HC Deb 23 December 1976 vol 923 cc999-1009

4.0 p.m.

Mr. William Whitlock (Nottingham, North)

When the National Health Service came into being in 1948, Britain led Europe in post-war recovery. We topped every worthwhile table and became at the same time the Welfare State, the envy of the world. Then, from 1951 we had 13 years of Conservative government, during most of which time Britain spent a lower percentage of its national income on health welfare and social security provision than did its neighbours. That fact, together with the frustrating, time-consuming bureaucracy brought into being by the reorganisation of the National Health Service enacted by the last Conservative Government, produced an ailing, demoralised Health Service which was in crisis at the time the minority Labour Government came to power in 1974 to face the worst post-war, world-wide slump, with Britain being left disastrously unprepared for it by the outgoing Conservative Government.

For all that, larger sums of money have been spent on the Health Service in the past three years than ever before in its history, thanks largely to the advocacy of my right hon. Friend the Member for Blackburn (Mrs. Castle), who fought so hard for it as Secretary of State for Social Services.

Providing truly adequate sums of money for the National Health Service as a whole to repair the damage of decades of under-financing is at the moment impossible, but within the present constraints and the resources made available to the National Health Service there must continue to be a commitment to a fairer allocation between the different regions. Siren voices have recently tended to suggest that, because their regions have serious deficiencies in health provision, the recommendations of the Resource Allocation Working Party—RAWP, as it is known—should not be implemented.

No doubt all regions can claim that they need more money, but none can make that claim with greater justice than the Trent Region. When the National Health Service was set up, there was in the South of England better provision for hospital and medical services than in other parts of the country. Therefore successive Governments, of whatever political colour, have had to continue to maintain and improve whatever services existed in each region. But the elimination of the imbalance and injustice between the regions has taken far too long.

Repeatedly, in speeches in the House, in interviews with Ministers and in letters to Ministers, I have in the past 17 years pointed out that the allocation of national resources to the National Health Service in the old Sheffield Region, and later in the Trent Region, was far too low and grossly unfair. For too long the expenditure per head of the population in the Trent Region has been below the national average. This has meant that in the region waiting lists for hospital beds and out-patient appointments have been longer than those in the rest of the country. It has also meant that the number of doctors, specialists, professional and technical staff, nurses, midwives and ancillary staff per 100,000 population has been lower in the region than the national average, and in some cases lower than the lowest figure in the other regions, while general practitioners have the biggest lists of any region.

Bad though the position may be when one compares the Trent Region with the rest of the country, breaking down the figures within the region itself shows a scandalous situation. The further south one goes in the region, the smaller has been the expenditure per head on the National Health Service and the worse the staff position. Cities like Nottingham and Leicester have not had their fair share of the cake even within the region, let alone within the national context. If one takes the fact that the Trent region has always been the Cinderella of the regions, and if one realises that Nottingham and Leicester have had such an unfairly low allocation of what has been made available in the region, one can see the gross inequalities from which Nottingham and Leicester have suffered for so long.

It follows, therefore, that the Trent Region has always been a seriously deprived region and that within it there are inequalities which are absolutely inexcusable. I am tired of having to point out this fact to successive Governments over the years, and I hope that I shall not receive on this occasion a ministerial dose of bromide which will not be in any way satisfying to the people of the Trent Region.

Massive injections of money into the Trent Region are necessary to correct the imbalance of allocation that has gone on over the years, but I appreciate how difficult it is for the Minister to promise that truly adequate sums of money can be found now. Nevertheless, I hope to hear from him some message of hope for the region in spite of the statement made by the Secretary of State on 21st December, when he said that he could not see that the equalisation of resources between the regions could be achieved in less than 10 years or so.

When I heard that, my heart sank, because in 1972 I was told in the House by a Conservative Minister that the imbalance of regional provision could not be eliminated in under 10 years. Why must the Trent Region in particular be offered jam at some ever-receding time—10 years from the latest ministerial statement—and no jam today or even tomorrow? The long-delayed day of justice for my region must be seen to be much nearer than 10 years away if we are to avoid an ever-increasing bitterness in the region.

