HC Deb 09 July 1973 vol 859 cc1217-30

12.42 a.m.

Mr. Wiliam Price (Rugby)

I am grateful for the opportunity of this Adjournment debate to raise a matter of vital importance to every family in Britain. I believe that we shall face an unprecedented crisis in our hospitals within 10 years. My specific anxiety concerns the St. Cross Hospital, Rugby, a project which has already been debated three times in this House. I am concerned also with the general capital building programme within the Birmingham Regional Hospital Board area. It is clear that the £4 million development at St. Cross is as far away as ever it has been. We waited many years for it. We are no nearer to our objective than when we set out. What is worse is that the Birmingham Regional Hospital Board, as is its habit, has smacked the dab hand of secrecy across the whole miserable affair.

On Midlands Television recently the Secretary of State was asked about fears that I had been expressing about the hospital cuts and he replied: He may have in mind some hopes, or even expectations, that have been created without any real basis. The Under-Secretary of State knows perfectly well where my hopes came from. I have a great regard for him and I have no wish to be spiteful. He has always been most helpful to me. I only hope that his memory is better than that of the Secretary of State.

I will remind the hon. Gentleman where those hopes of mine, which the Secretary of State says were created without any real basis, came from. He was at the meeting in Rugby in May 1971 when officials of the Birmingham Regional Hospital Board gave the most specific pledge that we should get 160 new beds and ancillary services at St. Cross Hospital by 1979 at the latest. I invite him to confirm whether that promise holds good. My information is that it is not worth the paper on which it was printed. We have no hope of getting those beds. We have been conned. The board has told us nothing officially. We live with no real hope.

We would not even know what the position was unless, after receiving strange and conflicting answers in the House, I had asked to see the Minister. That meeting took place on 21st May. At least I can say that he spelt out the position to me very fairly and fully and, I believe, very honestly. I was told by him and his officials that for a variety of reasons the hospital building programme envisaged for the late 1970s would not go ahead as planned. The main reason appears to me to be a levelling-off of expenditure after the peak of the mid-1970s.

There was to be no doubt about it. I was assured that the Rugby project had not been pushed back down the queue, as it had been so often in the past, that what had happened was that the whole queue had gone back down the street and that what was true in the Birmingham region, what was true in the Coventry hospital management area, was equally true for the rest of the country.

In the same television interview, however, the Secretary of State denied that hospital building in the West Midlands had been put back. He said: On the contrary, Birmingham, like the rest of the country, has benefited from an increase in real spending power. To put it as generously as possible, there appears to be some conflict within the Department. Either the entire building programme, including St. Cross, will go ahead as planned or it will not. I am in no doubt.

I think that the Under-Secretary is right, and he and I know the reasons. Recent reports have spelt them out only too clearly. The health service has been starved of funds for the past 25 years. We now spend less on it than does practically any other developed country. That is why we have acute overcrowding in the Birmingham region, 60,000 people on the waiting list for admission to our hospitals and many decrepit hospitals. That is why more and more people who can afford it are opting out and purchasing their own protection.

The prospect before us is even less appealing. In Rugby, as in many other places, we have waited year after year for our hospital developments. If we get them in the next decade and a half we shall be lucky, and no one is even prepared to give us that guarantee. Indeed, from the Birmingham Regional Hospital Board there is no guarantee: there is not even information. If it had not been for the campaign run by the Birmingham Post and my own Questions in the House, with occasional help from my hon. Friend the Member for Nuneaton (Mr. Leslie Huckfield), no one would know anything.

The board is a very strange animal. Its behaviour was summed up in an editorial in the Birmingham Post on 22nd June, when it said: The manner in which the Birmingham Regional Board conducts its affairs is rapidly becoming a public outrage. It returned to the attack five days later with this comment: In a letter on this page today a spokesman for the Birmingham Regional Hospital Board takes the Post to task for criticising the board for the lack of information it gives to the public. Not to divulge information is clearly the policy of the Board and, therefore, of course, of its officers, for today's letter gives absolutely no information at all and merely repeats the wearisome excuses of the Board as to why it has nothing to say. That is a fair assessment. I am not surprised that the Birmingham Post is becoming agitated. So am I.

The board had an urgent meeting about capital expenditure with Ministry officials and promised a full statement afterwards. We had one. It consisted of four sentences. There was a refusal to elaborate. Those sentences said nothing. But that was a major step forward. Four sentences from the Birmingham Regional Hospital Board is a major policy statement.

