§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Coleman.]
§ 12.4 a.m.
§ Mr. David Watkins (Consett)The matter that I am raising on the Adjournment this evening is the allocation of resources to Shotley Bridge General Hospital. This is a hospital of nearly 600 beds, situated in my constituency near the town of Consett, which enjoys, and has enjoyed for a long time, a high level of public esteem throughout the area that it serves. It is situated in the North-West Durham health district, which has a population of about 100,000.
An important point that I want to make at the beginning, because it will have a great bearing on everything that I propose to say in my speech, is that 90 per cent. of all hospital services in the district are provided by this one hospital. To put it another way, 100,000 people, or thereabouts, are totally dependent upon it for nine-tenths of their hospital requirements. That is the measure of the importance to the community of this hospital.
Like hospitals throughout the country, Shotley Bridge has felt the effects of inadequate financing of the National Health Service over the years. I am not making a political point in saying that. I am stating a fact. Indeed, I am sure that my hon. Friend the Minister of State, who is to reply to the debate, would be at one with me and with all my hon. Friends in regretting the circumstances which have brought about cuts in the NHS provision of late years and would certainly look forward to the time when this situation can be remedied and there can be a greater allocation of resources to the whole NHS.
My hon. Friend the Minister will be aware that I have been writing letters to him and have been asking Questions in the House about this hospital and its resources and facilities for the past two years or so. The situation is now so serious that I feel forced to raise it on the Adjournment.
The situation that has been developing has been accentuated recently by two particular developments. First, there is the 1144 transfer of the cardiothoracic unit to Newcastle upon Tyne. Second, there is the acceptance by the Secretary of State of the 1976 report of the Resources Allocation Working Party—RAWP, to give it, I suppose, its inevitable but singularly ugly jargon name. Indeed, when I say "RAWP", it sounds almost as though I am making a rude noise. I am not doing that, though I am aware of the fact that in the NHS there are many who think that RAWP is a rude noise.
The transfer of the cardiothoracic unit has resulted in a reduction in the district budget for the forthcoming year of about £1 million, from about £7.3 million to to about £6.3 million. It is proposed that the facilities vacated by the transfer of the cardiothoracic unit should be used by existing services. If this proposal were implemented, there would be no real saving at all financially. If the RAWP report is implemented at district level, that will mean further cuts, on top of the £1 million, of about £250,000. Such a further cut could be achieved only by a reduction in the complement of beds overall, including, of course, a reduction in the complement of beds for the treatment of actue cases in medicine, surgery, orthopaedics, gynaecology and the treatment of children, for which there is currently provision of about 340 beds. Such a cut would mean cutting the present 340 beds for acute cases to about 230—a very substantial and serious reduction.
The figures that I have quoted are for the district. As I have said, 90 per cent. of the total provision for the entire district is in this one hospital. There is no alternative provision. There can be little question of people in the area shopping around and looking for other hospitals in which they might be treated. Any reduction in the number of beds such as that to which I have referred would clearly have the most serious consequences, and the hospital provision would be well below the requirements of the patients.
There is a further development to which I must refer—namely, the proposed closure of the Lee Hill geriatric hospital. This is also in the North-West Durham district, though it is not in my constituency. It is in the constituency of my hon. Friend the Member for Durham, North-West (Mr. Armstrong), the Under-Secretary of State at the Department of 1145 the Environment. He is aware that I shall be referring to the hospital.
Lee Hill has 130 geriatric beds and its closure is proposed by December of this year, with the transfer of patients to Shotley Bridge, but already—well in advance of the ultimate closure—geriatric patients are being accommodated at Shotley Bridge and are taking beds required by other patients, including acute, surgical, medical and orthopaedic patients. The proportion of orthopaedic beds occupied by geriatric patients has already reached 40 per cent, of the available total. This has produced an intolerable situation. Far from any reduction in orthopaedic services being possible without serious reductions in the services being provided by the hospital, there is an urgent need for an increase in resources.
Orthopaedic waiting lists can only be described as impossible. The latest figures show that there are 463 people on the list and that the waiting time between appointment requests and examination by the senior of the two consultant surgeons is 115 weeks—getting on for two and a quarter years. And that surgeon's colleague is seeing only urgent cases.
