§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jim Marshall.]
§ 9.44 p.m.
§ Sir John Eden (Bournemouth, West)
I congratulate my hon. Friend the Member for Beeston (Mr. Lester) on bringing to the House the petition which he has just presented. On behalf of the pharmacists in my constituency, I endorse every word that my hon. Friend said about the strength of feeling which he has so adequately represented. Those who have been responsible for organising the petition and collecting the signatures have done extremely well. They are to be congratulated on having amassed so many names and on having made clear to us in the House, and hopefully to the Government, too, what action needs to be taken in the interests of the pharmacists of England and Wales.
Before the House adjourns I wish to draw attention to a matter of considerable importance to the people of Bournemouth—the shortage of hospital beds in that area. I hope that my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) will have the opportunity of catching your eye, Mr. Deputy Speaker, to support what I say.
There is a serious shortage of hospital beds in the Bournemouth area. That is, however, not a new situation. It has existed for some years. I have seen the lists kept by one consultant that give details of every patient who was waiting on the emergency bed service for over 48 hours during the past three years to four years. It happens—this is not to 1531 dramatise but to make a point of fact—that some of the patients died before they were found a bed in hospital.
The consultants in the Bournemouth area have for long been worried about the shortage of hospital beds. Two of them—the chairman and the vice-chairman of the medical staff committee of the Bournemouth and East Dorset Group Pathology Service attached to the Royal Victoria Hospital in Bournemouth —recently wrote a letter to the local Press in which they stated:While patients in hospitals are receiving adequate care there is no doubt that too many patients wait too long to get into hospital because of an acute shortage of beds.These are responsible people who write such things. They are not given to hyperbole. They weigh their words with care and speak with deep anxiety.
The consultant representative on the East Dorset district management team, Dr. Christian Loehry, has played a leading part in drawing attention to the seriousness of the shortage. He has given me details of waiting time for in-patient treatment that fully justify all the expressions of anxiety and concern. The records have also been shown to the community health council, which I understand now fully supports the views of consultants that early and effective action is most necessary. I see that in a recent statement in the Evening Echo it recommended thatevery effort be made to co-ordinate efforts to effect a long-ovedue improvement in the situation regarding emergency admissions.The figures that I have seen indicate that in the first week of February 1978 the aggregate number on waiting lists for in-patient treatment in the East Dorset district was just under 5,000. In some specialties—notably general surgery, ENT and orthopaedic—the numbers were especially high.
I know that orthopaedic waiting lists have been eased slightly by the opening of the Christchurch facility. That is extremely welcome, but the situation is still very serious, especially for those who are waiting for hip operations. That information comes to me not only from my constituency but from the two constituencies on either side of mine. It bears out the difficulties and personal 1532 problems that are being experienced in the whole of the region—I have an interest to declare because tomorrow morning I have to go to an orthopaedic surgeon to have my hip checked. I hope that something will be done in that regard. It is a serious matter which for far too long has been attended by waiting lists which are totally indefensible.
There is another matter which should be discussed. When speaking of the Bournemouth area we are speaking of a holiday resort. There is a substantial influx during the holiday months which, at its peak, doubles the population. This causes additional problems for the existing services and no special regard seems to be paid to them. It places extra demands on consultants and doctors and obviously puts new pressures on the beds that are available.
In this area there is also a marked shortage of assessment beds for geriatric cases. Not surprisingly, Bournemouth has a large number of elderly people. We welcome them. Many of them come to Bournemouth to retire and to spend the remaining years of their lives in this attractive area. But this means that they have special requirements which are not being met adequately. Because of the many elderly people in the area, the need for more geriatric beds is urgent. This applies not only to Bournemouth but also to Poole.
In answer to a case with which I have been dealing, the district administrator at the hospital wrote to me and said:Facilities for psychogeriatric patients are grossly inadequate in this district—that is the East Dorset health care district. He explained that because of this very difficult decisions on priorities had to be reached.
It is appalling that that should be so. It is appalling that people should have to take decisions of that kind. Of course as I know the Minister understands, it is far more serious for the patients themselves.
