HC Deb 17 March 1978 vol 946 cc933-44

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

4.1 p.m.

Mr. Norman Fowler (Sutton Coldfield)

I seek to raise the question of the critical position of the Good Hope Hospital, in my constituency. Good Hope Hospital has been much in the news in the last few weeks. Virtually every national newspaper and television company sent a representative to the meeting of patients which took place last Friday and I am sure that the Department has had a report. In parenthesis, I say that the Birmingham Evening Mail, the Birmingham Post and the Sutton Goldfield News deserve the credit for having raised this issue constantly over the years.

I emphasise that we are dealing here with a long-standing problem. In October 1973, for example, the medical staff at the hospital wrote to the regional hospital board making what was even then a familiar case. They said: Good Hope Hospital has 360 acute beds to serve a population now estimated at between 320,000 and 330,000 and expected to rise by 1980 to over 350,000. … The Medical and Nursing Staff during these past three years have been working under enormous pressure as can be seen by comparison of the turnover rate of both in-patients and out-patients when compared with any other hospital group in the Region. They were prepared to continue with this heavy and increasing work load for 2 or 3 years further whilst the planned hospital expansion was proceeding according to schedule. But the only thing that has taken place and the only factor that has changed is that in the autumn of 1974 the plans for extending the hospital were cancelled again. The hopes of the medical staff and patients were dashed by the cancellation of these plans.

The position today is that we have a hospital with just over 400 acute beds to cater for a population of about 310,000, taking in not only Sutton Cold-field and North Birmingham but Tam-worth and Lichfield and parts of Aldridge and Brownhills.

The hospital should have over 750 beds and that, of course, is the essential problem. The result of this situation is that there are waiting lists in all areas. I emphasise "all areas". Orthopaedic patients waiting for hip operations must now wait four years, or even longer. Patients waiting for general surgery such as hernia operations must wait for five and a half or six years. Children waiting for eye surgery must now wait, on average, about four years.

It is these waiting lists which are the essence of the problem at Good Hope. That is why I think that it was absolutely correct of Mr. Cozens-Hardy, the consultant, to call his meeting of patients on his waiting list last Friday. It seems to me that the National Health Service is about seeking to meet the needs of the patient. If it fails to do that, it fails in everything. The meeting of the patients last Friday—patients waiting for operations—brought home to everyone there, including the Members of Parliament, the human suffering that is involved in these enormous waiting lists and waiting periods.

I believe quite sincerely that the Secretary of State was totally mistaken in his comment on the Saturday, as reported in the Birmingham Evening Mail, that Mr. Cozens-Hardy was politically motivated in having called that particular meeting. I think that it was quite wrong of him to make that suggestion.

One of the reasons why I am very disappointed—this will not come as a surprise to the Under-Secretary—that it is the Under-Secretary who is to reply to the debate rather than the Minister of State responsible for health is that I would have hoped that the Minister of State had the authority to withdraw that charge, which I think would be recognised by everyone who was at that meeting to be totally without foundation.

However, my essential hope, and certainly my approach—I emphasise this—is that in dealing with this issue we should approach the problem in a non-party-political way. I hope that it can be dealt with not in terms of party politics but from the point of view of the patient. I hope that the Under-Secretary will agree to that.

Many patients were interviewed as a result of the meeting last Friday. Some of these were in their sixties or their seventies. Perhaps I may quote what one or two of them have said. Mrs. Kathleen Needle, who is aged 72 and lives in Sutton Coldfield, has been suffering from rheumatoid arthritis since the age of 70 and has been waiting for about three years for an operation. She said: I am beginning to lose heart altogether. I will be too frightened to go in for the operation when the time comes. Another lady who attended the meeting last Friday, Mrs. Margery Lloyd, from Tamworth, has been on the waiting list for more than three years for operations to relieve arthritis of the knees, hips, elbows and wrists, and she is now confined to a wheelchair. She said: I am in such constant pain that I have to take a load of pain-killers just to keep going. A further constituent of mine wrote to me and said that he was placed on the waiting list in June 1976. He said that when he went to see the consultant for the first time in 1976, I could walk with the aid of one stick, but since then I have got two sticks and now have to go on to crutches and cannot walk at all without, but I still do a little part-time job as a caretaker with great struggle, and I do not wish to give in. As I see it, I am on capsules, expensive ones, and heart tablets due to the heart attacks I have had due to worry; also sleeping pills". He asks: Don't you think that this is disgusting? It is very difficult for a Member of Parliament to do anything but agree on that question.