This situation is, in effect, destroying the whole purpose of the waiting list because it means that less urgent cases have no hope of treatment. These cases may be regarded as less urgent, but that does not mean that they are any less uncomfortable or painful for the patient. It is little less than scandalous that such a waiting list should exist. The less urgent cases, whose condition may be uncomfortable and painful, can hope for treatment only if there is an increase in the allocation of resources to the hospital.
I have mentioned the transfer of the cardiothoracic unit. Facilities will be left that should be utilised, but, because of the lack of funds, they cannot be properly utilised. The vacated operating theatres and intensive care unit cannot be staffed because that would need an additional 24 nurses at the hospital at a cost of about £100,000 a year, while the appointment of a third orthopaedic surgeon with support services to deal with the huge waiting list and the demand for treatment would require the allocation of another £90,000.
1146 The plastic unit at the hospital serves the entire region—a population of 877,000 —and the demands on it are increasing rapidly. The latest figures show 253 people on the inpatient waiting list. The appointment of a third plastic surgeon is required and has been approved nationally and regionally, but the appointment cannot be made unless there is an increase in funds.
On the general issue of staffing, an important feature of the national figures is that 75 per cent. of hospitals' budgets is for salaries, with 44 per cent. paying for the provision of nurses. Only 5 per cent. of the budgets is for drugs. So the overwhelming effect of a reduction in budgets is in staff.
There is already a desperate shortage of nurses in the hospital. Instances have been drawn to my attention where only two nurses have been on duty in wards of 44 beds. The Halsbury Report recommended better conditions of employment for nurses, and it was calculated that to implement it 14 additional nurses would be required at Shotley Bridge Hospital, but the budget allocation was for seven, only half the number required to implement the report.
In an effort to avoid redundancies among long-term staff in the general rundown which I am describing and which is taking place, all new staff have been given only short-term contracts. That is something that has been agreed with the appropriate unions, and it is a situation that will last until the run-down figure is reached. However, when those coming to the hospital are given a contract for a few months, which at the end is perhaps renewed for another two months, it is a desperate and demoralising situation. The fact that desperate and demoralising expedients have had to be introduced is a measure of the existing situation in the hospital.
I have made it my business to meet a wide and represenative cross-section of those who are concerned and involved. I have talked with general practitioners in my constituency, with hospital doctors and consultants, with nurses and nurses' representatives. Furthermore, I have talked with the representatives of a wide range of supporting staff. It goes without saying that I have talked with patients, many of whom are among my constituents and who for a long time have 1147 been making complaints to me, principally about the length of the waiting lists.
I find myself amazed by the high level of morale among the staff at all levels in what is an impossible situation. However, I have found that there is a general air of growing depression among staff at all levels and, furthermore, a growing level of public concern at the deteriorating service. That has been reflected in the discussions that have taken place on the North-West Durham Community Council, which is equally concerned about that with which we are confronted in the hospital.
The hospital is faced with an acute shortage of finance. That is the basic problem. The shortage has arisen from circumstances that obviously are beyond the control of the hospital authorities. Services are being maintained only by heroic efforts within the hospital. That means that in practice there are constant expedients internally in trying to shift resources as required between departments as crises arise one after another. It is a policy that was described by one of the senior members of the consultant staff as robbing Peter to pay Paul. That has to go on all the time of the hospital is to provide any sort of service. The overall situation has resulted in waiting lists for treatment and a continuing crisis.
As the hospital provides 90 per cent. of all the hospital services in a district of 100,000 people, who have no alternative place for treatment, the situation is especially acute. However, in the fact of the conditions that I have described it is proposed that resources are to be reduced. The amount of treatment that is needed is not diminishing. There seems to be a firm prospect of closures, curtailed facilities and even longer and lengthening waiting lists.
I recognise that there is a difficult national situation that has been worsened by the Opposition's demands for still further cuts in public expenditure without regard to the effect of such cuts. The hospital is a classic demonstration of the effect of public expenditure cuts on ordinary people, and the effect of a policy that a combination of Opposition parties have so pitilessly used their majority to 1148 introduce so further to increase the price of the people's food.
