§ 12.32 a.m.
§ Mr. Arthur Davidson (Accrington)The title of the debate is somewhat misleading, because it refers to the maternity unit at Accrington Victoria Hospital. In fact, we do not have a maternity unit. The purpose of the debate, despite the title, is to draw the Minister's attention once again to the need for a new maternity home in Accrington. I say "once 207 again" because, as my hon. Friend will know, this is not the first time that I have raised this matter in the House.
Some years ago I raised the matter in a similar Adjournment debate, also in the early hours of the morning. It is a sad reflection on the state of affairs as a whole that several years later we should still be without a maternity home in Accrington, though plans are now positive for the building of a 17-bed unit, plus a new out-patients' department, in the old nurses' home.
The history of the maternity unit, or the lack of a maternity unit, is littered with delay, deferment and disappointment. Therefore, once again I have to raise this matter, but I am happy to do so in conjunction and associating myself with the excellent, forthright and continuing campaign being run by the Lancashire Evening Telegraph under the title "Hands off our hospitals." The Minister will no doubt be aware of this campaign and will have seen the cuttings. I am sure that my right hon. Friend the Secretary of State for Social Services, who is most diligent in noticing everything that goes on in North-East Lancashire, will have personal knowledge of this campaign and will be sympathetic.
I know that my hon. Friend is aware of the sad history of this whole affair. It was then considered outdated and inadequate, and yet today, about 13 years later, the 11-bed maternity home still provides the only maternity facilities in Accrington.
The Minister will know, if he has read the reports in the Lancashire Evening Telegraph and elsewhere, that the home is outdated, but the staff do magnificent work, and the birth rate is about 365 a year—almost one a day. I am sure that the Minister, being a doctor, will realise that it is inadequate and deplorable that such conditions should exist in 1974. This is not to decry the staff or the excellent work that they do. The home is regarded with great affection throughout Accrington, but it is still totally inadequate to meet the needs of 1974.
The 20-bed plan was put forward in 1961. A couple of years later a new plan came into being. This was to build a 40-bed unit on waste land beside the 208 hospital, and this was to be linked to the main building by a tunnel under Whalley Road. The estimated cost was about £500,000. It was possibly rightly considered to be too expensive, and the project was then shelved.
However, the fight for a propel maternity unit went on, and in 1967 I presented to the then Parliamentary Secretary a petition, signed by about 17,000 people, which had been organised by the then medical officer of health and which had been campaigned for vigorously by two former mayoresses of Accrington, Mrs. Pollard and Mrs. Frances Smith.
That culminated a couple of years later in possibly the largest meeting ever attended by representatives of the regional board—they said this—at the town hall in Accrington. It was agreed that a 20-bed proposal, which was being put forward by the board itself, would be proceeded with. Although the audience and my constituents felt that a 40-bed unit was correct, the local medical practitioners in their wisdom—and possibly they were right—felt that a 20-bed unit was adequate, and we are prepared to accept that. It was understood that this was to be built in the old nurses' home, and the nurses moved out for the unit to be built.
A couple of years later there was further bad news. We then learned that the 20-bed unit was not to be built, but that a 17-bed unit would be built instead, but this would also mean that alongside it or as part of the nurses' home there would be a new out-patient department, and possibly this was a better use of the nurses' home than building only a maternity unit.
It was the Accrington Observer which drew attention to this change. I took the matter up, as did that newspaper, and we were at least partly assuaged in our anger by the fact that the unit was to be built and had been included in the building programme for this year. However, earlier this year we learned that there was to be a further deferment. This was the direct result of the deplorable public expenditure cuts that were announced by the previous Government in December. I was one of those who pointed out at the time how badly North-East Lancashire would be hit by those 209 cuts, and this is just one of the direct results. The cuts have extended to education and elsewhere, but it would not be right for me to refer to that in this debate.
The first purpose of the debate is to draw my hon. Friend's attention to the need for a definite decision. If he cannot restore the cuts to the extent of guaranteeing that the maternity unit will be built this year—and I do not expect that he can, for it is too late—I should like at least an assurance that it will be given the earliest possible priority, and that it is intended to proceed with the 20-bed or 17-bed maternity unit and outpatient department at the earliest possible opportunity.
The second purpose of the debate is to draw attention to the fact that North-East Lancashire has been treated very badly and unfairly over the years in the way in which resources have been given to it for hospital building as a whole. One of the points the Evening Telegraph and the regional committee have made is that over the years the North-West has received far less than its fair share compared with another region. They point out that the North-West, with 9.5 per cent. of the population of England and Wales, has received only 7.2 per cent. of the money distributed for hospital building since 1948. They are deplorable figures. It is scandalous that that situation should have gone on so long. I hope that my hon. Friend will say that he intends to rectify it at the earliest opportunity.
I hope that the new basis for allocation will not be purely that of population, although that must be one of the factors. My hon. Friend must also take into consideration the state of hospital building as a whole. In the North-West there are probably more old and dilapidated buildings than in most other regions.
Apart from that, North-East Lancashire has suffered doubly badly because it has had less than its fair share in a region which itself has had less than its fair share. That state of affairs must also be rectified.
