HC Deb 03 March 1978 vol 945 cc932-44

Motion made, and Question proposed, That this House do now adjourn—[Mr. Thomas Cox].

4.1 p.m.

Mr. John Ovenden (Gravesend)

I am grateful for the opportunity to raise the subject of the allocation of National Health Service funds to Kent, particularly as I did not have the opportunity to debate it on a Private Member's Motion.

The imbalance in the distribution of National Health Service resources has occupied the House and people outside on a number of occasions. However, the argument has tended to focus too much on the disparities between the regions. The deprivation of some areas inside prosperous regions has been forgotten. The Kent area is a prime example.

The South-East Thames Region is well provided for by any standards. In terms of the allocation per head of the population it is one of the wealthiest regions in the country. It comes third in the list of regional health authorities. But in terms of the resources that are devoted to it Kent is on a level with the poorest regions in the country.

The distribution of funds bears little or no relation to the population or to the health needs of the district. It is based on a pattern established by the ability of particular areas and particular hospitals—especially teaching hospitals—to secure for themselves a disproportionate share of resources. No proper criteria are applied. The matter is determined more by muscle and influence than by need.

The disparities are glaring. In the current financial year Kent will receive £75.3 per head of population. The teaching area of Lambeth, Southwark and Lewisham will receive double—£146.9. The non-teaching areas of Greenwich and Bexley will receive £105.9, which is 40 per cent. more.

Those hon. Members who represent Kent constituencies find these anomalies intolerable. Some time ago the Government established the Resource Allocation Working Party. Most of us regarded that as a major step towards achieving a decent allocation of resources on the basis of need rather than historical accident. The working party reported two years ago and it has had no effect on the South-East Thames Region. The Government accepted that report and it is now Government policy. The Secretary of State and Ministers have made it cleat that the Government are committed to adopting the working party's report.

It is not enough to redistribute resources between the regions. The same principles must be applied throughout the whole of the health service and distributions made within areas. That is essential if we are to have a good level of health care throughout the country. If the RAWP formula were applied, Kent would receive an extra £22 million, or 16 per cent. more than it does now.

Every district in the Kent area is under-funded Canterbury, Thanet, is underfunded to the extent of £6.5 million, Maidstone by £5 million, Medway by more than £4 million and Gravesend and Dartford by £3.2 million. This problem does not involve just one or two deprived districts; it is common throughout the county. The nature of particular problems in particular districts may vary. In Medway there may be a shortage of beds. In Gravesend and Dartford there may be no shortage of beds. We may be up to the norm established by the Department. But we are grossly under-funded in running the services. It is difficult to determine which is the worse situation—not to have the facilities, or to have them and not to have the money to run them.

Therefore, in any area of Kent, whichever of these problems exists, the situation is still desperate. The under-funding means that virtually every area of the service suffers. We have a shortage of about £14 million in our provision for non-psychiatric in-patients, a £2.5 million shortage in the provision for the mentally ill and one of £1.5 million for the mentally handicapped.

It is not a matter of inadequacies in one or two specialties. It is a matter of deprivation throughout the county and throughout the range of specialties in the National Health Service. The general deprivation is shown up more clearly by the figures for hospital beds than by anything else. Kent has 42 per cent. of the population of the South-East Thames Region and 32 per cent. of the beds. It has 34 per cent. of the operating theatres.

The number of consultants per thousand of the population in Kent is only three-quarters of the regional average. Only 86 per cent. of our maternity confinements take place in hospitals with specialist services, as against over 90 per cent. for the region as a whole. The provision of special care baby cots in the area is only 90 per cent. of the national average. In five out of six districts we are short of operating theatres. In September 1977 there were 630 urgent cases awaiting admission to hospital, very large numbers of whom had been waiting for very long periods.

