HC Deb 15 March 1978 vol 946 cc597-610

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

11.0 p.m.

Mr. Roger Moate (Faversham)

My object in seeking this Adjournment debate is specifically to draw attention to the need for a new general hospital in the Swale area. I emphasise that this is the ultimate target. If we could gain acceptance for that, by implication there would be acceptance for all the other elements in the long-term capital programme for hospital development needed in the Medway health district. That district includes much of the Swale area.

Essentially, what I am trying to do is to see whether we can get a commitment to a sustained programme of major capital investment in the Medway health district to cover the next 15 to 20 years. I understand that such a commitment has not been unusual elsewhere nationally, and particularly in the case of teaching hospital development programmes. Just such a programme has been set out in the district plan of the Medway health district, published in September 1977. I understand that this plan has been endorsed by the Kent health authority, and I hope that it will be approved by the region and the Government.

The background to the plan is one of serious deprivation in terms of hospital facilities in the Medway district. I do not think that there is any dispute about the facts. The case has been put strongly in Adjournment debates raised by the hon. Member for Rochester and Chatham (Mr. Bean) and more recently by the hon. Member for Gravesend (Mr. Oven-den). The case has been pressed frequently and tirelessly by my hon. Friend the Member for Gillingham (Mr. Burden), who is hoping to catch your eye later, Mr. Deputy Speaker. This emphasises very much the fact that this is in no way a party political matter. Its history spans many previous Governments, and I suspect that before it is solved many future Governments will be involved.

The debates we have had recently have concentrated largely on the serious shortage of revenue available to Medway health district for the maintenance of our existing services. On 3rd March the Minister of State acknowledged that this year only £78 is being spent per person in Kent compared with £108 in Greenwich and Bexley and £122 in Lambeth, Southwark and Lewisham. Incidentally, the Minister of State said that he intends to visit the district later this year. May I say how welcome he will be? I hope that he will find time to visit us in the Swale part of the district and see how inadequate are our hospital facilities.

There is no doubt that Kent as a whole is relatively under-funded. It is acknowledged that, within Kent, Medway is one of the most deprived districts. It is worth emphasising that, compared with the target allocations under the formula of the Resource Allocation Working Party, Medway is under-funded by £4 million, Maidstone by £5 million and Canterbury and Thanet—which includes part of the Swale district—by £6 million, which Kent as a whole is under-funded by £22.2 million.

Comparatively, the teaching area of Lambeth and Lewisham is, in theory at least, over-funded by £23 million. I say "in theory" because in practice I am beginning to think that the RAWP formula is in many respects unworkable and should be reviewed. It might work well in a period of increasing resources, but I question whether it really can work in a period of restriction. Can it really work when poorer districts can be helped only by the closure of hospitals in other districts? I regret to say that in the short term we seem to have very little hope of any substantial improvement in the revenue situation.

The extent of our deficiency in hospital services is quite dramatic. According to Government standards, we should have over 1,900 hospital beds. We have about 1,000. That is a shortage of 900 beds. Looking at the figures for the average daily bed provision per thousand population, we find that Medway is right at the dismal bottom of the league table, both for Kent and the South-East Region, and we are way behind the Department's own recommended guidelines. This means longer waiting lists and that many patients have to travel longer distances for treatment. It means that in our area we face acute shortages in geriatric and maternity services and in acute surgery and psychiatric services.

Looking at the provision of capital funds, we see that the region comes out badly. Apart from massive investment such as £45 million for St. Thomas's Hospital and Guy's Hospital alone, the region has regularly had the lowest share of capital per head of population of all the regions in the country. This year the figure is £3.3 per head, compared with £9.2 per head in the best region. No new hospital has been completed in the South-East Thames Region since the start of the National Health Service in 1948, with the exception of Greenwich Hospital.

How is this great gap in the Medway area to be filled, and what assurances can the Government give to the people of Medway that in future adequate hospitals will be available? A programme has been drawn up for Medway and for Swale. This programme includes a number of major hospital developments. It includes the long overdue expansion of the Medway Hospital to provide, among other services, for extra geriatric, psychiatric and acute surgical services. It includes the improvement of All Saints' Hospital, with a first priority for the new special care baby unit. It includes the phased provision of a second major hospital, ultimately to have 500 beds, in the Swale area. As the plan puts it, the site acquisition for this "should be pursued immediately".

