HC Deb 16 December 1977 vol 941 cc1143-60

11.55 a.m.

Mr. A. J. Beith (Berwick-upon-Tweed)

I am glad to have the opportunity to raise the problems of the Health Service in the Northumberland area. I am glad that the Minister of State is here to reply. I know that it is not without some personal inconvenience that he agreed to be here. But it is important that he should be here, because when he answered a Question which I put to him on the subject some weeks ago he either did not fully realise the situation in Northumberland or was wrongly advised about it. His Answer was received with disbelief and dismay by health workers in Northumberland, and it was that which convinced me that I should raise the matter again today.

The debate must be seen against a background with which all hon. Members are familiar. The serious shortage of funds is a problem in many parts of the Health Service throughout most of the country. It has been difficult to maintain standards and achieve improvements during a period when public expenditure has been restricted because of the battle against inflation. I hope that the Government will continue to fight to make good the lost ground as quickly as the economic conditions will allow.

It is a tragedy that at such a difficult time the Health Service should have to carry on its back the crippling burdens of increased administrative costs that were brought about by the misguided reorganisation of the Health Service by the right hon. Member for Leeds, North-East (Sir K. Joseph). That has not helped and it is deeply frustrating to many of the devoted professional staff who are struggling to maintain services to see that the administrative superstructure has been growing at a time when every penny is needed to maintain and improve services at the hospitals and at the general practice level.

Despite these difficulties, the Government have rightly set themselves the task of trying to do something about the great differences that exist in the resources for the Health Service in different parts of the country. I do not hesitate to commend them for what they have done so far by means of the Resource Allocation Working Party formula. They have sought to redistribute resources to regions which are under-provided but which have a high need. Equalisation is bound to take longer than it was originally believed. It could take at least 10 years because of the present economic circumstances.

The Northern Region is the third poorest in England and therefore it rightly benefits from the Government's policy. In the years 1978–79 and 1979–80 the region will be allowed a growth rate of 2 per cent. per annum, which is twice the national average rate.

I now come to the difficulty. The Northumberland area of the region is the fourth poorest area within that region. It is a poor area within a poor legion. The problems of the area are all too apparent to one who is proud to represent it. It is an area where family incomes themselves are low, and it is generally a low wage area where people's ability to meet claims upon private resources for medical attention is even smaller than it is elsewhere in the country, so that the Government cannot expect them to undertake such payments.

Geographically, Northumberland is an area of long distances and separation of the people from medical facilities. Obviously, this presents problems both for individuals and for the medical and hospital authorities. The other day in my Saturday morning constituency surgery I was talking to one of the many people who come to me to point out that in order to see a specialist at the nearest place where such facilities are available from Berwick one has to go to Newcastle, making a journey of 60 miles each way from Berwick, with costs of nearly £4. If someone has to go for a fortnightly consultation or special treatment, at £4 a time the cost becomes quite serious.

This constituent put the question quite simply: "Why do I have to meet this cost when someone in Newcastle can take a 10p or 20p bus ride to obtain the same specialist consultation?" I speak here of a constituent who is not able to obtain any help with such travel costs from the Department of Health and Social Security.

Thus, my constituents start at a severe disadvantage. Almost all of them are a long way from the medical facilities which they need. Moreover, as I have said, the hospital authorities themselves have to contend with the problems presented by the extent of area to be covered, which means that their resources have to be widely distributed.

Northumberland has nothing like a district general hospital in the whole health authority area since its resources have had to be spread over the whole area. I should add that I have always taken the view that this is right and that the creation of a district general hospital must not have priority over ensuring that we maintain locally based hospital services a long way from the place where such a hospital might be. It is important that services in Berwick and Aldwick, for example, are maintained. We have good small hospitals there, but the maintenance of these services is an expensive operation made essential by the scattered nature of the population and the long distances involved.

There is another feature of the Northumberland area of which the Minister of State is aware and to which I drew his attention some weeks ago. It is a massive provider to the rest of the region of hospital beds in the mental handicap and mental illness fields. Prudhoe Hospital, for example, has over 1,300 beds for mentally handicapped patients, and I believe that, at the latest count, fewer than 70 of its patients came from Northumberland.