It is clear that there is widespread concern amongst informed and responsible people about the inadequate number of beds in the Bournemouth area and about the difficulties experienced in admitting patients through the emergency bed service.
1533 For these reasons I and my hon. Friend the Member for Bournemouth, East feel fully justified in raising the subject in Parliament and in pressing the Minister to authorise early action to ease the intolerable situation. Our constituents want action.
We welcome that in August 1982 a start is to be made on phase 1 of the new 900-bed district general hospital. When phase 1 is completed—and that is planned to be in August 1985—the hospital will provide 281 beds. The net increase in beds, however, depends upon what else is done in the meantime and what else is done when phase 1 is completed. For example, if it is planned to close the Royal National Chest Hospital, some beds will be taken away and the net position will not be as good. We must be careful to ensure that by the end of this exercise we are better off than before.
My anxieties in this regard are aroused by the fact that we are not to get a complete hospital in 1985. We are to get phase 1 of a complete hospital. Phase 1 is, in fact, a unit package, with many of the essential specialties omitted from it. I am not disappointed that we are getting phase 1; believe me, it is far better than nothing at all. But what would be better still would be a complete hospital, with all the facilities, all the specialties and all the services provided there.
When is that to happen? When is phase 2 to begin, to complete the hospital that has been planned and talked about for such a long time? When is phase 2 to start? Will the Minister assure me this evening that there will be no gap between the completion of phase 1 and the start of phase 2?
Meanwhile, it is most urgent that we press ahead with the building of a new 30-bed ward at Boscombe Hospital. This has also been under discussion for years, but for some reason no decision has been taken until just recently. For some reason, the Wessex regional health authority seems to have been sitting on this proposition. I have seen letters from the authority to consultants in my constituency which left me speechless, since they seem to be unaware of the urgency of the situation. Now, at last, it seems that it will go ahead, but exactly when I am not absolutely sure.
1534 I want to know exactly when this new 30-bed ward is to be built. I want to know when it is to be started and when it is to be completed. If the Wessex regional health authority does not understand the urgency of the situation, it should give itself a holiday from its paper work and come to Bournemouth to ascertain the facts on the spot.
I want to make two other points. The first is related to this, although not directly concerned with the in-patient aspect. I refer to the out-patient problem. There is an acute waiting time for new out-patient appointments with consultants. In some cases this is grotesquely long. In neurology, it is as much as 35 weeks. There seems to be a grave shortage of neurologists. I do not know what steps are being taken to try to overcome it. I do not suppose that it is peculiar to the area I represent, but this seems to me to be a problem which deserves close attention. A period as long as 35 weeks must be wrong. In surgery, the period is anything from 10 to 31 weeks. In orthopaedics, it is anything from 10 to 29 weeks. In ENT it is 21 weeks, and in urology, 20 weeks.
It is wrong that we should have to contemplate figures of this order of magnitude. I am certain that the Minister would like to see them shortened. We would all wish to see them shortened. What worries me is that they have been going on like this for far too many years. I had a letter the other day from a leading doctor in my own constituency who has said that over the last seven or eight years, far from getting better the situation has been getting worse. No wonder doctors are worried and frustrated.
Finally, I should like to make one general point. It is that by comparison with other areas, Dorset is seriously under-funded. Will the Minister please undertake to look at this, and will he tonight give firm answers to the two questions that I have put to him?
§ It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn—[Mr. Jim Marshall.]
§ 10.0 p.m.
§ Mr. David Atkinson (Bournemouth, East)
I am most grateful to you, Mr. 1535 Deputy Speaker, for calling me in order to support my right hon. Friend the Member for Bournemouth, West (Sir J. Eden), and to say how much I share the concern which he has expressed on behalf of all the people of Bournemouth about the lack of hospital beds and health facilities generally, which cover not only our two constituencies but your own as well, Mr. Deputy Speaker.
This is a situation which has existed for a number of years, and it is likely to continue for at least seven more years until the first phase of the Castle Lane Hospital becomes available.
I am sure that the whole House will wish my right hon. Friend well on the inspection which he is to experience tomorrow with regard to his hip. We wish him every success. I should also like to say how right my right hon. Friend was to stress the enormous pressure which exists on hospital beds and health facilities generally with the Bournemouth area. During the summer season the population of that conurbation is swollen by at least 100 per cent. by people who fill the 600 hotels and the many more small boarding and guest houses which exist in the area.