There is not a great deal more I wish to say, because I know that my hon. Friend is aware of the problem, as I have discussed it with him privately. It is unfair that a whole region should be served by 210 an outdated 11-bed unit which was built as a home, which has been adapted, and which has many inadequacies. It is in need of repair. It does not even have a lift. It is scandalous that mothers in that late stage of pregnancy should have to be carried upstairs in 1974.
I visit the unit regularly, and I pay tribute to it. I visit it most Christmases. Only two or three Christmases ago Mrs. David Lloyd, the wife of the distinguished cricketer who has batted so well for England recently, had a Christmas Day baby there. Many distinguished citizens of Accrington have had babies there. But the unit is now too old and there is an urgent need for an immediate start on building the new 20-bed or 17-bed maternity unit and out-patient department in the old nurses' home.
I hope that the debate has highlighted the need, and that my hon. Friend will have reasonably encouraging news to give in reply.
§ 12.44 a.m.
§ The Under-Secretary of State for Health (Dr. David Owen)I am grateful to my hon. Friend the Member for Accrington (Mr. Davidson) for the way in which he has argued his case. I know that ever since he has been a Member he has taken a considerable interest in this aspect of the health services affecting his constituency. I very much regret that over the years he has experienced disappointment, delay and frustration, which are shared by his constituents.
I assure my hon. Friend that, following my own discussions with him and my discussions with the Secretary of State and with the regional health authority, we are both well aware of the problem, and, as my hon. Friend knows, the Secretary of State has a particular interest in this area and an extreme knowledge of it. I have discussed the whole problem with her. I have also read the campaign being conducted in the local newspapers, and I welcome the interest they are taking in the health service and the recognition they have shown that this requires extra resources.
I want to deal with the issue. I do not think that the House needs any further elaboration from me of the history. My hon. Friend is well aware of the changes and the delays, but it is worth putting on record the main facts. The size and 211 nature of the maternity unit have been debated over many years, and undoubtedly have been changed from time to time, but since mid-1973 it has been decided by the then regional hospital board that, first, it would be a 17-bed unit on the first floor of the former nurses' home, the ground floor being needed for out-patients. I recognise that even that reduction of beds from 20 was disappointing. Secondly, it was programmed to start in 1973–74 at a cost, then, of £181,000, but it did not start in 1973–4, having been caught by the three-months' moratorium on building starts. Thirdly, it was decided that it would replace the Rough Lee general practitioner maternity unit—11 beds—which would in due course be closed.
The problem has been that it was delayed because of the first sign of the economic difficulties that were starting in 1973–74 under the previous Government, when there was a considerable moratorium on building starts.
It was then affected savagely by the December 1973 cuts. The then Government announced reductions of about £1,200 million in public expenditure planned for 1974–75, including a reduction of one-fifth in capital programmes. For hospitals and community health services in England alone this meant a reduction of about £45 million.
Then, coming to 1973—at the end of 1973—for the 1974–75 programme the question facing the Department and the health service was how and where this cut was to be applied; it was inevitable that sacrifices would have to be made and that cherished schemes would have to be postponed. The problem was how to minimise the adverse effects while still achieving real economy.
My right hon. Friend has from time to time championed in the House the need to spend money on the health service and, what is more, has been prepared to go to the electorate and argue for increases in taxation, and I find it strange that now, after the first three months of the first financial year, people seem to be disregarding the effects of the December cuts in the health service, the hospital programme and, particularly, the education programmes.
When we looked at the way in which these cuts would operate it was decided 212 that apart from special allocations for geriatric service, certain teaching hospital schemes and certain ex-local authority schemes, the allocation of capital to regional health authorities for 1974–75 should be based on the following factors: first, the needs of authorities to meet the contractural obligations of their predecessor regional hospital boards; secondly, the need of authorities for a programme of essential small schemes and the purchase of essential equipment; thirdly, provision for the highest priority major schemes planned to start in 1974–75. To this end the Department's officers made visits to every regional health authority and discussed in some detail the programmes they were inheriting from their predecessor regional hospital boards.
The Government decided that priority was to be given nationally to services for the mentally ill and the elderly, services for the younger chronic sick and mentally handicapped and certain other services, including fire precautions. Within these guidelines the North Western Regional Health Authority decided as a matter of principle that schemes designed to enable services to be provided where none already existed should take precedence over schemes designed to improve existing services. Though I recognise that the scheme is new, it is designed to improve existing services. The resultant main programme allocation for the North Western Regional Health Authority for 1974–75 was £11.6 million to cover all capital expenditure, including the purchase of land and property, ambulances and equipment.
I do not disguise from the House that regional health authorities had an unenviable task in trying to select priority schemes from a list of schemes all of which were important enough to be scheduled for commencement of building in the succeeding financial year. The new maternity unit at Accrington Victoria Hospital is intended to replace and improve upon existing facilities at Rough Lee. It could not be treated as essential however desirable an improvement it might be. It was one of a number of larger schemes which suffered the same fate, so it cannot be suggested that Accrington has been singled out for unfavourable treatment. It is, I fear, the consequence of the substantial cuts in public expenditure affecting the health services.
