HC Deb 20 March 1978 vol 946 cc1221-67

3.44 a.m.

Mr. Peter Brooke (City of London and Westminster, South)

Some are born great, some have greatness thrust upon them, and some find themselves doing unexpected things in the middle of the night. I might have known that there was going to be a singular and unexpected role assigned to me, as, uniquely in Mr. Speaker's ballot batting order, I am accorded neither an initial nor the final letter of my name. I in no way hold that against you, Mr. Deputy Speaker.

The first eccentricity is something of a compliment, going back to those days of first-class cricket score cards when amateurs were accorded their initials while professionals were vouchsafed only their surnames. The spelling alarmed me slightly more, because, as the American politician once said of the Press, "I don't mind what they say about me, provided they spell my name right".

However, here I am—to maintain the cricket analogy—going in as night watchman after my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) has been dismissed under the two-minute rule, playing in his second Test, and after my hon. Friend the Member for Canterbury (Mr. Crouch) has retired hurt.

I was ill-prepared for the excitement of opening the innings in fading light. I hope that the House will forgive me if I "play in" the debate rather than go for runs.

The first obligation on me is to establish a framework of numbers. The United Kingdom hospital waiting list figures from Social Trends run to 629,000 in 1974, 705,000 in 1975, and 722,000 in 1976 and, from other figures that I have seen, the 1977 figure will be worse. Hon. Members who follow me will no doubt add the urgent element to these figures. The 1976 figures, for the greater part—685,000—are, as one would expect, surgical.

We speak tonight primarily of people in need rather than of the Government's shortcomings. I must in fairness say as many things as can be said in extenuation of these deteriorating figures. First, at the micro levels the figures can be phoney. They can be like council housing lists, in that they depend on how recently they have been considered, and how many people have died or moved away. In this case they depend on how many are registered at several hospitals. If a consultant team is making a case for another consultant one does not have to be Professor Parkinson to recognise that that element of the list will be built up fast. Equally, if, for instance, a plastic surgeon has given a patient a planned date for an operation, that place on the list is irrelevant to the list's overall performance.

Secondly, in my constituency I have checked on present levels as against a year ago. At Westminster Hospital, taking all in all, there is no overall deterioration in the list. An increase in general surgical cases is matched by an equal fall-off in orthopaedic cases. At St. Bartholomew's there is no waiting list to speak of in general surgery, but there is a two-year list on certain aspects of orthopaedics and gynaecology.

Thirdly, time and scatter on the list is more important than raw numbers. An elderly patient waiting for acute assessment or for a bed can be a much more serious case than the generality. Classic waits are two years for varicose veins or hernias. These may be dismissed as simply tiresome, but they are more than tiresome to the patients concerned, and for someone waiting a year and a half for a hip replacement, that can be 18 months of total immobility, while a joint replacement could mean a wait of two years.

Equally pressing are the cases of short-term urgency. I heard the other day of a geriatric patient who could not be taken into hospital for six weeks. At the end of that period the patient had to lose a leg, because of clotting. No one can tell whether he would have lost it if he had gone in within 10 days. Similarly, malignancies which have to wait for between four and six weeks can be fatal. By definition, the timing is critical on abortions.

Fourthly, in terms of being fair, I am not critical of the overall level of expenditure. Between 1960 and 1975 Germany increased its proportion of GNP spent on health more than twofold, France increased the figure by 70 per cent., the United States by 60 per cent, the United Kingdom by 50 per cent., which was on a level with Australia and was significantly above Canada, which increased the proportion by more than 33 per cent. I therefore rebut the charge so often levelled at us from the Labour Benches that we are simply in favour of more expenditure.

Fifthly, I recognise that change occurs within different spheres of medicine. Orthopaedics is an expanding field, and hip and joint replacements are becoming common place, even for octogenarians. Cystoscopy automatically extends the waiting list, because for every new examination for bladder tumour one increases the regular numbers that one will have to do. Ten years ago Bart's was doing scarcely any coronary work; now it is heavily involved in this expanding field.

All these things can be said in fairness to the Government, but here I must switch from being fair to being critical. I shall use the coronary bypass operation as the means of changing gear.

RAWP and SIFT—those horrid acronyms created by someone with either too much imagination or too little—distort the resource pattern of the hospitals which practise these operations. On the figures that I have seen of a teaching hospital outside my constituency, the actual cost of performing the coronary bypass operation is £2,500. The RHA average transfer value for which the district gets credit is £322. That hospital handled a case load of about 300 in 1977 from outside the district, so the district is receiving about £100,000 for carrying out the operations, which are costing it £750,000, thus creating a deficit of £650,000, which the hospital must find over and above the ravages of RAWP.

I am in no position to comment on cause and effect, but the same hospital in the expanding field of orthopaedics, without receiving any extra resources, has seen its waiting list go up from 641 to 800 in the past year. I cannot help feeling that the resource allocation system is not helping reduce the list, let alone hold it steady. It is not a function of surgeons' energy. If there is a shortage of nurses or beds, or if the theatre can be open and working only from 8.30 a.m. to 5 p.m., the waiting list remains round the surgeons' necks like an albatross.

Secondly, there is the make-up of the list. There are always bottlenecks in the list, and it takes detailed research and creative imagination to remove the constraints. It takes what in other arenas would be called critical path analysis, and the critical path includes GPs, nurses, administrators and consultants. Consultants do care passionately for their patients, as the House would expect, but clearing up the list depends very much on the driving force of consultants, it requires good will on the part of all, but it also requires good management.

If the consultants are browned off, as the present Government have so effectively caused them to be, that sorting out of the list is less likely to take place promptly. In the present state of morale, the consultants are less likely to let the administrators help them clear it up.

Thirdly, although I have sought to be fair in examining the micro-aspects of the waiting lists, these distortions must even themselves out year in year out, and thus the underlying waiting list figures are getting worse.

The shadow £9½ million that the Secretary of State has been brandishing is a sign of the times. I suppose that it passes for a strategic weapon. There have been a number of strategic weapons throughout history, but this is a shadow weapon. One can only assume that the Secretary of State hoped that it would not be noticed that the £9½ million was being double-counted. But it has been noticed, and in being noticed its use has brought attention to the fact that the Secretary of State is clearly on the defensive on this issue of the waiting lists.

The importance of the subject is attested to by the number of my hon. Friends and other hon. Members to debate it at this extraordinary hour of the morning. I shall be greatly interested to hear the rest of the debate, particularly in view of the number of hon. Members present from all parts of the country.

3.54 a.m.

Mr. Bruce George (Walsall, South)

It is fashionable to denigrate the National Health Service. In this, its thirtieth year, I unashamedly record my pride in the achievements of the Welfare State and the NHS. Although I am far from being uncritical of its shortcomings, I do not think that the Tory butchery that the NHS could suffer if the Conservative Party were elected would be a solution to the obvious and undeniable deficiences of the Health Service today. If we consider the Tory alternative we are somewhat uncertain about what the public would have in store for them. We cannot go by the 31 lines in "The Right Approach", because that passage is hardly a positive indication of Conservative Party policy.

An article in General Practitioner—a very reputable journal—entitled "The Tory road to health" points out that what has been suggested by the Conservative Party over the past few months has been an end to health centres, the abolition of one of the NHS administrative tiers, which, incidentally, the Tories themselves established, an increase in prescription and other charges, an end to the concept of the Health Service free at the point of use, and, according to this article, a return to pay beds and privilege in the Health Service.

Will these provocative suggestions, if implemented, reduce waiting lists? Will they replace out-of-date buildings and equipment? Will these suggestions, if implemented, improve the extent and quality of service and health care? I believe that they will not. Schemes like these are designed to reduce Government commitment to health care, but they are unlikely to reduce overall health care expenditure. Those are not my words. They are the words of Dr. Derek Stevenson, formerly Secretary of the British Medical Association. Dr. Stevenson, in General Practitioner of 11th November 1977, goes on to state, looking at some of the suggestions by the Conservative Party: We investigated the potential of an item of service scheme while I was at the BMA. We looked into it several times and there are advantages, but once again there are vast administrative costs to consider. If this scheme were implemented there would be a considerable increase in administrative costs and it could lead to abuse, and evidence in the rest of Europe indicates that the advantages of such a scheme are not as great as they may appear at first sight. Certainly the scheme there does not reduce patient demand.

The suggestion of "hotel charges" was rejected by the Guillebaud Committees 20 years ago and the DHSS's more recent calculations show that this scheme, although at first sight it might have some attractions, is not on. If, after 30 years, we abolish the principle of taxation as the sole means of finance of the NHS and replace it by some form of health insurance, I believe that this would be to the detriment of the Health Service. It would undeniably lead to an increase in spending in the high technology areas of the spectrum at the expense of the more Cinderella areas.

If health insurance schemes were more widespread, this would be to the detriment of my constituents, very few of whom could raise the money necessary to provide themselves with adequate cover or the high cost of operations.

The Conservative Party is being rather dogmatic in its proposals, yet in "The Right Approach" it accuses the Labour Party of being divisive and doctrinaire. Its own proposals fall into that category. How the Conservatives would improve the quality of the Health Service whilst cutting public expenditure considerably defies facile analysis. In considering some of the speeches of the hon. Member for Reading, South (Dr. Vaughan)—

Mr. Norman Fowler (Sutton Coldfield)

If the hon. Gentleman intends to persist in making this into a party political debate, which is quite inappropriate, will he at some stage say how he is going to serve his constituents, and what solutions he sees to the undoubted problems of the NHS?

