§ 11.24 p.m.
Mr. Bernard Conlon (Gateshead, East)
sought leave to introduce this Adjournment debate on a matter which is of great concern to the 260,000 population of the Gateshead metropolitan area. It concerns the proposals that have been lying on the table for 10 or 11 years in connection with the development of the Queen Elizabeth Hospital. It was originally intended that the development of a new district hospital to serve the whole of Gateshead would be developed in three separate stages. Phase 1, which consisted of a new out-patients' department and an operating theatre was completed in 1967. Phase 2, providing for an accident and emergency department, was completed in 1973. That left phase 3 outstanding—the most crucial part of the development.
Phase 3 was originally scheduled to commence in 1976 and to provide 380 1637 acute beds and 90 psychiatric beds, together with a psychiatric day hospital. In addition, it was proposed that there would be six further operating theatres. Because of financial stringency the regional health authority has been informed that phase 3 cannot be started. On learning of this my colleagues from the area and I were extremely alarmed because we believe that the area is already under-supplied with hospital services. We believe that the area has been neglected in this sense for far too long.
It has only been because of the promise that phase 3 would be started in 1976 and completed two or three years later that the staff have maintained morale, and have been able to service the area and care for the patients in a commendable way with a high degree of efficiency. Now that we are informed that phase 3 is likely to be deferred indefinitely we can easily imagine that the staff is seriously alarmed. Morale is weakening. All are concerned at the prospect ahead.
We recognise that the Government are in difficulty. My hon. Friends the Members for Blaydon (Mr. Woof), Chester-le-Street (Mr. Radice) and Gateshead, West (Mr. Horam) and I met the Under-Secretary of State some months ago to impress upon him the urgency of the problem. Following that meeting it was decided that the officers of the area health authority and the regional health authority would get together and devise plans for a reduced scheme. In other words, instead of going ahead with the full scheme for phase 3, it would be scaled down to give the bare essentials.
I impress upon my hon. Friend that the scaled-down scheme is the minimum that we could possibly accept. However, even now the scaled-down scheme is in jeopardy. A circular has been sent to regional health authorities instructing them that schemes that cannot be commenced by 1978–79 must be deferred. Because of the uncertainty and delay it is likely that we shall not be able to get our scheme off the ground by that date. We could, therefore, have to stop at the planning stage.
I tell the Minister in the strongest possible terms that we need these new hospital facilities in Gateshead because we have been deprived of adequate ser- 1638 vices. We have been reluctant to complain as vigorously as we should have done because the prospect of the new district hospital was always there. We are seriously alarmed at the latest news about phase 3.
§ Mr. Albert Roberts (Normanton)
Is there any likelihood of staff leaving the hospital and depleting essential services?
§ Mr. Conlan
That is a serious problem. Within two miles of this hospital, there is a new hospital in Newcastle. Staff will not stay in a Gateshead hospital where working conditions are bad and facilities are poor. This is an additional reason for pressing ahead with phase 3. We recognise that the Government faces financial problems and that public services have been, and will be, cut back. The limited funds that are available for hospital building should be directed to areas like Gateshead which have been deprived in the past. I hope the Government will ensure that the phase 3 work can start in 1976–77.
§ Mr. Deputy Speaker (Mr. George Thomas)
I understand the hon. Member for Gateshead, East (Mr. Conlan) and the Under-Secretary have agreed that other hon. Members should participate in the debate.
§ 11.32 p.m.
§ Mr. John Horam (Gateshead, West)
I am grateful that my hon. Friend the Member for Gateshead, East (Mr. Con. Ian) has raised this matter in the Adjournment debate. The hospital is in his constituency and naturally he has the foremost concern, but my constituency adjoins his and my constituents use the hospital. I am as concerned as is my hon. Friend about this matter.
