HC Deb 20 November 1974 vol 881 cc1480-92
Mr. Deputy Speaker (Mr. George Thomas)

I understand that the hon. Member for Harborough (Mr. Farr) has reached agreement with the Minister that a number of his colleagues may intervene in the Adjournment debate.

11.16 p.m.

Mr. John Farr (Harborough)

Mr. Deputy Speaker, I am glad to have colleagues on both sides of the House join briefly in this debate. I hope that the debate will make apparent to the Minister the strength of feeling throughout The Leicester area at the inadequacy of the hospital facilities in the district.

The first unusual feature of the debate is that it is related to Early-Day Motion No. 17, which concerns itself with the hospital services in the Leicester area. The motion was signed by all hon. Members representing the Leicester area. The second unusual feature is that most, if not all, of my area colleagues are present at this late hour to show that on both sides of the House there is strong feeling about the woeful inadequacy of conditions in our area.

I want an indication from the Minister that his right hon. Friend the Secretary of State for Social Services will receive a deputation from both sides of the House and from expert medical advisers. Second, I wish to stress that the disgraceful disparity between conditions in the Leicester area and elsewhere has already been raised in the House several times over the past few years. During the last eight years alone there have been no fewer than three Adjournment debates on this subject. Those debates took place on 7th March 1966, 14th December 1971 and 20th March 1972. On each occasion the Minister who replied made a statement which could only be described as a bundle of platitudes.

Mr. Michael Latham (Melton)


Mr. Farr

Yes, whitewash. We have heard only soothing sounds. The fact remains after all this time, and after repeated debates calling attention to the serious position of Leicester and the Leicester area, that we have continued to lag both on an area basis and on a national basis compared with the rest of the country. The situation is gradually getting worse and is now virtually intolerable.

We are not asking for another host of platitudes. We have had that before. We are seeking an assurance that there will be a major shift of expenditure into the Leicester area, which has been denied resources almost ever since the inception of the National Health Service. I am sure that the Minister will have read the early-day motion to which I have referred. It is fairly concise and effective in its description of the way in which our area has been starved of funds. We do not want any more soft soap from the Minister. We require a specific undertaking that this major shift of emphasis will take place.

I conclude by calling the Minister's attention to the human angle. Why do we who represent constituencies in the Leicester area continually have to defend the health service to our constituents? How can we continue to explain to them, when they come to see us at our "surgeries" or in interview sessions, that they have to wait up to three years for a National Health Service operation or three months or more for an appointment with a consultant in the Leicester area? It is an impossible and invidious task. A number of people who have come to see me have gone to the expense and trouble of borrowing money to have their operations and consultations "on the private", as they say, because they cannot afford the anguish of waiting almost indefinitely.

I demand action from the Minister.

11.21 p.m.

Mr. Tom Bradley (Leicester, East)

I congratulate the hon. Member for Harborough (Mr. Farr) on his good fortune in securing this Adjournment debate and thus drawing attention to the serious situation in the National Health Service in Leicester and Leicestershire. I pay tribute to his generosity in yielding part of his time to those of us who also wish to speak. That illustrates the non-party nature of our protest.

Under successive Governments the hon. Gentleman and I and others have drawn attention to the inferior allocation of NHS resources to Leicester and Leicestershire. Indeed, the last Under-Secretary to the Department in the Conservative Government acknowledged the inferiority of the allocation when he visited Leicester in February 1973. It is well known—the figures and statistics speak for themselves —that the Leicester Health Authority is at the bottom of the regional league, which is at the bottom of the National Health Service league. This has been the position for many years, as is illustrated in the early-day motion which we have tabled.

It is intolerable that Leicester hospitals have such long waiting lists, a shortage of consultations and staff in all categories, inadequate bed provision and an expenditure per head which puts the city at the foot of the fourth divison, talking in national soccer terms. Inequalities in the distribution of revenue moneys over the country can be seen readily by comparing Leicester with any other major health authority.

What is the Department doing to readjust the allocation of resources available to areas like Leicester which are most in need, and, particularly, what has the Minister to say to us tonight which will encourage us to feel that Leicestershire's days as one of the medicine's depressed areas is nearing an end? That is what we want to hear. We need action. I agree with the hon. Member for Harborough that we have been put off by platitudes and soft soap under successive Governments for far too long. Where are we going? We are all united in this cause.

11.23 p.m.

Mr. Adam Butler (Bosworth)

The fact that there are four times the standard number of Members in the Chamber for an Adjournment debate speaks for itself. The early-day motion also does that for us. There is no reason to draw further attention to the figures, because they speak for themselves.

