HC Deb 05 May 1975 vol 891 cc1175-86

11.24 p.m.

Mr. Nigel Lawson (Blaby)

I was interested in that lesson in procedure, Mr. Deputy Speaker.

The scandal of Countesthorpe health centre is, first, that there is not one, and, secondly, how this has come about. I should like to go over the history fairly briefly.

Over the past few years the population of Countesthorpe has trebled from 2,000 to pretty nearly 6,000. In addition, the surrounding villages, which are in the same catchment area for general practitioner services, have a population of another 2,000. The development proposals already in the pipeline will increase the population of Countesthorpe by a further 2,500, making a total population in the catchment area of more than 10,000 people in only a few years.

All the people in Countesthorpe and the surrounding villages, but, above all, in Countesthorpe, are served by a partnership of three doctors, operating from a single, cramped consulting room in the private home of the senior partner. I think that everybody agrees that this is obviously an intolerable situation both for the doctors and, not least, for the wife of the senior doctor.

The people of Countesthorpe have nothing but the highest praise for the way in which the three doctors concerned have managed to provide a medical service, despite these appalling conditions, but they arc rightly seized with the real fear that before long their local medical service will collapse altogether. I am sure that the Minister will have seen the petition on that subject, signed by 1,700 residents of Countesthorpe, which I forwarded to his hon. Friend the Minister of State last month. This large number of signatures was collected with no difficulty at all over a period of only a few days, which gives some indication of the strength of local feeling on the issue.

It has long been clear that the only solution to this acute local problem is the provision of a fully equipped health centre for Countesthorpe. This was first proposed by the then county medical officer of health for Leicestershire in 1971.

During 1972 and 1973 a suitable site was acquired by the county council, and a firm of architects was thereupon commissioned, I believe for a fee of £3,500, to prepare plans for the building, the construction of which was expected to start at an early date.

But last year, as a result of the reorganisation of both local government and the National Health Service, the responsibility for health centre development was transferred from the county councils to the Department of Health and Social Security. The Department asked the Leicestershire Area Health Authority its suggested order of priorities for health centre development in the whole of Leicestershire during the current financial year, and quite rightly, the Leicestershire Area Health Authority placed Countesthorpe top of the list for the entire county. This was duly endorsed by the regional health authority officers last July, and it was generally assumed throughout the county that the construction of the Countesthorpe health centre would start this year.

Evidently it was not to be. The new Labour Government decided to use their powers to ride roughshod over local knowledge and wishes. Officers of the Department sat down with officers of the Trent Regional Health Authority and prevailed upon them to draw up a new list of priorities for health centres in Leicestershire, under which Countesthorpe was down-graded from No. 1 in the county to No. 15; in other words, from this year not to next year but to sometime or never.

Mr. Naylor, the regional administrator of the regional health authority, in a letter to Mr. Mansfield, the secretary of the South-West Leicestershire Community Health Council, dated 18th March 1975, said: The Ministers have decided that the 1975–76 Health Centre programme be centrally selected. The RHA have formally written to the Department objecting to this decision on the grounds that it minimises rather than miximises delegation which is a central objective of the NHS reorganisation, and asked that policy be reconsidered accordingly. I hope that the Minister will address himself to that point, among others, in his reply. In view of the clear statement, The Ministers have decided that the 1975–76 Health Centre programme be centrally selected", I find it astonishing that the Minister of State, when I raised the downgrading of Countesthorpe at Question Time in the House of Commons exactly a week later, should have sought to justify it by—I think the Minister will have to agree—the wholly misleading excuse: Countesthorpe health centre was not among the list of priority schemes put forward by Trent Regional Health Authority for consideration for inclusion in the 1975-76 programme."—[Official Report, 25th March 1975; Vol. 889, c. 236.] This may have been technically correct, but in every other sense it is a travesty of the truth.

The "central selection" of health centre priorities is determined by the Department, and rubber-stamped by regional health authorities, according to eight criteria which the Minister circulated in the Official Report of 25th March as part of his answer to my Question. Following that answer, I got in touch with all the relevant bodies—the regional health authority, the area health authority, the community health council and the local district council—on the specific question of these criteria, and I have had written replies from all of them.

The only criterion which Countesthorpe clearly does not satisfy is c in the Minister's list, since it is not part of a larger development (including hospitals university teaching units)". There is some disagreement among the authorities that I consulted over a and d, which are not strictly medical at all, but depend on whether the proposed centre is situated in an "urban zone" or a new town or other new community". Bearing in mind the rapid growth of Countesthorpe, to which I have alluded, the area health authority is of the opinion that at least one of these criteria applies, while the community health council believes that both do.