The list on inadequacies, deficiencies and deprivation is endless and far too long for me to be able to recite in a debate as short as this. However, it will suffice to say that the position throughout Kent is a catalogue of deprivation and inadequacy in the National Health Service. My hon. Friend the Member for Rochester and Chatham (Mr. Bean) and the hon. Members for Gillingham (Mr. Burden) and Faversham (Mr. Moate) have met the Secretary of State on a number of occasions. We have met the chairman of the regional health authority to discuss these problems, and we have exchanged numerous letters with the Department and the authority. The strength of our case has been recognised at every meeting I have attended and in all the correspondence in which I have been involved.

My right hon. Friend the Secretary of State and the chairman have shown genuine concern for the problems in Kent, and they have expressed what I believe to be a sincere desire to help. But progress is painfully slow. There may be light at the end of the tunnel, but there does not seem to be much indication of when we shall get there.

We have been waiting a long time for anything to happen. Kent's prospects of a better Health Service depend on the reallocation of resources away from the over-funded areas. I welcome the determined stand that the Secretary of State has made in trying to persuade Greenwich and Bexley area to live within its means. But progress there is slow. Perhaps my hon. Friend the Minister of State can tell us something about that. He may have a personal constituency interest in this matter—[Interruption.] I understand from the noises that he does not have such an interest in Greenwich and Bexley.

Perhaps my hon. Friend will tell us how much Greenwich and Bexley will be giving up in the current year, to what extent its share of the region's resources will be cut, and how much we can expect to be available for distribution to the deprived areas in the region. Again, progress is slow. There seems to be movement, but it is far too late and far too small.

In the teaching areas there seems to be no sign of any move to release funds. Two years after the adoption of an official policy on redistribution, Kent's real position in relation to other areas in the region has detetriorated. If we were getting now the same share of regional resources that we received in 1974–75, we would be getting an extra £4 million. I do not want to quibble over that figure, but we have not made any progress. Unless there is some speedy and effective action, the situation in Kent will deteriorate. Population changes mean that if the county receives no extra money it will be £39 million under-funded by 1986–87. It needs an extra £12 million just to ensure that it does not slip any further down the regional table.

I understand that the region is planning to give Kent just 40 per cent. of the funds it needs by 1986–87 to reach its proper funded level. But that is only £3 million more than we need to stand still. It looks generous that we should be promised a 40 per cent. move to the RAWP formula, but what we are in effect receiving is only an extra £3 million.

That means that by 1986, 10 years after the RAWP formula was adopted, Kent will be receiving 84 per cent. of its proper share of regional resources as against the 81 per cent. that it receives now. That may look generous, but it does not show any determined effort to progress towards redistribution. If we are to move at that pace, it will be about half a century before we receive our proper allocation of resources.

The South-East Thames Region maintains that it is impossible, within the context of its overall allocation, to move any faster on reallocation of resources. I have with me a letter written by the chairman of the regional health authority, Sir John Donne, in response to a petition submitted by the Medway area about health services: I fear, however, that our overall allocation is such that it is going to be some time before a really significant move in the right direction can be achieved. I underlined that so that I could quote it, but I could have underlined it for other reasons—especially when we have had to wait 10 years to achieve only a 3 per cent. improvement.

There are too many uncertainties and unanswered questions. After our meeting with the Secretary of State and the chairman, we are still no further forward in knowing precisely what will happen in the region. Perhaps the Minister can clarify some of these outstanding questions.

First, my hon. Friend should tell us whether the Government still adhere to their intention to carry out the reallocation of resources within the 10-year period, which I understood was the target. If so, do they intend that that target shall be applied to South-East Thames as well, or will South-East Thames be exempted? If the latter is the Government's intention, what is their official reaction to the region's claim that it cannot achieve any substantial progress even by 1986?

If it is impossible or undesirable to shift resources quickly enough from the teaching areas and the other over-funded areas, will the Government consider interim grants to the under-funded areas so that Kent does not have to pay the price of its difficulties and suffer from problems over which it has no control?

