the gap between the deprived and favoured regions to be closed except at a very slow pace.

Rightly or wrongly, we rejected the alternative of building up the deprived regions at the expense of cutting back services in the more favoured regions and recognised the need of all regions to develop services to allow for population increases and the use of modern medical practice and techniques.

In recent years the annual development addition to hospital revenue expenditure has in real terms been considerably increased. In 1970 my Department therefore decided, after consultations with regional hospital boards, to allocate revenue by means of a formula which over the 10 years from 1971–72 would progressively achieve a more equitable distribution of revenue between regions and lead to a better balance in the levels of service provided throughout the country. My hon. Friends will share with me pleasure that it has been under the present Government that it has been possible to launch a 10-year plan with the object of diminishing and gradually eliminating disparities which have been such a blemish in regional comparisons.

I will not go into the details of the formula, which was first used to make hospital revenue allocations to regional hospital boards for 1971–72. The effect of the formula is to increase progressively and considerably the additional development revenue allocated to the deprived regions while the rate of increase in the revenue allocations to the more favoured regions is held back.

I stress that it is the additional revenue that is adjusted, not the basic revenue required to run existing services. By about 1980 it is expected that an equitable distribution of revenue will have been achieved between all regions. Among the principal beneficiaries will be the Sheffield Region.

The basis for distributing capital is also being reviewed. At the last definitive distribution in 1968 the basis was primarily population both present and forecast to 1981, with an allowance made for the fact that those over the age of 65 make substantially more use of hospital services. Some account was taken in a subjective basis of the services in each region. We are now considering whether account could be taken of the relative needs of regions for capital on a more objective basis, while not placing an undue burden on regional hospital boards in assessing these needs.

Hospital expenditure per head of population in the Leicestershire area is lower than that for the Sheffield Region as a whole. In 1970–71 it was £12.2 compared with £13.9. The corresponding national figure was £16.5. Nevertheless, as the allocation per head in the Sheffield Region progressively increases relative to that of all regions, so does expenditure in Leicestershire. For example, expenditure per head of population in Leicestershire in 1970–71 increased by 19.6 per cent. over that in 1969–70, compared with an increase nationally of 17.9 per cent.

However, revenue support in itself can only help to the point where shortage of hospital facilities needs to be remedied by capital development and, as I have explained, massive capital developments have already been planned for Leicester. As these developments mature, recurring expenditure will rise rapidly in the area to meet the cost of additional medical, nursing, professional and ancillary staff as well as the additional services and facilities that will become available. The huge capital input in Leicester will in turn generate very much higher levels of recurring expenditure and will thereby reduce the disparities which we so much regret.

As my hon. Friends know, it has been decided not to divide the existing Sheffield Region, with the exception of South Humberside. This decision took into account the views of all interested bodies made known both at a meeting specially convened for this purpose in Nottingham and by correspondence following the publication of the consultative document on the reorganisation of the Health Service. I had the privilege and pleasure of chairing the half-day conference which took place in Nottingham for which all interested parties gathered together precisely to exchange views on the subject of how the region should be considered in the future, whether it should be split into two, whether it should be split, and so on. Against that background my right hon. Friend decided that it was quite right, given full consideration of all the alternative options, not to divide the Sheffield Region.

My hon. Friends will also both be aware that under the reorganisation Leicestershire will become an area health authority in its own right and will be largely responsible for developing services within its own area. The needs of Leicestershire will continue to receive the special attention which they deserve.

Both my hon. Friends referred to the anomaly of the headquarters of the region being located, as my hon. Friend the Member for Harborough put it, 60 miles north up the motorway. The question of where the future headquarters of the new regional health authority will be is by no means determined by reference to the fact that we have decided to leave the existing region undivided. It does not necessarily follow that the future headquarters will be in Sheffield—but I must not stray further into prophesies or forecasts—from the fact that we are leaving the Sheffield Region, as it now stands, virtually intact.

Under the existing organisation the needs of Leicestershire have not gone unheeded by the regional hospital board or by my Department, although in the face of the competing demands on the resources available it has not been possible to remedy long-standing deficiencies as soon as we would have wished. Nevertheless, much progress has been made, is being made and is in prospect. The situation will not be wholly redressed until the major development schemes now in progress have matured.

I expect that there will be a number of subsequent debates in which the point is rubbed home. I am happy to be able to point to solid plans that committed allocation of current and revenue funds will help with the removal of disparities.

Mr. Tom Boardman

Is it true that there are plans for fewer geriatric beds by the end of 1974 than there are today? That is a matter of very considerable importance.

Mr. Alison

I think that I have notice of a Question from my hon. Friend on this matter. It may not be in order for me to anticipate in detail the full and somewhat lengthy reply which my hon. Friend will presently be getting but, taking it out of context, I can confirm that the board envisages that on 31st March, 1973, geriatric beds per thousand of the elderly population will be 9.2 as opposed to 9.4 on 1st January, 1972. The differences in numbers per thousand at this level are marginal. But I can reassure my hon. Friend by saying that the extra geriatric beds in view under existing committed plans will rise to up to 10 per thousand of the elderly upon completion of this phase of our development by 1976, which will bring it up to the national average. It may be better for my hon. Friend to await the definitive answer. Perhaps he could then correspond with me about further questions.