Northumberland is quite happy and proud to be able to offer to the region a mental illness and mental handicap service of the quality which is still maintained at Prudhoe and in other psychiatric hospitals. But it is a costly business, and the county is conscious of the need to bring standards of staffing and accommodation in those hospitals nearer to the standards which are being set nationally. At the moment, it does not have the resources to do so.

There are other psychiatric hospitals in Morpeth, one with 900 beds and the other with 750, and similar problems are confronted there. The community health council has drawn attention to the serious under-funding in the psychiatric hospitals. It claims that the Prudhoe Hospital is under-funded by £1 million a year on current revenue allocation and that St. George's hospital at Morpeth is £750,000 short.

In order to draw attention to these particular difficulties as part of the general problem, I raised the matter at Question Time on 22nd November. I put the issue to the Minister of State asking him about the psychiatric hospitals, and he told me about his response to the representations which he had received from many quarters. I then asked: Is it not the case that under the region's revenue plan for the next two years betterment funds are being steered away from the Northumberland area, so that if essential improvements are to be made in these psychiatric hospitals it can only be at the expense of the other medical services in Northumberland, despite the fact that the hospitals serve the whole region? The Minister of State replied: The hon. Gentleman has got the wrong idea, because half of the betterment funds for this year going to the Northumberland Area Health Authority have been directed towards psychiatric hospitals. In any case, the region is a receiving region under the Resource Allocation Working Party formula and is therefore likely to enjoy a growth rate of at least 2 per cent. on current forward projections for the next decade. Therefore, the second point raised by the hon. Gentleman is not true either."—[Official Report, 22nd November 1977; Vol. 939, c. 1302.] Of course, half the betterment funds for the Northumberland area went to the psychiatric hospitals this year. It was the only way the area health authority could seek to make any progress at all. But the work it has done in the psychiatric hospitals this year brings revenue consequences in the two years about which I asked the Minister. I did not ask what the area had had this year. I asked about what the region proposed to do for the area in the next two years. There is no way in which the area health authority can continue to stand by the psychiatric hospitals as it did this year with the resources which will be available to it in the next two years.

The second point on which the Minister claimed that I was wrong, when he seemed to assert that the 2 per cent. growth will be available to the area in the next year, still stands. The truth is that the 2 per cent. will not be available to the area at all. The region gets a 2 per cent. allocation, but it is expected that in the next year only less than 1/2 per cent will be available to the area health authority, and over the two years only little over 0.9 per cent.; which is less than the nationally expected rate of betterment and less than half the level available to the region.

The share of regional betterment funds going to the Northumberland area has been drastically reduced. The figure is apparent from the proposals made by the region in 1976 for these two years. It was then proposed that Northumberland should receive 13.1 per cent. of the regional betterment funds. It is now proposed that it will have only 3.5 per cent. There has been a large shift of emphasis in the use of regional betterment funds towards providing for the revenue consequences of major capital schemes such as the Freeman Road Hospital in Newcastle and other facilities in places such as Darlington, in some of which the problems of the National Health Service in terms of waiting lists are less severe than they are in the Northumberland area and in which levels of provision are such that they do not justify so drastic a switch of funds from an area which is at present so weak.

In other words, I believe sincerely that I was right to say that betterment funds are being steered away from Northumberland. Certainly, everybody working in the National Health Service in the Northumberland area believes it.