We have waited a long time. The House as a whole, especially those Members who represent Kentish constituencies, are entitled to some answers. I hope that the Minister will try to give them today.

4.13 p.m.

Mr. Roger Moate (Faversham) rose

Mr. Deputy Speaker (Mr. Bryant Godman Irvine)

Does the hon. Gentleman have the Minister's permission to speak?

Mr. Moate

Yes, Mr. Deputy Speaker.

I thank the hon. Member for Gravesend (Mr. Ovenden) for allowing me a brief moment of his time to support his case. I congratulate him on his success in achieving this debate and on his clarity and eloquence in putting an unanswerable case.

The facts are virtually undisputed. In Medway district we have over 1,000 beds—short, on the DHSS's own criteria, by about 900. The Government do not dispute that or the facts that Kent is an under-provided area and that Medway is an under-provided district. We accept that the South-East Thames Region is over-provided within the RAWP formula. That formula seems to be working when it comes to reallocation of resources away from the region, but not when it comes to the reallocation of resources within the region to the under-provided districts.

There have been all-party delegations on this matter, and the other day we received from the Secretary of State a letter that I do not fully understand. I am sure that it was intended to be helpful, but I have a very simple question on behalf of my constituents. Will extra funds be forthcoming for Kent and Medway within the near future? What prospect is there of that bed shortage being made up within, say, the next 10 years? Do the Government accept this degree of deprivation, or do they intend that there should be a programme to make up that deficiency?

The Secretary of State simply said in his letter that the Government would look at the programme. There is a programme for the next three years. But that is not the answer. Will the Minister examine the Medway Health District programme and try to find a way to give an assurance to the local people that they can look forward to having as good hospital ser- vices in their district and in the Kent area as the rest of the country?

4.15 p.m.

Mr. R. E. Bean (Rochester and Chatham)

I congratulate my hon. Friend the Member for Gravesend (Mr. Oven-den) on his speech and on raising this subject in the House once again.

I join the hon. Member for Faversham (Mr. Moate) in stressing that we have particular problems in Medway. We have the highest birth rate in the country. In contrast to the rest of the country, where the population is falling, in Medway it is rising. In each of the past two decades it has risen by 30 per cent. The rise is continuing, and it is expected that by the mid-1980s about 45 per cent. of the population will be under 18. Therefore, we have a great deal of stress, and it will be with us for the next two decades.

I shall be grateful if my hon. Friend the Minister will say that he will visit Medway to see the problems for himself, because it is impossible to argue the case in such a short time today.

4.16 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I must join my hon. Friend the Member for Rochester and Chatham (Mr. Bean) and the hon. Member for Faversham (Mr. Moate) in congratulating my hon. Friend the Member for Gravesend (Mr. Ovenden) on his choice of subject for this debate. He has sought every possible occasion to bring to the attention of Ministers and the House the various shortcomings in the Health Service, not only in his constituency but in the Kent area as a whole. When I saw that his motion on 6th February was not reached, I thought that probably it would not be long before he would be seeking an opportunity to raise this important subject again. I welcome this opportunity to respond to his plea for better health services in Kent.

There is no doubt that change is needed. Here I agree with all three hon. Members. My hon. Friend highlighted various aspects of historical neglect in Kent, going back over at least the 30 years since the inception of the Health Service and probably even before. Although I do not accept all my hon. Friend's figures, broadly speaking I recognise that Kent is not receiving a proper share of the Health Service resources available to the South-East Thames Regional Health Authority. I acknowledge that the people of Kent are at a disadvantage in the provision of health care compared with those in other parts of the country and the region, particularly the two Inner London areas in the region.

I should like to give some of our statistics. In the 1977–78 allocation only £78 is being spent per person in Kent's catchment population, compared with £108 in Greenwich and Bexley and £122 in Lambeth, Southwark and Lewisham. Even making generous allowance for the higher costs of teaching and specialist services, this comparison indicates a fairly substantial imbalance. That indication is derived from the Resource Allocation Working Party formula, which is largely hospital-based. To judge from what I have been able to ascertain, it should be said, to offset this, that the general practitioner services in Kent are of very good quality. That is important.