I emphasise that the intention to develop Medway Hospital to its full potential as an 800-bed district general hospital was agreed by the regional board in the 1960s. My hon. Friend the Member for Gillingham knows all about this, because he has been involved in it for so long.

Today we only have phase one, with 213 beds, and it is likely to be the mid-1980s before we see phase two completed, if we are lucky. Also, the idea of providing a second major hospital within the health district is not new. It was recognised and agreed by the former regional hospital board. The only change is that it is now the view that this second hospital should not be built on a site which would have been fairly close to the Medway Hospital but should be situated within the Swale area, to meet the needs of that expanding population. There is a strong case for this.

The population of Medway itself has increased by 30 per cent in each of the last two decades, and the population of Swale has also expanded substantially. It is significant that there is an exceptionally high proportion of young people and that this is expected to increase the demand for hospital facilities certainly into the 1990s. Therefore, it makes sense to have a new hospital in Swale. We accept that this is something for the longer term, but there will be no hope of achieving it even for the next generation, let alone the present one, unless we earmark a site now for the hospital and take steps to secure it now.

It is very difficult for the health authorities to make such a commitment when they are so desperately concerned to find enough revenue to maintain existing services, but it is our job to look ahead. This is where the Government can give the necessary backing to the region and to the district by supporting this capital programme.

I think that the case for the Swale hospital has been made very effectively in the Medway plan for which we are seeking Government support. A plan has been agreed for the provision of a new 28-bed geriatric unit at the Keycol Hospital. There is a desperate shortage of in-patient geriatric services, and this unit is needed. There is no conflict there with the long-term idea of a proposed Swale hospital development. I do not know whether there is yet an indication that the money for the Keycol project will be made available, but I hope that it will be soon.

Although we are talking about new hospital facilities, there is no fundamental belief that the answer to health care is simply to build bigger, better and more hospitals. That point has been made clearly and emphatically in the health district report, and the health care planning team emphasises that it sees the provision of in-patient services as being combined with the equally important aim of reducing the need for hospital care and treatment by developing community and primary care. But our case is that the existing provision of hospital facilities falls far below the minimum needed to provide adequate and decent hospital services for the people of the Medway and Swale area.

Before allowing my hon. Friend the Member for Gillingham to make his contribution, I ought to say that, in emphasising the need for a new hospital and in making a plea for it by drawing attention to the inadequacy of our present services, I do not wish it to be thought that I am denigrating the staff in our present hospitals, who do a splendid job of work, and the many voluntary organisations which give so much of their time and effort to supporting the existing hospitals. Even if we get a new Swale hospital, when we get the expansion and improvement of the hospitals about which we are talking there will still probably be some sort of role in the National Health Service for many of those hospitals.

Although the Minister may not be able to promise us the money, I hope that he will at least be able to promise a sympathetic look at the need in the Swale area for a new district general hospital.

11.10 p.m.

Mr. F. A. Burden (Gillingham)

I am extremely grateful to my hon. Friend the Member for Faversham (Mr. Moate) for giving me a few moments, and in the short time available to me I shall not go into the figures which he has already given and of which I have no doubt that the Minister will take note. But I emphasise that two hon. Members on his own side of the House have joined me and my hon. Friend in pursuing the need for the improvement of health services in the Medway towns. It is perhaps unusual for hon. Members on both sides of the House to act together in this way. However, when we do, it indicates that we all have the same purpose at heart and that we believe the matter to be extremely important. It also means, of course, that we can bring added pressure to bear on whatever Government may be in power at the time in order to improve the situation.

I have been a Member of the House for a long time, and I have been pressing the case for an improvement in the health services in the Medway towns for many years. Recently, the Under-Secretary of State came to Medway to see conditions for himself after we had represented to him that the health services were in a critical state. He did not disagree with us. Then we saw the Secretary of State. He, too, agreed with the arguments that we put forward. Alas, he was not able to give us very much encouragement that anything could be done to improve our revenue position—an improvement which is necessary if we are to maintain services at their existing level.

Now we are promised a visit from the Minister of State, and tonight we have replying to this debate no less a person than the Minister with responsibility for the disabled. He should realise that the National Health Service in the Medway towns is disabled, and I hope that he will do as much for that as he does for those people for whom he shows so much sympathy and compassion in doing his job.