It is not surprising that local people think that visitors are given preference when it comes to filling hospital beds or taking advantage of the health facilities which are available. But the simple reason is that at the height of the holiday season those facilities and beds are not enough to go round. Perhaps one aspect which is not always appreciated is that because of the high concentration of population along a very narrow coastal strip, the distance which an ambulance in an emergency has to travel from one end of that area to the other—perhaps to Poole Hospital—is twice the distance which an ambulance would have to travel in an inland town in order to go from the outer perimeter to the facilities which would normally be expected to exist in the centre of that town. This extra long distance in Bournemouth could put life at risk.
I should like to illustrate what I am saying with an example in relation to a member of my own family. Regrettably, a few weeks ago my wife dropped our one-year-old son. She tripped and fell and dropped him on the concrete path outside our house. As a result he was 1536 concussed. Naturally, she took him straight to our doctor, who immediately suggested that she should take him to the local Boscombe Hospital where there was an accident unit. However, on ringing up Boscombe Hospital the doctor was told that it closed in half an hour. The time was 3.30 p.m. and he was told that it would be open the following morning. The doctor was advised that my wife should take my son, who was still concussed, the 10 miles through the very busy Bournemouth shopping area—choc-a-bloc with tourists—to Poole Hospital, where proper treatment could be given and where X-ray facilities were available. My wife had to undergo that experience. It took at least half an hour. Fortunately, it was not a matter of life and death. Fortunately, my son was all right.
I mention that to support my right hon. Friend in his demand for more beds and better health facilities, not just in seven years time, but now, in order to serve the Bournemouth-Poole-Christchurch conurbation.
I hope the Minister will appreciate as a result of the Resource Allocation Working Party formula, the Dorset area health authority is experiencing a shortfall of £2 million, simply because of the bias in the allocation of resources away from expanding areas such as Dorset in favour of the inner urban areas which, as we all know, have had declining populations in recent years. I also ask the Minister to appreciate that at present 25 per cent. of the population in Bournemouth is over the age of 65. That figure is likely to rise to 30 per cent.-plus within the next five years. Quite clearly there will be further strain on existing hospital beds and existing health facilities. I urge the Minister to appreciate the fact that we are experiencing a crying need for more beds and better facilities and that we are short of about £2 million that we could desperately do with at present, as a result of allocation of resources to our area.
§ 10.6 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I should like to begin my reply to the right hon. Member for Bournemouth, West (Sir J. Eden) by congratulating him both on securing this opportunity 1537 to bring this matter before the House and on his presentation of the argument. He has spoken of a matter which is quite properly one of considerable concern to his constituents. He has not dramatised it or exaggerated it in any way. I can assure him that it is also of concern to the Wessex Regional Health Authority and the Dorset Area Health Authority, which are responsible for the provision of health services in Bournemouth.
It is not part of my brief this evening to dismiss or deny the right hon. Gentleman's basic argument. Rather, I recognise, as do the health authorities concerned, that the provision of further hospital beds in Bournemouth and other parts of the East Dorset Health District, of which Bournemouth is a part, is a significant and important need. In that connection the right hon. Gentleman mentioned reports of deaths while waiting. I shall examine any specific cases which he can let me have because this is something that we must try to avoid at all costs.
In the time available to me. I shall tell the House something of the efforts that have already been made to attempt to tackle the problems of which the right hon. Gentleman, and his hon. Friend the Member for Bournemouth, East (Mr. Atkinson) have spoken, and of the major plans which exist to secure a more permanent solution in East Dorset generally and, more specifically, in Bournemouth.
I suppose that somewhere in the country must exist a "typical" health district with an "average" population provided with facilities which at least broadly equate to national norms and recommendations. Whether or not this district does exist is a matter for conjecture, but it most certainly does not exist in the form of East Dorset. It is a most significant fact for the district's health services that it has a local age structure which is 50 per cent. above the national average in respect of the over-65s and 100 per cent. above the national average for the over-75s. It is well known that whilst all age groups make use of the Health Service the needs of the over-65s and even more so the over-75s are disproportionately great.