By any criteria, Gateshead is a deprived area—despite the efforts of a local authority which has often been short of cash. It does not have the facilities that money has bought for other, more affluent areas of the country. It needs positive discrimination by the Government in its favour—particularly by a Labour Government, given the strong Labour traditions in the area. It is getting some assistance through the urban aid programme, but it is not as systematic as many of us would like. Knowing the Under-Secretary's reputation, I imagine 1639 he will be concerned about positive discrimination towards less affluent areas—especially as he represents a North-West constituency himself.
Medical services in Gateshead have been the Cinderella of the town's social services and there is no sign yet of a happy ending. Hospitals have been starved of cash for years because we have been waiting for the phase 3 development. Delaying the work would be a double blow—money has already been foregone and there would be no possibility of the scheme on which we have been depending.
There has been concern about the standard of local services. There has been a 50 per cent. increase in the waiting time for surgical cases at Gateshead district hospitals in the past year. This is not a reflection on the staff, who have done a magnificent job in very difficult circumstances. It stems from the shortage of cash and the poor selection of priorities by the regional authorties and the Government. I do not think Gateshead should be let down again. We must have priority for the phase 3 development.
The Gateshead area hospital authorities have been reasonableness itself in their approach to this matter. They have already cut down the size of the scheme and reduced its quality. This indicates their willingness to consider the national situation and national priorities. They are not grabbing for more, regardless of the consequences for national spending and national programmes. In return for this extremely reasonable attitude, in a very difficult and trying situation, the Government should display equal willingness to meet the very reasonable and long-standing commitment which exists. I do not feel that in this respect Gateshead can be let down again.
§ 11.36 p.m.
§ Mr. Giles Radice (Chester-le-Street)
I want to speak in support of what my hon. Friends have said. My constituents are as anxious as are those of my hon. Friends that the reduced scheme—and I emphasise the word "reduced" because it has been reduced to 200 beds—should go forward. Gateshead has special health needs. The low level of geriatric and psychiatric services has been specifically commented upon by the Hospital Ad- 1640 visory Service, and without the completion of the redevelopment of the Gateshead hospital services, even on the reduced basis, there is likely to be a serious breakdown in services and an unacceptable lowering of staff morale. By all the tests, we constitute a priority area in health terms.
The Government are in a severe economic crisis and we accept that they face problems in respect of public spending. Nevertheless, we urge the Minister to consider sympathetically the special case that we have put forward, because we think there is a great deal of force behind it, and we urge him to agree that the reduced scheme should go forward.
§ 11.38 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Meacher)
I wish first to congratulate my hon. Friends the Members for Gateshead, East (Mr. Conlan), Gateshead, West (Mr. Horam) and Chester-le-Street (Mr. Radice) for the forceful way in which they have presented their case. I too, pay tribute to the excellent work of the Gateshead hospitals. I fully appreciate the effect on staff morale of any uncertainty about the timing of the start on the next phase for development of the Queen Elizabeth Hospital and the difficulties of recruiting good junior staff.
My Department is very much aware of the need to bring together the existing acute illness beds into one hospital so that a more efficient service shall be provided. My hon. Friends did not mention the question of the deficiency in psychiatric services in the Gateshead area, but we are conscious of it.
My hon. Friend the Member for Gateshead, West mentioned the waiting lists in the area, which, as in many other parts of the country, are causing a great deal of concern locally. Large numbers of people are at present on surgical waiting lists and many of those with non-urgent conditions are having to wait a long time for treatment.
I cannot deny that bringing the surgical facilities in Gateshead together by the early completion of the next phase of the Queen Elizabeth hospital would go a long way to reducing waiting lists and waiting times.
In general, as a national policy we have made a start by asking health authorities to identify specific capital schemes which 1641 will help to reduce bottlenecks which are preventing the reduction of in-patient waiting times and need not cost a great deal in the current economic circumstances. We are making a capital allocation of £5 million in the present financial year for this purpose. Whether anything can be done in Gateshead in the interim—until the next phase of the Queen Elizabeth Hospital is completed—will be a matter for the area health authority to consider.