It follows that the psychiatric needs cannot be met out of betterment funds. I quote now from a letter sent to me—before I asked my Question—by the area administrator of the Northumberland Area Health Authority. He says: Our complaint is that the revenue planning assumptions adopted by the Regional Health Authority last month are markedly different from those published last year. Northumberland's figures have been reduced from £374,000 to £139,000 for 1978–79 and from £464,000 to £217,700 for 1979–80, with the result that the planning work done in the intervening year has been completely undermined. As one of the most underfunded areas in the Region, the Authority expected its betterment funds for 1978–79 and 1979–80 to be closer to the regional level of growth and certainly above the national level. In fact, it would seem that the Region intends that Northumberland should have less that the national level in 1978–79 with the effect of leaving the Area further from its target allocation than it will be at the end of 1977–78. Even the proposals for 1979–80 do not envisage North-umberland Area Health Authority being any closer to its target allocation than it will be at the end of 1977–78. In arriving at this decision the Regional Health Authority appears to have given no particular weight to the national policy of improving services for priority groups such as the mentally ill and the mentally handicapped. Had it done so, Northumberland, which provides so many of these services for the Northern Region, must have received a considerably larger proportion of the betterment funds available. It would also seem that the Region has effectively nullified the recommendations of the Resource Allocation Working Party report in that the funds made available for equalisation appear to have taken third place behind the wish to protect the revenue consequences of capital schemes and the needs of the regionally managed services. The area administrator goes on to say that there has been no consultation with the area or its officers on any of the matters which he has mentioned, and he adds that his authority has requested an urgent meeting with the regional health authority. I understand that this has now taken place.

What will be the consequences of this financial situation. First, it is plainly impossible to do much to improve the position in the psychiatric hospitals, and this at a time when other areas within the region which do not carry our large responsibility in the psychiatric field can spend their betterment funds quite freely on the general medical services. North-umberland hoped that by spending quite a hit of its money on the psychiatric hospitals last year it could have turned its attention in the next two years to some very pressing problems in the other fields.

But if one tries to deal with the psychiatric problems, other very necessary projects become threatened. One of the projects which is threatened is one of the most hopeful signs that we have seen in the Health Service in our area in recent years. I draw the Minister's attention to the fact that one of the projects which will be threatened by this would be the new orthopaedic wing at Ashington Hospital, which serves my constituency. I remind the Minister that the orthopaedic wing of Ashington Hospital has one unique feature about it. It is the only case that I have come across in recent years of an administrative block in the Health Service being turned into a ward block, rather than the other way round. It is a very commendable and necessary project. There are severe orthopaedic waiting lists in Northumberland and there is serious under-provision in that sphere. If the costs arising from that project cannot be met, it will not be able to open as expected. With the problems in the orthopaedic field added to in other ways, that is very serious.

I remind the Minister that Northumberland's request for a third orthopaedic surgeon in 1978–79 has been rejected in favour of Durham—a district of much smaller population which is already better served. There is even doubt about the provision of alternative orthopaedic beds for children from Northumberland who are being treated by consultants from Northumberland once the Sanderson Children's Hospital in Newcastle is closed.

It is not simply that. If the Ashington orthopaedic project, of which I very strongly approve, does not go ahead, it will hold up increased provision for general surgery because the reallocation of physical resources in Ashington was going to provide for that. We shall have lengthening waiting lists, which are already serious, in general surgery if this is not done.

As well as those problems, it is well known that there is insufficient geriatric provision in Northumberland. The revenue needed to run the new block to replace Castlegate Ward in Berwick seems to be threatened again if the financial allocations remain as they are. In Berwick we have an old workhouse building which is to be replaced by a new geriatric block with more beds in it. It will inevitably cost more to service because of its larger occupancy. It is a very necessary project for which the area has been fighting for a long time and which was inherited from the previous regional hospital board. We have been working for this for a long time. If the running costs of that are to be threatened, the under-provision in our area will be made worse.

Perhaps the most serious matter of all is that the nursing staff in several Northumberland hospitals are well below acceptable numbers. The strain on this hard-pressed nursing staff is appalling. It is a miracle that they manage to cope. They cannot achieve the standards which they want to achieve and which they have been trained to achieve if they are filling in for the jobs of two people in their particular hospital.

I receive very moving tributes from constituents who have been in hospitals in my constituency, such as Berwick, Alnwick and Rothbury, and in Ashington Hospital, to which many from my constituency go, to the dedication, skill and care of the nursing staff. But the constituents say "Cannot something be done to provide more staff? These nurses have far too much to do. They are having to cope with far more than is reasonable." The constituents, who pay particular tribute to the nursing staff, point to the inadequacies of present staff levels.