I wish to make two points only and to support what has been said from both sides of the House. We are grateful for the expenditure planned for the three new or expanded hospitals in Leicester. But I ask that in carrying out this expenditure in the county as a whole the local hospitals—those on the periphery—should not be forgotten. It is easy for planners to expect patients to be drawn into the centre of the web. One accepts that the efficient use of medical resources is important. One accepts the argument that the time of the doctors and specialists is important. But the medical service deals with human beings, and most of those human beings, the unfortunate patients, prefer to be in a hospital close to their homes where their friends can visit them. There is also the cost of travelling from, let us say, my constituency into the centre of Leicester with bus fares being so high.

We have to find the balance between super-efficiency in the medical service on the one hand and the more important human factor on the other which is so often forgotten. My plea is that out of the money which must be spent in Leicestershire as a whole a fair proportion should go to the local hospitals.

My second point is that one accepts in our current economic situation that there must and should be some restriction on the rate of increase in health service expenditure, however much the crying need. But it is only fair that areas which have benefited most in the past should now experience the restraints. What cannot and must not happen is that Leicestershire's expenditure plans should be cut. We are discussing a problem of deep social and human need, but we are also discussing fair play. All the statistics and experience of the past show that Leicestershire has been hard done by, and this unfairness must be put right.

11.27 p.m.

Mr. Greville Janner (Leicester, West)

I join in thanking the hon. Member for Harborough (Mr. Farr) for kindly allowing us to take part in a united shout of protest from both sides of the House. Individually, most of us are well-known for being nuisances in the interests of our constituents. The nuisance that we are making together is a great one which will continue until we have an assurance that it will get results.

There is stark inequality and unfairness in the treatment of the citizens of Leicester and Leicestershire in respect of the health services. I pay tribute to all those who have enabled the system to bear the weight even as it has—those "angels" of Leicester, the general practitioners, consultants, nurses, auxiliaries, workers in the domiciliary services and all who help in the hospitals and homes. They do a fantastic job in much more difficult circumstances than obtain in most parts of the country, but there are not enough of them.

At present 17–4 per cent. of the total beds in the Leicester General Hospital—that is, 90 beds—are closed. In Hillcrest Hospital 20 per cent. of the beds—30 beds—are closed, and in Groby Road Hospital 31 beds are closed—7.6 per cent. That is caused mainly by lack of staff. It is a disgrace. It is not enough to have the hospitals. We must also have the staff to look after the patients.

We ask the Minister for an assurance that the proposals for a teaching hospital in the Leicester area will survive any cuts that may be made. We are entitled to a firm assurance on that on behalf of our constituents.

I pay tribute to those who work in our hospitals. This morning, because of my voice—for which I apologise—I joined the queue at the Royal Hospital. I sat there for some time and was eventually seen by a distinguished consultant who informed me that nothing was growing on my larynx. When I asked him what I should do, he laughed and said "Stop talking." I do so, with thanks, again, to the hon. Member for Harborough.

11.29 p.m.

Mr. Nigel Lawson (Blaby)

I endorse all that has been said by hon. Members on both sides of the House and thank my hon. Friend the Member for Harborough (Mr. Farr) for allowing me the opportunity to take part in the debate.

The facts stare the Minister in the face, and have done so for a long time. His figures of annual National Health Service expenditure show that against the national average of £37 per head the expenditure in the Trent region is about £31 per head and in Leicestershire £25 per head—only two-thirds of the national average. That is a scandal. One would like to think that this was explained by the people of Leicestershire being exceptionally healthy. They are exceptionally wise, but I do not think that they are exceptionally healthy. No such explanation can fit these figures.

This is a long-standing inequality. Indeed, it was pointed out as such in The Hospital in July, 1971, in an article headed, Inequality and Management of the National Health Service", and written by someone not from Leicestershire. The article pointed out that there had been inequality since the inception of the N.H.S.

That inequality will only be put right as a deliberate act of policy. It will be put right by two things. First, the capital spending must be greatly increased, since current spending follows capital spending. Secondly, in particular, we must have the new district general hospital at Glenfield. There must be no backsliding on that.

My hon. Friend the Member for Bosworth (Mr. Butler) pointed out that the broadest backs should bear the heaviest burdens in the health expenditure cuts to come. Whatever other health service expenditure cuts there have to be, there should be none in Leicestershire.

11.31 p.m.

Mr. Jim Marshall (Leicester, South)

I, too, thank the lion Member for Harborough (Mr. Farr) for allowing hon. Members on both sides of the House to join in the debate. I am the junior Member for Leicester and Leicestershire.