The present hospitals in Gateshead, as my hon. Friends have rightly said, are, in the main, old and inconvenient. I understand that, over the years, a great deal has been done to improve the conditions, with the completion in 1967 of the first phase of the redevelopment of the Queen Elizabeth Hospital. This comprised the outpatients' department, out-patients' day wards, one operating theatre and part of the X-ray department.
The second phase of the redevelopment was completed early in 1973, and comprised an accident and emergency department, and supporting services. Other minor work has also taken place over the years, and continues—for instance, the area health authority has recently provided new isolation facilities at the Queen Elizabeth Hospital. In the field of primary care—which is just as important, if not even more so—the first health centre in the area was opened at Felling in 1968. A second was opened at Worcester Road in October 1974 and a third is planned, also for Felling.
My hon. Friend the Member for Gateshead, West also paid particular attention to the argument of positive discrimination, and I should like to make clear to him that we are not satisfied that the present means of allocating capital to regions is satisfactory. Since we have taken office we have given urgent priority to restructuring the criteria for allocating resources to make them more responsive to the needs of different parts of the country, particularly areas like Gateshead, in the Northern Region, of significant health deprivation.
For this purpose my Department has set up a working party which is giving urgent study to ways of objectively measuring existing local variations in the distribution of resources. I have to admit that it may be some time before we are 1642 able substantially to improve the present system, but I hope that we shall soon have the means to provide a fair and more rational allocation of resources throughout the country.
As I have mentioned at some length, we are aware of the particular problems of Gateshead. As my hon. Friend the Member for Gateshead, East said, only last December my hon. Friend the Minister of State received a delegation of members, including my hon. Friend as well as representatives of the Gateshead Area Health Authority. Just as my hon. Friends have done today, the deputation expressed its very grave concern about the prospects of any deferment of the planned phase 3 to the hospital. In the course of an exchange of views, which was very useful, the members of the deputation considerably impressed my hon. Friend the Minister with their willingness to accept the need to reduce the content of the phase 3 scheme, as originally planned, in order to reduce costs, and with the argument that the realistic objective of attempting to provide the most urgently needed facilities is a first step in the further development of the District General Hospital. On that occasion the members of the delegation showed their willingness to adopt the realistic view that a more modest scheme would, in our economic circumstances, have more chance of finding a place in the region's capital programme over the next three years. The area health authority had gone ahead with its planning of a smaller phase 3 on this basis.
The new proposals would involve extending the present maternity department and providing new buildings consisting of a central operating department, an anaesthetic department and about 180 beds. I recognise that that is only about a third of the number planned in the original phase 3.
I understand from the regional health authority that an appreciable period is required to complete the design and planning work, and in its estimation it is unlikely that the scheme could be ready for a building start before 1979. That may seem a considerable delay, but I am advised that, taking into account the new feasibility work, planning work and design work, the total period involved prevents a building start before, perhaps, the middle of 1979.
1643 That brings me to the central point of the debate. My hon. Friend has asked me to give a categorical assurance that approval will be given for a start to be made on the next phase of the redevelopment of the Queen Elizabeth Hospital no later than the year 1978–79. I think that he referred to an earlier date, in fact. Unfortunately, it is not possible to do it before. The issue is whether there can be any certainty of its being started in 1978–79. Even on that limited question it is impossible to provide my hon. Friend with the certainty that he would like.
§ Mr. Conlan
Will my hon. Friend please clarify the point that I made in connection with the circular sent to regional health authorities about the suspension of all planning work on any scheme that cannot be commenced before 1978–79? If what we hear is true, this will rule out further planning work on this phase.
§ Mr. Meacher
My understanding is that, whatever may have been said in the circular, there is provision for feasibility work and for planning and design work to go ahead in regard to this more modest phase 3, and that there can be no question of that being ruled out in the present circumstances. This is very much a sub-optimal proposal. However, there can be no question but that the necessary works for the completion of that by 1978–79, given the considerations to which I may come, will proceed. I give my hon. Friend that absolute assurance.
