§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Frank R. White.]
§ 10 p.m.
§ Mr. Arthur Jones (Daventry)
The serious position of National Health Service provision in Northamptonshire came to the notice of the general public towards the end of last year when it was dis closed that an overspending of £600,000 was predicted in the financial year up to 31st March 1977. The senior doctors in Northampton felt that the situation was so serious that they took the unprecedented step of issuing a statement so that, as they said:the public shall be fully aware of the circumstances.389 The statement referred to the fact that medical service in the county had been historically under-funded for years, since 1952, as I understand it, and that the savings required to keep within the budgetary decisions of the regional health authority would have serious consequences, including the delay or refusal of acute admissions. Patients, the statement said,will be admitted only if they fall into the category of emergency.The possibility of the closure of facilities was referred to together with the delay in completing phase one of the new district general hospital in the town. It is said that it cannot be operational until 1978. The medical staff committee, in a letter to Mr. David Woodrow, chairman of the Oxford Regional Health Authority, expressed:disappointment and disgust at the continued delay in completion of the project.The Northampton Community Health Council had earlier drawn attention to a rapidly deteriorating situation, particularly to under-funding, which it attributed to the fact that population figures for mid-1975 were used in the allocation computation which fell short by 14,000 of the actual increase which had taken place in the two subsequent years.
This evening I have received a telegram from Northampton Community Health Council which reads:Please tell the Government that the people of an expanding Northampton find it incredible that despite forward planning and moneys made available for roads, houses, industrial estates, schools etc., there is no provision for up-to-date revenue allocation for the people who come to Northampton.In addition, about 60,000 residents in North Buckinghamshire, from the rapidly-growing town of Milton Keynes, look to the Northampton district for acute geriatric and maternity services. I am pleased to see my hon. Friend the Member for Buckingham (Mr. Benyon) in his place. I know that the people of Milton Keynes look forward to the time when a general hospital is built there.
Some of the treatment required in the Kettering district, arising principally from Wellingborough, is met by the services in Northampton, with accidents arising on the Ml at a contributory factor. The two districts comprise a county area health authority.
390 On the question of demands upon the Northampton district by residents outside the area, the Oxford Regional Health Authority said in a letter of 8th February to my hon. Friend the Member for Northampton, South (Mr. Morris), who is in his accustomed place this evening:We have not got adequate information about the total cross-flow of in-patients nor do, I think, have the area health authorities.It appears that budgets in the health service have been built up year by year according to the services actually being provided, with modest increases for local developments. It was said by the regional health authority thatNorthamptonshire may require upward adjustments at the expense of other areas but certainly at this stage we cannot say with absolute assurance that this is the position.Having regard to the fact that the National Health Service is the largest single employer in the country and one which makes tremendous demands on public resources, this is a confession of no mean significance.
In recent months an increasing number of complaints about the inadequacy of the service has been brought to my notice. A constituent involved in a motor accident which left him in considerable pain and discomfort has been told by his doctor that he will have to wait months for attention. There are two cases which are similar in character where replacement knee joints are required. I am informed that because the Northampton Hospital is desperately short of cash, the cost of the equipment makes it impossible to order them as required. The specialist particularly interested in replacement surgery finds himself in the position of possibly being forced to stop doing the operation altogether through the National Health Service. I am referring her to a letter from by constituent's general practitioner.
There is considerable concern over the Government's plans to phase out provision of three-wheeler or suitably adapted four-wheeler cars for the disabled and handicapped, with the substitution of a mobility allowance. The seriousness of the situation is demonstrated in the terms of a letter sent three months ago to one of my constituents by Mr. S. G. Hill, administrator for the Northampton district. He says:A crowded clinic involving long delays, inadequate and unsuitable accommodation, 391 overworked staff and the consequent increased risk of error, all derived from insufficient resources of buildings, staff and money to run the services on a decent and acceptable level.That is a tremendous reflection on the service which is provided—[Interruption.] I believe that I heard the Under-Secretary say that it is a reflection on the state of the country. That may be the case, but I think there are particular circumstances in Northampton which require a particular approach.
The Secretary of State responded with commendable speed to the serious situation arising in Northampton. He visited the general hospital on Monday, 17th January, and heard first hand the problems, both medical and administrative. My hon. Friend the Member for Wallasey (Mrs. Chalker) visited Northampton General in March when she, too, had the opportunity of seeing for herself the serious situation to which I have referred. Continuing representations have been made since the turn of the year by the hon. Member for Northampton, North (Ms Colquhoun), my hon. Friend the Member for Northampton, South and myself.