Meanwhile the row in Birmingham continues. I quote from one newspaper's recent headlines: Doctors deplore delay in Selly Oak Hospital improvements. Another headline asks: Why this secrecy?—consultants ask." The next headline says: Urgent hospital plan 'put back by Government spending limits.' There are then three headlines which I should mention. The first says: MP reveals that hospital building estimates will not be increased. The second says: Midland MP tables his first 20 questions on hospitals. The third says: MP plans 100 questions to beat secrecy over hospitals.

Mr. Leslie Huckfield (Nuneaton)

Name him.

Mr. Price

He is a modest and gentle soul. More Questions are coming. There are another 20 on the way. They will be tabled on Wednesday.

I find the board's apparent belief curious. It seems to think that, if it says nothing, that will be the end of the matter. It seems to believe that no one will do his homework and that we shall act like good boys in the face of a stern headmaster. It should know by now that it has no hope at all.

It was the Under-Secretary of State who served me with the necessary information in a letter dated 29th June. He said: In the sense that the whole of the tentative programme for later years has been reconsidered by the Board, it is fair to say that a number of major schemes have moved from the position originally envisaged for them. That is a gentle way of saying that many major hospital schemes in the region, and inevitably throughout the rest of the country, have been dealt the most grievous blow. No other interpretation can be put on the Minister's remarks. That leaves the hospital of St. Cross of Rugby where I came in eight years ago, despite one assurance after another in the presence of Ministers and otherwise. We have about as much chance of getting a new hospital as I have of being the next leader of the Conservative Party.

Mr. Huckfield

I should not say that. That is a possibility.

Mr. Price

We are not, as the Minister knows perfectly well, unreasonable people. It was not easy, after the meeting in 1971, for me to go to my constituents. The hon. Gentleman knows what a hot issue this is for me. It makes the Common Market pale away into insignificance. I had to go and tell them "I am awfully sorry, but it will be another eight years." But I did it. He knows that I did it. Now I shall have to go back to them and tell them "Brothers, it was to be eight years but the authorities did not really mean that at all. It may be 10 or 12 years, but it is much more likely to be 15 years." They will not be at all happy about that.

Meanwhile the board, with its monolithic organisation which operates as a law unto itself, plods on apparently oblivious to criticism. It seems determined to keep bad news to itself. It does not even give out good news. For reasons which I do not understand, officials of the board would not even tell me the time of day. I have to go to the Minister for my information. Every so often the board makes a statement saying, "Price has not come to us for any information for six months." I have not been to it for information for six years. I found a long time ago that that was not a productive exercise. I ask the hon. Gentleman for information. I do so by Questions and Adjournment debates. It was at a private meeting that he was kind enough to tell me what I was up against.

All I can hope for tonight is confirmation of my worst fears, which I repeat, are simple enough: that because of a cutback in the late 1970s, so far largely unnoticed in the House or outside, there has been, or will be, a savage reappraisal of all major hospital developments throughout the country. That is a tragedy for the tens of millions of people who depend on the health service. It is a situation of which everyone in this House should be thoroughly ashamed. It is one which makes me despair. I see the crises of the past in the health service, and I see the disasters of the future.

12.56 a.m.

Mr. Leslie Huckfield (Nuneaton)

I congratulate my hon. Friend the Member for Rugby (Mr. William Price) on once more raising with vivid determination the question of the activities of the Birmingham Regional Hospital Board. My constituents and the Nuneaton Borough Council had exactly the same assurances from the Birmingham Regional Hospital Board about the new district general hospital in Nuneaton. The trouble was that, with the board's usual bungling incompetence, it even got the population of Bedworth and Atherstone wrong while it was giving those assurances.

When I was a member of the Birmingham Regional Hospital Board, even when it had money it said either that it had insufficient projects to occupy the allocation of it or that the architects' department was overcrowded. If ever a hospital board needed investigation by the Department, this is it. When it has money, it does not know what to do with it. When it has worthy projects, it cannot find the money. I do not know whether in the past it has been a question of its concentrating too much on major projects. When, as a member of the board, I proposed minor improvements, I was told that most of the board's capital allocation was being consumed by fairly major projects. Now the board seems far too consumed by minor projects so that it cannot undertake deserving major projects like the St. Cross Hospital at Rugby and the new district general hospital at Nuneaton. The activities of the board need to be examined.

When public expenditure cuts were made by the Department two or three months ago, we were told that hospital building projects would not be affected. If the Minister can give a stringent denial that the hospital cuts to which my hon. Friend referred are not connected with those cuts, it will be some reassurance. If he says that the regional hospital board failed to make sufficient allowance for inflation, that is a bad reflection on the regional hospital board. If these cuts are not part of the public expenditure cuts, I want the hon. Gentleman, if he can, to say so. If it is the board's fault because it has failed to allow for inflation, it is an even more serious condemnation of the board.