Those cases are typical of many more people living in retirement or people nearing retirement and whose pain could be alleviated or prevented.

I also wish to emphasise one further point, which is that, even in the situation of the orthopaedic patients, it is not just the elderly who suffer. I should like to quote from two letters that I have received from constituents on this particular point. One lady constituent wrote to me this year and said: I have developed arthritis in both hips over the last four years. I had one hip replaced at Good Hope in May 1976 and am on the waiting list for the other hip to be done. I have now a DHSS invalid tricycle which enables me to continue my job, but I have to use sticks to walk on and I am in constant pain. I am still in my forties. Another lady who lives in my constituency wrote to me this month and said: As our local MP can you please try and bring some pressure to bear on the appropriate department to enable the orthopaedic facilities to be improved at Good Hope? I am 33 years of age, married with an eight-year-old son. At present I am waiting for a hip replacement operation. I am in constant pain and unable to walk more than a few yards. I have to rely on someone pushing me in a wheelchair wherever I want to go. Under the present situation it seems I shall be suffering for years to come, with the pain increasing, and the damage to my hips continuing to progress, making the resultant hip replacement a much bigger operation with less chance of success. I quote one more case to emphasise that at Good Hope we are concerned not solely with the problem of the orthopaedic waiting list but with waiting lists generally. This case concerns the 19 month-old son of a Sutton Coldfield family. He is awaiting an eye operation. The letter from his family says: Although he has already been on the waiting list for over 12 months for an eye operation to cure a very bad squint we are told he has at least another 18 months to wait before the operation can take place although, ideally, this operation should be carried out within the next five months. Meanwhile, although he is under constant supervision and everything is being done to ensure that his sight will not deteriorate while the operation is being awaited, it is a very difficult job, with a child so young as patching etc. is distressing to him and therefore deterioration cannot be ruled out. That is a case of undoubted distress affecting a 19-month-old child.

In Monday's debate on the Consolidated Fund Bill we shall have the opportunity to go into general policies on waiting lists. Clearly it is open to the Minister to reply that the problem is not exclusive to Good Hope. That is correct. There are almost 600,000 patients on hospital waiting lists throughout the country—an enormous and terrible total.

Clearly there is a grave national problem to be tackled and, unless we tackle it, waiting lists will grow and suffering will increase. That is the stark challenge that politicians in all parties must face. We can say that things are well and seek to sweep the problem under the carpet, or we can say that the staff in the National Health Service are doing a job under the greatest difficulties and that their dedication is a cause for admiration and praise, but it is beyond doubt that they need our help. Above all, we can say that more resources within the NHS must be directed to the treatment of patients. Clearly, this means that economies in administration must be made. It is a matter of priorities and, in my view, the patient comes first.

I should like to see a debate started in this country on the way in which more resources can be brought into the NHS. Both political parties are committed to the NHS, but are we prepared to allow it to rely so overwhelmingly on general taxation? If we are, shall we be in the same position in 10 years' time? Will hon. Members still be raising such debates then?

Is it possible to move partly to an insurance principle, as a number of my constituents and, interestingly, a number of people at Friday's meeting suggest? This is a proper area for debate, and such a debate would benefit the country, the Government and the Opposition. But even within that debate I submit that Good Hope faces exceptional difficulties It is basically half a hospital. It desperately needs to be completed if we are to offer some hope to the patients on the waiting list, and I therefore strongly urge the Minister to give the 300,000 people who need this hospital's services some genuine hope for the future.

4.15 p.m.

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

I congratulate the hon. Member for Sutton Coldfield (Mr. Fowler) on securing this Adjournment debate and on focusing attention on a situation which I know is the cause of great concern to his constituents and those of other hon. Members. I include among those other hon. Members my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) and my hon. Friend the Member for Lichfield and Tamworth (Mr. Grocott) who have raised this matter previously with my Department.

In essence, the hon. Gentleman is saying that Good Hope Hospital has insufficient beds and other facilities to cope with the needs of the people who look to it as their district general hospital. The inevitable corollary is long waiting lists, and there is particular concern over the time patients have to wait for hip and other joint replacements, which was the focus of the meeting arranged last Friday by Mr. Cozens-Hardy, a consultant at Good Hope. However, the hon. Gentleman has accepted that this is a long-standing problem and emphasised that it is not a party political one in any way. I agree with him whole-heartedly.