I recognise why this arises in a national context, but I must put it squarely to the Minister of State that the situation can be corrected only by an allocation of additional resources so that this fine hospital can provide the public with the service which everyone connected with it wants to give, and which the public in the area—patients, former patients and potential patients—want it to give and are justifiably entitled to expect.
§ 12.20 a.m.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)I can well understand that my hon. Friend wishes to raise the subject of Shotley Bridge General Hospital, since the health services in the North-West district of Durham are suffering the tribulations of change as the Health Service changes its stance in that area. However, I can commend to his constituents the assiduity and energy with which my hon. Friend the Member for Consett (Mr. Watkins) has pursued this matter on their behalf over the last couple of years.
Before I describe the future plans for the health services in the district, it would be useful if first I explained the circumstances behind the transfer of the cardiothoracic services. This is basically because, in the late 1960s, the former Newcastle Regional Hospital Board planned and subsequently built a new hospital at Freeman Road, Newcastle. This is to be the centre of the regional specialties.
Now that the hospital has been built, the regional specialties, with one exception, are being moved into the new hospital. That part of the plans for the Freeman Hospital which directly affect Shot-ley Bridge Hospital is the transfer of the cardiology, thoracic surgery and urology beds. This means that 155 beds at Shotley Bridge are to be vacated, 130 of them in cardiothoracic services, which were transferred last year, and 25 in urology services, which are expected to transfer in April this year.
The transfer of these beds has enabled the area to work out a programme for the implementation of its plans—to rationalise and redeploy its services—which will result in health services related to the population served by the district. The key to the plan for the district 1149 is the development of Shotley Bridge as the district general hospital for the North-West Durham district. It will have a pivotal role in the health services there, although perhaps not with the glamour that is associated with the regional specialties. This redevelopment will be achieved primarily by the relocation of the cardiothoracic and urology beds, the development of the Maiden Law Hospital for long-stay provision, and the development of South Moor Hospital as a community hospital with general practitioner cover.
The actual number of beds to be provided to meet the needs of the population in the district is under consideration between the area health authority and the North-West Durham district, but the district's current bed numbers are in excess of the national bed norm. For example, by the end of December 1978 the district plans to have 200 geriatric beds, excluding those at South Moor hospital, compared with a national bed norm on the basis of 10 beds per thousand of the population over 65, which would give 130 geriatric beds.
Nationally we aim at 2.8 beds per thousand of the population on the acute side, and this would give an allocation of beds in that sphere at Shotley Bridge of 230, compared with the actual number of 320. It is to be expected that the district plans are likely to result in a planned reduction of beds over the years in order to bring the numbers in the district more closely into line with national targets. This is the district's outline plan for its future services. I can appreciate, from what my lion. Friend said, that he is concerned about the detail of these plans.
First, the Lee Hill Hospital is concerned with geriatric patients. These will be transferred both to the Maiden Law Hospital and the Shotley Hospital—100 beds to each. This is in line with departmental policy that 50 per cent. of geriatric beds should be on the district general hospital site with access to diagnostic, therapeutic and rehabilitation services, because it is clear that the greatest users of acute services in the country are the geriatric population. It is expected that there will be a gradual transfer of patients from Lee Hill Hospital throughout 1978 leading to its eventual closure in December this year.
Before the transfer of beds from Lee Hill Hospital can be effected, the vacated 1150 wards at Shotley Bridge need to be converted and improved. Those are the wards vacated by the cardiothoracic and neurology services. The capital for this will be found on the area and district's capital allocations for 1978–79 and from the district's allocation of extra moneys for aid to the construction industry which my right hon. Friend the Chancellor of the Exchequer made available in his autumn Budget last year. Therefore, there is no question of the vacated wards lying unused because there is a lack of money to convert them. They will be gradually brought into use as they are converted and upgraded, using revenue from the 1978–79 revenue allocation together with savings from Lee Hill Hospital when it closes.