The position is really serious. We have been to the South-East Thames Regional Health Authority to express our views about the need for capital investment in the area. But, although the authority's representatives were sympathetic, they held out practically no hope.

I happen to believe that the National Health Service is in a very sad state in the whole country, and I hope that the Minister will not disagree with that. But in Medway it is in a much more critical condition than it is in practically any part of the country. The extraordinary feature is that because it is in Kent, which is supposed to be a comparatively well-off area, there seems to be less care and less intention to provide money even to hold the present position than there is in some of the areas in the North which are under-privileged from the health point of view.

The Minister must make up his mind to do something for Medway. I hope that he will have consulted his right hon. Friend and that he will realise that, no matter how long it may take, the Members for the area in and surrounding Medway will continue to press the interests of their area and the tragic need for improving the health services there, and that we shall do so not merely on a party basis but as Members from both major parties in the House. If for no other reason, the Minister must take note that unity on such a subject as this means that the need is extremely great.

11.15 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)

I congratulate the hon. Member for Faversham (Mr. Moate) on having secured a debate on this important subject and on his very proper determination to ensure that problems affecting the health services in Medway are fully and publicly discussed.

My ministerial colleagues have been involved in consideration of these problems on a number of occasions. As the hon. Member for Gillingham (Mr. Burden) has mentioned, my hon. Friend the Under-Secretary of State for Health and Social Security, the hon. Member for Waltham Forest (Mr. Deakins), replied to an Adjournment debate and then visited the district last summer. My right hon. Friend the Secretary of State for Social Services received a delegation of the four Medway Members just before Christmas. My hon. Friend the Minister of State, Department of Health and Social Security replied to a further Adjournment debate less than two weeks ago in which he announced that he would be visiting the district later this year. The hon. Member for Faversham referred to my hon. Friend's forthcoming visit. I have no doubt that my hon. Friend will want to consider the claims of Swale when the programme for his visit is being drawn up.

I am aware of the sustained interest that the hon. Member for Gillingham has taken in the whole question of National Health Service provision for Medway. Both he and the hon. Member for Faversham have fully appreciated in their speeches tonight the deep interest and concern of my hon. Friends the Members for Rochester and Chatham (Mr. Bean) and Gravesend (Mr. Ovenden). As both hon. Members have mentioned, there is no party animus whatever in this very important matter.

One further introductory point that I must make is that the Government have planned to allow resources for health and personal social services to increase over the next few years. Hon. Members will recall that details of the decisions taken in the public expenditure survey of 1976 were given in paragraph 1.6 of our publication "The Way Forward", which covers both capital and revenue expenditure to 1979–80.

On this occasion we are referring specifically to capital expenditure. Previous debates have focused mainly on revenue funding, which is a quite different matter. It is necessary to establish a clear distinction between the two kinds of resource allocation, not because Medway is acknowledged to be deficient in only one of them—quite the reverse—but because the means of overcoming the deficiencies differ according to whether one refers to capital or revenue.

As the House knows, the redistribution of revenue funds on a year-by-year basis is related to target figures determined in accordance with the criteria laid down by the Resource Allocation Working Party—RAWP. The Government are firmly committed to bringing about a fairer distribution on these lines. However, we must recognise that the pace of change will be influenced by a variety of factors, which were debated here as recently as 3rd March and which indicate that progress will be slow at first.

So we come back to the question of meeting the immediate hospital needs of the growing populations in Medway and elsewhere by other means. An expedient we naturally cannot afford to dismiss is that they should continue to look to the Inner London hospitals for at least certain types of service. The more specialised types in particular are often located at the major teaching hospitals and are meant to cover the whole region anyway. In addition, these teaching hospitals are, of course, centres of medical education and research. Although the population of their immediate area has declined, the number of students has not. Moreover, we want to maintain the number of medical students, since their education is vital for the future of the National Health Service. As far as can be seen, we shall be needing more doctors rather than fewer if we are to make good the shortages of specialists in most of the under-doctored areas in future.

The location of the three teaching hospitals in South-East London makes them reasonably accessible to most other parts of the region, and they have traditionally drawn patients from those parts. However, there is the cost of travel for patients and their visitors, and it is wholly understandable that the Medway should look forward to the provision of adequate facilities nearer home. The provision of such facilities will, of course, demand a great deal of capital investment.