Mr. George

Yes. I have no intention of making this ostentatiously into a party political debate, but a debate on the Health Service obviously revolves round political decisions. I have a number of quotations that I want to make from statements by the hon. Member for Reading, South in which he pointed out the deficiencies of the service. I believe there are very few Conservatives with the approach of the hon. Member for Harrow, West (Mr. Page) who sought in a previous debate to reconcile the dilemma of improving the service with cutting public expenditure. He said that those of us who demand cuts in public spending must have the courage not to bellow when cherished local institutions are up for slaughter on the altar of economy."—Official Report, 20th January 1977; Vol. 924, c. 815. This is something of a dilemma in the Conservative Party's policy and one which many people will be looking to resolve in the months ahead.

In my constituency, which presents a microcosm of the problems facing the Health Service in general, how has the action of the Government since 1974 affected the town's hospital and medical provision, and how will it affect it for the future? Alternatively, what would happen to the Health Service if the Conservative Party's philosophy gained respectability and credence?

The Walsall Area Health Authority, when inaugurated, was bequeathed with just about the worst hospital system in the country. There can be few hospital systems which rival Walsall for their poverty and lack of quality. That was the situation in which the authority found itself, and one needs only to look at a document such a I have here, publicised by the regional health authority, and headed "Profile of the Walsall Health Services", to see the abysmal state of the hospitals in 1974. The hospitals were grotesquely under-financed, and the consequences were apparent for all to see.

I recall being with a delegation to meet the then Minister of State—my right hon. Friend the Member for Plymouth, Devon-port (Dr. Owen)—and in the material submitted to me by the Walsall Area Health Authority the following was said, just to indicate the extent of the poverty of the services in 1974: Discussion has taken place over many years regarding the provision of a new District General Hospital to serve the Walsall area; however, progress has not been made beyond various extensive studies and pre- liminary planning stages and the scheme has not found entry into the latest 10 year planning programme. The new authority, faced with a situation which has deteriorated alarmingly over the past few years, feels that positive action must be taken to place a definite scheme in the long-term budget programme and … unless the Regional Health Authority can positively elevate Walsall in the scale of priorities, its position as a deprived area will be further emphasised. I had a meeting with general practitioners at around the same time and they presented a brief to me which pointed out the appalling situation in our hospitals—old inadequate buildings, operating theatres out of date and inefficient, the baby unit unsafe, no psychiatric beds, difficulties in attracting specialties, and cumulative neglect going back generations. I could go on almost indefinitely itemising the deficiencies.

The finger of blame cannot be pointed in any one direction. It was a cumulative neglect.

Since that time the desperate plight of the people of Walsall has been recognised, and two years ago in an Adjournment debate the Under-Secretary of State for Health and Social Security said that There is no single definition of deprivation against which the circumstances of particular areas can be measured, but whatever criteria of deprivation one looks to, Walsall comes out as deprived. I indicated the shocking state of the hospitals, and in that debate the Under-Secretary indicated some hope at long last. He said: It will take three years to plan the Walsall scheme, and the probability is that building will start around 1980. … The broad intention is, however, that the Walsall development will start around 1980, in other words, almost as soon as it is fully planned."—[Official Report, 4th May 1976; Vol. 910, c. 1272.] This was most heartening after years of believing that the district general hospital was a pipe dream, a sort of mirage, so often promised but never realised. I have in my hand the actual plans for the new building—the feasibility study, 1977. The scheme is getting off the ground. Site boring will be starting in two months, and at the end of next year, if all goes well, phase 4 of the district general hospital will begin, with 160 surgical beds, 20 medical beds, a pharmacy, fracture clinics, an X-ray unit, and four new theatres. This is really an exciting development, and it is hoped that phase 5 will begin before the end of the next planning period.

I should not be eulogistic, even though I have before me the feasibility study. I point out to the Minister that, despite phase 4 of the district general hospital going ahead shortly, the situation is still very critical.

I pay tribute to the Secretary of State for accepting the principles of the Resource Allocation Working Party, which has ensured that deprived areas such as my own in generally deprived regions such as the West Midlands, ironically, in fact will get a better share.

The case for Walsall has been recognised. As the Minister wrote to me recently, When the West Midlands Regional Health authority applied RAWP principles in the region Walsall emerged as the area furtherest from its notional target revenue allocation—more plainly in terms of revenue allocations Walsall is the most deprived area in the region. As the RHA seek to redress inequalities over the coming years Walsall will clearly be the main beneficiary, but I must emphasise that this will be a long-term exercise. An indication of how deficient the service is can be found in "Towards a Strategy for Health", published by the regional health authority in December 1977. It shows that Walsall, with a target allocation of £20 million, had an actual allocation of £12.5 million and that we in the Walsall area are 32.7 per cent. away from the target.

I am pleased that the Minister and his Department recognise the problems of Walsall, but I should not entirely subscribe to saying that the solution will be long-term. I hope that this long-term strategy for improving the quality of service in Walsall will be rather less long-term. The distance from target is quite deplorable. It means a continuation of over-long and unacceptable waiting lists. It means a bed deficiency, regarded by the region as "very poor". The bed deficiency is running at more than 300. We are 48 beds short in general medical services, 74 in paediatrics, 108 in geriatric and 64 in orthopaedics. It goes on and on. The problem is serious. There is great difficulty in attracting new staff, consultants, doctors, nurses and others. There are five consultant vacancies at present. It is a tribute to the staff that, despite the fact that they are coming in insufficient numbers, there are any staff at all working in Walsall, in view of the much better quality hospital service on the peri- phery of Walsall. I pay tribute to them all.

There are chronic deficiencies in St. Margaret's, a hospital for the mentally handicapped, and a number of critical reports have come out. Fortunately, the Department has recognised this fact by making a special allocation of £100,000 with the promise of more next year. One-third of the budget of the local area health authority has been devoted to improving St. Margaret's, and a wander round as I have often done will indicate the enormous amount which has to be done to raise the standard of that hospital to an acceptable minimum.

We know that an enormous amount has to be done in the area as a whole. We know that considerable progress has been made so far. But even when phase 4 of the DGH is completed, it will only replace the general hospital—Sister Dora—so that even with phase 4 there will not be a significant increase in the number of beds available. Walsall will not be self-sufficient for a decade if the existing plans go ahead. It must be self-sufficient much sooner.

I am pleased that we are given a high priority by region and the Department. I recognise the public expenditure constraints. But I ask the Minister to speed up the process by which we shall reach the minimum standards which his Department accepts. As emphasised, equalisation with the rest of the region is much too long in my view.

I accept that additional money given to an authority which is not able to utilise that money might be wasted, but I am certain that in Walsall we are able to spend more money than has been allocated to us. I estimate after my consultation that we could absorb £750,000 per annum development addition, which is substantially in excess of the amount that we have received so far.

Meantime, a great deal can be done even before the DGH is completed. I ask the Minister whether he will look at the possibility of emergency measures and, prior to the DGH being completed, perhaps consultants temporarily being drafted from areas which are more favourably served. Another possibility is that of advice being given to my constituents about where else to go to get treatment, because there are areas where the waiting lists are much shorter.

Walsall is undeniably an area of deprivation—educationally, economically and certainly in terms of health and hospital care. We look to the Government not to decimate public expenditure, as has been suggested elsewhere, but to raise it. By doing this, areas like mine will get the quality of service that they deserve.

I assure the Minister and my constituents that I shall carry on campaigning, as I have done ever since I was elected to the House, to obtain for the people of Walsall the quality of service that has hitherto been denied them.

4.11 a.m.

Mr. Robin Hodgson (Walsall, North)

I do not want to follow the speech of the hon. Member for Walsall, South (Mr. George) in terms of the party political diatribe with which he began his speech. However, it is fair to point out that there is general agreement that the National Health Service is short of revenue. Quite apart from the philosophy of maintaining freedom of choice, it ill behoves the Government in these circumstances to cut off the pay bed structure which generated between £40 million and £50 million badly needed additional revenue for the NHS.

In opening the debate my hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) carried out a tour d'horizon of London hospitals and referred to the situation in the capital. Then we heard of the situation in the West Midlands, and in Walsall, particularly. Unlike the hon. Member for Walsall, South, I believe that present policies being followed by the Secretary of State are failing to help the situation in the West Midlands in general and Walsall in particular.

We have heard that the West Midlands is a deprived region—7.7 per cent. below the national average for revenue target and allocation—and how, within that region, Walsall is the most deprived part. The 32.7 per cent. deficiency in Walsall—£7 million to £8 million—is enormous, and it is one that cannot stand to the credit of this Government.

The result of the shortfall is that hospitals are run down, staff shortages are acute, existing staff are demoralised and waiting lists are lengthening.

I shall give a number of specific examples. During the past 12 months the accident department at the general hospital, which is the town's main hospital, has had to be closed on occasions because of lack of staff. This is not something that can be blamed on years of neglect; it is something that has happened over the short term. This accident department covers an area in which 268,000 people live and work. It is an area of major industrial activity, and accidents are unfortunately relatively frequent. Also, it covers between six and 10 miles of the M6 motorway, which is one of the busiest in the country. In the light of those facts it is not good enough to have anything but a 24-hour seven-day coverage in accident and casualty services.

The main hospital for the mentally ill is St. Margaret's. The hospital is more than 100 nurses under strength, and the patients sleep in such overcrowded conditions that lockers have to be turned sideways in order to give a few extra inches. The weekly amount spent per patient is £47.18, compared with a similar hospital in the region, Lea Castle, at Kidderminster, where it is £76.66. This is not good enough, and again cannot be blamed on years of neglect. Something should be done urgently.