213 My hon. Friend can rightly ask what we have done to try to alleviate the situation. As he knows, one of the biggest problems we have, far from restoring the December cuts, is to ensure that the consequences of inflation do not undermine the position any further. My right hon. Friend was able to announce last week that an extra £40 million would be made available, which reflects the increase in the running costs so far this year, for hospital and community health services. In national terms, it is an increase of about 40 per cent. We read in the newspapers that this sum was considered by the British Medical Association at its conference in Hull to be "derisory". All I can say is that there are many other areas in the country which would consider £40 million a substantial injection. Of course it is not enough, but it is an attempt to show that, subject to the requirements of general economic policy, the Government are determined to make further additional allocations in the light of experience of price increases in such a way that the growth of expenditure in real terms will be maintained at its planned level of around 2 per cent. in the current financial year.
The growth would have been 3½ per cent. had it not been for the severe cuts in expenditure imposed by our predecessors last year. Had we taken no action, that growth rate would have been cut even further. Already money has been provided to meet extra costs arising in the health services which were until April this year the responsibility of local authorities. Details of those sums to be allocated to health authorities have not yet been finally settled and we are having discussions with regional health authorities about this.
This brings me to the other important point raised by my hon. Friend on the North Western Region and particularly the capital allocations. As my hon. Friend knows, a deputation from the North Western Regional Health Authority saw my right hon. Friend and myself on 24th June. The chairman of the authority referred to the "Handbook of Information" prepared by the regional health authority for the meeting with Members of Parliament and emphasised the points made in that document. He felt that the region was deprived as measured by cri- 214 teria bearing on the quality of life. Nobody who knows that region would deny that. He thought that in future the region needed greater allocations than would derive solely from population criteria to compensate for the past when its allocation of resources had been less than the national average. While he agreed that the service depended on people rather than buildings, a theme we have tried to emphasise over the last few difficult months, lie felt that staff could not be attracted to work in appalling conditions.
We said that we accepted that the region had not done as well in the past as had others. Nevertheless, between 1968–69 and 1972–73 the Manchester Regional Hospital Board's main capital allocations were slightly greater than the national average on a population basis. For 1974–75 the North-Western Region received for new work an allocation matching the national average, and it had been subsequently augmented for the Preston Hospital scheme. Its total allocation fell short of the national average because its commitments to contracts already let was less than the national average. It was also said that Manchester Regional Hospital Board had tended to underspend on capital to a greater extent than the national average, and that this might be due to its approach to the design and planning of major schemes. But it has this relic of a very large stock of old buildings, and I think that it has put a high priority on maintaining existing old buildings and not felt able to start as many new complete capital schemes as perhaps some other regions.
Since coming to office in March, we have never made any secret of the fact that we are not happy with the way that money is allocated to the regional health authorities. In the past a distribution predominantly population based has been gradually correcting this imbalance, but we want to accelerate the pace of change and give a higher priority to redressing inequalities of care and health standards throughout the country. We have made it clear that we are now actively involved in taking steps to change the existing basis for the allocations. But if we are to re-allocate expenditure and be selective in the way we spend money, we have got to carry the rest of the regions with us. As I have stressed from the Dispatch Box previously, any new system has to be 215 based on objective criteria, not on subjective criteria.
I think that the regional hospital authority accepted that it was possible to have assistance in 1974–75 with only smaller schemes such as health centres, and here the present Government have made substantial increases in the provision for health centres over that which we thought we would be able to make when we came to office. I think that the authority accepted that it would not be possible, on account of its size, to start now the Accrington scheme, which had been deferred from 1974–75.
As to next year, on which my hon. Friend has quite reasonably pressed me, I can only say to him that this must be a decision for the regional health authority. It is well aware of the feelings in Accrington. It has accepted the obligation and much of the need. A lot will depend on the resources that can be made available to the region and the relative priority that it gives to the various different schemes that apply in its area. I cannot pre-judge, therefore, decisions which it is likely to make in applications for the next year. But my hon. Friend has made a very strong case, both on the specific issue of the maternity unit at Accrington Victoria Hospital and on the more general but none the less important and related issue of the capital allocations to his regional health authority.
216 The capital allocations to the regional health authority are decisions for central Government. At present I cannot say what will be the result of the studies, and it will take time to make the sort of substantial change which I think will be necessary. But of this my hon. Friend can be assured. The Government are determined to redress the inequalities and unevenness of standards throughout the health service. Of course we need more money. All aspects of the health service need more money. But that can be said of many other parts of our public life at present. What we can say is that when we have less money it is all the more important to channel those resources to the areas of greatest need. That will certainly be our objective over the next few years.
I hope, therefore, that it will not be long before my hon. Friend is welcoming a new decision to build the new unit at Accrington Victoria Hospital. Certainly, because of his persistence and efforts on behalf of his constituents, I believe that that day will be hastened by this debate. But I fear that I can give him no further promises than that. I hope that this will at least give his constituents the feeling that their concern is shared by Ministers and by his regional health authority.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to One o'clock.