While the need is acknowledged, there are a number of complicating factors, notably that the better-provided areas which are aiming to release revenue funds by rationalising their services may yet be obliged to incur a certain amount of capital expenditure in the course of such rationalisation. There is also an overriding commitment to continue the funding of major capital developments which are already in progress. So we cannot proceed towards equalisation of capital resources in the same way as for revenue, by setting notional targets and then urging health authorities to move steadily towards them over a period of years. A somewhat different approach is needed.

The Resource Allocation Working Party made recommendations for the distribution of capital in the longer term, but they have not been positively accepted for immediate implementation. The exact method to be adopted is still undetermined, but in the meantime the Secretary of State has decided that capital resource assumptions for the years from 1978 to 1980 will be calculated broadly in line with the RAWP principles. It is possible that the method of distribution finally adopted will be influenced by the review of National Health Service capital currently being carried out by the Department.

The 1977–78 and 1978–79, cash limits have been calculated in line broadly with the RAWP recommendations for the transitional phase to provide for contractual commitments as well as a minimum sum for other capital expenditure. In calculating the resource assumptions to be notified in the 1978 planning guidelines for the years from 1979–80, the method recommended by RAWP has been used with some modifications.

In the Department's planning guidelines for 1978–79, which are currently being issued, the capital programme for South-East Thames Regional Health Authority is set at around £20 million per annum in real terms for up to 10 years ahead, although there will be variations from year to year. Regions are also being urged to consider the effect on their priorities of significant variations—up to 10 per cent—on either side of the cumulative total for the seven years following 1981–2. Joint financing for local authority social services projects is shown separately from these figures, all of which are meant to be used in connection with the strategic planning now in progress.

As the hon. Member for Faversham has pointed out, these references to hospital development at Swale occur in the Medway health district plan of September 1977. One of the stated aims of the district strategy is to seek regional health authority commitment to the provision of a second major hospital in the Swale area, the site acquisition for which should be pursued immediately". It has been brought forward from earlier years and latched on to the new planning system. No cost estimate has been attempted, even for phase one, nor is it given a target starting date, however, provisional, in the outline major programme for the next 20 years. In such circumstances its destiny must seem rather speculative, especially as it involves looking beyond the strategic time scale of 10 to 15 years.

I hasten to add that the plan contains many excellent features in other respects, and it comprehensively surveys health service needs for Medway. It also stresses that the district management team will continue to provide the highest standard of service within the resources available. To this end, the team gives first priority to the development of community services in support of primary care.

The plan goes on to say that primary care will be developed in such a way that admission for hospital treatment is, where possible avoided and that where it is unavoidable it is kept to the absolute minimum. Nevertheless, there are a number of development proposals for existing hospitals. Some have already secured a place in future capital programmes, such as the special care baby unit at All Saints' and the first phase of the Medway Hospital improvements. Others will no doubt come forward in due course on their merits, as revealed by the progress of service planning. It is encouraging to note how well they conform to the priorities which are steadily being established and to the need for better use of limited resources. Flexibility of planning will be essential in the years ahead. There will be many who see this as the way forward for health services in Medway.

The regional health authority issued in January its own draft planning guidelines, including resource assumptions, as a consultative document. When these come to be finalised next month they will, of course, take account of the national guidelines just issued. In the RHA's document, the section on distribution of capital resources refers to a second option of making more funds available for new buildings by transferring specific sums annually from the revenue account. Greater flexibility of this kind is a welcome step forward since there is no magically correct balance of resource utilisation up and down the country. The document therefore covers the distribution of capital resources throughout the region according to either option but observing the same basic principles.

Probably the most significant of these principles is that, with regard to major capital schemes, this region has in the past been criticised by the Department for spending too small a proportion of its capital allocation on major developments. This was largely due to the fact that available resources had to be used in renovating existing stock in order to maintain a viable service. The region has many small hospitals, the replacement of which should increase effectiveness and in some instances release valuable sites. Much of the capital stock is in need of complete replacement, and this is particularly true in the case of long-stay institutions. Major capital schemes would therefore help to remedy these problems and contribute to the redistribution of resources both between areas and between the various health care activities.

It is accordingly proposed to give greater emphasis to major schemes, the annual allocation being more than doubled from the current level to some £13.2 million in 1986–87. But even phase one of a new hospital such as Maid stone can cost nearly £10 million. The control—

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Eleven o'clock.