The Trent Regional Health Authority has told the Secretary of State that it believes that it cannot meet its obligations to provide more clinical teaching facilities for its expanding medical schools and cope with the severe deprivation of the health services in the region unless the recommendations of the Resource Allocation Working Party are implemented quickly.

The authority has not only given warning to my right hon. Friend the Secretary of State of the deficiencies which exist within the region but, since so many heart cries have gone up recently about the difficulties of the London regions, it has given him some comparisons between the situation in the Trent Region and those which obtain in the London regions. The situation in the Trent Region is much worse than in London, bad though it may be in the capital. I was intending to give the House particulars of those comparisons, but I must suppress the desire to have them on record and merely say that they show that what I have said about the Trent Region lagging far behind is absolutely true in every respect. I am sure that my hon. Friend who is to reply knows this perfectly well.

It is evident from the statement made by my right hon. Friend on 21st December that he has not been misled by what I have called the siren voices which have been raised recently suggesting that the recommendations of RAWP should be scrapped. I hope, however, that he has given due consideration to the warning of the Trent Regional Health Authority, despite what he said in his statement about the remoteness of equalisation of resources.

From time to time I have raised in the House the serious deficiencies of the Nottingham hospital service, but I wish to mention one now which has not been raised before. That is the need for a second accident and emergency department in Nottingham. That need, I think, has been acknowledged by regional headquarters, but what is now planned is merely the setting up of an accident and emergency department at the Nottingham University Hospital to replace the present department at the Nottingham General Hospital and the department at the Children's Hospital. This move will involve more inconvenience for the population of the North Nottinghamshire area in getting to the new department because of the difficulties of transport.

Sites allocated for major social, health and community facilities should have good access by all available forms of transport from the catchment areas served. Since a hospital serves a very large population, coming from a far-flung catchment area, it is very important that an accident and emergency department in particular should be readily accessible to public transport.

Taking into account all these considerations, the Nottingham City Hospital site is more suitable for an accident and emergency department than is the Nottingham University hospital site. I believe, however, that a single accident and emergency department will prove to be inadequate and that it will be quickly demonstrated that there is a need for two departments. I should like to think that there has been an in-depth examination of this very important matter, and I should welcome my hon. Friend's comments on it.

The Trent Region as a whole is not some remote, backward, underdeveloped, underpopulated region. It is an important region of the country, with a great diversity of industry and a population of 5 million. It is nothing less than a positive disgrace that under all Governments it has continued to be an impoverished region from the National Health Service point of view. In fact, it is one of the poorest regions, if not the poorest, in all indices of health care. That is a sad situation. I hope that my hon. Friend will comment on it in a meaningful way today, even though I realise that his Department has many difficulties.

4.15 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

With the leave of the House, I should like to intervene again to reply to the points made by my hon. Friend the Member for Nottingham, North (Mr. Whitlock) whose knowledge and persistence in championing the cause of the Trent Region in general and Nottinghamshire in particular are well known in the House and cannot be too well known in the locality which he represents. I pay tribute to my hon. Friend's assiduity in this respect

I should add that my right hon. Friend and myself have recently received a number of representations from the area in support of the view that my hon. Friend has urged on the House this afternoon. These representations on behalf of the Trent Region, and some of those on behalf of other deprived regions, have served to complement, illuminate and supplement the representations that we have received from some other much better provided regions that are already better off under the recommendations of the Resource Allocation Working Party.

These representations have helped to redress rather misleading views which may have been seen in the national Press recently in respect of the less deprived regions. I assure my hon. Friend that no one has urged that the Resource Allocation Working Party approach to the allocation of resources in the National Health Service should be scrapped. I think that the argument is about the pace of implementation rather than whether reallocation should take place.