Bed availability in Walsall is no better. By and large, it is about half the national average of England and Wales. The Minister of State, in a reply to a series of parliamentary Questions that I tabled a few months ago, said that there were 0.6 geriatric beds per 1,000 of the population in Walsall, compared with a national average of 1.2. In paediatrics, general medicine, and acute surgical cases Walsall has about 50 per cent. of the beds available in England and Wales.

There is an acute shortage of key staff, particularly in the radiology department. The authorised establishment for Walsall hospitals is three radiologists. None of the posts is filled. Currently they have to be covered by temporary staff on secondment part-time from other areas.

The position about the waiting lists is no more satisfactory. In gynaecology, the patients on the list per available bed number 16 in Walsall as against between seven and eight in England as a whole. That shows once again that Walsall is about twice as badly off as the nation as a whole.

The situation concerning non-urgent operations is even more frightening. My right hon. Friend the Member for City of London and Westminster, South, referred to patients having to wait two years for hernia operations. He said that that was a thoroughly unsatisfactory state of affairs. He is lucky that he does not and nor do his constituents live in Walsall, where the waiting period for this operation is three years and 10 months. The period for gall bladder operations is one year and five months.

This cannot be said to be anything other than a discraceful state of affairs. What is the Minister doing? We have had a promise about the new district general hospital, and we have heard talk about narrowing the gap in the RAWP allocation. But in the current year the additional allocation to Walsall totals £85,000, against a deficiency of over £8 million. By my arithmetic, at that rate of striking, it will take 94 years to make up the deficiency. As the Minister said in a letter to me, this is "a modest start". I can only reply, a modest start indeed.

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

I take it that what the hon. Gentleman is saying is that he is in support of the RAWP principle.

Mr. Hodgson

I am in support of bringing the Walsall Area Health Authority up to certain medical standards.

Walsall needs a much clearer commitment on the start date for the new district general hospital. We have been waiting a long time for it. I am slightly alarmed that on page 19 of the document to which the hon. Member for Walsall, South referred there is reference to a series of new district general hospitals for Stafford, Telford, Dudley and North Worcestershire. Nowhere does it mention the Walsall hospital. Perhaps the Minister will be able to enlighten us on that matter.

Above all what sticks in the gullets of people in Walsall is speeches of the sort made by the Secretary of State. I have here a Press release put out by his Department in which he refers to improved planning for more efficient use of scarce resources; redistribution to the deprived areas; higher priority for long neglected services for the mentally ill …; improvements in industrial relations machinery. Walsall has a total of £85,000 a year to solve the problem of redistribution to the deprived areas. The right hon. Gentle man talks of a higher priority for long neglected services for the mentally ill when we have hospitals such as St. Margaret's, and he refers to improvements in industrial relations machinery when last week we had the telephonists on a go-slow and work-to-rule.

The right hon. Gentleman says that these policies are being pushed through with determination in difficult circumstances. That will cause a hollow laugh in Walsall, and it is further evidence to the people in the area of the complacency which has become the hallmark of the Secretary of State.

Above all, the Secretary of State has ignored the enormous amount of personal inconvenience and human suffering that occur even in minor cases. It may be difficult for us to appreciate the full significance of a figure like £8 million being the deficiency in the RAWP target, but we must not forget that in talking about this huge deficiency we are talking about the effect on a series of individuals. It is they who will suffer, and it is they who must bear the burden of the problems in the Walsall area.

I therefore conclude by mentioning one such case. Mrs. Gladys Bickley, an old-age pensioner and a constituent of mine, is having increased difficulty in getting about because she has hammer toes. She wishes to have treatment so that she may maintain her mobility. She is keen to be able to travel round and not be confined to her home. She is worried about the increasing inconvenience and discomfort that she is suffering from her hammer toes.

Mrs. Bickley has aplied for an appointment for treatment, and the first appointment she can obtain is on 2nd September 1980, 18 months away. During that period, Mrs. Bickley will undoubtedly become increasingly crippled and will find it subsequently more and more difficult to get about, even if the treatment is satisfactory.

Therefore, I appeal to the Minister not just to deal with the major issues but to bear in mind the plight of Mrs. Bickley and thousands like her in Walsall borough. That is why I have sought to emphasise the disgraceful state of the NHS in the Wallsall area.

Mr. George

Will the hon. Gentleman explain how Mrs. Bickley's life will be improved if Conservative proposals are implemented?

Mr. Hodgson

Yes, because we intend to make sure that resources are directed towards those who are really in need and are not wasted on doctrinaire moves, such as the ending of pay beds, which deprived the NHS of urgently needed resources and I am seeking to draw the Minister's attention to Mrs. Bickley and the plight of people who are in a similar position because of the Government's lack of attention to them is symptomatic of the problems that beset the NHS.

4.22 a.m.

Mr. David Penhaligon (Truro)

The Minister will not be surprised if I seek to use this opportunity to mention the state of the National Health Service in Cornwall. The matter has received a good deal of attention in the Press in our area recently. One letter was signed by 18 junior doctors from the Royal Cornwall Hospital at Treliske. Subsequent to those 18 doctors having the courage publicly to sign a letter and issue it to the Press, between 20 and 30 other doctors have added their names to the letter. In addition, there is another letter, which has been signed by over 200 nurses at the same hospital, indicating much the same line of complaint.

There are a number of specific problems in health matters in Cornwall at present on which I should like ministerial guidance. To begin with, all Cornwall's health problems seem to centre on the lack of geriatric accommodation.

I have turned up the figures given to me by the Department showing the number of beds per 10,000 of population aged over 65. They show that out of 94 area health authorities in England and Wales, there are only three with a smaller number of such beds than Cornwall. Let me point out that Walsall is not one of them. The three that exist are in area health authorities and are on the edge of urban areas. The figures there suggest that there is an intelligent transfer from one area to another. However, in Cornwall there are 57.3 geriatric beds for each 10,000 numbers of the population over the age of 65. In neighbouring counties the figures are as follows: Devon, 77; Dorset, 79; Hampshire, 68; Wiltshire, 71; Berkshire, 73; Gloucester, 85; Somerset, 85.

Added to the sheer lack of beds available there is a second problem, which I have been unable to quantify but which exists in Cornwall, I refer to the number of people with no normal family support who choose to come to Cornwall to retire. If a person is reaching his latter years in the area in which his or her family lives, his family provides some of the care and attention that he needs in his declining years. That is not the situation in Cornwall.

My local doctor has produced a figure the validity of which I have not been able to check, but I have no reason to disbelieve it. I am informed that the national average for elderly people with no family support is about 12 per cent., whereas in Cornwall it is about 18 per cent. We have one of the lowest provisions of geriatric accommodation of any area throughout the country, and we have the added problem of no real family support for so many old people.

A problem for Cornwall that causes me considerable disturbance is that of the summer. I appreciate that it is easier to make up figures than it is to find facts, but I believe that the summer problem is of such gravity in Cornwall that a special investigation should be carried out to ascertain the severity of the problem. In reply to a Question, the figures being based on August 1977, it appears that about 16 per cent. of the addresses given by those occupying acute beds in Cornwall were outside the county. I do not know the accuracy of the addresses that were supplied. I do not know whether some patients gave the address of the hotel or holiday camp where they were staying. Further inquiries could be made on that score, but for present purposes I am satisfied to stick to 16 per cent.

If the ailment for which the patient requires medical treatment is of moderate severity, the normal procedure is for a fairly quick transfer to be made to the family home when some recovery is made. However, that is impossible when the patient is living 100 miles, 200 miles, 500 miles or even 600 miles from his or her natural home. That means that the average stay in hospital in Cornwall may be above the average for the rest of the region.

The words "Red Alert" in the health service within Cornwall have become a by-word for July and August. "Red Alert" means that for those living in my part of Cornwall who require operations that come into the so-called non-essential category the hospital is virtually closed down.

I have asked Questions about the length of waiting lists. On reading the crude figures it seems that the position is quite good. For instance, in 1973 there were about 4,600 names on the waiting list in my part of Cornwall, whereas the present waiting list has decreased to 4,100. That has come about as a result of the initiative shown by those who in 1973 reorganised and made the best use of facilities. That is what has led to the reduction, but at what cost!

The average stay for a general medical case in the United Kingdom is now 12.2 days but in Cornwall it is 8.5 days. The average stay for general surgery throughout the United Kingdom is 8.6 days, whereas in Cornwall it is 6.8 days. The utilisation of general medical beds in the country has now reached a staggering 99.63 per cent., whereas the average for the United Kingdom is 84 per cent. For general surgery the utilisation is 92 per cent., whereas the national average is 74 per cent. Those are the figures that have been supplied in response to my Questions.

Far from the hospital at Truro being a place where loving care is administered to those who enter, it is like a factory. People enter at one end and are churned out at the other end in the manner of a factory system.

I shall make two quotations from the letters to which I have referred. The doctors concerned write: We are sending patients home before they are fully investigated, seriously undermining not only their confidence in us, but also the morale of the medical and nursing staff who know they are dealing with problems inadequately. The nurses say: The statistics on bed usage … affect our ability to give that standard of care which is the prime motivation of every professional nurse, and for which we are trained. Our inability to achieve even a reasonable pro- fessional standard of care removes that sense of job satisfaction essential to the maintenance of good morale. The sense of frustration generated by our present situation creates a vicious circle, demonstrated by such factors as continuous high sickness rates, and high staff turnover, all leading to an exacerbation of the situation—in short, the patient will suffer. Recently wide publicity was given in the county to a very sad case which centred on a coroner's inquest. A lady in Treliske was sent home before she should have been. Complications set in. When she was readmitted, it was too late. The present situation is bad. With a bed utilisation rate of 99.63 per cent., nothing further can be done.

