§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Snape.]
§ 11.11 p.m.
§ Mr. Martin Flannery (Sheffield, Hillsborough)
I am grateful for the opportunity to raise what is a very serious question in Sheffield and South Yorkshire—the question of the future of the splendid new Hallamshire Hospital in Sheffield. This hospital, which is almost completed, and very urgently needed, is liable to remain closed for many years to come unless more money is made available through the regional health authority, which has used up practically all the funds that it has been allocated. Therefore, this is really an appeal to the Government to help us in what we consider to be a real emergency.
202 Sheffield and South Yorkshire people were dumbfounded when they realised that this immense and splendid hospital, which they have seen being built since about 1969 in the university area of Sheffield—one of the more salubrious areas—was liable, because of a shortage of funds, to stand there, with its equipment in it, expensively empty for a long time.
I say "expensively empty" because, these days, to keep a great building in a state of repair, with all that that means, with all the wonderful medical equipment that is in that hospital, is expensive. I do not know what the exact cost would be. I do not think that it has been costed, but it would amount to a large sum of money just for the building to stand there unused.
Sheffield Members of Parliament have been seized of this problem for a considerable time, and you will have noticed, Mr. Deputy Speaker, that only last week three Sheffield Members raised this matter on a Question. I know that all the Sheffield Members are deeply worried about this hospital and that all our people are taking note of this short debate. More interest has been shown in it since it became known that it was to take place than 203 in almost anything that I can recall during the few years that I have been in the House.
Sheffield Area Health Authority is keenly aware of the financial difficulties that the Health Service is facing. How could it not be aware? It knows of the general public expenditure cuts, and many members of its members deplore them. They are aware of the needs of the Health Service. The authority has proposed to the Trent Regional Health Authority that a once-for-all allocation of £4 million over a period of three years should be made to enable the hospital to be commissioned and to put into use all these beds, in modern surroundings, for acute cases of various illnesses. This money would prime the pump and enable the authority to fund the new development on a permanent basis.
We are not asking for special favours. The Government have made a serious effort to enable us to catch up, but the whole Trent region, for reasons that many of us still do not understand, has fallen behind in allocations for medical training and health generally.
There are three hospitals in my constituency. The Royal Infirmary was opened in 1797 and was literally next door to the great hammers of the developing Sheffield steel industry. It is surrounded by the small back-to-back houses of the Industrial Revolution as well as some of the good houses of the employers. It was near the squalor of industry. I saw it when I was a boy, and now it is cluttered with additions that have been built on to it because it was not designed to deal with the sick of today.
The Royal Hospital was built in 1832 and is almost in the city centre. It is outdated and difficult for patients and medical staff. One wonders how they manage to do such a wonderful job in the hospital.
The new hospital is long overdue and is destined to improve the facilities for patients in Sheffield and to replace the other two ancient hospitals that are still functioning. It will be a referral centre for adjacent areas in basic medical and surgical specialities, including neurology, neurosurgery, renal transplants and haemophilia.
204 The general quality of hospital accommodation in Sheffield is poor and has been known to be poor by almost everyone for a long time. Only the splendid new Hallamshire Hospital and the accident and emergency department in the Northern General Hospital, in the Bright-side constituency, are programmed for the near future. Even after the commissioning of the new hospital, only 700 of the 2,000 "acute beds" for the really sick will be in modern accommodation. Conditions in other old Sheffield hospitals should be mentioned. They are woefully deficient in quality and quantity, and inadequate for the clinical teaching needs of medical and other students.
Unless the Hallamshire Hospital is opened, Sheffield will be the only area of South Yorkshire without a modern general hospital by 1980. What is proposed in the Brightside constituency indicates that we need two district general hospitals. We have one that is almost completed. The equipment is inside, and it stands ready. People have watched it being built since 1970 and taken pride in it. Now it is likely to stand empty—a veritable medical Centre Point that will not make the money that Centre Point made while standing empty. It will stand idle for many years because the regional health authority cannot provide the funds to open it.