But there certainly is a clear consensus among all these bodies that Countesthorpe satisfies at least five of the eight criteria. To be precise, b is: General practitioners are committed to present premises and are dependent upon a health centre for new premises. A critical word has been left out of the Official Report. Criterion e is: General practitioners have strong desire to develop primary health care but are frustrated by lack of suitable accommodation. The next one, f, is: Present general practitioner premises are well below modern standards and other means of improvement are not feasible. That again is unequivocal. Criterion g is: Proposed centre is sited where there is at present inadequate accommodation for community based nursing staff or for preventive health activities. Finally, there is h,to which the Department attaches particular attention: The proposed location is in a 'health deprived' area [a health deprived area should for the time being be interpreted as a locality in which the level of primary health care services falls well below the average obtaining in the Region]. I am sure the Minister will not need reminding that the whole of Leicestershire is a health deprived area. He will no doubt recall that on 20th November last there was an Adjournment debate when all the Leicestershire Members, irrespective of party, combined to complain that Leicestershire's share of National Health Service resources was the lowest of the Trent Region, which in turn was the lowest region per head in the country.

I remind the Minister of what he said in reply to that debate: …my right hon. Friend recognises the need to continue to improve Leicester's relative position in relation to the region and the country as a whole."—[Official Report, 20th November 1974; Vol. 881, c. 1490.] I think it is clear that, all in all, even on the basis of the Department's own criteria the case for a Countesthorpe health centre is overwhelming. Why, then, has the Department chosen to kill it —because that is what it has done by its decision? The only clue that I have been able to discover, because I cannot believe that Ministers have allowed party political considerations to affect their judgment, came in a letter from the Regional Administrator of the Trent Regional Health Authority dated 28th April in which he said, and I quote this for the last time: Stress was also laid by Department officers on the concept or urban deprivation, which in the Leicestershire circumstances relates to the city of Leicester itself. But how can it be right that the city should get everything and the rest of the county and the less urbanised communities, even if they are considerably built up, are neglected? How can it be right, when the county health authority itself has carefully weighed up, from its own detailed knowledge of conditions on the ground, the relative needs of the different communities within its borders, that that judgment should be overruled—without any consultation, incidentally, with the area health authority—by the Secretary of State sitting in Whitehall?

Fortunately, the crisis at Countesthorpe has for the time being been somewhat abated by the decision, not perhaps unconnected with a certain amount of pressure on this subject, of the regional health authority and the area health authority, accepted loyally as a second best by the doctors concerned, to erect a small, prefabricated health centre in one corner of the site earmarked for the health centre proper. This, however, is not a satisfactory solution for anything other than the very short term.

The whole thing has been a shabby story in which a great deal still remains to be explained. The people of Countesthorpe feel this very strongly indeed. They and their doctors, for whom, as I have said, no praise can be too high for the way they have coped in appalling conditions, are still denied their health centre. Can they have it next year if it cannot be this year? I for one will not be satisfied unless the Minister gives an undertaking that this indeed will be so.

I want to make it clear that this is not a case of calling for higher public expenditure at a time of national economic stringency. This is a case of priorities within a given total of public expenditure, and priorities, too, within a given county. It is, above all, a case of proven need of a local community objectively assessed by those best placed to assess it not being overruled, as it has been done until now, or ignored by the man in Whitehall who thinks that he—or she— knows best.

11.37 p.m.

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

Let me say at the outset to the hon. Member for Blaby (Mr. Lawson) that I well understand the feelings of the people in the area and certainly of many organisations in the area as witnessed by their representation of the problem they face and their wish to have this health centre. When, however, the hon. Mem- ber said towards the end of his speech that this was not a question of increasing public expenditure and that it was merely a question of priorities, I must say to him that this is the sort of argument we receive continually from hon. Members who advocate increased cuts in public expenditure in general but never the acceptance of any cut in particular.

The hon. Member knows full well that particularly in the Budget debate he called for considerable cuts in public expenditure. While we would wish that we could do more in the health sector, it is somewhat strange to hear people calling for cuts in public expenditure in general and always suggesting that their case is of higher priority than the remainder of the country.

Mr. Lawson

I thought I made is perfectly clear that I was not calling for any increase in public expenditure in this field. The fact is that the area health authority said that this should be the first priority. Unless the Minister says that there should be no health centres built at all, his case will not stand up. We arc talking about a question of priorities, not the total level of public expenditure.