Another message that I should like to convey to my hon. Friend is that people in South-East London tend to say that they have spent a great deal of money on their social services in the past few years, and they are not sure that people in Kent have done the same. They sometimes think that the weakness of the Kent social services is being used as an argument to take Health Service resources from them, whereas they have played the game fully for many years. My hon. Friend has no responsibility for that, and I am not saying that it is necessarily true. Kent certainly now has a very go-ahead director of social services. Nevertheless, that may be a message that my hon. Friend will care to take back to Kent.

National policy on the redistribution of resources is quite clear. In December 1976 my right hon. Friend the Secretary of State said: I am determined that the resources of this national service should be more fairly shared. Redistribution must not only be between regions but within regions "— that is the point my hon. Friend was making— as some of the biggest inequalities are between rich and poor areas or districts. But in seeking a fairer distribution I am equally determined not to destroy the quality of excellence in the National Health Service, the opportunities for new discovery or the tradition of medical education of which we are rightly proud. We certainly need the products of that medical education if we are to man the National Health Service of the future in Kent and elsewhere.

When allocations were made for 1977–78, the regional health authorities were told that resource targets should be assessed for areas, and preferably for districts, to provide some measure of relative need and that generally a limited movement towards targets should be possible.

I shall not now dwell on the criteria used in assessing targets. The principles adopted are those recommended by the Resource Allocation Working Party and have been explained to the House on many occasions. I should say, however, that we do not claim that targets worked out in this way can be used without modification in allocating resources, particularly to areas and districts.

There is a great deal of work to be done in this regard. There are a number of factors which cannot be fully taken into account in formulae. For example, housing, environmental health, employment and even transport facilities have relevance to the needs for health care. We should also like to do more work aimed at obtaining a more accurate measure of morbidity. I must also make it clear that it is not our policy that districts should necessarily plan for self-sufficiency in all their services.

Accordingly, we have told the authorities that they should not seek to apply mechanistically a formula that we have adduced or a predetermined rate of change from existing allocations towards targets. The pace of change must depend on the ability of above-target areas to rationalise services without unacceptable disruption to the existing level of provision or to teaching or other specialist needs.

Nevertheless, my right hon. Friend and I expect to see a significant redistribution of revenue resources achieved generally in the next financial year. If this does not happen, he wants authorities to make clear the reasons why it is not practicable in particular instances. That is the general policy.

Turning now to the situation in the South-East Thames Region, I should first like to let my hon. Friends the Members for Gravesend and for Rochester and Chatham know that I propose later this year to visit the Medway District to see the situation for myself and to hear the views of those on the spot. Although I have received a full account from my hon. Friend the Under-Secretary of his visit there last year, I felt it right to gain a first-hand insight into the very real problems of a deprived district in an over-provided region, particularly as I represent an area of the region which is rather better off and which even now, and more so in the future, will have the role of assisting my hon. Friend's constituency. Having been born in Tunbridge Wells, I have some pretensions to being a man of Kent and I shall take an interest in the problem.

I can assure my hon. Friend that the regional health authority is fully aware of the need to redistribute resources so as to improve the situation in Kent. The chairman has personally told my right hon. Friend of its determination to achieve this. The authority has calculated that Kent is £26 million below its target on its present allocation, that Lambeth, Southwark and Lewisham is £27 million above target, and that Greenwich and Bexley is £7 million above its target. The authority has projected its calculations to 1986 and shown how the situation is likely to worsen due to the projected continued shift in population directed towards Kent.