Before I come on to the health problems of the Trent Region, I can perhaps illuminate a corner of the Nottingham battlefield where, I am afraid, my hon. Friend will have to fight for some time longer. He drew attention to the need for a second accident and emergency department in the city of Nottingham. I am aware that the new accident and emergency department about to be opened on the south side of the city involves a transportation problem across the city from the north side, and that people on the north side of Nottingham are worried about what will happen with regard to the present accident and emergency department at the General Hospital on the south side.

It is, of course, the responsibility of the Nottinghamshire Area Health Authority to determine how many accident and emergency facilities there should be in the area and where they should be. I understand that the area health authority's decision to concentrate the city's accident and emergency services on the University Hospital in 1979 was confirmed by the authority first after full consultation with the community health councils of both north and south Nottingham in November last year. At the same time it was accepted in principle that a second accident and emergency unit should be provided in due course at the City Hospital. This remains the authority's intention.

However, in view of the many other important schemes competing within both the region and the area for the limited capital funds likely to be available, it would be unrealistic to suggest that an early start will be possible for this new second accident and emergency department at the City Hospital. By the time I have described the situation as it is developing elsewhere in the Trent Region, I hope that my hon. Friend will accept that at least the deprivation of Nottingham in respect of a second accident and emergency unit is not leading to inaction elsewhere.

Turning to the problems of the Trent Region in general, it must be said straight away that my right hon. Friend the Secretary of State and I recognise that the region is deprived and under-resourced compared with most other regions in the country. Patients in the Trent Region have to wait longer than the national average for hospital care. Compared with the national average, the region has fewer beds, sees fewer out-patients and has less hospital manpower and fewer nurses and midwives. What is more, the lists of general medical practitioners in the region are longer than in most other regions of the country. We accept that.

Successive Governments have attempted to solve the problem with no great success because they have been relying on historical factors to guide them. We have now learned from bitter experience that reliance on historical factors means that new resources go to where activity is already the greatest and, therefore, that the disparities tend to be increased rather than diminished if that technique is followed.

Therefore, this Government set up the Resource Allocation Working Party in Order to try to produce a new approach to the reallocation of resources in the National Health Service in the hope that the problems of regions such as the Trent Region and the North-Western Region might be solved.

In September of this year, my right hon. Friend received the report of the RAWP, which, incidentally, comprised not only civil servants from the Department but representatives of health authorities and others and was set up to advise Ministers on the principles and methods for allocating capital and revenue resources to National Health Service authorities.

Last Tuesday, 21st December, my right hon. Friend said that the Government's long-term commitment to a fairer allocation of money between the differing regions of the country would be confirmed and accepted. It is Government policy that there should be a fairer allocation of resources to the Trent Region. He also said that, having considered the views of the NHS authorities and other interested bodies consulted on the report, he had accepted the recommendations of the RAWP as a basis for distributing resources for the next years ahead.

The new approach in the criteria proposed for judging the health care needs of populations compared with the previous historical approach upon which Governments had been working is the introduction of standardised mortality ratios weighted for age and sex as an indication of morbidity or illness and, therefore, of relative health care needs. The application of these formulae to the population of the Trent Region shows that the region is in greater need of health care than had been indicated hitherto, with the result that the region will continue to receive one of the highest rates of additional funds in real terms for the future.

Again on 21st December, my right hon. Friend announced that, notwithstanding the economic situation, the planned growth of services to patients for the whole National Health Service in real terms had been left intact despite the recent cuts in public expenditure and that, as a result, a deprived region such as the Trent Region would receive an allocation of about 3 per cent. in additional funds for the next financial year. This would compare with the most provided region in the south of the country, such as the North-East or North-West Thames Region, which will be obtaining only about 0.25 per cent. in additional funds for the coming year.

My hon. Friend will see that there is a positive attempt being made to guide such additional funds as are coming into the NHS in the direction of the Trent Region. Obviously an increase of 3 per cent. in additional funds is not a superabundance, but it is one of the highest rates in the country and, in straitened circumstances, probably the best that we can do as a Government.