The effect on my constituents has been exactly the same as that on my hon. Friend's constituents. Imagine the effect of all the reassurances which have been given time and again by the very efficient public relations department of the Birmingham Regional Hospital Board. It knows how to do public relations because the board's PR man used to be assistant editor of the Birmingham Post. It is the only newspaper which seems to have cottoned on to him. It is one of the few newspapers which he has not managed to nobble.

Constituents have said to me time and again "If the Birmingham Regional Hospital Board intends to build a new hospital in Nuneaton, why is it spending so much money on improving the present hospital?" If it is serious about bringing the bulldozers on the site, why should it spend so much time and money on patching up the existing hospital?

I can assure my hon. Friend that the board acts in a very secret way. Once when we had a board meeting there were people outside trying to find out where the board met. The vice-chairman of the board called the police and they sat at the hack of the room for the rest of the board meeting, no doubt in case some of the information got outside.

I know that the Minister may not be able to give me any specific assurances tonight. If he cannot do so, I sincerely ask him to write to me. We had an assurance and many other parts of the Midlands have had assurances. Although I have some regard for the hon. Gentleman, I shall not believe anything until I see the bulldozers on the site.

1.0 a.m.

Mr. John Golding (Newcastle-under-Lyme)

What my hon. Friend the Member for Rugby (Mr. William Price) has said applies in general terms to North Staffordshire too. I ask the Minister to tell us the plans for hospital development in North Staffordshire, where the situation is far from satisfactory, and to give an assurance that no proposals that have been made so far will be held up in any way.

1.1 a.m.

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

My natural benevolence would lead me to wish to refer to the hon. Member for Nuneaton (Mr. Leslie Huckfield) and the hon. Member for Rugby (Mr. William Price) as the heavenly twins of the West Midlands. But, alas, the style of their speeches tonight and the presence of the hon. Member for Newcastle-under-Lyme (Mr. Golding) makes it obvious that they are the three furies.

I shall deal with only one fury, the hon. Member for Rugby, whose Adjournment debate it is, but I shall certainly take note of what has been said by the hon. Member for Nuneaton and the hon. Member for Newcastle-under-Lyme. The hon. Member for Newcastle-under-Lyme has asked me so many questions on this subject that I can hardly give him more information, but I will try.

The hon. Member for Rugby started with the national picture and I shall start with that and end by dealing with Rugby, for we have to consider the position of the Birmingham board in the national context.

It goes without saying that many of our hospitals are not up to modern standards and patients receive devoted care behind old walls, as the House knows well. The inheritance of our generation has been a hospital service that has not renewed its stock of building for many years. We started building new hospitals in this country only as recently as 1962. This is a situation that we all wish to see rectified and there has been a considerable increase in hospital investment in the National Health Service over the past 10 years.

When the Hospital Plan was presented to Parliament in 1962, capital expenditure on hospitals in England was £33 million, the equivalent of about £60 million at current prices. At the time of the revision of the plan in 1966 the level had risen to £75 million, about £120 million at current prices. We estimate that in the current financial year, 197374, hospital capital expenditure will be £227 million, an increase more than threefold in real terms since 1962. Under the present Government alone expenditure on hospitals has increased by about one-third in real terms.

The capital allocations made to the Birmingham Regional Hospital Board for its main capital programme reflect the rapid growth in hospital investment over the past few years. The board's capital allocations rose from £9.3 million in the first year in which the Government came to power to £17 million in 1972–73, an increase of about one-third in real terms.

My right hon. Friend the Secretary of State intends to maintain a high level of hospital capital building. It is expected that expenditure on hospitals in England will be some £850 million in the five years from 1972–73 compared with about £650 million in the previous five years, again at comparable price levels. After allowing for a change in the definition of "capital", with which I shall deal later, the increase in real terms in the current quinquennium is about 25 per cent.

I should like to say a little about the distribution of hospital capital among the 14 regional hospital boards. To ensure that each board is treated fairly, ideally we need a fully costed programme for all regions based on objective assessments both of need and of the quality and quantity of existing services and an assessment which takes account of the practical scope that there may be for modernisation and adaptation of all existing buildings at reasonable cost. But at present we have neither a comprehensive assessment of need nor a thorough going audit, as it were, of the existing stock. We must therefore do our best from year to year using the measures available to us.

In the most recent capital distribution, that of the autumn of last year, we based our allocations largely on forecasts of future population weighted by age and sex. We have taken account of shortages of geriatric and acute beds in aggregate and the extent of teaching provision in each region. At present, allocations to regions are made on as objective a set of criteria as we can devise. We realise that our criteria are far from perfect and we are continually trying to improve them.

