HC Deb 01 August 1978 vol 955 cc692-704

11.31 a.m.

Mr. Tony Newton (Braintree)

I am grateful to the usual channels for arranging that the debate on the Bill should continue for a little while, and I shall try to respond by being brief so that my hon. Friend the Member for Edinburgh, Pentlands (Mr. Rifkind) may also begin his debate.

This is, in any case, the fourth time since March that I have raised the problem of health services in my constituency and in Essex generally, so I have made some of the points before, but I do not apologise for raising the subject again. It is a matter of intense concern to my constituents, and the degree of anxiety about the state of health services in Essex remains very high.

I shall refer to only one recent example of the way in which that concern has shown itself. A petition was raised in my constituency by Roy Smith, headmaster of one of the main primary schools, about the absence of any significant casualty facilities for dealing with minor casualties in the two main towns of my constituency, Braintree and Witham. There are some small facilities, but they are inadequate in many ways.

It is a measure of Mr. Smith's worry, as the headmaster responsible for the welfare of 700 children—and he is supported by all the other headmasters in the area and many parents—about the situation that the petition has been circulated. There is a risk that it could take children an hour or more to get emergency treatment because of the distance, and the traffic congestion involved on the way, to the nearest accident emergency unit. This is an even bigger problem than the pressures on staff arising from the problems in education and the need for staff to travel with children. It is a source of major anxiety. I share that anxiety and I am supporting efforts to get something done to improve the minor casualty facilities.

It is worth noting that the local authority is considering whether this is a need that could appropriately be supported by a local lottery. I am entirely in favour of trying to raise money through local lotteries for such purposes, but it is a sad commentary on our National Health Service if essential, basic medical services can be financed only by local authority lotteries.

My main point is that it is accepted on all sides that Essex has suffered from historic neglect. Its population has grown rapidly but its health services, particularly the hospital services, have not kept pace. We are about £20 million under-funded, which is about £1 in every £5, and of all the counties around London associated with Thames regional health authorities we have the lowest spending per head. It is significant, for example, that Kent, whose Members made most noise in our last debate on hospital services, currently receives more than £84 per head of population, while Essex has only just over £70 per head and is bottom of the list.

The question is not whether we need more money but whether the exercise in redistributing resources is going fast enough and in an adequate way. I must make clear that the area health authority does not believe that it is. I received a letter earlier this year from the area administrator of the area health authority, who said: Having regard, therefore, to the fact that it is generally accepted that a small percentage increase is required annually by the Health Service merely to keep pace with medical and technical advances, the prospect for Essex is that its funding situation is likely to deteriorate in the foreseeable future rather than to improve. The regional health authority, with which Essex Members have had a meeting, say in effect, that it accepts the need and that it is doing its best but that it is in an impossible position for two reasons. First, the Resources Allocation Working Party formula does not take sufficient account of London problems and the burden imposed by the existence of teaching hospitals, of which there are four in the North-Fast Thames region. Secondly, there have been delays about decisions on closures in London that are necessary to release resources for Essex.

I had intended to quote a letter from the regional health authority, but in the circumstances I shall not do that and will say merely that there is a clear indication that the Minister has been delaying decisions about the closures that are required to release resources for Essex. That is at variance with and calls into question the answer that I was given in May, when the Minister of State told me: I am satisfied that the authority's policies are directed towards redressing inequalities within the region and I have no reason to doubt its judgment as to how quickly this can be done."—[Official Report, 9th May 1978; Vol. 949, c. 418.] If the regional authority is right in saying that there has been undue delay in agreeing to the closures that are necessary to redistribute resources, the Minister is being disingenuous. He cannot say that the region's judgment is right and at the same time allow it to emerge that he is not supporting the region's decisions with the necessary vigour.

Let me, finally, list briefly what I should like to hear from the Minister, including some points that I have not been able to touch on as fully as I would have liked. I should like to be told that the RAWP formula is to be reviewed in the light of experience to see whether it should be adjusted to take account of special London problems so that the needs of Essex can also be taken properly into account. I hope that the Minister will also consider whether there ought to be an entirely separate system of funding the teaching hospitals, which appear to be one of the major difficulties in all the Thames regions.

I should also like the Minister to underwrite the regional health authority's commitment that nothing will be allowed to hold up the urgent developments at Broomfield, near Chelmsford, and at Colchester, both of which are vital to my constituents.