Extra money has been allocated to Cornwall—£400,000. That will be very welcome. As the local health authority is running at a deficit of £600,000, it will be seen how necessary it is. In effect, it means that it will now go bankrupt slightly slower than it did before.

The most amazing economies have been considered and seriously debated. One possibility, which received publicity in the local Press, was the possible stopping of the hospital car service. How such a proposal in a rural part of the country could have been conceived, other than out of sheer desperation, I do not know, but it was seriously considered, cost-analysed and, I fear, nearly put into action.

The last point concerns Cornwall's peculiar population trends at the moment. I do not know why it is that an economy which boasts 14 per cent. male unemployment should have an increasing population, but that is the position in Cornwall. Apart from areas for which population increases are planned, Cornwall has the fastest growing population of any part of the country.

The only figures that one can look up—the census figures are meaningless and old—are those of the electorates for constituencies. The five Cornish constituencies had an electorate of just over 295,000 in 1974. The most recent statistics that I could get were for 1977. Between 1974 and 1977 that electorate had increased to 310,000—an increase of 5 per cent. in three years. That fits in with the general figures quoted in the county.

I have outlined the problems as I see them. I look forward with great interest, as do the doctors and nurses who have written to the Minister of late basically posing the same questions as I have posed, to the answers that the Minister will give.

I regard an increase in geriatric facility as the key to getting out of Cornwall's difficulty. Clearly, the elderly are still being treated, but in beds which were not designed for them. That is putting great pressure on the remaining facilities.

I should like a thorough investigation into the effect on Cornwall and perhaps other summer visitor areas—Cornwall is not unique in that respect—of the tremendous increase in population as a result of the influx of visitors during the summer months. I should like an assurance that, even with the pathetically inadequate statistics that exist, population growths of the degree to which I have referred—5 per cent. in three years—are adequately taken into consideration when the funding of the area is considered.

It is not just a matter of increasing the money per head for the extra 5 per cent. Capital facilities are required which would normally be accumulated over a long period by setting a small amount aside out of current expenditure each year. But for population increases of this size specific capital allowances are required. These are the questions to which the people of Cornwall wish to hear replies. I look forward to the Minister's comments.

4.35 a.m.

Mr. David Atkinson (Bournemouth, East)

When I made my maiden speech on Thursday I did not expect to be called again so soon, or at this hour of the morning. I welcome the opportunity of drawing to the attention of the House the serious problems of the National Health Service in my constituency, and of hospitals in particular.

We all know how important good health is to our quality of life. It is the major consideration. For this reason it is easy to become emotional and almost neurotic about health. It is especially easy to create and respond to sensational headlines which indicate that the Health Service is falling down on the job and on the verge of collapse. It is equally easy for those responsible for the Health Service, when faced with such criticism, to overreact the other way and to dismiss it as sensational. It is easy for them to say that there could be a problem, that it is nothing that they do not know about, and that they have it under control.

On important issues such as the nation's health, I prefer to hear what those who are involved professionally with the problems, the patients and hospitals, have to say about it before I suggest political solutions. When the professionals speak, not a happy picture emerges.

Last month doctors and consultants from two areas which are geographically far apart—East Anglia and the West Country—sent letters to the Minister which contained the same fundamental message. It was that hospitals are understaffed and that patient care is suffering as a result. In a letter to the Secretary of State the junior staff at Truro maintained that in the last few weeks it has been almost impossible to admit patients from the waiting list. We have had to refuse admission to some acutely ill patients. Those patients who are admitted, are done so at the expense of discharging others who should ideally have stayed. Another letter, from 45 Norwich district consultant staff, refers to three consultants resigning to take up posts abroad because of the deteriorating financial position of consultants.

Earlier this month my area health authority was told that people in Dorset may have to wait two or two and a half years for surgery. We are told that in January 1974—a significant date—the number on the waiting list was 1,288. Last month it was 1,641. A man who is now almost blind first had an appointment for treatment in 1975. He has still not been admitted.

It appears that the problem is not necessarily a lack of resources nationally. We frequently hear that criticism, but the problem is caused by the unfair allocation of resources to the different areas. I understand that the allocation is still based on calculations made in 1948 and that it is topped up each year. Since 1948 there have been great shifts of population throughout the country. The result is an unfair distribution of cash in favour of the big cities and at the expense of expanding areas such as mine, which should be receiving £2 million more than it is for health provision.

The problem is not just one of mismanagement in allocation; it is also one of mismanagement of existing resources, coupled with a lack of co-ordination throughout the entire caring system. This was particularly brought home to me at the weekend, when I was speaking to a local consultant surgeon who informed me that many elderly patients who enter hospital for straightforward operations—for example, a fractured femur—and who normally would be ready for discharge after two or three weeks at the most, often cannot be sent home because they live alone or because they have an elderly partner living at home who cannot cope with them. There are no guaranteed adequate back-up facilities in the form of home helps, health visitors, social workers, and so on, with the result that these elderly patients remain in those beds.

At the same time, in the same hospital—the Royal Victoria Hospital in Boscombe and Bournemouth—there is a urologist who is working round the clock to clear an in-patient waiting list that stood at 386 last month. The area health authority is prepared to appoint another urologist but cannot do so because there are not enough beds. This is an Alice-in-Wonderland situation, which makes one inclined to believe some of the more sensational headlines referring to a crisis in the National Health Service.

But we have a more sinister situation to consider, regrettably. Again I refer to the last meeting of my area health authority and the chairman's comments. He said: A lot of the problem has been caused by industrial action of one kind or another. This always builds up the waiting list, and when you are doing as much as you can, you cannot do anything to catch up. What kind of industrial action are we talking about which is contributing to these waiting lists? The hon. Member for Walsall, North (Mr. Bruce) referred to the 1,000 telephone operators who are working to rule, which has led to doctors having to queue up in corridors to use public telephones to allocate emergency beds. Last year, we had members of the Transport and General Workers Union in hospitals in the Epsom health area looking through medical supplies to the elderly and mentally ill during an eight-day strike by ancillary workers over a new rota system. Again, in Hackney we had inexperienced NALGO workers left to handle the switchboard and to operate the special emergency telephone system for cardiac arrests after telephone operators and domestic staff walked out of the Queen Elizabeth Hospital for Children. Surgeons had to postpone operations.

It is events such as those that led one of our most experienced and promising consultants in the service—he is a consultant obstetrician and gynaecologist at King's College and Dulwich Hospital in London—to say: Five years ago, it was a disgrace to cancel an operation. Now it's commonplace … Like any nationalised industry, the Health Service is rapidly being dominated by unionised non-medical staff. The inevitable result is that patients will die. It is comments such as that that encourage questions such as who is running the Health Service, and for whom?

There is a deteriorating situation in our Health Service, and it seems to me that there are a number of sensible actions that the Minister can take to begin to reverse it. First, I hope that he will try to match existing resources to existing needs fairly throughout the country so that declining areas, such as Liverpool and London, do not take more than an equal share of the national cake from the expanding areas such as South Dorset or Cornwall.

Secondly, if there is a lack of back-up services which is preventing patients from returning home to adequate care, cannot there be a crash programme to return to the pre-Seebohm system of specialised health visitors to deal with particular client groups, such as the elderly?

Thirdly, we need to discover the full effect on our hospitals of the industrial action, official and unofficial, and to assess the serious effects that this is having on patients and waiting lists. We need to face the reality, that there will never be enough State cash for the National Health Service to satisfy the needs. We need to start encouraging the investment of private money into the service through more pay beds and the building of more private hospitals, because everyone will gain from this. There will be better facilities, shorter waiting lists, more cash to go round, a wider choice of health provision, satisfied staff and, above all, better care for the patient and this is surely what our national health should be all about.

4.46 a.m.

Mr. Norman Fowler (Sutton, Coldfield)

I agree with a great deal of what my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) said and I compliment him on his second speech to the House. Since it was made at 4.35 a.m., it must be some sort of record.

Like many other hon. Members, I shall concentrate on problems in my area but I shall do so in order to point to the evidence of a general trend inside the National Health Service.

I have in mind the Good Hope Hospital at Sutton Coldfield and the acute problems facing the hospital or, more accurately, the patients. I raised this matter on the Adjournment on Friday and I make no apology for returning to it.

We have just over 400 acute beds at Good Hope Hospital, which serves a population of 310,000, taking in not only Sutton Coldfield but north Birmingham, Tamworth and Lichfield and parts of Aldridge-Brownhills. For such a population, the hospital should have more than 750 acute beds. The problem is that it is only a little over half a hospital.

The result is waiting lists in all areas and all specialties. Orthopaedic patients are waiting for hip operations for four years or longer. I have a letter from a consultant at the hospital, Mr. Cozens-Hardy, who tells me that he has 13 patients who have been on the waiting list for total hip replacements since 1974. There is no question but that the delays are causing personal suffering and distress.