Following the Secretary of State's visit, it was announced that a further revenue allocation of some £153,000 would be made. It was at about that time that the three of us saw the Minister of State, presenting the facts to him in their stark reality. I regret to say that he could give us no comfort.
Subsequently, we visited the regional board at Oxford, which provided an opportunity to go into some detail with Mr. Woodrow, the chairman, and some of his senior executives. We came away still questioning the criteria upon which area allocations are made, and despite the submission of considerable material to us I am still of the opinion that hitherto a number of important local factors have not been given adequate weight in the calculations.
A particular difficulty in Northampton arises at the Princess Marina Hospital, opened by Her Royal Highness a few years ago. It is significant that although it has been in operation for seven years, only 13 out of the 19 wards have been opened, and as part of the economy drive the closure of the Bugbrooke ward was contemplated.
392 This hospital, purpose-built for the treatment of the mentally handicapped, is a showpiece to visitors from all over the world, providing unrivalled facilities both in the county and beyond. It is an example of advanced nursing techniques and training methods, and any reduction in the service would have severe repercussions not only for the patients but for those families unfortunate enough to have a mentally retarded child. In particular, the Bugbrooke ward for children fulfils a unique role, providing high dependency phase care and relief. Many families in its absence would find the strain intolerable and the withdrawal of facilities could not do other than lead to children being placed in permanent care.
My hon. Friend and I visited the hospital on two occasions and we have seen both parents and devoted members of staff. I was particularly impressed by the dedication of the young men and women in this vitally important sector of the National Health Service. Their personal commitment made a great impression on me. Happily the intended closure was lifted a few weeks ago.
The circumstances in Northamptonshire, particularly in respect of the Northampton District Health Authority, is extremely serious and deteriorating. It is no exaggeration to say that if savings have to be made to bring the area within its budget allocation, they could be achieved only by dismantling the health service in the county, with serious and disturbing consequences for the whole population.
This is in no way an exaggeration on my part but a quotation taken from a financial statement dated 17th June 1977 prepared by the county area health authority. This report points out that in the financial year 1976–77 there was a net overspending of £600,000–£750,000 for Northampton, and £50,000 for Kettering, with area based service underspent by £200,000. The estimated shortfall for this year including the overspending for 1976– 77, is £1,890,000 in a budget approaching £30 million.
The Authority has prepared two possible schemes. A saving of £444,000 involves the closures of the Margaret Spencer Hospital in Northampton, the Wellingborough Cottage Hospital, Pitsford House for geriatric care and the Corby maternity unit. Beds currently out of 393 use, including the Princess Marina Hospital, to which I have already referred, total 531. The area health authority is having to inform both Oxford and the Department that it will not be possible for the authority to live within its financial allocation this year.
It should be noted that while these and other recommendations were submitted to and approved by the area health authority so that the necessary consultative procedure could be commenced, by the end of the financial year none of these closures had been effected but the closure procedure had reached an advanced stage.
The second list indicates the very serious consequences for the service to bring the area within its allocation for this year, and it has been made clear that these would have such drastic effects that implementation would not proceed without specific instructions from the region and Department. The total closure and the discharging of patients home and declaring staff redundant would be necessary at Pitsford and Creaton, together with the John Greenwood Shipman Home and the Naylands family unit. It would involve the closure of the Kettering Rock-ingham Road Hospital, Wellingborough maternity unit, Hayway out-patient department at Rushden, two acute wards at Kettering and a general reduction of the provision of out-patient services. In addition, there would also be the closure of Rushden Hospital leaving the psycho-geriatric unit only and very limited provision of alternative facilities.
That is the measure of the serious position in Northamptonshire and the potential dismantling in the absence of additional resources. That is the point that I want to make in the gravest possible terms to the Minister. The right hon. Member for Kettering (Sir G. de Freitas), my hon. Friend the Member for Northampton, South and myself had an opportunity of discussing the situation with Mr. Seddon, the vice-chairman of the area health authority, Mr. Burrell, the area administrator, and Dr. McQuillan, the area medical officer, yesterday when they stressed the gravity of the situation.