I recently received a letter from Professor Crane, Dean of the Faculty of Medicine. Since Sheffield is a university area, the new hospital would be a teaching hospital. He said:You may find it helpful to know that the Sheffield Medical School has given offers to admit 150 medical students this coming October in response to Government pressure for an increased number of doctors needed for the National Health Service. These admission offers, which we are legally obliged to honour, when taken in conjunction with our previous expansion figures means that we have a 25 per cent. increase in clinical medical students to teach in our existing hospitals. One of the important factors that influenced our decision to respond to Government to expand our numbers in the national need was the expected completion and commissioning of the Hallamshire in 1978. It was due for completion in 1975".This hospital, which is to stand empty for a long time, cost £27½ million to construct and equip, only to stand idle. The university medical school has committed itself to increasing its intake per annum. 205 It is alarmed by the difficulties to be faced if the hospital does not open.
The old hospitals have lived in uncertainty, because the staffs have been told that they are only there until the other hospital opens. These two hospitals have been partially run down because the staffs were expected to move into the great new hospital. These dedicated people are carrying on in uncertainty, in adverse conditions. They are bound to suffer a loss of morale as a result.
It has been calculated that to run the infirmary—the older of the two hospitals—until the 1980s will cost £3½ million. To run the other hospital will cost the same. We are asking for only £1.8 million, at the most, for one of the three years over which we would need £4 million for our splendid new hospital.
I am told by an authoritative source that the effect on the morale of the medical staff in Sheffield cannot be overstated. They have put up with poor conditions and accepted a deteriorating standard of maintenance because they expected to move into the wonderful new hospital. It is particularly demoralising to ask people to work in old premises when every day they pass the empty, brand-new hospital which is lying there idle.
Sheffield is a great industrial city and part of an even larger industrial complex. Steel is its heart-beat. Cutlery is part of Sheffield's past and is still a great trade. Sheffield is on the edge of the greatest expanding coalfield in Great Britain—the Yorkshire coalfield. Our people have worked hard and are proud of the work that they have done. Sheffield used to be one of the dirtiest cities on earth because of the major part that it played in the Industrial Revolution. Through smoke abatement, and so on, its people have made their city the cleanest in Europe, and possibly in the world. Its people have suffered adverse conditions for a long time. They have seen more salubrious areas receive better treatment.
Now they see this beautiful hospital. They regard it as their own, but public expenditure cuts have interfered. They think that they have earned their new hospital. It stands there, modern and, medically, completely up to date. The sick and others in the area expect to see it used.
§ Mr. John H. Osborn (Sheffield, Hallam)
This hospital is in the Hallam constituency. The headquarters of both the area and regional health authorities are also there. Is not one of the problems that the balance of expenditure in the region is outside Sheffield rather than inside? Should not the appeal be to the regional authority to make that £4 milion available and to the Minister to put pressure on the regional authority?
§ Mr. Flannery
That is an important point. We ask the Minister to bring the imbalance to the attention of the regional authority, which has received powerful petitions from the area health authority. Much as I should like that: imbalance redressed, I also make a plea for more money to go to the regional authority, because it has been held back for many years and has fallen behind.
As I was saying, the hospital stands there splendid but not about to be used. Therefore, we ask my hon. Friend to make the necessary moneys available so that our sick and injured may look forward with confidence to treatment in this great new hospital. I emphasise the need for the treatment of the injured, because in an area such as this one never knows whether or when industrial accidents will take place. That was one of the matters that my hon. Friend the Member for Sheffield, Brightside (Miss Maynard) knows we have to take into account, since hers is the industrial area.
For all those reasons, we plead with my hon. Friend to make the moneys available so that the sick, the injured and all of us when in need may look forward with confidence to splendid hospitalisation of the highest order in the new Hallamshire Hospital.
§ 11.26 p.m.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)
I am grateful for the opportunity to reply to my hon. Friend the Member for Sheffield, Hillsborough (Mr. Flannery), because I know that the matter that he has raised is of great concern to all Sheffield Members, as was demonstrated both by his speech tonight and by the Questions put to me on 21st June, when the Department was first for Questions.
The matter is of close concern also to the health authorities—both the area 207 health authority and the regional health authority responsible for Sheffield, South Yorkshire and the rest of the Trent region—as well as to my right hon. Friend and myself.
First, I want to sketch in briefly the background to the development of the Hallamshire Hospital. It consists of an integrated teaching hospital and medical school, with 746 acute beds, including 12 day beds, with appropriate supporting services—out-patients, accident and emergency services, and so on—together with teaching facilities for about 120 medical students in order to provide for the growth of medical teaching in accordance with the Government's policy of expanding medical education, and particularly medical education in the Trent region, since we have good reason to believe that to a noticeable extent medical students, when qualified, practise in the area where they are trained. This would provide extra medical help to the Trent region.