I have a letter from a constituent who, talking about his wife's mother, says: She is 74 years of age and has suffered for a considerable time with arthritis of the hip and is in constant pain and is in need of an operation for the insertion of a plastic joint. Her doctor informs her that there is a waiting period of about four years. I think that it is disgusting that a 74 year old woman is told she must wait until she is 78 or 79 by which time she will probably be too old or unable to stand the operation. I would point out that she lives alone in a first floor flat and is finding it increasing difficult to use the stairs. She has had numerous falls and lives in fear of causing herself more serious injury. That is the sort of letter which is all too common and is being received by myself and other hon. Members whose constituencies are in the Good Hope catchment area.

The crisis at Good Hope is not confined to orthopaedic patients. General surgery patients can wait for five and a half to six years for operations such as hernia operations. In one of the most serious areas, children needing eye surgery must wait on average for four years. I do not think that the Minister of State would challenge that this is the position. What hope can the Government hold out for the hospital?

In my Adjournment debate on Friday 17th March the Under-Secretary of State replied: 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 1980's. That, again, underlines the continuing nature of the crisis. Basically what the Minister is saying is that the Government cannot promise any substantial improvement until the mid-1980s at the earliest and very probably the late-1980s. The fact is that on present plans the patients will have to go on waiting and suffering because that is the reality of the lists that we are discussing tonight.

It was because of that position that Mr. Cozens-Hardy called his meeting of patients 10 days ago, which received a great deal of attention from both the newspapers and television companies. It was the first meeting of its kind where patients actually expressed their feelings about the situation in the NHS. We hear from the politicians, from the unions and from the medical professions, but rarely do we hear from the patients themselves. But that is what the NHS is all about. It is about serving the needs of the patients.

The message of that meeting was clear. I would point out to the hon. Member for Walsall, South (Mr. George) that it was not a criticism of the people working in the NHS. Even less was it a criticism of the NHS concept itself. It was simply an affirmation that something must be wrong if young housewives, at one end of the age spectrum, and retired people, at the other, have to wait four years or more for hip operations. It was an affirmation that something must be wrong if young children have to wait four years or more for an eye operation.

It was a meeting which did not proffer solutions but which asked questions. If I were to make one point in this debate it is that we should in no way seek to minimise the problems in the NHS and that we should listen to the kind of questions and problems that are being put forward by the patients themselves.

Let me add that the meeting which Mr. Cozens-Hardy organised in Sutton Coldfield was certainly an unusual meeting. It was perhaps the first of its kind. Nevertheless, it was quite wrong for the Secretary of State—when questioned about this the following day—to hit out at Mr. Cozens-Hardy and accuse him of being politically motivated. Mr. Cozens-Hardy may have made criticism of all politicians for their failure to be able to respond, but certainly he was in no way, shape or form putting forward a party political case.

I would say in all seriousness to the Minister of State that it is a great pity that when a sincere man seeks to try to express the frustrations of NHS patients he should be criticised by none less than the Secretary of State himself as being a politically motivated man. That was not the case, and I now ask the Minister of State to take the opportunity of putting the record straight. His hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) took a tape recording of the meeting and delivered it to the Minister. If it has not yet percolated through to him, doubtless it will. I hope that he will listen to it.

I ask the Minister to do one further thing. Will he consult the hon. Members for Perry Barr, Birmingham, Erdington (Mr. Silverman) and Lichfield and Tam-worth (Mr. Grocott) and ask them whether they thought that the meeting was politically motivated? I think that they will all confirm that it was not. That meeting was a genuine attempt to express some of the concern that exists in the Health Service, and it is up to the Minister now to withdraw the slur on the surgeon who was seeking to do that.

I hope that the question of the Health Service can be dealt with in as nonparty political a way as possible. I hope that the standard we can use for the debate is not the standard of knock-about party politics. That would be totally inappropriate. The standard to be used must be patient care—the interests of the patients themselves.

I recognise that Good Hope hospital is part of a much bigger national problem. A waiting list of 600,000 people is a terrifying figure. Above all, it presents a challenge to politicians in this House. There is a great deal of common ground on health matters in the House of Commons, notably a commitment of all parties to the Health Service itself. It should therefore be possible to have a constructive and sensible debate on health, not a party political debate in the worst sense.

We should now be seeking possible ways forward. Economies are possible in the Health Service, and perhaps funds could be diverted to the treatment of patients. Surely to this end improvements could be made in administration. But we are still left with the crucial problem of getting more resources into the NHS, and it is on that matter that the debate should centre.

We have had the great education debate. We could now have a debate on health, geared to the question of resources. Some will say that no debate is called for, that the present system of financing the Health Service is correct and that it requires only more public expenditure financed out of general taxation. But I fear that if we pursue that course we shall be debating the same question in five or 10 years' time. The problem will be that the position will by then have got much worse.

We should now examine all possible ways of supplementing the taxpayers' contribution. A number of options are canvassed, such as moving to some form of insurance-based scheme to provide at least part of the finance of the Health Service, examining where charges could be made without causing hardship. If that is not the right way forward, let us discuss what is. Above all, let us have a sensible discussion of how resources can be brought into the service and how that can be to the benefit of the patients.

That is not a criticism of the service, which functions as well as it does only because of the magnificent work and devotion of those who work in it. The trouble is that it is now failing to provide for many thousands of patients. We must give some hope to those who are waiting for treatment. On the Government's own statement, that hope is denied to them at present.

The issue is, what are the interests of the patients? There may be very difficult questions to answer. But we do not serve patients' interests by ignoring the questions, nor should we seek simply to attain a quiet life for politicians. The principles and questions here are fundamentally too important. We should start talking seriously about how we can get more resources into the Health Service.

5.1 a.m.

Mrs. Lynda Chalker (Wallasey)

This has been a very valuable and interesting debate. The contribution of my hon. Friend the Member for Sutton Coldfield (Mr. Fowler), who said that we had a duty to examine all possible sources of finance for the Health Service, was one of the good things that sometimes come out at 5 o'clock in the morning when we have these long debates.

I congratulate my hon. Friend the Member for City of London and Westminster, South (Mr. Brook) on raising the question, and I congratulate other hon. Members on joining in at this late hour. My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) and my hon. Friend the Member for Reading, South (Dr. Vaughan) regret very much that they cannot be here, which is why I am in a slightly unaccustomed position.

I have for a long time been extremely concerned with the Health Service, not only in the North-West and the Mersey regions, where we have had particular problems, but across the country. What is bothering people is the fact that this is the first opportunity we have had for some time for a straightforward debate in which we can put the facts on the record clearly and unequivocally.

The answer about waiting lists given in column 728 of Hansard on 22nd February brought many groups up with a jolt when they saw what had been happening in the Health Service. From 526,000 on the waiting list at the end of December 1970, down to 479,000 in December 1972, then the waiting lists climbed steadily to 607,000 at the end of December 1976. That has shown us just how bad things have become.

But it is not only that things have become bad. It is also that we have not had the degree of frankness that we would expect in discussing these matters in the House. My hon. Friend the Member for Reading, South alerted the House to the fact that something was wrong when he asked the Secretary of State about the increasing waiting lists since 1974. The right hon. Gentleman the Secretary of State replied: We now have a period of increasing activity in the Health Service, which explains why the numbers on the waiting lists are coming down."—[Official Report, 22nd November 1977; Vol. 939, c. 1292.] Whether or not the right hon. Gentleman intended to mislead, he did indeed mislead. In reply to my hon. Friend the Member for Devon, West (Mr. Mills) on the same day he had said: The health authorities are spending £9½ million this year. That sum is designed positively to reduce waiting lists."—[Official Report, 22nd November 1977; Vol. 939, c. 1291.] If that was not enough, in another place, in answer to my noble Friend, Lord Sandys, on the question of waiting lists, the Secretary of State's noble Friend, Lord Wells-Pestell, said: I would point out that my right honourable Friend the Secretary of State recently said that £9½ million would be available to help regional health authorities, through their area health authorities, to come to grips with this particular problem. We have been told that, if there could be renovation of operating theatres, the provision of new operating theatres, restoration of wards and the creation of new wards, it would all help—as indeed it would—to reduce the waiting lists. The sum of £9½ million has been made available in the forthcoming year to enable area health authorities to do precisely that."—[Official Report, House of Lords, 28th February 1978; Vol. 389, c. 360–1.] We hoped that that £9½ million would start to bite into the problem. However, we have discovered from the recent debate that that was not an additional £9½ million. So the situation has steadily built up to an increasing waiting list without extra resources. We view the issue with grave concern.

Last Friday, in reply to my hon. Friend the Member for Sutton Coldfield, the Under-Secretary referred to long orthopaedic waiting lists. Many other references have been made to severe waiting lists by my hon. Friends and by the hon. Member for Truro (Mr. Penhaligon). The Under-Secretary said: I do not deny lack of facilities is to some extent to blame for the lengths of waiting lists for both in- and out-patients, and that is certainly true in the case of Good Hope. The hon. Gentleman went on to make a more important statement: I am convinced that better management practices can compensate appreciably for lack of resources for the overall expansion of services."—[Official Report, 17th March 1978; Vol. 946, c. 943.] It is to that that we must look.

We have been talking about better management practices for a very long time. That is why I am as concerned about the subject as I am. Back in November 1976, in answer to my hon. Friend the Member for Newbury (Mr. McNair-Wilson), the Minister of State said that about 27 per cent. of those on waiting lists had been waiting for longer than a year. On 10th February 1977 another parliamentary Answer indicated that throughout 1976 the Secretary of State had been reviewing waiting list management. In May 1977 the Secretary of State announced his new offensive against the traditional foe of the National Health Service—the waiting list.