I am informed that allocations from the region have hitherto been on the basis of revenue consequences of capital expenditure but that more recently the criteria of assessments of relative health care 394 needs recommended by the Resources Allocation Working Party—RAWP, a very awkward abbreviation—led to a review of procedures. A letter dated 23rd May addressed to Mr. Softley, the chairman of the Northampton Community Health Council, written on behalf of the Prime Minister, says:The Oxford Region as a whole is assessed as being relatively well endowed with revenue funds … and is one of those which must make strenuous and widespread efforts to make better use of its funds and seek ways to redeploy resources to the localities in this area which are relatively deprived or under pressure.This lends support to the case that I have tried to make earlier with regard to regional allocations and the shortfall resulting for Northamptonshire.
Those of us who went to see the Minister of State will remember that he said that the Department could not interfere in regional allocations. I question whether the maintenance of that situation is wise in the circumstances that I have tried to outline.
I welcome this opportunity to draw to the attention of the Government the circumstances existing in the National Health Service in Northamptonshire. This is not the occasion to consider ways and means of ensuring adequate provision for the National Health Service as a whole. I hold strong views on the profligate and irresponsible behaviour of this Government in the use of taxpayer's money both in this field and elsewhere.
The issues for Northamptonshire have been clearly identified and the necessity for additional resources substantiated. I hope the Minister will announce this evening that a departmental investigation will be carried out as a matter of urgency and give the five Members representing constituencies in Northamptonshire an assurance that their representations will be heeded and their submission acted upon without delay.
§ 10.16 p.m.
§ Sir Geoffrey de Freitas (Kettering)
As I represent a constituency in Northamptonshire and the district covering Kettering and Wellingborough, I wish to say to the Minister that the hon. Member for Daventry (Mr. Jones) has my full support.
§ 10.17 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I must congratulate the hon. Member for 395 Daventry (Mr. Jones) on securing a debate on the closure of National Health Service buildings in Northamptonshire and North Buckinghamshire. I know that these proposed closures have been causing anxiety to the people in the areas concerned, and I am grateful for this opportunity of putting the Government's view. However, before talking about the various proposals, perhaps I might sketch in the economic background against which the health authorities are having to take some very difficult decisions about rationalising the services they provide in order to make the best possible use of their limited resources.
I am sure that the hon. Member would agree that in considering the local pattern of hospital services, health authorities must have regard to the overall resource situation both locally and regionally. In spite of the economic difficulties facing the country, the Government have continued to give a high priority to the maintenance of services provided for patients in the NHS, and the total sums made available for current expenditure nationally on the hospital and community health services have increased from year to year in real terms. For the current financial year, the sums made available for these services represent a real terms increase of nearly 1½ per cent. nationally. Nevertheless, I recognise that this is a relatively low rate of growth compared to the recent past and in view of the need to provide for the growing number of elderly people and advances in methods of treatment. In considering how this 1½ per cent. national growth in resources for current services in 1977–78 should be distributed between regions, my right hon. Friend the Secretary of State decided that the broad principles recommended by the Resource Allocation Working Party in its second report, published last September, should be followed.
The Oxford region is the fourth-best provided region in terms of resources for current services on the basis of the criteria recommended by RAWP, its actual revenue allocation being some 107 per cent. of the target allocation. Nevertheless, in deciding on a differential distribution of the growth money for the current financial year in favour of the deprived regions, we recognised that there were also difficulties facing the better- 396 provided, or above target, regions, and so they have received some, though necessarily very limited, growth over last year. Oxford's growth represents an increase of 0.4 per cent. over 1976–77. Two of the difficulties that we took account of in deciding on a minimum growth for the above target regions were the pressure of cash limits and the need for some room for manoeuvre to allow for redeployment of hospital resources into newly completed facilities.
I turn now to the situation as it affects the part of the country to which the hon. Member for Daventry has referred. The population there is expanding. Northamptonshire AHA is recognised by the Oxford Regional Health Authority as being amongst the needier of the areas in the region, and this has been reflected in the 1977–78 intra-regional allocations. The RHA provided for real terms growth in the allocation to Northamptonshire AHA of 0.4 per cent. while Buckinghamshire received no growth. The RHA has still not completed the studies which will make an objective comparison of the resources available to the four areas on the lines commended by RAWP, and, pending this, its caution in making differential allocations for the current year was justifiable on the grounds that drastic change could lead to perhaps unwarranted disruption of important services.
§ Mr. Arthur Jones
The Minister mentioned 0.4 per cent., but the population has increased by 0.9 per cent. Is it any surprise to any of us that the services are collapsing in that situation?