Will the Minister also give an assurance that there will be reconsideration of the way in which GP services operate, and particularly of the structure of remuneration of GPs, so that the services can take better account than they seem to do at present of changes in transport patterns and the problems of village people getting to see their doctor? I should also like the guidance given about casualty facilities to be reconsidered so that towns of the size of Braintree and Witham are not left with nothing, or virtually nothing, to deal with the sort of accidents that can occur in schools and factories.

Finally, as I said in the Regional Affairs Standing Committee last week, I hope that when the Government finally publish their response to the review of the South-East strategy there will be a significant section in it about how they intend, in the light of further population changes, to remedy the deficiencies in the NHS structure in Essex and to make sure that further population increases will be matched by commensurate increases in health services. We must not have any more planning documents issued about population increase and development in Essex that do not assure us that proper care will be taken of our health needs.

11.40 a.m.

Mr. Julian Ridsdale (Harwich)

The problems concerning the hospital services in Harwich are almost double what they are in the constituency of my hon. Friend the Member for Braintree (Mr. Newton). In Harwich we have an elderly population of 35,000 over retirement age. The problem is growing all the time. That is why I welcome the opportunity to make a few comments in this debate.

The problem is largely one of finance—the under-funding of the Essex area health authority by £20 million. Although my hon. Friend has talked about the difficulties of getting a fair share by shifting money from Kent to Essex, part of the trouble is that in this region as a whole we are not getting the money that is required for the services we need. To take money from Kent and then give it to Essex will hurt Kent. Although we want to see some money coming from London, the difficulty is that in the years in which we have had a Socialist Government, alas, the necessary growth in the gross national product has not taken place.

As a consequence of that, we have had a cut in health services. My constituents are now having to suffer from that because Socialism has not made the money that is required to support the general services and the health services that are required.

The waiting list for hospital beds grows. The general practitioners' position is under great strain. Although I am talking about difficulties in the hospital service, the empty beds in some of the hospitals are empty because the health authorities are not able to recruit nurses for the hospitals.

It is a most serious situation. We must consider the closing down of the Middlesex convalescent home in Clacton and the closure of the military hospital at Colchester, and then we must consider the promise from the Government that hospitals will be created possibly in five years' time. It is now that we should deal with the problem, not in five years' time. We want action immediately. What nonsense it was for the Government, just when the holiday period was beginning, to say that they would close the casualty ward at Clacton.

We are also concerned about the position of the mentally handicapped. I hope that when the Minister advises the Essex area health authority he will bear in mind the number of people whom we now have in private homes. I hope he will not just say that we do not have our fair share of resources because that number is not credited to us in official statistics. Some people locally are convinced that we are dealing with more than our fair share of mentally handicapped people because of this, and they would much prefer the Middlesex convalescent home to be a release care home to look after the very many elderly in the constituency who are in homes in which people have to look after them.

Finally, I would mention the dental position in Essex. Again, that is becoming very serious. The dentists came up to see us only last week. The stories that they told us of the lack of facilities in the hospitals, particularly facilities for specialist treatment, and of a waiting list of 46 weeks for an appointment to be seen and then a 52-week waiting list to be seen again after that, indicate a crisis.

This is something to which the Government must apply their minds. Merely to say that help is coming because they will cut away money from Kent to give it to the Essex authority is not good enough. The Government should be giving more money, because we have a far bigger share of the elderly population in our part of the world than is realised.

We want help now. Pensioners welcomed the increase in pensions, but it is not good enough that they should find two things to be worried about. One of them is the lack of hospital beds and facilities. The other worry is that they also find they are having to pay increased fares to reach the hospitals. They are being put in a most invidious position. The only way in which we can help them is by having a change of Government, and a Government who will make the money required to put these services into the right condition.

11.43 p.m.

Mr. Antony Buck (Colchester)

My hon. Friend the Member for Braintree (Mr. Newton) has done a great service in raising this matter in the House yet again. All of us who have the privilege of representing Essex constituencies are deeply anxious, continually so, as the Minister knows, about the health service in our area.

I have promised some of my hon. Friends who wish to debate another matter that is of some urgency that I shall be brief, in view of their anxieties.

The Minister is familiar with the problems of our area by now. He has visited our area. Also, I had the privilege of taking a delegation to see him and the Under-Secretary of State for Defence for the Army about the lunatic decision of the present Administration to close the Colchester military hospital. That is a decision which has exacerbated the situation in regard to the health service facilities provided in our area.