We do not deny any of this, but we seem to have been doing an awful lot of talking about the subject for a very long time without any appreciable benefit to the service and, above all, without any benefit to the waiting patients.

One of the problems we know about, although it does not seem to be the case in Cornwall, as the hon. Member for Truro said, is that of bed occupancy and throughput. I know that one Portsmouth gynaecological surgeon increased his throughput dramatically by having day patients, by using five-day wards, and so on. That put the whole of the rest of that hospital's services into utter confusion, because with a high throughput of beds the nursing staff must be appreciably greater. I can speak from some personal experience in this regard from having been a helper to nursing staff years ago.

Not only must one look at operating capacity and nursing ability to cope with increased throughput, but one also requires extra radiography and pathology and various other ancillary services. Those just are not available to make better use of the existing facilities.

Yet this problem seems hardly to have been examined by the Secretary of State. If it has been examined, very little useful guidance has been given to area health authorities and the many hospital teams dealing with their longest ever waiting lists.

As the position was worsening, we thought it right to bring it before the House. It is no good trying to kid us or the public that all is well. I suppose it was a step forward when we had a release from the Secretary of State last week calling for a balanced debate. We agree with much of what the right hon. Gentleman said in that release. We do not find fault with it, but there are matters on which we need more figures and honesty from the Secretary of State. In an article he wrote, or had written for him, in Pulse on 18th February this year he proudly talked of the steady level of capital spending at about £400 million per annum. I remind the House that in 1972–74 capital spending was £600 million per annum and the pressure on resources is not easing up. It is actually becoming greater. That does not seem to emerge from all that I have read. The average rate of NHS spending, taking capital and revenue together, from 1972–73 to 1977–78 was just below 2 per cent. per annum at constant prices. For the period 1977–78 to 1981–82 it is planned to grow at only 1.7 per cent. per annum. Taking revenue alone, the 3 per cent. growth over the past five years will be actually cut back to a 1.6 per cent. per annum growth over the next four years on the figures so far made available. All this is saying to us that we shall not have more money under the present Government plans, and therefore we have to make even better use of the resources which are available.

Many of us have grave doubts about some of the detail of the Resource Allocation Working Party plans, partly because much of the planning is based on very out-of-date population trends. The Minister will know as well as I the problem that Northampton has faced with the growing population of Milton Keynes, which was just not allowed for in the forward estimates of the area money allocated by the region. Trent Region has had mammoth problems in coping, and the Minister has already received delegations from doctors and Members of Parliament in the region.

How can we make the available resources stretch any further? This is where I think that the advice from the Department has not been forthcoming at a time when it was so urgently needed. The British Medical Association has criticised the Government very strongly for robbing Peter to pay Paul—in other words, the plan to take money from the acute services to put it towards some of the long-term services.

The Minister knows full well that I do not deny and have argued consistently that the mentally handicapped and the mentally ill need a better proportion of the resources, but there is no point in cutting the resources for acute care today when it could cause a larger proportion of long-term chronic sick in the future, if they are not dealt with in their acute stage.

We have to look for new sources of finance and we have to look for much better management. Where do we start? I believe that we have to educate the public about costs and demands. The Minister will agree that the public has no idea of the cost of the services that it is very often using. That is not to say that people should not be using them and having them free when they are ill. But we have to create understanding and not cover up.

I notice that in some local management there is a call for greater flexibility. One of the administrators in Liverpool was offered another dialysis machine, the money for which would be raised by contributions from work forces in different factories. It was a thoroughly worthy idea, but the problem is that if he had that machine he could not use it. He cannot use subscribed funds to pay nursing staff or technical staff that he would need to put the machine into operation. There is, therefore, a lack of flexibility of spending at the local level.

There is something even worse, to which my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) referred. That is the lack of trust which exists between the different sections of the health profession. We have seen disruption of all sorts in the last four years, and unequivocally we say that disruption of patient care by any group, wherever it comes from, is wrong. But it took an awful fight to get Government condemnation of one of the prime disrupters in recent weeks—the telephonists.

We hope very much that the Government will sort this problem out. The point is that the understanding of what is being faced by the patients, and by the surgeons when they cannot make arrangements for their patients, seems to be totally lacking. There is, therefore, a fear and lack of trust. We condemn all industrial action, but let me say that I think greater efforts have to be made on industrial relations at local level within the health services.

We look to the lead of the Minister, as a member of the well-known union involved in the Health Service, to try to help promote better industrial relations and cut out some of the really niggling disruption, where the only people who suffer are the patients.

There are plenty of reasons for using every resource and facility which comes the way of the National Health Service. If there are volunteers wishing to help with patient transportation, flowers or books in the hospital, we believe that they should be used to the utmost in order to leave the professional staff to do the professional jobs in the health services. If there are people willing to contribute something towards health care, surely this should be another resource for the health services. We have a mammoth organisation of 800,000 employees spending £6,000 million per annum. It is too large and too vital a service to the country to let it go by default by not taking the necessary action to promote good working relations. There is no doubt that all those who are involved in the caring services want to make the NHS work. It can work. It could work a lot better if it had leadership, the right sort of advice, and much less interference with its day-to-day management, which should be done at local level.

No new hospital, whether it be for the hon. Member for Walsall, South (Mr. George) or anyone else, will be any good unless we use every resource we have to run it properly. We should seek to get rid of the rush to spend the end of the year's allocation, which is reported in one newspaper cutting after another, because there is no proper system of roll-over of local revenue funds. We should be looking at every way in which the cash limits can be made to work at local level so that people are conscious of the health spending that they are undertaking on behalf of the nation.

I believe that there is a lot that we can do to cut back the bureaucracy still further through natural wastage—and do not let me hear from the Minister that the 1974 reorganisation was responsible for all of it. If he has read the Select Committee report he will know that from the end of the 1960s the NHS administration was growing steadily. It is true that there was a hiccup in 1974, but it was little more than a hiccup in what had already been established over the previous 10 years as a growing administration.

Mr. Penhaligon

Do I gather from that comment that the hon. Lady is defending the reorganisation of 1974?

Mrs. Chalker

The hon. Member gathers from that comment that the reorganisation of 1974 had to be allowed to settle. But there are ways in which it can be improved still further, and in due course, at the right time, the hon. Gentleman will be told about it. I believe that the overall framework is probably going in the right direction—this is a personal view—but that it needs modification, as many hon. Members on both sides of the House have said.

Mr. Moyle

In that case, if the framework is right, I take it that the hon. Lady disagrees with her hon. Friend the Member for Reading, South (Dr. Vaughan), who wants to abolish the area level.

Mrs. Chalker

I thought that I used the words "overall framework". I do not disagree with my hon. Friend the Member for Reading, South, but I do not think that the NHS, its employees or anyone else would welcome a major reorganisation. In any event, it would be wise to await the report of the Royal Commission on the NHS, which I am sure will be presented to us before very long.

We know that the funds are not as plentiful as any of us wish to see. But there is a duty on this House and especially on the Department to make sure that there is wise spending and that no source of revenue is turned down. We know that standards have fallen. We know that something has to be done to improve standards of health care and to reduce waiting lists. Whatever means are used, that requires leadership, and that is the one thing that we cannot genuinely say we feel that we have had in the NHS over the past few years. We hope soon to see a positive change from the Secretary of State and from the whole Department.

5.20 a.m.

Mr. Tony Newton (Braintree)

I welcome the opportunity to contribute to the debate. I shall be brief, in view of the number of speeches that have been made already, and the Minister's desire to reply.

I certainly do not want to take time with a long stream of statistics that almost any hon. Member could give about the problems in his or her area. However, I do wish to refer to some of the problems in my constituency, and particularly in the Chelmsford and Colchester districts of the Essex Area Health Authority.

I confirm what has been said about the rising anxiety felt by everyone within the NHS and among those using its facilities. One of the remarkable features about the concern felt in the NHS at the moment is the extent to which it appears to be shared by everyone—administrators and professional people at every level in the NHS are deeply worried, just as much as the public.

Every hon. Member must get a steady stream of people who are concerned about what is happening to them and their relatives within the NHS. Within the last two or three weeks, for example, a constituent has been to see me about a serious waiting list problem affecting his daughter. Last Saturday morning I spent a long time talking to people whose mother was very seriously ill with cancer, and who felt that she had not had the degree of sympathetic care and support that she should have had. I do not pretend to be able to make an instant judgment of all these cases, but they do illustrate the dilemma that we all face.

Hon. Members are faced with the problem of knowing whether to create the maximum amount of public fuss. If we do we can be accused of undermining morale even further, and appearing to attack the staff, which we do not intend because we know their problems. But what is clear is that if the stops were really pulled out on all the problems that are drawn to our attention, and especially on every case of people who have died and whose relatives are not satisfied with all the circumstances but who for understandable reasons do not want to create a public row, we would need not one NHS Ombudsman but a very large team to cope with all the complaints.

I have had formal approaches from local authorities, consultants and everyone in the service. The most depressing single thing in the NHS is the fact that in my area, anyway, nobody ever invites one to see how good the facilities are, or seeks to display them with pride. Many industrial firms want to show off their factory or production line. But once one sets foot inside the hospital door, the staff do not say what a marvellous job they are doing; they point out how difficult conditions are and how difficult it is to cope.