I know that the regional health authority has made little or no progress in moving allocations towards these targets. Its attempt in 1976–77 to reduce allocations by £1.75 million in Greenwich and Bexley and £0.75 million in Lambeth, Southwark and Lewisham led to overspending in those areas, and the regional health authority concluded in March 1977, against the background of low overall growth rate, that it would be impossible to continue redistribution until these two areas could carry cut major economies. The allocations for the current financial year therefore aimed at maintaining current levels of service. This, of course, caused disappointment in Kent and gave rise to doubts about the regional health authority's commitment to redistribution. But the need for rationalisation in the Inner London area to be carefully planned must not be under-estimated.

In Lambeth, Southwark and Lewisham the situation is particularly difficult, because the general hospital services there are no more than the average for the country. What makes the area a very rich one is the existence of three major teaching hospitals, two of which have been redeveloped in fairly recent years, as we can see if we look across the river.

Although the population of the area has declined, the number of medical students has not. Indeed, we would want to maintain the number of medical students. Medical education is absolutely vital for the future of the Health Service. As far as I can see, we shall be needing rather more doctors than fewer if we are to fill up all the shortages in specialists in most of the under-doctored areas in future.

There are also important specialist services which have been traditionally located at these hospitals and others, and they have to be safeguarded. The people of Kent make substantial use of these specialist services. Indeed, there is some argument for saying that anything with a regional appeal is probably better situated in South-East London than in almost any part of Kent and Sussex from the point of view of accessibility to those who have to rely on public transport to visit their friends and relations who may be in hospital.

I have no doubt that there is scope for rationalisation of acute services in this area. On any objective assessment, as has been mentioned, the number of acute beds exceeds considerably that which is required for direct service of the area, and for teaching requirements. I hope that the area health authorities will look very carefully and constructively at the acute services in order to see whether economies can be made without risk of damage to essential teaching and specialist needs. The area health authorities have to produce a well-thought-out strategic plan showing the extent to which they consider that acute services can be rationalised.

It is not only an acute problem. There is also a problem relating to the provision for the mentally ill, the mentally handicapped and the elderly. The area's strategic plan has to show how these services can be improved as well. It should be stressed that these services have been the subject of neglect throughout the National Health Service since its inception, and it is as true of the Inner London areas as of the rest of the country or the region or the area which we are discussing. However, it is bound to take time before planning can be thoroughly done and the proposals worked out.

The regional health authority's task is very difficult. To encapsulate, it is faced with over-provision of acute services in the Inner London areas and with under-provision in Kent and East Sussex, due to a combination of previous building policies and the movement of population from London.

Mental illness and mental handicap services are concentrated in institutions outside London, and to change the pattern of care towards comprehensive district-based services will not be easy. There is a continuing increase in the number of elderly people along the South Coast.

There will not be any easy solutions to these problems. It is not easy to alter the historic pattern of health care provision in an area, and, in addition to money, time is an essential element. Even if there is a substantial provision of money, there is still the difficulty of time.

The regional health authority, as hon. Members will know, has issued a consultative document proposing redistribution by 1986. The authority is now receiving comments on its proposals and will be discussing these with the areas. I can promise hon. Members that I shall be taking a very close interest in the progress of these discussions and that I shall need to be satisfied that the redistribution of resources is proceeding smoothly.

There was mention of the position in Greenwich and Bexley. My right hon. Friend has agreed to the closure of existing services at three hospitals, and savings from this rationalisation should soon become available. He did not agree to the closure of St. Nicholas Hospital but asked the regional and area health authorities to consider the practicality of transferring services from the Memorial Hospital and closing the British Hospital for Mothers and Babies in return. The area health authority has decided that these proposals of my right hon. Friend are not practicable. In the circumstances, we are now awaiting the views of the regional health authority. When we have received these, my right hon. Friend will review the position in Greenwich and Bexley yet again.

I hope that I have said enough to reassure lion. Members that the regional health authority, my Department and the Ministers are committed to the redistribution of resources and are fully aware of the comparative shortfall of resources in Kent. Whatever gaps there may be in my own education, I certainly hope that I shall be able to fill them up when I visit the Medway area some time during the coming summer.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes to Five o'clock.