How has the Trent Region done in recent years? Outside London, of course, the Trent Region is unique in that it contains three medical schools—those at Sheffield, Nottingham and Leicester. Those at Nottingham and Leicester are very new, having been established in 1966 and 1971 respectively.

The decisions to establish new medical schools in the region were based in part on the knowledge that in this way the region as a whole would stand to gain in the long term from the observed tendency of many doctors to make their careers in the region in which they have been trained. Furthermore, it was recognised that the establishment of medical schools in these areas would lead to an improvement of the hospital services there generally as the capital developments necessary to bring the local services up to a standard consistent with the needs of both the community and undergraduate medical teaching came on stream and additional medical and other staff required were recruited.

In addition to the normal allocations, the Department has made available to the regional authority additional funds specially necessary for the upgrading of existing hospitals in both cities and in anticipation of medical teaching generally.

Phase one of the new University Teaching Hospital at Nottingham is due for completion next summer. A start on phase two has already begun, and by the time this magnificent new 1,000-bed hospital is completed some £33½ million will have been invested in its construction. This excludes any addition that may be made to meet inflation.

In addition to the new University Hospital in Nottingham, the region's capital programme in recent years makes fairly impressive reading. There is new district general hospital provision either in whole or in part in Barnsley, Boston, Doncaster and Rotherham, and a new teaching hospital—the Hallamshire—in Sheffield, as well as other major hospital developments in Derby and Leicester, in close association with the new medical school.

Earlier this year my right hon. Friend gave approval to the Trent Regional Health Authority's capital programme for this year, which included phase one of the long-awaited district general hospital at Chesterfield, of which the estimated total cost, excluding land, will be about £12.2 million at today's prices. There will be a new accident and emergency department costing £2 million and a new mental illness unit costing almost £2 million at the new Northern General Hospital in Sheffield.

There is also the new ward block, as I am sure my hon. Friend has noticed, at the Nottingham City Hospital. This is a scheme the merits of which have been urged on successive Health Ministers by my hon. Friend on behalf of Nottingham. He has waged a very effective campaign over a number of years, and I am glad to be the Health Minister who tells him that work on the new ward block started in November this year.

Mr. Whitlock

I appreciate very much all that my hon. Friend is saying, but in fact he is pointing out that we are only now receiving some of the backlog due to us to make up for the neglect of the past. We have a long way to go to get equalisation.

Mr. Moyle

Indeed. All I am saying is that at last we have begun the process of catching up. There is a long way to go before the Trent Region begins to compare, in terms of resources, with some other parts of the country. This year £66 per head of population is being spent on health care in the Trent Region, compared with an average of about £86 in some parts of London and the South. The Trent Regional Health Authority's capital programme for this year also includes phase one of the replacement of the boiler plant at the City and Sherwood Hospital, Nottingham.

In addition to the various capital provisions, we are of course making an effort to ensure that joint funding takes place. This is a technique whereby the health authorities will provide capital contributions to local authorities setting up provision for social services in their area which also look after people. Although the joint financing by the Trent Regional Health Authority in the current financial year is only about £¾ million, it is due to grow in the next three years to about £2.5 million.

It is not just a question of buildings. There is also the question of manpower. For example, although the approval of my Department is necessary for the establishment of new posts in hospital services, we are giving very high priority to achieving a fairer distribution of medical manpower. The population of the Trent Region is less than 10 per cent. of the population of England and Wales, but the region as a whole has been given 15 per cent. of all new consultant posts over the last four years. Trent did even better with nearly 20 per cent. of the approvals in radiology and more than 25 per cent. of those in anaesthetics.

I hope that my hon. Friend the Member for Nottingham, North will consider this statement of the Government's policy and that, having considered the information I have given him, he will agree that, although Trent Region has a long way to go before it has a health service comparable to that in London and the South, things are beginning to move in the right direction. We welcome this prodding by him from time to time until the targets are achieved.