§ Mr. Deakins
I am coming to that point. The interim allocations have not been finally settled and the pattern still has to be finally implemented in the Oxfordshire region. When this has been done there will be an improvement in the figures. It depends on the total resources available to the Oxfordshire RHA in the first place, and then on the division between the various areas.
In Northamptonshire new hospital buildings have been occupied, and more are ready and waiting to be occupied; yet more are nearly ready for occupation. Notwithstanding the significant increases in revenue allocation which the area health authority received in the years following reorganisation, it has a 397 history of over-spending. In other words, in delivering health care to the community it serves it has consumed more resources than were allocated to it. So it has achieved a level of expenditure and a level of service which is greater than it can offord.
In the present economic climate it is imperative that all public bodies—and this includes all health authorities in general and Northamptonshire AHA in particular—keep their spending within the cash limits notified to them. Under the system any over-spending in 1976–77 is recoverable from the 1977–78 cash limit. Thus, any failure to deal with over-spending in one year comes home to roost in the next. So the AHA must find a way to bring its expenditure under control and within the allocation. Clearly they must give careful consideration to the less viable units which have been or which are scheduled to be replaced in new developments, or which are supplements to services which would be adequate, less costly or more efficient without them. These, then, are the economic constraints which the health authorities must bear in mind in managing and planning their services.
Against this background it must be clear that all health authorities have to ensure that their resources are deployed to the best possible advantage of the community. For example, authorities are increasingly having to look at the relative effectiveness and efficiency of the smaller, under-used and older hospitals. Some of these tend to be rather costly to run, especially when one considers the limited range of services they provide. The services offered in such hospitals can be provided more cheaply and effectively in the large district general hospital which has the benefit of readily available, wide-ranging support facilities. And, whenever possible it is only natural that health authorities should seek to rationalise their services by making closures and transferring facilities to the DGH.
The Northamptonshire Area Health Authority has two large new buildings which are opening or will be opening shortly; one is a 128-bed development at the Northampton General Hospital and the other is a 415-bed scheme at the Kettering General Hospital. It has an opportunity here for the sort of rationalisation 398 process I have been describing and it is proposing to take that opportunity. I shall say more about the precise nature of its proposals later.
People get used to having small, homely hospitals on their doorstep, and when they hear of proposals to rationalise services involving the closure or change of use of the local unit they naturally object to what they see as a withdrawal of a service they value. They see the hospital as their hospital, they have visited patients there or have been patients themselves, it is convenient and patients can easily maintain contact with friends and relatives during a long stay in hospital, and they may even know some of the staff. However, in these difficult economic times health authorities must put these sentiments aside and make sound rational judgments about the cost effectiveness of their services. When they have reached conclusions they must have the courage to face up to the fact that their implementation might prove unpopular in some quarters.
When people oppose closures they have to give careful consideration to the alternatives: if the staff, money and other resources cannot be made available both to open the new and maintain the old, the options at the extremes are clearly either to move into the new accommodation, vacating the old, or to leave the new unoccupied while the old accommodation and services—with their inadequacies— continue to be maintained.
Of course, the people affected by rationalisation proposals might find them a good deal more palatable if they are fully informed of the reasons the health authority has made them. It is important to keep the public fully informed and the local community health council, whose telegram we heard tonight, and whose duty it is to represent the views of the general public to the health authorities and to educate and inform them, obviously has a vital role to play.
Before coming to the central issue in the debate—the proposed closures in Northamptonshire and North Buckinghamshire—I should like to describe the procedures which my Department has asked health authorities to follow when they wish to close or change the use of a health building. And I should like to make it quite clear that both the 399 Northamptonshire and the Buckinghamshire Area Health Authorities have assiduously followed these procedures. Briefly, my right hon. Friend the Secretary of State for Social Services is required to take the final decision on a closure or change of use which is opposed by the community health council but which, nevertheless, the area health authority and the regional health authority wish to implement. However, where the community health council supports such a proposal the area health authority can implement it, notifying my Department and the regional health authority of its decision. But I should emphasise that before any decisions are taken health authorities must consult widely at local level.