The Minister may well know that in the current year there had to be imposed something of a moratorium on nursing appointments, on overtime and hours worked by part-time staff, which has presented very serious problems. It is hoped that this may be able to be relaxed increasingly, but a complete embargo had to be brought in on new appointments in the area. No overtime could be worked, except in cases of sudden emergency, without the express permission of the area nursing officer.

It is also the case that recruitment of good youngsters into nursing in an area of high unemployment has had to be held back. The number of nurses in training in Northumberland has been drastically cut. There are very good youngsters who want to go into nursing both in the general field and in the psychiatric field At a time when good school leavers are available, it really is a great tragedy, as I know the Minister himself will feel, that we cannot be taking some of these keen, good youngsters into nursing and giving them the training.

All this falls far short of the objectives which the Minister has held out to the poorer areas in the National Health Service. I cannot believe that he is happy about it.

On page 4 of "The Way Forward", which is the document in which the policy is set out, there is a very significant phrase: It will be particularly important to redistribute within regions in keeping with the national approach". That is what I am arguing to the Minister is not happening within the Northern Region.

I put two points to the Minister by way of conclusion. First, I very much hope that he can do something with the new resources which the Chancellor of the Exchequer is seeking to make available to the Health Service to remedy the problems that have been described. Much of those new resources is committed to capital projects, which will give something of a boost to the construction industry. There are many desirable projects not just in Northumberland but throughout the country that one wants to see go ahead. I believe that some of that money is available for revenue raising and could be used for betterment purposes. I hope that the Minister will try to see that these resources and any new resources which an improvement in the economy can bring about will find their way into an area which is seriously under-provided.

I put a second point to the Minister. It is not sufficient—I hope that he will not seek to do so—to argue that this is simply a matter for the region and if the region feels that it is necessary to steer its funds in some other way, we must leave it at that. I hope that he will involve himself personally in trying to ensure that his national policy is carried out. I repeat the phrase: It will he particularly important to redistribute within regions in keeping with the national approach". The regional health authority is not an elected body. It is not responsible to the electorate, as is a local authority. The Minister cannot say, as his right hon. Friend the Secretary of State for the Environment could say, "I have allocated the money via the rate support grant. Now it is up to the local authorities to decide how they spend it". It is not that kind of a system. It is a system in which the Minister himself retains a great deal of responsibility. Moreover, the Minister is dealing with a regional health authority none of whose members comes from anywhere near my constituency. There are no members of the regional health authority who live in or near the part of Northumberland area whose interests I am representing today. Its ability to make wrong decisions about the Northumberland area has been well illustrated in the past, for example, when it set out to amalgamate ambulance stations. I am glad to say that it has seen the error of its ways. But it is an illustration that the regional health authority is a remote body and one that does not have the same kind of direct democratic responsibility to the areas about which we are concerned, which would obviate the necessity for the Minister to take a hand in this matter himself.

I believe strongly that if the policies to which the Minister is committed, in the execution of which he and his right hon. and hon. Friends have devoted a great deal of effort, are to be carried out, and if an area which is now under-provided for, with very serious needs, is to be improved, and if there are to be any improvements at all over the next two years, he must take a hand and try to ensure that the national objects of equalisation are carried out in the Northumberland area.

12.18 p.m.

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

I think that it is important front time to time to consider these matters of funding the Health Service. It is a matter of considerable complexity, and it might help the House, therefore, if I explain, first, the background to current methods of allocating resources in the national context. I shall then move on to explain the position as it affects the Northern Region and, in particular, the Northumberland Area Health Authority. In doing so, I hope that I shall be able to explain to the hon. Member for Berwick-upon-Tweed (Mr. Beith) why it is that I shall not be taking a direct hand in the decisions of the Northern Region in the allocation of funds, in the way in which he asked me to do in the concluding part of his speech. I hope that at the end of my remarks he will have a better understanding of how ministerial influence is exercised on these matters.

Perhaps before going any further I should reassure the hon. Gentleman that I have no information which leads me to believe that the Ashington Hospital orthopaedic block, which was a particular matter that he raised, will not open in April 1978, as is, I think, currently planned.