Nothing has done more damage to the NHS than the Secretary of State's appearance of complacency last summer. It would be wrong to say that without this complacency people could put up with the situation, because they are at the end of their tether. But at least, if the DHSS would only recognise and admit the extent of the problem, and give some clear idea how it is to be solved, people could bear the difficulties more easily. I hope that we shall get more from the Minister than we have had from the Secretary of State over the past two years.

In my constituency there is concern about all the problems raised tonight, but there is one that is particularly disturbing—the deep concern about the state of the casualty services. The main towns in my constituency are Braintree and Witham, which lie between Chelmsford and Colchester. The two districts overlap in many respects, and my constituents have to look in both directions.

That means two things: first, they have to travel quite long distances, so that there may be long delays in getting emergency casualty treatment; secondly they are looking to two major towns, Chelmsford and Colchester, where the facilities have in no way kept pace with a rapidly increasing population. These problems are compounded by the fact that in Chelmsford the accident and emergency department at the Chelmsford and Essex hospital is located in a position where serious traffic delays can occur at certain times.

The anxiety about casualty services is great. Local firms write to me about their worries concerning what would happen if somebody was injured at work. They are right to be worried. Local headmasters are in process of raising a petition about the casualty facilities because they are deeply anxious about what would happen if a child were injured at school. They are right to be worried, and they will have any support I can give them in pressing the case. Yet all they have been told is that the new accident and emergency department, together with other developments which should be taking place in Chelmsford have been put back from 1982 to 1984. Their mood is that they will believe it when they see it, because year by year we have been told that something will happen and year by year the dates are deferred still further.

My constituents—I am talking about professionals as well as lay people—believe that the situation has become a scandal. I share their view. Underlying this—this is the point on which, particularly, I ask the Minister to comment—is what I take to be the undoubted fact, about which there can be little dispute from the Department, that Essex is grossly underfunded as a result of the failure to allow for the increase in population which has taken place not just in the past few years, although the increase is continuing, but over virtually the whole period since the war.

All the towns that I have mentioned—the two which are concerned with my constituency, Chelmsford and Colchester, which do not lie within it, and Braintree and Witham, which do lie within it—have had enormous increases in population. In several cases the population has doubled or more than doubled in a relatively short time. Yet since 1945 there has been no new hospital project or major improvement in the whole of that part of Essex. Neither Chelmsford nor Colchester has had a new hospital or major improvement since the NHS was inaugurated. In that time the population has increased out of all proportion and includes large numbers of young couples with children.

My hon. Friend the Member for Wallasey (Mrs. Chalker) referred to the contribution which better management practices, incentive budgeting, and the possible drawing of funds into the Health Service in other ways could make. I would add that quite a significant and immediate contribution could be made if the Government would abandon their ridiculous policy on pay beds, which is sucking money out of the service at a time when the Government are unable to provide proper facilities for my constituents and many others.

Apart from those relatively limited points, the Government must give a dearer indication of their intentions, if not about the Resource Allocation Working Party exercise in detail, then about the problem which was the reason for setting up RAWP. We understand why the Government see some difficulties about that at a time of financial constraint, but it cannot be right to leave in their present position areas such as that with which I am concerned, which have had no increase in resources for health to match the increase in population which has occurred over a long period. We have to face up to the need to reallocate resources, whatever statistical basis we use to do it.

As a general proposition, Essex Area Health Authority needs more funds. There is a problem because it is part of the North-East Thames Region, which on a RAWP basis is over-funded. I sometimes think that the worst thing that can happen is for one to be in an under-funded area in an over-funded region. But that is the situation in Essex, and the Minister must face it. Steps must be taken towards moving resources to where the population has increased.

The bitterness—and I do not think it is too strong a word—that now exists on this score in Essex, and the fact that the RAWP exercise has not been properly carried through in our area, are compounded by the fact that when it comes to taking money out of Essex to put into London under the rate support grant the Government are prepared to move very fast indeed. For four years the Secretary of State for the Environment has been doing his calculations on how resources should be moved around the country. He has come to the conclusion that Essex is one area that should lose a share of Government grant, and one cannot see the right hon. Gentleman for dust.

Year after year rate support grant funds are being taken away from Essex. Yet when overall NHS calculations clearly show that there should be some redistribution from London, in which the population is falling, to such counties as Essex, where the population is rising fast, there is back-pedalling, and my constituents are being left in the lurch. That cannot be allowed to continue.

I do not expect the Minister to be able to comment on every detail of local problems in my constituency, but I hope that he will say something about the pattern of the use of resources in the NHS and tell the House what the Government intend to do to ensure that Essex gets a share of NHS resources commensurate with its population and needs.

5.33 a.m.

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

We had had a long and interesting debate, even if sometimes it has not been as well-informed as it might have been. A large number of points have been made with which I am sure the House would like me to deal. I shall try to deal with as many points as I can and shall take them as quickly as possible at this hour of the morning, but it is a substantial task.

I think I can put the hon. Member for Braintree (Mr. Newton) out of his misery and say that we recognise that in NHS terms Essex is historically under-funded. We intend to deploy resources towards Essex, and I am sure that the hon. Member for the City of London and Westminster, South (Mr. Brooke) will co-operate fully in that exercise since it is his constituency—and mine—that will have to make some contribution towards this movement.

Serious problems are involved in the exercise, and we all know that a great many Government resources are deployed in the teaching hospitals. We need the output of those hospitals at its present level, and we hope at a slightly higher level in the country as a whole, to meet NHS needs in places such as Essex in the years to come. Any deployment of NHS resources towards the Home Counties from London will have to be at such a rate that it does not damage the seed corn of the NHS of the future. That is an important point to bear in mind.

I was pleased to hear the hon. Member for Wallasey (Mrs. Chalker) say that the National Health Service should be free for those who are ill. I entirely agree with her, and in that respect we join forces. I agree that the Health Service should be free for the user. I am glad that that policy has been firmly established. However, that was not always what the right hon. Member for Wanstead and Woodford (Mr. Jenkin) said from a place near the Opposition Front Bench. It is not the sort of thing that the hon. Member for Sutton Coldfield (Mr. Fowler) was saying. However, it is what we always say, and it is the principle that we shall maintain.

If Opposition hon. Members have an alternative policy, it can only be that they could manage the Health Service better than us. They adopt the approach "Anything you can do we can do better". Surely on no other subject is the credibility of the Opposition so fundamentally strained. The fact is that they have no alternative policy.

The hon. Lady referred to a hiccup in 1974, which she was most anxious to avoid discussing. That was a reference to the reorganisation of the Health Service. The hon. Lady claims that reorganisation has not affected the main framework of the existing organisation of the Health Service. It must be remembered that she and her right hon. and hon. Friends have not had any responsibility for maintaining the service since 1974. As a result of good electoral fortune, they left office in that year.

In an article that the right hon. Member for Wanstead and Woodford wrote recently in Pulse he stated that he is aiming at a better management of the service. As both he and the hon. Member for Reading, South (Dr. Vaughan) voted in favour of every dot and comma of the 1974 reorganisation, the Opposition are bereft of any credibility when it comes to organising, running or managing the Health Service.

The hon. Lady has referred to a hiccup in 1974. If that phrase ever gets round to the employers in the Health Service, it will be one of the biggest jokes in the service in 1978.

There is a quaint convention that if my hon. Friend the Member for Walsall, South (Mr. George) makes a political remark, that is being political, whereas if Opposition Members make political remarks, it is not. I have had to listen to two personal attacks on my right hon. Friend the Secretary of State. He has been accused on two counts of misleading the House. The accusations are not true. The hon. Lady, supported by the hon. Member for City of London and Westminster, South, said that in the summer of 1977 my right hon. Friend claimed that waiting lists were coming down, and that that was misleading. In fact, that was the truth. It was not misleading.

At the end of 1976 waiting lists stood at 606,000. By June 1977 they had fallen to 594,000. The latest estimate that I have is 591,000. That was the level in September. If that is not an example of waiting lists being reduced, I do not know what else it is. I am prepared to agree that waiting lists are infinitely too long and that our object must be to shorten them by all the means at our disposal.

The hon. Lady also said that it was stated that £9½ million has been set aside to take action with a view to shortening waiting lists, and that my right hon. Friend was again misleading the House. Again, that is not true.

Mrs. Chalker

So that waiting lists could reduce in size they had to increase from the figure that I gave the hon. Gentleman for 1972. I think that he will agree with that. Secondly, if the hon. Gentleman reads Hansard of 22nd November and studies the two columns to which I referred, he will see the passage dealing with the £9½ million. The hon. Gentleman will surely accept that that sum was available to reduce waiting lists. Indeed, that understanding was confirmed by a Government spokesman in another place on a later date. That is why the people were under the impression that there was an additional £9½ million to be used to help the waiting list problem.

Mr. Moyle

I do not disagree that the hon. Lady formed a misimpression. After all, she has not had responsibility for managing the National Health Service under this reorganised system. The fact is that the £9.5 million was spent by area and regional health authorities directly towards reducing waiting lists throughout the country. There is no denying that, and that is what my right hon. Friend said. Therefore, why, because the hon. Lady formed the wrong impression listening to him, she should get so excited, I cannot understand.

The hon. Lady said that capital spending between the early and late 1970s had fallen from about £600 million a year to about £400 million a year. I should not deny that. But we cut capital and other spending in the public sector with the agreement of the Opposition. Indeed, they were unhappy that the Government did not cut public spending by the amount that they would have cut it. Therefore, how the hon. Lady can turn to figures such as those and try to prove that anything that we do, they would do better, I do not know. The argument appears to be founded on a misconception.