I shall now deal with the proposed closures in Northamptonshire. The area health authority anticipates that it has overspent its cash limit for 1976–77 by about £600,000; its allocation of revenue funds from the Oxford Regional Health Authority for that year was a little over £30 million. For this year the Regional Health Authority has increased the area's allocation to just over £35 million. After allowing for inflation this represents an increase in real terms of 0.4 per cent. However, unless economy measures are taken, the area authority will undoubtedly have another large overspending this year—not as large as the hon. Gentleman said, but it could be considerable. There is, therefore, a compelling need for the authority to take a close look at its services, and seek ways of rationalising them. Furthermore, as I mentioned earlier, large new developments at Northampton General Hospital and Kettering General Hospital are becoming ready for use, and the money must be found to make the best use of this large capital investment by fully opening them. I have some more details, but I do not wish to go into them further.
In order to avoid a further overspending and to make full and proper use of these two modern hospitals the Northamptonshire Area Health Authority is proposing to close, at least temporarily, the Corby Maternity Unit, which has 24 beds; Wellingborough Hospital, 34 gynaecology beds; Pitsford House Hospital, 48 geriatric beds; and the 400 Margaret Spencer Hospital, 45 pre-convalescent beds. The authority has the future of various other hospitals under consideration, but no firm proposals have yet been made. I can assure hon. Members that before any decisions are taken about any other hospitals, full consultation will again take place. Services at Corby and Wellingborough, in the event of their closure, would be transferred to the new Kettering Hospital, with the benefits of a far wider range of support facilities and more intensive use of beds; the patients at Pitsford House would move to the Northampton General; and the service at the Margaret Spencer Hospital would be transferred to other hospitals in the Kettering health district.
I understand that at a recent meeting Northamptonshire AHA indicated that it was not prepared to proceed with the second group of closures.without specific instructions from the Regional Health Authority and the Department".It is unlikely to receive such instructions.
My right hon. Friend has made it clear that he will make final decisions about closures opposed by CHCs, and he could hardly approach such issues impartially if his Department had directed that the closure should be proceeded with. But even if there were no such problem, neither the RHA nor the Department could have the initimate knowledge of services in Northamptonshire that is necessary to survey the options for making economies and to select from those options so as to maintain a satisfactory service. This is clearly a task for the AHA.
The community health council has opposed all of these proposals and, therefore, under the closure and change of use procedures, which I described earlier, my right hon. Friend the Secretary of State for Social Services will have to take the final decisions. At present he still has the future of these hospitals under consideration, and consequently I cannot comment on the merits of the proposals in case anything I might say is construed as prejudicing the issue.
I should now like to say a few words about the new town of Milton Keynes. 401 This rapidly growing town has few hospital facilities of its own and is consequently placing considerable strains on the services of Northampton and Ayles-bury to which its population looks.
The Northamptonshire area authority maintains that because the population of Milton Keynes looks to it, at least in part, to provide specialist hospital services its financial problems have been exacerbated. It must be remembered that Northampton itself is a rapidly expanding new town as is Corby. However, as far as Milton Keynes is concerned, I am pleased to say that a 102-bed community hospital is due to be completed there next year and a district general hospital is planned to start in 1979–80. These developments will undoubtedly case the pressure on Northampton.
Perhaps I might now say something about the closures which the Buckinghamshire Area Health Authority is proposing in the north of the county. Although the authority did not over-spend its cash limit in 1976–77, it does anticipate financial difficulties this year because of the rapidly expanding population of Milton Keynes and certain new hospital developments which are coming on stream. Therefore the authority, like Northamptonshire, is having to consider rationalising its services.
The only firm closure proposal which the authority has at present is that to close the geriatric unit at the Winslow Hospital. Like Northamptonshire, the 402 authority has the future of other hospitals under consideration but has not yet made any firm proposals. Once again I can assure hon. Members that before any decisions were taken about the closure of other hospitals in the country the area authority would conduct full consultations.
I am conscious of the complexity of the problems faving the health authorities in maintaining services for communities in North Buckinghamshire and Northamptonshire. There can be no doubt that there is an urgent need to bring levels of expenditure under control, and to redeploy services locally to this end. The hon. Member for Daventry has drawn attention to some changes which are regarded locally as placing services in jeopardy. I must stress that the target which the AHA is set is ne of some £35 million—a greater amount, even allowing for inflation, then has ever been made available for provision of health for the services to the community of the county population. It is for the AHA to deploy those resources so that the greater needs of the community are met effectively and ecnomically. I am confident in its ability to do just that. I hope that it can deepnd on the local community to take a rational and constructive view of its proposals.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.