I turn to the main theme. The hon. Gentleman is quite right in saying that the Government are committed to a fairer sharing between regions of the resources available for hospital and community health services and to remedying the even greater deficiences within the regions Last year we received the second report of the Resource Allocation Working Party, which was set up with members from the Department and various disciplines in the Health Service. It advised my right hon. Friend and myself on principles and methods for allocating capital and revenue resources to the National Health Service authorities on as objective and fair a basis as possible and according to the health care needs of their populations. We accepted the recommendations. They were used as a basis for distributing resources in 1977–78—that is, the current financial year. It is our intention to continue the process for 1978–79.

The measures of relative need obtained by using the working party's suggestions are an indication of how the available resources should be distributed among health authorities in proportion to relative needs. Obviously it will not take place overnight. The imbalance of the past 30 years, or perhaps of the past 100 years, cannot be corrected at a stroke, to coin a phrase. We must do all we can to direct as much of the additional resources available for the health services to the more deprived regions and areas, but the pace of change should not be so fast as to put at risk essential services which already exist in the better-provided regions. This includes the teaching hospitals, which are helping to provide the doctors and dentists of the future in the hon. Gentleman's constituency as well as in any other.

It is common ground between us that the Northern Region is one of the most needy regions in terms of the resources available for health care services. On the basis of the RAWP report, the Northern Region was the third most needy region in England for the financial year 1977–78 and we gave it an increase in resources of about 3 per cent. in real terms, which was more than twice the national average. This meant that the Northern Region received about one-seventh of the total of additional revenue resources available for the health authority services in the current year. Earlier this year, the region was told that it should plan on the basis that, for the next two years, it would receive an annual addition to its revenue funds of about 2 per cent., based on a growth of revenue resources for England of 1 per cent.

It is up to the regional health authorities to make allocations of funds to the area health authorities in their regions. Regional health authorities have been asked to apply the same principles to allocations to the areas within their regions as we as a Department apply to allocations to the regions. The RAWP said that the pace of change within a region must depend on local circumstances, including the plans for the development of services in the regions and as resources become available. The actual use made of the available resources must, therefore, be related to national and local priorities.

How did the Northern Region set about allocating its funds to the areas? It might be helpful if I go through the history of the methods used by the regional health authority. At the beginning of this year, the Northern Regional Health Authority published its strategic plan for the next 10 years and explained its revenue planning assumptions for the years 1977–78 to 1979–80. My Department had issued details of revenue planning assumptions for each region in May 1976 based on the White Paper, Cmnd. 6393, which represented the Government's view of the future level and distribution of public expenditure. They were not commitments but were described as assumptions which might be made as the basis of forward planning.

The region worked out a target for each of its areas based on the funds available to it. This obviously showed that some areas were above the regional average and others, including the Northumberland Area Health Authority, were below the regional average. The region made the assumption that the below-average areas would receive the major share of the additional resources available.

But the Northern Regional Health Authority had to remember that there was a substantial programme of major developments to be commissioned during the period to 1979–80 and beyond. These developments included major schemes at Freeman Hospital, Newcastle; Darlington Memorial Hospital; Sunderland General Hospital; the Newcastle Dental Hospital and School; the South Cleveland Hospital. The regional health authority considered that the impact within the region of the revenue implications of these schemes was so great that it would be unrealistic for it to disregard this factor in deciding allocation principles for the next few years. It had to take a view, therefore, as to how much of the betterment funds—that is, the increment of additional funds in any year compared with the preceding year—should be earmarked for revenue consequences of capital schemes.

The RHA decided for planning purposes that in the year 1977–78, 75 per cent. of the betterment funds should be earmarked for revenue consequences of capital schemes, reducing to 70 per cent. in 1978–79 and to 65 per cent. in 1979–80.

On this basis, the regional health authority planned to allocate to Northumberland AHA in 1977–78 £21,000 for revenue consequences of capital schemes, plus betterment funds of £319,000. This was to be followed in 1978–79 with £124,000 for revenue consequences, plus betterment funds of £240,000 and in 1979–80 with £41,000 for revenue consequences, plus betterment funds of £423,000. These capital schemes in the Northumberland AHA were not for major developments. These figures were published in the regional strategic plan in January of this year.