It is precisely because we have tried to improve the criteria for splitting up the capital between the 14 regions that every look at the 10-year plan from year to year as it rolls forward must lead to situations in which some of the longer-term forecasts change, because every time we succeed in getting better criteria for assessing the real needs of a region we may have to make, towards the end of a 10-year period, a switch from one region to another because we understand more about the relative needs in terms of the ages, the special needs of the elderly, the mentally handicapped, and so on. They vary between regions, and as we get to know the realities of a region it stands to reason that we should be prepared to make some switches.

I turn to the particular problems of the Birmingham Regional Hospital Board. The board did not benefit, indeed it lost out, from the modified distribution of capital which we introduced on revised criteria in 1972. I emphasise that I believe that, on the new distribution method, an improvement has been made on the lines we tried to organise. At the same time it has had to face the ending of the "once off" programme for the improvements to the accommodation of the elderly which my right hon. Friend introduced as a once-for-all operation when he first came to office.

All these factors have created special difficulties for the Birmingham board and it will not receive as much capital over the next few years as expected, and as we expected it would under the criteria we were looking at earlier. It has therefore had to review its programme and defer some capital schemes. This is where we we come to the decision of St. Cross Hospital, Rugby. Phase one of the redevelopment of this district general hospital has already been completed. In April 1970 the board submitted proposals to my Department for the subsequent development of St. Cross whereby it would replace the existing St. Cross, St. Luke's and St. Mary's Harborough Magna hospitals.

My Department approved these proposals since, taken together with a new district general hospital at Walsgrave, they seemed appropriate for the area as a whole. Aspects of this proposal were unpopular in Rugby, as the hon. Gentleman knows, where some feared that there would be a diminution in the status of St. Cross Hospital to that of a cottage hospital, as someone said. To try to clarify matters, a series of meetings was held between board members, officers and local interests, when the proposals were explained in detail. At that time the board gave an assurance that planning of the development would be completed by 1974–75. I understand that this target at least is expected to be met.

At a meeting I attended the board expressed the intention, and I readily confirm it, that 160 beds of the new development would become available within 10 years, by 1981. The board expressed its intention against the background of expectations of capital allocations which, for the reasons I have outlined, have not been made. The revised criteria mean that it will not be getting as much towards the end of the 10 year period as it expected. The board has been forced to reconsider its programme and is now of the view that it will be unable to fulfil its expressed intention.

I fully realise how disappointing this is to the people of Rugby. In one sense it shows how dangerous it is to try to be too specific and forthcoming about firm starting dates a long time in advance of the work actually being started on the ground. When the intention was expressed the board felt confident that it could be met. Factors which are largely beyond its control have forced it to reconsider the position. It can hardly be expected to sacrifice schemes which in its view are even more necessary than the second phase of St. Cross. At the same time, neither the board nor I like to disappoint expectations. With reluctance, the board at present feels that it must go back on its expressed intention, as it has had to do in other cases. While I am full of sympathy for those in Rugby who will be disappointed by the decision, taking an overall regional view I believe that the board is right to do so.

The hon. Gentleman may say that I was associated with the expressed intention and therefore the central Department should provide funds specifically to enable it to be fulfilled. Again, I regret that, taking the wider national view, I cannot agree to this. Indeed, the slippage of St. Cross is due to the attempt, through national criteria, to give a fairer distribution throughout the country as a whole, taking account of and giving priority to other areas where there is even greater deprivation.

The position is that the Birmingham Regional Hospital Board cannot say when the second phase of St. Cross will be completed. The new West Midlands Regional Health Authority will be taking responsibility for Rugby on 1st April, 1974 and will have to make its judgment as to the future programme. It will then consider the degree of priority that should be attached to St. Cross. While I realise that this is of small comfort to the local population, this is how matters stand at present.

The picture is not altogether one of sombre gloom. St. Cross Hospital has been firmly designated for development as a district general hospital. These are not paper plans or projections. Phase one of the St. Cross Hospital has been completed. Other developments are also proceeding. In this year alone we intend to start capital developments costing £225,000. This includes the provision of a mental health day centre, the upgrading of engineering services, dispensary and drug store, additional boilers, and wall sluices. These are a foretaste that we do intend not to run down St. Cross but to develop it. It is one question in an agonising series of priorities extending throughout not only the Birmingham Regional Hospital Board but other parts of the country, particularly the South West, where there is an appalling backlog of geriatric provision and other facilities because they have been starved of capital.

It is a sad fact that, in our new criteria for allocating capital, we are having to put Birmingham at a relative disadvantage compared with other regions, but I confirm—

The Question having been proposed after Ten o'clock on Monday evening,

and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twelve minutes past One o'clock.