The Minister received an all-party delegation, which also included an ex-Labour Cabinet Minister who now sits in another place. Lord Alport, my predecessor as Member for Colchester. However, in spite of the strong representations made by us and in spite of a great campaign raised in Colchester and the whole of the area, which was backed by the local press and by all responsible people, the lunatic decision to close the military hospital has been implemented. Perhaps the Minister will be able to say something about what is intended with regard to the future of the hospital that the Government were foolish enough to close.

Like my hon. Friend, I, too, ask for an assurance that the new hospital will go ahead in Colchester. The situation is desperate. It is exacerbated by the closure of the military hospital. I am concerned not only about the lack of proper facilities for the civilians in our area but also, as a former Under-Secretary of State for Defence for the Royal Navy, about the effect that this closure could have on the troops in Colchester and, more particularly, on their families. I am concerned about the fact that when they serve in Northern Ireland and their families are left behind in Colchester, we are not able now to see that they are provided with proper medical facilities. What an effect it must have on the morale of a young soldier serving in Northern Ireland if he knows that his family back in Colchester are not receiving the very best of health service treatment.

My hon. Friends have outlined some of the problems. They are manifold in our area. They are particularly bad on the maternity side, where help is desperately needed. I reiterate what has been said by my hon. Friend. We seek from the Minister an assurance that the new hospital planned for Colchester—whatever the financial climate and the situation in the country—will at long last go ahead.

Ever since 1961, when I became the Member for Colchester, I have been campaigning for a new hospital in our district. It is now more desperately needed than ever before. Even after this lengthy debate concerning other matters I hope that we shall have an assurance on this subject from the Minister today, before we proceed to other matters about which some of my hon. Friends are worried.

11.47 a.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins

I know that the problems facing the National Health Service in Essex are of deep concern to the hon. Members for Braintree (Mr. Newton), Harwich (Mr. Ridsdale) and Colchester (Mr. Buck), and, indeed, to other hon. Members whose constituencies are in the area. My right hon. Friends the Secretary of State and the Minister of State share the view that at present the Essex area health authority is under-funded and that further resources need to be made available. Both have also visited the area and have seen at first hand the difficulties that the services are experiencing. We have had some examples this morning from hon. Members.

The North East Thames regional health authority is also fully aware of the serious concern expressed by hon. Members. The RHA chairman has been in close touch with the Essex AHA chairman, who has had a meeting—which was mentioned by the hon. Member for Braintree—with a number of Essex Members of Parliament. The RHA chairman has confirmed the RHA's intention to direct extra resources to Essex.

The population in Essex has been rising rapidly for many years, and, while there have been a number of major building schemes, the provision of new services has not kept pace with the population growth.

While my right hon Friend is committed to a policy of achieving a fairer distribution of resources, both between regions and between areas within them, it must be recognised that there are very real practical difficulties which have to be overcome in accelerating the rate at which resources may be increased in under-provided areas, such as Essex.

The speed with which the distribution of resources between RHAs and AHAs can be achieved obviously depends upon the amount of funds available to the hospital and community health services. While I welcome the call made by the hon. Member for Harwich for more resources for the NHS, I have to remind him and the House that the NHS share of national resources—gross domestic product—has increased substantially under the present Government.

While one always welcomes calls to support increased spending, there must nevertheless be some limit to the amount of national resources that can be preempted for the NHS. Whether we have reached that point is another matter, but I would certainly welcome the assistance of all hon. Members, especially those in Essex, of both major parties, in fighting a battle to get more resources. Redistribution must inevitably be a gradual process, because the above-target regions and areas must plan for the redeployment of resources and rationalisation of services without putting important health services at risk.

The North-East Thames RHA, which is responsible for the allocation to Essex, is, under the RAWP criteria, above its target allocation in terms of current resources. This means that the region as a whole will attract only minimal growth in its allocation to assist in the rationalisation of its services and to effect some further progress towards a fairer distribution of resources within the region. Both my right hon. Friends and the RHA accept that the Essex AHA is under-funded, and that the long-term answer is to achieve the sort of redistribution of resources envisaged in the RAWP report. However, the extent of that under-funding has not yet been finally determined.

Based on the interim report of the RAWP, the RHA calculated, as the hon. Member for Braintree pointed out, that Essex was under-funded by about £20 million in 1976 on a population basis, but that calculation did not fully take account of factors such as the cost of regional specialties, medical and dental undergraduate training, providing services in London, and meeting the deprivation in inner city areas. As the regional chairman has pointed out, spending per head is not the only criterion, and account has to be taken of the factors mentioned at length in the letter from which the hon. Gentleman would have quoted had he had time.