In February of this year my Department issued further guidance to regional health authorities on revenue allocations for hospital and community health services and at the same time informed each region of its revenue cash allocation for this year. That resulted in further future adjustments.

First, it was recognised in the further guidance that even in the regions receiving the biggest increases this financial year would be a year of consolidation rather than development. So in March 1977 the regional health authority published its recommendations for the allocation of revenue funds this year including several refinements.

The first of the refinements was that the cost of providing for revenue funding of major schemes and certain other developments of regional significance should be a first charge on the allocation to the region and funded specifically to the areas. The remaining betterment funds were allocated to areas on the basis of the distance of the actual allocation for the previous year from target allocation. Every area is given a target to which it must move gradually over the years. This element of the allocation apportioned a sum directly and solely in proportion to the degree of deprivation revealed by the comparison of the actual allocation with the target allocation.

The second refinement was that all the additional revenue consequences of the smaller capital schemes this year should be met by the area from its total revenue allocation. This was considered feasible because the total sum available for developments was considered to be sufficiently large to ensure a substantial increase in allocation for almost all areas.

When these refinements were put into operation the region calculated the allocation of betterment funds to Northumberland as £341,800 for 1977–78. This included £40,000 towards the revenue consequences of minor developments at Ponteland Health Centre and the upgrading of a villa at Prudhoe Hospital. The final proposed revenue cash allocation for Northumberland reached about 88.63 per cent. of its target.

I have explained the history of methods used for the calculation of the planning assumptions of the regional health authorities up to March this year so that the hon. Member might understand the background to the current position. I hope that it has not taken too long, but I think that it will have been useful.

In May of this year, my Department followed up its earlier advice by issuing a circular giving planning guidelines for 1977–78 together with revenue planning assumptions for 1978–79 and 1979–80, based on the public expenditure projections contained in what is now Command 6721. Again, the regional health authority studied the guidance given by my Department and examined the various methods of distributing the additional funds. It came to the conclusion that account had to be taken of certain commitments for the two years about which we are talking before it could calculate the distribution of betterment funds to areas.

Those commitments were the needs to fund certain schemes commencing during 1977–78, to fund the consultant and senior medical staff expansion programme, to fund the regional training programmes and, finally, to fund the development of the Northumbria ambulance service. But these commitments, of course, had the effect of reducing the balance of betterment funds, so that further assumptions were required. The regional health authority realised that its policy of using 70 per cent. of the additional funds to meet the revenue consequences of capital development in 1978–79 and 65 per cent. in 1979–80 would not redress inequalities between areas as quickly as if the distribution had been based solely on the recommendations of the Resource Allocation Working Party, but it considered that it was necessary to give support to the additional running costs arising from these developments.

In addition, the regional health authority was able to assess target allocations for all its areas on the basis of the national average rather than the regional average. This showed that all the areas in the region were below the national average and that, therefore, it would be appropriate to plan to remedy the deprivation in all its areas rather than in only the more deprived of them.

The regional health authority met in September and considered a paper prepared on the basis of revenue planning assumptions for 1978–79 and 1979–80. It decided to adopt these proposals, and area health authorities were subsequently advised about their revised planning assumptions for the next two financial years. As a result, the Northumberland Area Health Authority was given allocations of £139,000 in 1978–79 and £217,000 in 1979–80. Even over the past 12 months there has been a continually changing situation, and the resource assumptions for the future were adjusted in the light of the events. But in no sense can it be said that betterment moneys are being steered away from the Northumberland Area Health Authority, because it has been allocated betterment funds on an increasing scale for the next two years. There are other factors which the hon. Gentleman mentioned in his speech, and we shall certainly consider those as well.

We are now getting to the nub of the argument, because clearly what concerns the hon. Gentleman and the Northumberland Area Health Authority—this is, what the hon. Gentleman said today and not what he said in his supplementary question on 22nd November—is not that the funds now available to the area health authority are to be cut, because they are not. In real terms, the authority will receive an increase in revenue in the coming financial year. The real concern is that its expectations have been drastically reduced, based on the planning assumptions given in 1976. That was not what the hon. Gentleman said in his supplementary question on 22nd November, but that is what he really wanted to say. If I am correct, I think that I have considerable sympathy with him.