My hon. Friend referred to nursing staff and the redeployment of nursing staff in the district. We have to rely on the best professional advice that we can get. The district nursing officer believes that during the next three or four months, while the wards are being converted and improved, she will be able to maintain an adequate service with the nurses available, including those transferring from Lee Hill. By the time Lee Hill closes, there will be sufficient nurses available to man the newly converted wards at Shotley Bridge. There has recently been a small reduction in the numbers of untrained nurses in post, but this is due to the new policy of increasing the numbers of trained staff within the nursing budget.
My hon. Friend expressed considerable concern about orthopaedic waiting lists. This is an aspect of a national problem. I shall not go into detail, but orthopaedic waiting lists throughout the country are substantial. The waiting lists at Shotley Bridge are a local manifestation of this national problem. There is now an opportunity to work towards an improvement in the orthopaedic services as the long waiting lists in this speciality have been a matter for concern for some time. This improvement will follow the rationalisation of the services taking place in and around the Shotley Bridge Hospital.
Now that the cardiothoracic service has moved to the Freeman Hospital, the triple theatre suite can be upgraded to permit a reallocation of accommodation and facilities. The orthopaedic service will occupy 60 beds and have exclusive use of 1151 the hillside theatre facilities close by with the service of a full theatre sterile supply unit. That will improve throughput and lessen waiting times.
As my hon. Friend said, the district has put in a bid for an additional consultant orthopaedic surgeon. The post has been approved by the Central Manpower Committee and the region expects to accord the post to North-West Durham. Up to there I think that we are in agreement.
The region is awaiting this year's revenue allocations from my Department before deciding whether it can fund the additional post. Initially, it is intended to allocate an equivalent number of beds and theatre sessions to the existing consultants, but there will be room for expansion when the third consultant is appointed, which should lead to a considerable further reduction in waiting times and increase throughput.
I mentioned that one regional specialty was being retained at Shotley Bridge. That is the regional plastic unit. The demand for plastic surgery is increasing nationwide, because of improved techniques, and there is an increase in cosmetic surgery in addition. To meet this demand North-West Durham district will be making improvements to the operating suite. This is a fairly big design job due to commence this year, and it is already in the capital programme.
The appointment of a third consultant plastic surgeon will not be feasible until the theatre suite is nearly finished, but the district has put in a bid for this additional appointment. The consultant's salary will of course be paid by the regional health authority, but the district will have to fund the revenue consequences of the appointment.
I assure my hon. Friend that the Durham Area Health Authority will take account of the population it serves when preparing its strategic and operational plans, and the district's basic need will be met by building up a good district general hospital at Shotley Bridge.
In some cases my hon. Friend and I agree on the facts, but possibly he regards them as rather dismal and gloomy, whereas I regard them as being desirable in some respects. We do not agree as to some of the other facts, but I hope that 1152 my hon. Friend will take my view as ground for optimism for the future.
An important background element to all this rationalisation of services is the Resource Allocation Working Party policy, to which my lion. Friend referred. My hon. Friend should commend and support that policy, because it means a substantial movement of national funds to the northern part of the country. If RAWP goes, the growth money of the National Health Service will end up in London with the teaching and postgraduate hospitals and not up in the North around Newcastle.
Although my hon. Friend's district may be having a rather difficult time as a result of the working party's report, the area as a whole is benefiting from it. The Northern Region has been given a 3 per cent. growth in funds as a result of the working party.
Within the region, revenue allocation must be made to each area. Originally the North-West District of Durham was given an allocation of £7½ million, aginst a target allocation of 8.3 million, but then the regional specialties were moved away from the district, and that accounted for about £2½ million of revenue costs. On the basis of an allocation of £7½ million, the North-West Durham District, following the removal of the regional specialties, is receiving a sum somewhat in excess of that needed to run the services at Shotley Bridge and the other hospitals after that transfer.
That means that the funds going to the North-West Durham Area Health Authority will have to be reduced over a period of years, but we accept that reallocation of resources of that kind is a matter that must be discussed between the region, the area and the district. It must not be hurried. The pace of change should not be so fast as to endanger essential services. The figure of eventual allocation to the district is a target to be achieved over a number of years. It is not expected to be achieved within a few months as a result of Draconian measures.
I hope that as a result of that approach to the problem, the fears expressed by the patients and staff at Shotley Bridge and by my hon. Friend tonight will not be realised.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes to One o'clock.