Ever since December 1973, when the Conservative Government found themselves forced to impose severe cuts on health service expenditure—or, in their treatment of the economic problems of that time, chose that option—successive Governments have had to plan on lower levels of future expenditure than they would have wished, because of our general economic situation. As my right hon. Friend the Secretary of State for Social Services said on Budget day, we had faced the prospect when we took office that unless we restored some of the cuts we would be faced with a complete moratorium on all major scheme starts. By making additional funds available we have been able to remove this possibility and have been able to 1644 approve starts on about 30 major schemes in 1975–76.
I must say frankly that the prospects for the future are not very encouraging. A consequence of the reduction in public expenditure announced by my right hon. Friend the Chancellor of the Exchequer in his Budget Statement is that expenditure on the health capital programme in 1976–77 is likely to be about a fifth lower than in the period 1975–76. It is inevitable that the number of new major starts in the next few years will be much lower than we would wish. We hope shortly to be able to advise regional health authorities about the planning assumptions which they should adopt in forming their capital programme for 1976–77.
Given this overall restraint on our resources, we need a mechanism for deciding on priorities at both national and regional level, and to ensure, as far as planning and resources allow, that the most pressing needs are met earliest. For the future, we shall have the NHS planning system, which will be introduced formally from April 1977. Already we have asked regional health authorities to review existing plans in conjunction with area health authorities, and produce outline strategic proposals for the development and redeployment of services and resources for the next decade. This review will apply both to the obvious need for new capital expenditure in hospitals such as the Queen Elizabeth, and for what are in many ways the more important elements of the health service—good primary care facilities.
How does this relate to the Gateshead situation or, for that matter, to the situation in other parts of the Northern Region? It means that the Northern Regional Health Authority will be able to consider the needs of Gateshead against, say, the needs of North Tyne and Barrow, which I am sure my hon. Friends will also recognise as having a high degree of priority, and will prepare a priority list of projects. The aim will then be, as far as resources and the actual planning of the schemes allow, to undertake the schemes with the highest priority as early as possible.
Thus, the very real need, which we recognise, to improve the hospital services in Gateshead, which my hon. Friends have highlighted so forcefully tonight, 1645 must be viewed alongside the other no less real needs in the region.
I am afraid that there is no getting away from this. It is the Northern Regional Health Authority which has the responsibility for assessing the relative priorities of the necessary schemes being planned by different areas in the region. This is as it should be, and my hon. Friends, I am sure, will agree with this, because the regional health authority is in a much better position to know the relative priorities in the region than we are at the Elephant and Castle.
I appreciate that my hon. Friends and their constituents will be disappointed that I am not able—partly because of the overall situation in regard to resources and partly because of the relative ordering of priorities within that constrained overall set of resources—to give them the full and absolute assurance they seek tonight. I have to make it clear that no decisions have yet been taken about major hospital building starts for 1976–77, let alone for later years. Decisions cannot be taken until the health authorities have completed the strategic reviews to which I referred earlier. We are hopeful that we shall have the results of the 10-year plan by the end of 1976.
§ Mr. Albert Roberts
Is it safe to say that the modified scheme of phase 3 could be completed by 1980?
§ Mr. Meacher
If the level of overall resources is sufficient, and given that the Northern Regional Health Authority gives the go-ahead to this project, as opposed to others, such as North Tyne and Barrow, there is no reason why a building start should not begin in the middle of 1979.
Decisions have to await the completion of the strategic reviews by the health authorities and then can be taken only on a priority basis, which is set against the limited capital likely to be available.
Having said all that, I do not wish to give the impression that we are not impressed by the way in which the Gateshead Area Health Authority has set about reviewing its plans to produce a much more modest scheme, thereby ensuring that its aims and objectives are not thwarted by bidding for too large a share of regional resources——
§ The Question having been proposed after Ten o'clock 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 six minutes to Twelve midnight.