1538 In this connection I draw the House's attention to our discussion document published yesterday on the elderly, entitled "A Happier Old Age". This states that the cost to the health and personal social services of a person over 75 is seven times that of the average adult.
The effect of this in East Dorset is enhanced by the fact that many of its elderly residents are not indigenous to the district but have moved there after retirement and so often have no family living locally to offer support at times of ill health. Thus, the need for both hospital and community health services in East Dorset is noticeably greater than would be implied by a superficial "head count" not refined by the special factors which apply in this case. There is also the effect of the influx of holidaymakers.
There can be no doubt that the hos. pital services available to the people of East Dorset are hard pressed, and this is by no means confined to one particular branch of the service. There is a shortage of beds which applies to geriatrics, services for the elderly severely mentally infirm, services for the mentally handicapped and to certain acute specialties. To add to the problem, many of the existing beds are in old hospitals, some of which are not best located to meet the district's needs.
I shall look first at some of the problems of the acute specialties. In this context it is important to remember that the hospital needs of the elderly are not confined to the services provided by the departments of geriatric medicine. The elderly are major consumers of the services of the acute specialties. Bournemouth's heavy concentration of elderly residents allied to deficiencies in provision of geriatric services and of services for the elderly severely mentally infirm has resulted in substantial "bed-blocking" in the acute specialties and this is a major contributory factor to the district's long waiting lists for various forms of surgery.
At the Royal Victoria Hospital, Boscombe, this has resulted in the acute, specialties having a longer average length of patient stay when the regional average which, in the absence of additional bed provision, has been coped with only by the achievement of high occupancy rates. —around 94 per cent. for some specialties. 1539 which is very high, and very low turn-round times—that is, the time between patient A's discharge and patient B's admission to the vacated bed. Both these latter are clear identifications of a hospital working under pressure.
Other non-acute specialties also face problems. In addition to those specialties —for example, geriatrics, where the problem is simply a shortage of beds—there are those where the problem is the location of the beds. As a further example, the inpatient service provision for East Dorset's mentally ill patients, while numerically adequate, is for the most part in hospitals in the west of the county. The unsatisfactory nature of this arrangement will be obvious.
A permanent solution to problems of the scale facing East Dorset can be secured only through an investment in major capital building, and I am pleased to be able to tell the right hon. Gentleman that this is precisely what the health authorities concerned intend to do. Indeed, receipt in my Department of notice of this debate coincided to within two days with receipt from the Wessex Regional Health Authority of a stage 1 submission containing the proposals for the building of a major district general hospital in Bournemouth on the Castle Lane site. The authority proposes to build in three phases a full district general hospital with an eventual total size of 900 beds. It is hoped that a start on site for phase 1 will be made in 1982 and that the commissioning of the phase will be completed at the end of 1985.
The authority envisages a first phase cost of nearly £10 million. It is proposed that the first phase of the development should provide 224 general acute beds, 49 geriatric assessment beds, and intensive therapy and coronary care units each of eight beds. As well as in-patient accommodation, there are proposals to provide new operating theatres and X-ray rooms and rehabilitation, pathology and pharmacy departments. A further important feature of the first phase will be a new accident and emergency department. All in all, this will be a very significant improvement to the hospital facilities of East Dorset. It would be wrong of me to create the impression that the figures that I have quoted in relation to the 1540 facilities to be provided in the new hospital will represent net gains in hospital provision. They will not. Much of the facilities provided in the new hospital will replace existing services in other hospitals. However, the overall effect of phase 1 of the Castle Lane project, as it is now proposed, will be to increase the acute beds in the district by 32 and the geriatric beds by 49, thus enabling an extra 3,000 in-patients to be treated each year.
§ Sir J. Eden
I wish to underline the point that that addition, which is small but welcome, will not take place before 1985.