Let me say straight away that I accept the hon. Gentleman's basic contention: there is undoubtedly considerable pressure on services at Good Hope. I shall try to explain the background to this and how it may be resolved.

When the "Hospital Plan for England and Wales" was revised in 1966, the intention was to develop Good Hope Hospital as the district general hospital for North Birmingham and South-East Staffordshire. The first two phases of the development were under construction, and the third and final phase was included in a fairly long list of developments then expected to start after 1970.

The first major phase was opened in 1967 and the second in 1970. Together, these provided 500 beds, theatres, X-ray and other supporting facilities. Planning of the final phase, a further 280 beds and theatres, proceeded broadly to schedule. In April 1973 my Department approved the scheme, then expected to cost around £3 million. The scheme was put out to tender, but the lowest was for about £4.4 million—an excess of 40 per cent. In these circumstances, the Department had no alternative but to advise the then Birmingham Regional Hospital Board to invite further tenders.

In the next year two further sets of tenders were sought, but each time the lowest tender received was so far in excess of the cost reckoned to be reasonable for a scheme of the size proposed that the Department had no option but to advise the board to refuse them. The hon. Gentleman may remember that at the time—1973 and 1974—there was considerable pressure on the construction industry. Indeed, on 8th October 1973 the then Prime Minister, in a statement to the House, referred to the problem and various measures being taken to reduce the pressure and its effect on costs.

By late 1974, therefore, three sets of tenders had been invited and all three were rejected. As far as the Department was concerned, the position was that it was for the board's successor, the West Midlands Regional Health Authority, to seek new tenders when the situation in the building industry was such that more reasonable tenders could be expected.

The situation then changed for a reason wholly unconnected with high tenders. As I have already said, the plan was for Good Hope to develop into a major hospital, with about 500 acute beds, to serve North Birmingham and South-East Staffordshire. When the regional health authority came to review the regional strategy for health services, it began to question this concept. In its consultative document "Strategy for Health 1976–86", published in July 1975, the authority suggested that a "cardinal principle" of regional strategy should be the elimination of situations where one health district's population looked to hospital facilities in a neighbouring health district. This was to enable a fully integrated health service to be provided in each district. The document made it clear that in this context the proposed development at Good Hope would need to be re-examined.

In March 1976 the RHA determined its major capital building strategy for 1976–77 to 1985–86. This did not include a further phase of development at Good Hope but, instead, included a £3.5 million community hospital development in Lichfield or Tamworth which would be capable of being developed into a district general hospital. This was confirmed in the RHA's first strategic plan, published in October 1977. On present assumptions, the development in Lichfield or Tamworth is unlikely to start until the mid-1980s.

Thus the RHA has moved away from a strategy where Good Hope Hospital was to become the district general hospital for North Birmingham and part of South-East Staffordshire—a total population of about 280,000. Instead, it favours one where Good Hope would service the bulk of the population of North Birmingham, effectively 130,000, and a major development in Lichfield or Tam-worth would serve the southern half of the South-East Staffordshire health district.

The facilities now available at Good Hope are broadly sufficient for its North Birmingham catchment population. The present difficulties are due to the fact that up to 150,000 people in South-East Staffordshire are also looking to Good Hope, and, on present plans, are likely to continue to have to do so until the late 1980s. The question is whether anything can be done to improve the situation more quickly.

I understand that officers of the Birmingham and Staffordshire Area Health Authorities have been considering the situation and are likely to advise their members to ask the RHA to revert to the former strategy of developing Good Hope to enable it to meet the needs of the South-East Staffordshire population. This would mean a major development at Good Hope rather than at Lichfield or Tamworth. Then there is the question whether the development—be it in Lichfield, Tamworth or at Good Hope—needs to be a higher regional priority.

Finally, there is the question whether, until a major development can be undertaken, any interim developments can be effected to improve the situation in the short term. I understand, for example, that there is a proposal to refurbish and bring back into use two theatres and two wards now out of use, which were due to be demolished to make way for the third phase of the major development. It is possible that for a relatively modest cost—perhaps under £500,000—such a scheme could afford very significant relief to present pressures.