The first phase of the development, the provision of the main part of the outpatient department, was brought into use as early as 1961. Then the excavation and foundation works for the main buildings and extension of the out-patient department were completed in 1969, and for residential accommodation in 1975. The medical school was completed in September 1973 and brought into use in October 1973, and the main hospital building is being handed over to the Trent Regional Health Authority by the contractors, floor by floor, on completion. I understand that two-thirds of the floors have so far been handed over in this way, and the remaining floors are likely to be handed over very soon. The total cost of the scheme is £28½ million at current prices.
It is hoped also that after the usual period of commissioning it will be possible to admit in-patients progressively from April 1978 to February 1979, if resources permit. That is the problem—to get the resources to permit the opening of the hospital.
The Trent Regional Health Authority estimates that the new revenue consequences of opening the hospital, after allowing for planned closures, is likely to be about £5. million up to the financial year 1980–81. Of this additional 208 revenue sum that has to be found more than half is likely to fall in the next financial year 1978–79.
The Hallamshire Hospital is not the only new development in the Sheffield area. An accident and emergency department and a mental illness unit are also under construction at the Northern General Hospital, as is new provision for geriatric patients at Nether Edge Hospital. Further units of the Sheffield Mental Handicap Project are also due to come on stream during the period in question. Thus, although the cost of commissioning the Hallamshire is undoubtedly the major financial commitment facing the Sheffield Area Health Authority, there is also the problem of funding these other smaller schemes to add to its difficulties. The Trent Regional Health Authority estimates that the revenue consequences of these and other capital schemes in Sheffield in the period to 1980–81 total about £8 million spread over the years 1976–77 to 1980–81.
I should like to say that the regional heatlh authority will be able to fund the area health authority's need for additional revenue to operate the new buildings in full, but this will not be easy. At present it is far from the case, because the regional health authority in its turn is facing substantial financial difficulties. It estimates that it faces a possible shortfall of about £14 million needed to meet the claims for revenue to run new buildings that need to be commissioned from its eight areas, of which Sheffield is only one.
Basically, this is the problem in the area, that Trent was always regarded as under-funded and under-provided. A great drive has been made in the region to catch up. Every area has a new hospital or a new substantial scheme coming on stream, and the problem is to meet the financial consequences of this large number of hospital schemes.
Earlier this year the regional health authority faced the question how it might allocate to areas the revenue funds allocated to it by my Department and give areas revenue assumptions for the subsequent three years. Among other things it decided was that any area whose estimates of additional revenue needed to operate new buildings for the four years exceeded the amount needed to bring that area up to its special target figure 209 in 1980–81 should be restricted to the amount of half of 1 per cent. growth, with the exception of Sheffield, which, because of its existing and planned teaching commitment and the regional services it provides, should by 1980–81 be allowed to move further above the target figure than it is now. So that Sheffield will be allowed to have rather more than its fair share of the region's resources, no area likely to be below target in 1980–81 should receive less than a half of 1 per cent. increase in revenue growth.
I have set out these two points because they have a crucial bearing on Sheffield's ability to fund the additional revenue commitments in the period in question, including those of Hallamshire. The level of health service provision in Sheffield is much higher than in any other part of the Trent region, and bears comparison with that in the country as a whole.
The net effect of the regional health authority's adoption of the principles I mentioned on the actual allocation of revenue to Sheffield, and on its assumed level of revenue funding in the subsequent three years, will be to hold Sheffield's revenue growth down to not more than about half of 1 per cent. per annum. This means that it is likely to have less than £1 million of additional revenue over the period in question, when it is estimated that it faces additional revenue commitments totalling about £8 million. That is the gap to be closed.
The regional health authority estimates that even so, Sheffield will still enjoy the most favourable overall revenue position in the region and will be running at about 108 per cent. of its area target. If it were doing what it should do, it should clearly be working towards 100 per cent.