§ Mr. Deakins
The right hon. Gentleman is quite right. The addition falls within phase 1 and so will not be finished until 1985. It might be possible, if the site work goes well and there are no building troubles, to bring that date forward. But hospital building, even within the nucleus concept—which is relatively simple and straightforward, and which we are trying to sell overseas with some success—is nevertheless, a complex operation. I cannot offer any hope that the date will be brought forward substantially. However, I hope that the date will be reached. The difficulty with some other hospitals is that the date slips, and that would not be in the interest of the right hon. Gentleman's constituents.
The first phase will be able to exist as an independent hospital with support from the existing Royal Victoria Hospital, Boscombe, where all out-patient services will continue to be provided with the necessary support services. It will not be until completion of the second phase, which inevitably must be some way into the future, that the new Castle Lane hospital will be able to replace completely the services presently provided from the Royal Victoria Hospital.
I have taken careful note of the right hon. Gentleman's comments on the start on phase 2, but I cannot give any commitment, certainly not tonight. The start will obviously depend on the availability of resources, and I shall have more to say on that subject in a moment. I know that both the right hon. Gentleman and his hon. Friend are anxious to see in this connection further public expenditure, and I am pleased because the National Health Service could certainly do with a great deal more of it. I hope that we shall be 1541 able to count on the support of the right hon. Gentleman and his hon. Friend in pressing our case both within Parliament and in the country, because there are instances, as in East Dorset, where there is a genuine need for more money. One can try to run a more efficient service, but, as the right hon. Gentleman and the hon. Member have pointed out fairly, basically capital is needed in order to provide the extra essential beds.
Given that I have accepted the view of the health authorities concerned that major development of services in Bournemouth is a priority it becomes fair to ask such questions as the following. First, why must we wait until the end of 1985 —over seven years—to see the completion of phase 1 of the Castle Lane project? Why will a start on site not be made until 1982? And why cannot the Department "nod through" the regional health authority's submission and so speed things up? These are all fair and understandable questions but, equally, I think there are good answers.
§ Mr. David Atkinson
Does the Minister agree with the point that I tried to make, which was that with present resources expanding, areas such as Dorset are being unfairly treated in the distribution in favour of the inner cities?
§ Mr. Deakins
If the hon. Gentleman will wait a moment I shall come to his point. I shall say something about RAWP and the effect on Dorset.
In dealing with the questions that I have posed it is worth pointing out that a capital development of the scale proposed at Castle Lane is by any standards a major investment, and one which will dominate the pattern of health service provision in Bournemouth for many years to come. We are building for the next century. That makes it all the more important to ensure as far as is possible that what we build in Bournemouth is right and that we obtain good value from our heavy investment. That said, I should mention that attempts will be made to keep the development's design time to a minimum. This will be done by the health authorities making use as much as possible of the Department's standard hospital design work embodied in the nucleus hospital concept, which has been mentioned in the House on previous occasions.
1542 So, if we must wait some years yet for the permanent solution, what is being done in the meantime? I have, after all. acknowledged that here we are discussing a real and immediate problem. Again, I am pleased to assure the right hon. Gentleman that the health authorities have grasped the nettle and that action is being taken. I can give several examples of small or medium-size schemes which are in hand within the East. Dorset Health District which should contribute to a solution of some of the district's problems.
A third geriatric assessment ward of 28 beds is currently under construction at Christchurch Hospital and is due for completion in 1978–79. In the same year a start is planned on a new 28-bed geriatric ward at Alderney Hospital, which will enable two existing wards to be vacated and converted to provide temporary day hospital facilities. A development of the St. Mary's Hospital site at Poole, planned to start in 1980–81 will provide a permanent 30-place geriatric day hospital and 30 geriatric beds on a temporary basis. During the past three years a unit of 32 assessment beds for the elderly severely mentally infirm and a 30-place day hospital has been developed at the Royal Victoria Hospital, Boscombe, backed up by a community nursing service.
For this same category of patient there is planned to start in 1980–81 a 30-place day hospital together with 12 assessment beds at St. Mary's Hospital, Poole. The same hospital will also see the building. starting in 1980–81, of a 90-bed /160-day place mental illness unit. In addition, there has been good co-operation between Dorset area health authority and the Dorset county council on the use of joint finance which will benefit both health and social services. Finally, on the acute services side the regional health authority is proceeding with the planning of a 30-bed surgical ward at the Royal Victoria Hospital, Boscombe, which should offer the prospect of an improved service in the interim.