Mr. Jones

Whenever one talks of priorities, it must inevitably mean a question of one item as opposed to. another. If the hon. Member advocates the inclusion of one scheme as opposed to another, he must either call for an increase in public expenditure or name which of the expenditure he would propose to cut in place of that which he proposes to include.

The 1975–76 health centre programme must be viewed in the context of the national priorities, the policies and the resources which are available at the present time. I should like to highlight the general changes of direction and emphasis before dealing with the specific issue raised by the hon Member in connection with Countesthorpe.

In relation to policies and priorities, before 1973 there were no defined guidelines indicating where health centres should be developed. Local authorities' decisions to build health centres in particular places depended primarily on the willingness of general practitioners to work from the health centres, and, provided design proposals, cost limits and tenders were acceptable, loan sanction was approved by the central Government. Consequently, at that time, the impetus for health centre development depended more on local enthusiasm than on consideration of the quality of existing primary health care services.

In 1973 the then Conservative Government decided that loan sanction for health centre developments should be held nationally at £12 million, at 1973 price levels, and that this level should be retained for 1974–75. Because the number of schemes already proposed by local authorities—some 250—greatly exceeded the resources available, loan sanction was deferred in 1973 on many schemes, including Countesthorpe. The hon. Gentleman said that the decision to "abandon" Countesthorpe was the responsibility of the present Government: in fact, the deferment was a direct consequence of the decision of the previous Conservative Government in 1973. That Government also decided that the health centre programme should bear its share of the cuts imposed on health capital, thus reducing the allocation to £10.5 million, and announced their intention to select centrally for 1974–75 the health centre schemes considered to have the greatest priority.

When my right hon. Friend assumed office in 1974 she made clear from the outset her intention to seek to redress inequalities in health care provision by making financial allocations more responsive to health needs. In the debate on the National Health Service on 2nd December last my right hon. Friend explained that, despite the constraints within which she had to work in formulating the health capital programme for 1975–76, she had decided to give top priority to capital facilities for primary health care by increasing capital expenditure on health centres to £20 million in 1975–76. She stressed, however, her intention in this area, as in others, to be selective as a means of moving towards greater equality of provision.

My right hon. Friend also decided that the twin aims of ensuring a more equitable distribution of resources—for which the hon. Gentleman called in the previous debate—and the responsiveness of allocations to health care needs justified the continuation of central selection of schemes for the time being. It was not a new policy but a continuation of the policy of the previous Government.

I began by saying that the health centre programme should be viewed in the context of national priorities, policies and resources. Since coming to office we have clearly indicated our views on the priorities of primary health care; we have embarked on a policy of guiding resources to areas of health deprivation, and we have increased the resources allocated to health centre developments by £5 million this year, despite our present economic stringencies.

In the case of the area covered by the Trent Regional Health Authority, the region has been given approval to start health centre schemes costing in total about £1¾ million, accounting for 11½per cent. of the national programme, whereas the corresponding allocation by the then Conservative Government for 1973–4 was about £1 million in the same price terms or 6 per cent. of the national programme. This increased percentage is evidence of our determination nationally to improve the relative position of regions too long deprived in health care terms.

The hon. Gentleman talked of the Leicestershire area as part of the Trent area. Of the amount allocated to Trent for health centres in the current year. over £500,000 is for starts in Leicestershire. This figure represents about one-third of the region's total allocation. whereas the Leicestershire area accounts for less than one-fifth of the region's population. This switch is an acceptance of my point in the previous speech to which the hon. Gentleman referred, about health centres in this area, when I called for recognition of the need to improve Leicestershire's position. In health centre provision, we have improved the position of Leicestershire and Trent.

The hon. Gentleman has been critical of the method of selection of the health centre schemes for the Trent region in the first half of 1974. Prior to the Secretary of State's decision to select the programme centrally, officers of the Trent Regional Health Authority met area health authority officers in a series of forward-looking meetings and invited areas, after consultation with family practitioner committees and other interested parties, to submit health centre proposals and priorities for the coming year to the regional health authority.

The region intended to compile the 1975–76 programme on the basis of area health authority recommendations and the regional view of relative priorities, taking account of criteria already made known to local health authorities late in 1973 which did not, at that time, make reference to areas of health deprivation. If the hon. Gentleman is talking of areas of priority, surely it is right that we should give priority to those areas of health deprivation.