At this stage I cannot anticipate whether the two AHAs will accept their officers' recommendations and ask the RHA to vary its strategy—and before doing so they would wish to consult local interests, including the community health councils. Further, I cannot, of course, anticipate the RHA's response or whether on review the priority attached to the major development will be changed or a short-term operation mounted. All this must be considered in the light of other pressing needs in the region, in the context of the NHS planning system. It is likely to be early next year, when the RHA's next strategic plan is published, before these issues are solved.

The hon. Gentleman will say that that is far too late. But I must say to him that, unfortunately, the Good Hope problem is not the only situation in the region where facilities are under pressure. As the hon. Members for Walsall, South (Mr. George), for Nuneaton (Mr. Huckfield), for Rugby (Mr. Price), for The Wrekin (Mr. Fowler), for Bromsgrove and Redditch (Mr. Miller), for Kidderminster (Mr. Bulmer) and for Solihull (Mr. Grieve) will testify, other areas in the region have pressures and the RHA has to try to exercise the wisdom of Solomon in taking an overall view of priorities. So far, the RHA has considered all these situations and has taken a view. Under the planning system, it reviews priorities regularly and can modify them if it sems right to do so. It is, however, important that these situations should be considered on a region-wide basis, and not dealt with in isolation.

I cannot, therefore, offer the hon. Gentleman any firm answer or quick solution. I can only assure him that the area health authorities, the RHA and the Department are alive to the problem. I very much hope that it will be possible at least for the small, holding scheme that I have mentioned to be undertaken. If, however, it proves impossible even to do this, it will be because, within the resources that we as a Government can make available to it, the RHA has, after the most careful thought, concluded that there are yet more urgent problems in the region which must take priority.

Mr. Norman Fowler

Is it the suggestion that the Government will make available an extra £500,000 for the project?

Mr. Deakins

No, I am not suggesting that at all. As the hon. Gentleman will know, our allocations to regions are determined in the light of the overall resources available to the Department for the National Health Service. Within regions and between regions there is the Resource Allocation Working Party principle, which may well affect the issue one way or the other.

I should like to say something specifically about orthopaedic waiting lists. I should like, however, to preface my remarks by saying that I regard the long waiting lists of Mr. Cozens-Hardy and his colleagues mainly as a symptom of the general pressure on facilities at Good Hope rather than as a special problem in an otherwise satisfactory situation. I think that the hon. Gentleman appreciates that.

Of course, I realise the anxiety and frustration that long orthopaedic waiting lists can cause. It is unfortunately true that there is a national problem of unsatisfactorily long waiting lists for traumatic and orthopaedic surgery, because in an increasingly ageing population there are more patients with fractured necks and heads of femur and with degenerative joint disease who can nowadays in many cases best be treated by joint replacements.

Part of the reason for longer waiting lists in this area is the great advance that has taken place in medical techniques which has brought new leases of life to many people who would otherwise have remained crippled.

I do not deny that lack of facilities is to some extent to blame for the lengths of waiting lists for both in- and outpatients, and that is certainly true in the case of Good Hope. Despite that, nationally there has been a steady increase in the numbers of orthopaedic surgeons in recent years, and I am convinced that better management practices can compensate appreciably for lack of resources for the overall expansion of services.

Orthopaedic beds are, for example, all too often occupied for considerable periods by elderly female patients who have had repairs to fractured necks of femurs and for whom convalescent accommodation cannot be provided by their relatives or by the geriatric or social services. A closer co-operation between orthopaedic departments and these services can often lead to a more rapid turnover in the use of orthopaedic beds. Flexible use of beds within a hospital can also help, and carefully devised systems for initial screening of newly referred patients can also contribute to the resolution of some of the difficulties which face orthopaedic surgeons.

I am advised by Mr. Bettinson, chairman of the Birmingham Area Health Authority (Teaching), that at the Good Hope Hospital and other hospitals in the area thought is being given to the better management of orthopaedic waiting lists. I hope that this will produce some improvement. I have no doubt, however, that at Good Hope the answer lies in additional facilities, either there or in Lichfield or Tamworth. This will require additional public expenditure. I hope that the hon. Member for Sutton Coldfield will support that to the extent that it is necessary to improve the situation in the region where his constituents live and in order to cope with the problems he has so graphically illustrated this afternoon.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes past Four o'clock.