Mr. Greville Janner

But my hon. Friend will be here for a very long time.

Mr. Marshall

I was aware of the difficulties that we were facing in the city before my election. There was a recent meeting between the local branch of the British Medical Association and local Members of Parliament, at which I was present. I was appalled when I saw the allocations which had been made by the former Sheffield Regional Hospital Board to the Leicester area.

I say with diffidence, having been born and bred in Sheffield—naturally I do not like to see Sheffield receive good hidings —that on this occasion Sheffield deserved a good hiding. The resources allocated to Leicester within the former regional board area were appallingly inadequate.

At that meeting, a general practitioner told me of a patient he was treating for some tummy upset which he thought was an ulcer. He sent the man to the local hospital—the Royal Infirmary, I believe —for an X-ray. This indicated a stomach ailment of the kind he had suspected. The patient returned home and was treated by the doctor, who, six months later, sent him back to the hospital for another X-ray. The radiologist then wrote that the X-ray had been carried out but he was not sure whether the growth was malignant or non-malignant. Only then did the GP find out that the very machine needed to finalise the diagnosis was out of action and that the hospital could not specify when it would be in suitable condition again to carry out the work.

That is the kind of situation we are facing in Leicester, and I hope that my hon. Friend the Under-Secretary of State will indicate that it will improve in the not-too-distant future.

11.34 p.m.

Mr. Michael Latham (Melton)

I throw the weight of the people of Melton into the argument. Melton is a sharply growing area, and its people are extremely concerned about the present situation, which is becoming increasingly impossible for the reasons that other hon. Members have already cogently described. We have all written to the Secretary of State. None of us has been satisfied with the replies. We expect a better reply from the Under-Secretary of State tonight.

As Member for Melton, I, too, am tired of having to give gloomy advice to my constituents about the length of time it will take them to get proper attention in hospitals in the county. I had a deplorable case recently concerning a person waiting for a long time for treatment by an ear, nose and throat department. I was informed by the local area health authority that such a delay was normal.

This situation must change. The hon. Gentleman will have the full support of all Members from Leicestershire in changing it. I hope he will now tell us what we all want to hear.

11.35 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Alec Jones)

I am delighted to have the opportunity of trying to reply to this debate, but because so many hon. Members have taken part I am sure they appreciate that there will certainly be some individual points which I shall have to deal with in writing rather in the time available.

Mr. Greville Janner

Say "Yes" to us all.

Mr. Jones

That would be the easiest way and the one which I should like.

It would be churlish of me not to pay tribute to the hon. Member for Harborough (Mr. Farr), who has consistently pursued this problem, supported sometimes by one or two Members on either side. Tonight, however, he has achieved what I should have thought was the impossible; he has united all Leicestershire Members on this issue. Lest I should forget to say so later because of the speed with which I hope to proceed, I should like to assure the hon. Member that we have agreed to receive a deputation. Arrangements are being made, and he will be consulted on the matter.

I wish first to talk about the origins of the inequalities concerning the financial allocations. It is certainly true that these inequalities exist, and they have done so for a very long time. As a Member from another part of the country, I would say to the hon. Member, although it is no comfort to Leicestershire, that these equalities exist in other parts of the country.

Mr. Lawson

Not to the same extent.

Mr. Greville Janner

Leicester is the worst in the country.

Mr. Jones

We could argue at length, but if we were to do that I should not have time to reply to anything else.

In 1948 the Sheffield Regional Hospital Board inherited a situation in which the facilities for health care and the allocation of resources failed to reflect need in that area. In the region as a whole there were deficiencies in terms of buildings, levels of current expenditure and, consequently, levels of staffing. One of the objectives in setting up the National Health Service was to eliminate inequalities in health care provision, and successive Governments have faced the problem of achieving this against a background of rising public demand and a growth of resources which has been less substantial than all of us would really wish. I am sure that it has been less substantial than the Members for Leicestershire would wish for their area.

Any large-scale redistribution of current expenditure between regions must, however, be subject to the recipient region's ability to absorb and make effective use of increased allocations. This ability is linked to the level of existing health buildings and beyond a certain margin it becomes dependent upon the development of additional capital facilities. Those facilities are what hon. Members have asked for tonight.

Thus major problems of inequalty, such as are known to exist in Leicestershire, are only finally resolved over a number of years. It was for this reason that in 1968 the then Labour Government decided to begin to tackle the task of equalising the provision of health care in a systematic way. This decision led to the introduction in 1970 of an equalisation formula based on objective factors and designed, assuming a steady growth rate, to achieve equity in current expenditure among regions in approximately 10 years, starting in 1971–72.