The right hon. Member for Bournemouth, West asked about the timing. I shall consult the regional health authority on this matter and write to him giving as much information as is possible at this stage about the proposed starting date. My information at the 1543 moment is that the planning is being proceeded with. He would obviously like to know, as I would, how long it is likely to take. I undertake to let him know.
§ Sir J. Eden
I appreciate that assurance from the Minister. Will he take note that the regional health authority, for some reason, seems to have been sitting on this matter? It does not seem to have recognised the urgency of it. Will he do his best to put a bomb under its backside?
§ Mr. Deakins
I am sure that on reading the report of the debate tonight, if nothing else, and receiving a letter from me or my officials, the authority will appreciate the urgency of getting through the planning procedure and on to the starting date.
All that I have said so far is strong evidence that there is no complacency on the part of either of the health authorities involved. On the contrary, the problems are recognised and are being tackled.
I think that in acknowledging East Dorset's problems I may have given an impression that it has in the past been a district unduly starved of capital funds for new building. Indeed, it is true that the second report of the Resource Allocation Working Party shows that the Wessex region as a whole falls short of its capital stock assessed target and can therefore expect to receive above average levels of capital investment over the next few years. However, it would be wrong to overstate the case. I am sure that the right hon. Gentleman will agree with me that one has only to look at the Poole General Hospital—opened in the 1960s and now with nearly 600 beds—to see what has been achieved in East Dorset.
Finally, we have spoken a lot about beds and buildings. There is no point in having ample beds in new buildings if we do not have the money to run them. This Government, despite the country's economic problems, have maintained and, as far as possible, improved the level of finance available to the NHS. In addition—we have been criticised for this—we have been concerned to see that the overall "cake" is shared fairly. Thus, 1544 our object in adopting the recommendations of the Resource Allocation Working Party and adopting its proposed revenue allocation methods has been to move as quickly as possible towards a position where a region's or an area's revenue allocation is determined by its population's health care needs rather than by some historical factor. The working party's calculation showed that in this respect Wessex as a region was "below target" and similarly within the region that Dorset was a "below target" area.
However, application of the working party's principles has meant that both the Wessex region and the Dorset area have moved, and continue to move, closer to their targets. Thus, before 1978–79 the Wessex region was about 6 per cent. below target, but the 1978–79 allocation—including the additional funds for the NHS announced in the Budget—reduces this deficit to 4.2 per cent. This position is virtually mirrored by the Dorset area. where the respective figures are 6.4 per cent. and 4.2 per cent. below target. Therefore, although both region and area have still more ground to make up, their relative positions have improved.
I assure the hon. Member for Bournemouth, East (Mr. Atkinson) that there is no suggestion whatsoever of moving money to the inner city areas. I represent what is almost an inner city area in North-East London, and I can assure the hon. Gentleman that the move is very much the other way. Indeed, there are many political difficulties as a result.
The intention is clear. I do not think that anyone should be under any misapprehension about our aims regarding the redistribution of resources, both capital and revenue, between and within regions.
I hope that what I have said will serve to reassure the right hon. Member for Bournemouth, West and his hon. Friend the Member for Bournemouth, East and their constituents that we are moving as fast as possible to deal with the very real problems which I acknowledge do exist in Bournemouth.
§ 10.23 p.m.
§ Mr. Ian Percival (Southport)
As there are a few minutes left, perhaps I may mention two matters. I do not want to 1545 intrude in what is very much a Bournemouth matter. However, I could use much of what 1 have heard in a similar debate in relation to my constituency. Indeed, some of the Minister's comments apply to my constituency as well.
Once the Minister has set off the bomb for which my right hon. Friend the Member for Bournemouth, West (Sir J. Eden) asked, which I hope he will set off speedily, will he prepare another for delivery in the North-West to ensure that the nucleus hospital in my constituency 1546 follows closely upon that in Bournemouth?
Secondly, I should like to echo the good wishes expressed by my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) to my right hon. Friend the Member for Bournemouth, West. I join in the hope that his visit to hospital will produce great benefit.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes past Ten o'clock.