When the Secretary of State announced her decision to select the 1975–76 programme centrally, officials of my Department and the Trent Regional Health Authority, assisted by medical officers of the regional medical service, who are in close touch with primary health care matters in the region as a whole, met to consider the regional health centre programme.

The procedure adopted was, first, to consider proposals against the criteria drawn up for national selection and in the light of my right hon. Friend's wishes regarding areas of health deprivation ; secondly, to take account of the views of the priorities expressed by the area health authorities and the regional health authority and the feasibility of schemes to proceed ; thirdly, to list all schemes in descending order of service priority so that it would be possible to replace schemes that slipped from the firm programme by those next on the list, subject only to those schemes' readiness to proceed.

As a result of these joint departmental and regional considerations at officer level, a list of priorities was compiled for 1975–76 and a list for thereafter. The latter was intended to supplement the 1975–76 reserves as necessary and to act as an indicator to assist health authorities to programme future planning work.

These lists, together with those submitted originally by the area health authorities, were put to the regional health authority, which approved the later version. This was then sent to my Department for consideration and selection of the health centre programme by my right hon. Friend. Despite the fact that Leicestershire Area Health Authority gave Countesthorpe top priority, as did Leicestershire County Council in 1973, the scheme was not among those approved by the regional health authority for a start in 1975–76.

There was no Question of a Labour Government riding roughshod. The project was not in a list approved by the regional health authority. If one talks of democracy in the local health services and giving authority to those who ought to know, and do know, the regions best, it is better to accept the views of the regional health authority rather than the view, in the hon. Gentleman's words, that the man in Whitehall knows best.

Mr. Lawson

This is a polite fiction. The regional health authority changed its list at the behest of the Department, just rubber stamped the Department's own interpretation of the criteria and forwarded a formal recommendation to the Department. The Under-Secretary must know that the people on the ground are those in the Leicestershire Area Health Authority. The headquarters of the regional health authority are in Sheffield, which is a long way from Leicester.

Mr. Jones

The hon. Member keeps talking of the list. When preparing the 1975–76 list for submission, the regional health authority approved a further list of health centres in terms of descending order of priority. The purpose of the second list was to ensure that, if selected schemes failed to start for any reason in 1975–76, another scheme could be brought forward from the ton of the second list. Countesthorpe was eighth in priority on that second list, not even top of that list. It was not that it was not a deserving case, but, as the hon. Member pointed out, there is a pressing need to provide improved premises for general practitioners in the village.

I am glad that he paid tribute to the work of the three doctors who have been practising in difficult circumstances in that area. I join with him in paying my tribute to their work. In a situation of increased but still limited resources, however, the view was taken that the problem of practice premises was capable of speedy solution by means other than the provision of a full health centre, however desirable that might be. Countesthorpe has to be compared with other parts of the region. When we are talking of priorities we mean comparisons.

I am not saying that Countesthorpe is perfectly catered for, but it is not as bad as some other parts. This is always the difficulty when one has to decide priorities. If priorities mean anything, they must mean providing for the worst before those who are even slightly better off. It is true that the village has grown. There are 6,000 or more inhabitants, and the hon. Member suggested a future population of 10,000, but a comprehensive range of health services is already available to them locally, including facilities for chiropody, audiology, speech therapy, school clinics, ante-natal and child health clinics, and facilities for health education.

An assurance was given that proposals to provide improved surgery facilities would be put to the hard-pressed general practitioners, and on this basis Countesthorpe was not included in the current year's programme, priority being given instead to Uppingham Road in the city of Leicester. The hon. Member mentioned the possibility of Countesthorpe serving a population of 10,000 and spoke of priorities. Uppingham Road health centre will provide facilities for seven doctors serving 20,000 patients. So if one is talking purely in numbers, and I am not making heavy weather of the numbers issue, there is a clear difference.

The regional health authority, the area health authority and the Leicester family practitioner committee have secured arrangements to provide health practice premises for the general practitioners, and I am sure that I carry the hon. Member with me in expressing pleasure that the doctors concerned have accepted this offer. The new premises will provide accommodation for health visitors, midwives and other members of the primary health care team, and should be ready for occupation by the end of the summer, which is rather quicker than would have been the case if Countesthorpe health centre had been included in the 1975–76 programme.

Mr. Lawson

I am grateful to the hon. Member for giving me another opportunity. This is serious because it seems to have an implication for the whole country. Is he suggesting that any community with fewer than about 20,000 population cannot be expected to be allocated a health centre at any time under the present regime of the Department of Health and Social Security?

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 o'clock.