So far in the Trent Region the redistribution formula has had the effect of bringing hospital expenditure per resident head of population over the region as a whole nearer to the national average. For example, between 1970–71 and 1973–74 the region moved from 83.4 per cent. to 91 per cent. of the national average and in 1974–75 Trent Region's relative position in relation to hospital services has continued to improve. I accept that the improvement was not fast enough for the hon. Member for Harborough, but it indicates that the formula is beginning to work in the right direction and in the way that the hon. Member wants.

In addition to the improvements brought about by the redistribution formula, the region has since 1970 received a series of special recurrent allocations amounting, over a five-year period, to approximately £2 million at 1973 price levels, in recognition of the need to develop and upgrade services in preparation for the introduction of medical undergraduate teaching at one of the regions' two new medical schools —namely, at Nottingham. I can assure hon. Members that my right hon. Friend is aware that Leicester is in a similar situation to that recognised in Nottingham a few years ago, and she has in the current year made a substantial special allocation of funds to the Trent Regional Health Authority as a first step towards improving health facilities in Leicester to meet both service and medical teaching requirements.

My right hon. Friend and the Trent RHA are aware that there is a substantial shortage of hospital facilities in Leicester and that the low per capita level of expenditure will not be finally corrected until the planned programme of capital developments, which is now in hand, is fully implemented. To this end, in the past five years capital developments totalling approximately £14 million have commenced in Leicester, and further major developments are planned. Ongoing capital projects will cost in the region of £11 million. The actual figure is £10.8 million. The planned capital programme also includes the development of an additional district general hospital in Leicester at a cost of more than £23 million. This was the special request of the hon. Member for Blaby (Mr. Lawson) who made much of its importance, and I agree with him.

Mr. Lawson

We want an assurance that these figures will not be affected by any future cuts.

Mr. Jones

The hon. Gentleman will appreciate that all that I can do in the short time left to me is to try to deal with the points hon. Members have raised. I shall do my best. If there are others which the hon. Member for Blaby feels to be urgent, perhaps I can deal with them in correspondence. The hon. Gentleman will understand, I am sure, that I have given up part of my time to enable him to make a speech. It ill-behoves him to adopt this kind of attitude.

Mr. Lawson

I am obliged to the hon. Gentleman for doing so.

Mr. Jones

Developments completed in the past five years have already effected improvements in the quality of facilities available, and projects now in progress will improve the situation significantly within the next few years. Nevertheless, my right honourable Friend recognises the need to continue to improve Leicester's relative position in relation to the region and the country as a whole in the shorter term, and in the current year, with assistance from my Department, the regional health authority has made a substantial allocation of additional funds as a first step in this direction. The area health authority has in preparation plans for the deployment of this additional revenue allocation to ensure that the maximum benefit to existing services can be achieved.

I have dealt so far mainly with capital and current expenditure, but we must not forget that essential resources include manpower as well as money, and it is in the former field that the health authorities face particular problems in Leicester.

In relation to medical staff, my right hon. Friend is aware that shortages exist. The additional revenue allocations to which I have already referred should go some way towards remedying deficiencies and, in the longer term, the presence of the new medical school will both attract high calibre doctors from outside the Leicestershire area and generate an output of locally qualified doctors, many of whom may be expected to practise in the area. Doctors are by no means the only need, however. The development of hospital and other facilities on the extensive scale envisaged will require large numbers of all types of staff. My hon. and learned Friend the Member for Leicester, West (Mr. Janner) made this point about the shortage of staff. I am sure that he will be pleased that we have this in mind. It is for this reason that we have jointly commissioned Leicester University to undertake a study aimed at identifying manpower requirements and any potential problems and make recommendations.

From what I have just said, I trust that hon. Members will accept that the problems facing the health authorities responsible for providing services in Leicestershire have by no means passed unnoticed by my Department. The underlying causes of the problems now faced are largely historical, but the situation in Leicester serves to emphasise the point which my right hon. Friend has consistently emphasised during debates in the House; namely, that we are determined to find a better way of allocating resources if situations like that in Leicester are not to recur elsewhere.

I know that hon. Members who have taken part in this short debate appreciate that I cannot give them all the assurances for which they asked. However, I shall read their speeches carefully tomorrow and write to each of them dealing with their specific points. I assure them that neither my right hon. Friend nor the Department is unaware or ignorant of the real and genuine worries of the people of Leicestershire.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Twelve o'clock.