The hon. Gentleman asked me some specific questions, for example, about a separate funding of teaching hospitals, and also for some guidance about casualty figures in smaller towns in his area. I hope that he will allow me to write to him on these matters, in view of the time factor.

The North-East Thames region contains a number of socially deprived districts such as parts of Islington, Newham, Tower Hamlets and Hackney and, as the Government's inner city programme recognises, the problems existing in such areas require special attention. While the extent to which social deprivation affects health care is still a matter for detailed investigation, it is known that bad housing and social conditions inevitably lead to a lengthening of a patient's stay in hospital. This means that it is necessary for there to be a larger number of beds than may be necessary under the norm until such time as the social conditions can be improved. It is for this reason that in the acute sector there is a variation in the bed norms between districts.

As I mentioned, another of the factors the RHA must take into account is those services that are so costly that they can be provided only in selected centres, for example, neurosurgery and cardiothoracic surgery. These are known as regional specialties, and in the main cost substantially more to run than do the normal specialities, with a consequent effect on revenue distribution. While Essex has about one-third of the region's population, it has few of the regional specialties, and it is the RHA's intention to move more of these specialities into Essex. A small start has been made by the RHA's decision to progress with the siting of the regional burns unit at Billericay. As other regional specialties come up for review the RHA will consider which of these specialties might be relocated in Essex.

These factors all have an impact on the way in which resources are distributed within the region, and the RHA is now urgently investigating them with a view to re-calculating area targets.

In the present economic climate, with only a small real growth in the funds available to the North-East Thames regional health authority—about 0.3 per cent. in 1978–79—the redistribution of resources will take time to complete. However, even though the additional resources available have been limited, the RHA has in recent years begun to move resources to Essex. In 1976–77 the RHA made additional revenue available to Essex, and this is continued in the revenue allocations for 1978–79, with a further £268,000 on a recurring basis.

In addition to revenue, Essex also requires new health facilities, and some of these are currently being planned by the RHA. In the RHA's priority capital building programme, which has first call on its capital resources, three of the projects are in Essex. These schemes are for the development of a community hospital at Clacton and the provision of new district general hospitals in Chelmsford and Colchester. I will write to the hon. Gentleman about the timing of this, if I may, as it is a matter in which he and his constituents are particularly interested.

These developments will be costly to run and the RHA is committed to providing the additional revenue which will be required on their completion. Indeed, the RHA has decided that in making allocations the first call upon revenue in the coming financial year should be for new buildings coming into use. In the case of Essex this will amount to an extra £867,000 this year, and as more schemes are completed this will build up to approximately £2.5 million.

It is also clear that, necessary as these developments are, they will not in themselves produce a final solution. More facilities will be required in Essex and the region will be identifying these in its amended regional strategic plan.

Further assistance was given to health authorities by the additional £50 million made available to the NHS for 1978–79 in the Budget. The North-East Thames RHA has been allocated £1.28 million revenue from this sum and an extra £76,000 capital. The RHA has now distributed these funds to the areas and Essex has received some £613,000 revenue, comprising £250,000 for the commissioning of capital schemes, £284,000 for the improvement of mental handicapped, mental illness and geriatric services—of particular interest to the hon. Member for Harwich—£32,000 for the reduction of waiting lists, £29,000 for the development of health education and £18,000 for the improvement of foetal monitoring and special care baby units.

The allocation of resources to the health districts within the Essex area is a matter for the area health authority, and the authority expects that the additional funds made available from the RHA, together with the extra resources from the Budget allocation, will enable then to make noticeable improvements in mental handicap, mental illness and geriatric services. The resources will be used to bring the various units for the mentally handicapped up to the level of the best now existing, and services for the mentally ill, which are in great need of support, will derive substantial benefit from the appointment of additional community psychiatric nursing staff in each district. In accordance with national guidelines, the authority is seeking to promote the development of community geriatric services.

The hon. Member for Harwich mentioned a number of constituency points on which he has been very assiduous in correspondence with my Department. I take note of his continuing concern. When there are further developments I shall ensure that either I or the Minister of State will be in touch wih him.

The health services in Essex have therefore benefited from the additional funds made available by my Department and the RHA but both accept that further resources are still needed. Hon. Members may be assured that it is our policy to ensure that areas such as Essex will in the future receive their fair share of health resources. While this may take some time to achieve, for the reasons I have already stated, I am convinced that the North-East Thames regional health authority is committed to providing additional resources for Essex and intends pressing ahead with the necessary rationalisation of other services in other areas in order to make those resources available to Essex, where they are very badly needed.