§ Mr. John H. Osborn
I think that the Minister is referring to the per capita revenue figure, which I believe is £192 in London, whereas in Leicester and other areas it is £62 and in Sheffield it is round about the £100 mark. The point is that the capital expenditure has been incurred. There is a need to balance capital with revenue predictions and to balance capital commitments with likely revenue commitments. To mothball that hospital now would be a disaster in 210 Sheffield. The Minister has given nothing to overcome the difficulty.
§ Mr. Moyle
I am grateful for support from the Opposition for increasing public expenditure. That is an exceptional point of view to be held by a Conservative.
I was referring to the target and not to the per capita expenditure for the local population. The position of Sheffield cannot be considered in isolation from that of the rest of South Yorkshire. The Barnsley Area Health Authority is preparing to open phase 2 of its new district general hospital. The Rotherham Area Health Authority hopes to open phase 1 of its new district general hospital in 1978. Those two will therefore be coming on stream and the regional health authority had to work out the order of priority for the opening of the new hospitals in those two towns and in Sheffield. It decided to concentrate first on Barnsley, followed by Rotherham, with Hallamshire following behind. It was important for it to adopt that order because it wants to reverse the flow of patients travelling into Sheffield from the other two towns for hospital services, and to be treated instead in Barnsley and Rotherham.
Barnsley and Rotherham would have had major difficulties in recruiting manpower to staff their district general hospitals had Sheffield been allowed first to call on available staff. The financial problem facing Sheffield, therefore, is both immediate and substantial and the authority has reacted swiftly and constructively. It has pointed out that the approach adopted by the health authority assumes that the population served by the Sheffield area will be reduced by about 100,000 by the end of 1981 as the patient flow into Sheffield from Barnsley and Rotherham is progressively reversed.
The authority feels that strong action by the regional health authority in association with all concerned will be necessary in order to make sure that this reversal takes place, or Sheffield will be left at the end of the period with a reduced financial allocation but serving an excessive population.
At its meeting, therefore, on 2nd May, the area health authority resolved, first, that the regional health authority be 211 informed that the area authority is prepared to commission the Hallamshire Hospital to the extent needed to replace existing services, and to carry out a substantial proportion of other developments, provided that the Barnsley and Rotherham district general hospitals assume responsibility for the full population that they were planned to serve during 1978–79, and provided that a non-recurring allocation of £4 million over the next two or three years is made.
The authority resolved, secondly, that unless the conditions set out in the first resolution could be met, the Hallamshire Hospital could not be opened. Thirdly, it resolved that the regional health authority be asked to receive a delegation to put forward a case supporting this proposal. The RHA has agreed to meet such a delegation, and that meeting will take place shortly.
While Sheffield has been discussing these matters with the RHA, the authority, in its turn, has been making strong representations to my right hon. Friend and myself about the financial problems it faces. We met a deputation on 11th May from the Trent Regional Health Authority, led by the chairman of the RHA and including the Vice-Chancellor of Sheffield University, the deans of the medical schools of Leicester and Nottingham, and the regional administrator and regional treasurer.
The deputation drew attention to the major financial difficulties that the region faces in meeting the estimated cost of the major capital schemes in their three teaching areas, each of which has a teaching hospital coming on stream. These amount to about £20 million, with a peak estimate of about £10 million in 1978–79. It drew attention to the continued deprivation of health provision and the under-financing of the region as a result, 212 and expressed regret that we had been unable to implement the recommendation of the Resource Allocation Working Party that below-target regions such as Trent should be allowed a 5 per cent. annual growth rate.
It indicated that such a level of resources would have gone a long way towards resolving the region's financial difficulties. It also pointed out the region's inability to open on time certain major capital developments and said that the region was asking for a special advance allocation of £10 million over the next four years, of which £4 million could be non-recurrent. That covers my hon. Friend's point.
Reference was made to the special problems of Sheffield and the Sheffield Medical School, which the region had been encouraged to build in accordance with national priorities and which had increased its intake to 132 students in 1975, with 150 coming in 1977–78, on the assumption that Hallamshire was to provide the clinical facilities for 120 students The region was hoping that the hospital would be open by the time the students began their training. My right hon. Friend told the deputation that we fully accepted that the Trent region is deprived and under-resourced. But we said that the Resource Allocation Working Party recommendations are being implemented as fast as national resources allow, in spite of some pretty firm pressure from some other areas to shelve the RAWP report—
§ 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 nineteen minutes to Twelve o'clock.