To be fair to the regional health authority, it should be said that when it issued its planning assumptions in 1976 to the area health authorities it was stressed that they were tentative and could not be regarded as commitments. It was also made clear that they might be subject to further refinement following consideration of the final RAWP report. It was also made clear that some changes in figures issued only on planning assumptions were inevitable and could be significant.

As I have already mentioned, it is not yet possible to indicate the revenue allocations that will be made to the regions for 1978–79, but the Northern Region will receive a share of the £10 million revenue money which the Chancellor of the Exchequer made available to the NHS in September after representations by the regional health authority to consider its allocations.

Mr. Beith

I am listening with interest to what the Minister is saying. I hope that he will avoid using the word "refinement" when referring to a reduction from £364,000 to £139,000. Let us not mince words. It is not simply a variation of expectations: it is a very drastic reduction.

Mr. Moyle

It is a reduction in assumptions, but in actual fact the area is to get more money next year than it gets this year. It is equally important to put that on the record. There has been talk about steering betterment money away from the area health authority. Betterment money will go to the area health authority. However, if the hon. Gentleman is complaining that the authority is not to get as mach as it at one time hoped, that is a different matter. As I have said, I have great sympathy with him.

The hon. Gentleman also said that expenditure on psychiatric hospitals can be only at the expense of other medical services in Northumberland. That is a very positive emphatic statement and there is not a great deal of room for qualification. As I have just said, Northumberland's funds are growing—marginally maybe, but growing. Therefore, the extent to which betterment expenditure on psychiatric hospitals is at the expense of other medical services is a function entirely of the size of the betterment programme. Except in the most generfil sense, of course, £1 spent on the Northumberland psychiatric service is £1 which cannot be spent anywhere else in the NHS.

Since the last-mentioned allocation of £10 million was made, the Chancellor has made £400 million available to the construction industry, of which £38 million is being made available to the NHS. In the next financial year £2.3 million of that money will be made available to the Northern Regional Health Authority. Obviously there are limitations on the way it must be used. It has to be used to promote employment in the construction industry in the next financial year. It seems to me, however, that that money is tailor-made to spend on improvements to psychiatric hospitals. That having been said, the way that money is spent is a matter for local decision.

I have tried to explain how the allocations to Northumberland Area Health Authority's planning assumptions have come about. I fully acknowledge that this would be of little solace to the area health authority, and it does not help it to move more quickly to its target allocation. But this must be accepted all over the country in terms of restraint on the rate of growth to funds in the NHS.

That Northumberland is an underfunded area is not in doubt, and I know that the regional health authority is sympathetic to its problems and appreciates this fact. Whether the regional health authority has any room for manoeuvre between now and early in the new year when firm revenue allocations are decided is another matter. However, I know that the regional health authority will consider very carefully the case being presented so forcefully on Northumberland's behalf by the hon. Gentleman today.

The Northumberland area management team met the northern regional team of officers on Tuesday of this week to explain Northumberland's problems in financing and improving its health services. Today, member representatives of the area health authority are meeting the regional health authority, and I am assured by the regional authority that they will receive a careful hearing.

My own officials, as part of their normal duties, monitor the allocations made to areas within the regions. I have arranged that they will consider and discuss with regional health authority officers the planning assumptions that have now been issued. I personally want to be assured that the revenue allocations being planned for the areas, particularly in a gaining region, are as equitable as possible, bearing in mind, of course, the serious limitations imposed on the Northern Region because of the substantial capital developments coming on stream in the next few years.

In other words, I feel that Northumberland probably needs to move towards its target allocations at the fastest possible speed. In the ultimate, however, as long as the Northern Region can conform with the guidelines that we as departmental Ministers issue, the final decision on how fast that pace should be is a matter for the Northern Region. I am sure that the region will take into account the things that the hon. Gentleman has so forcefully said this morning.