Mr. Brooke

Does the Minister agree that, on the basis of what was said by the noble Lord, Lord Wells-Pestell, in the House of Lords, the noble Lord was misled and under a misapprehension about the figure that was quoted?

Mr. Moyle

I never discuss in detail what happens in another place. The attack was launched by the hon. Gentleman and by the hon. Member for Wallasey on my right hon. Friend the Secretary of State. I have now explained the situation. I see no grounds for any attack whatsoever.

Remarks were made about taking money away from acute services. That is not true. Next year we shall be spending £86 million more on hospital and community health services than this year. The rate of growth of acute services is likely to increase. Admittedly, we should like to see greater priority given to caring for the elderly and the mentally ill and handicapped. We shall urge those priorities upon the various health authorities within the overall rate of growth.

A great deal was said about industrial relations. Certainly there is too much industrial action in the NHS. Patients suffer when that happens. We want to improve matters in the NHS in that respect. The NHS has nearly 1 million employees throughout the country. That is a substantial number. I think that the rate of industrial dispute in the Health Service against that very large number—albeit not easy to defend—is very low and compares extremely well with industrial relations in any other comparable organisation.

The hon. Member for Wallasey said that we were ignoring the problems of places such as the Oxford and the Trent regions. That is not true. When the Oxford Region began to explain its difficulties, I went to Oxford and met the regional chairman, his regional team of officers and the area health authority chairman. I discussed the region's problems with them. I am not suggesting that the Oxford Region has now got wealth beyond the dreams of avarice, but at least I received thanks from the hon. Member for Northampton, South (Mr. Morris) and others who are now more content with the situation in Northampton than they were before.

The situation is the same in Trent where we have met the regional chairman and his team of officers. We have talked over their problems with them and suggested ways in which their budget can be better balanced and how important hospitals might be brought on stream to provide a good service.

Much of the discussion has been centred on waiting lists. I am glad that my hon. Friend the Member for Walsall, South came to the conclusion that the trouble is not the amount of resources available. That is common ground. There has been much talk about orthopaedic waiting lists. They are long. When a new technique is developed, it might take 15 years to train the appropriate surgeons. It might take several years to build up operating and other necessary facilities. This is true of orthopaedic surgery. In the meantime, GPs begin to refer patients, whom they know can benefit from the techniques, to those consultants who have mastered them. Naturally, waiting lists build up.

This is the situation in which Mr. Cozens-Hardy found himself at the Good Hope Hospital. I shall say nothing about the Good Hope Hospital in general because the hon. Member for Sutton Coldfield received a full reply from the Minister on Friday when I was looking at hospital facilities elsewhere. The situation has not changed since then.

The hon. Member for Sutton Coldfield asked me to comment on my right hon. Friend's remarks about Mr. Cozens-Hardy. The hon. Member stated Mr. Cozens-Hardy's case with more tact, moderation and balance than Mr. Cozens-Hardy did when he held his public meeting. My right hon. Friend did not have the benefit of the hon. Member's contribution when he spoke. All that he had was the report of what was said at the public meeting.

One of the statements was that some of Mr. Cozens-Hardy's patients would have to wait for 36 years for operations. I believe the hon. Member agrees that that was said. If that is so, Mr. Cozens-Hardy is grossly irresponsible to take someone on his waiting list when he knows he will have to wait 36 years. The only other thing that can be said is that he was not making an accurate statement. It was against that background that my right hon. Friend made his contribution.

It is clear that Mr. Cozens-Hardy was conducting a campaign—not necessarily political, but a medical campaign. My right hon. Friend has no cause to withdraw any of the remarks that he made on that occasion.

There is no doubt that orthopaedic waiting lists at that hospital are too long, as they are throughout the country. I understand the reasons for that and why some time will elapse before we can deal with them as quickly as we should like.

Mr. Norman Fowler

I wish to get the record straight. The Secretary of State accused Mr. Cozens-Hardy of being politically motivated. I suggest that that charge would not be accepted by any of his hon. Friends who were at the meeting. If the Minister wants to say that Mr. Cozens-Hardy is indulging in medical politics, that is not objectionable. What the Minister has said amounts to a withdrawal of what the Secretary of State said.

Mr. Moyle

No. It is in support of what my right hon. Friend said, and I have given the reasons why I should not condone a medical political campaign in the terms in which Mr. Cozens-Hardy was doing so a few days ago.

I come now to the general subject of waiting lists. I do not deny that in many cases a shortage of facilities and problems of the kind that I have been indicating are the reasons for long waiting lists, but there are other causes, and I think that we have to worry about those, too. There is the level of morbidity at any one time, which may fluctuate quite remarkably.

I have mentioned new surgical techniques. There are the referral patterns of general practitioners. Many doctors—quite properly from their point of view—refer their patients to the consultant whom they consider the best man for the job even though that consultant has a waiting list that is vastly longer than that of some of his colleagues who are as good as but a lot more unsung than the first consultant. Demographic and population changes can occur quite remarkably. Apart from Essex, where the population has been building up since the end of the war, there have been quite rapid falls in population in the centre of London and quite rapid rises in the Oxford region where there are new towns. Given the technical pace of planning and constructing new hospital facilities, that is bound to add to the waiting lists in some areas.

Then there is the management of waiting lists. One area health authority which I visited a few days ago did an exercise and went through its waiting lists. It had not done this before, and it found that 10 per cent. of the population had moved, for various economic and social reasons, to other parts of the country.

In addition, there are out-of-date lists. The circulation lists might be limited in many cases. It may be that general practitioners receive waiting lists only for their own districts, whereas a waiting list for their area, or for their region—or sometimes the waiting lists are for teaching hospitals in London—would be helpful to them in placing some of their patients.

Finally, as was mentioned by the hon. Member for Bournemouth, East (Mr. Atkinson) in what, without being patronising, I thought was an intelligent commentary on the Health Service, there is the problem of industrial action. This is bound to push up waiting lists in the service. This is another cause for delay, and it is one on which we must work in order to eliminate it.

The hon. Member for Wallasey commented on the things that had been said about management and said that it did not seem to be producing any action. I hope I have indicated that it has produced some action. It is not something to which the Health Service takes naturally, and as far as I can gather it is not an old idea in the Health Service. The scope for action in the management and improvement of waiting lists is substantial indeed, and in the educative process will not be a simple or quick matter to put across.

Mrs. Chalker

I wonder whether the Minister would be kind enough to give the House details of what has happened since May 1977 when the Secretary of State announced this attack on the management of this major foe of the National Health Service. The House lacks details of what has happened.

Mr. Moyle

The last thing that I want to do is to inflict on the House a reading out of the circular on the management of waiting lists, but I shall give the hon. Lady a copy in case she does not have one in the hope that she will be able to make use of it.

Mrs. Chalker

I read that circular when it was issued. I do not think that it spelt out in anything like the way that is necessary the help that is needed at area level. Therefore, one circular has not changed the situation.

Mr. Moyle

That is the last thing that I would claim. The hon. Lady wanted to know what had happened, and I can tell her that we are issuing circulars giving advice to management on the management of waiting lists. Of course, it will not be the last circular. As we learn from experience, we shall issue fresh guidance and advice as part of continual pressure on the administrative and medical personnel in area health authorities to reduce waiting lists.

My hon. Friend the Member for Walsall, South made another speech in the campaign he has been running for four years to get more facilities for his area health authority. I am glad that he has won a new ally in the hon. Member for Walsall, North (Mr. Hodgson). The only trouble with the hon. Gentleman's speech was that he spoiled his case with some inaccuracy. He said that we were taking money from the NHS by abolishing pay beds. Broadly speaking, that is not true. There were 5,000 pay beds in the service before the pay beds Bill became law and 2,000 authorisations have been withdrawn fairly simply and without too much turmoil because the beds were not being used. The loss to the NHS is minimal.

The new district general hospital at Walsall is in sight as a result of pressure from local people. It will cost a large sum of money and will be started in 1979. Resources are not the key factor. Design and planning of the hospitals are the key problems which must be solved. Walsall is the next area in the West Midlands for the construction of a new hospital. I was talking to the regional chairman on Friday about the problem. An extra £100,000 has been allocated to St. Margaret's Hospital to help it deal with its problems.

The hon. Member for Truro (Mr. Penhaligon) adopted a slightly different approach to NHS problems in his area. I have been to his constituency and I visited both hospitals in Truro. One is rather elderly and cramped and the other, though modern, is too small. Perhaps I may cheer up the hon. Gentleman by telling him that an aunt of mine was dealt with at the Treliske Hospital, and that she had nothing but the highest praise for it and, considering that she used to be a matron in a teaching hospital, that is praise indeed.

In places where there are insufficient facilities, the staff suffer more than the patients because they put themselves out to try to cope with the inadequacies. Geriatric provision at Treliske will be improved by the provision of a 56-bed unit this year, together with a shell for further development, should that be necessary. The Cornwall health authority has also set aside £6 million for capital development on the site in the early 1980s. Treliske Hospital is on the small side and needs developing.

The hon. Gentleman complained that there was no family support in the area, but this is a matter for the social service departments of local authorities. I know of the good intentions for the future in Cornwall, but in social services I found a fairly bad performance in the past. Cornwall has a lot to catch up on. The hon. Member for Bournemouth, East raised this point in regard to social service facilities in his area. He should direct his remarks to the local authorities in the area and get them to do their job. A tremendous amount has to be done with regard to the development of social services.

Incidentally, Cornwall will improve its position under RAWP in the years to come because it has been unfairly dealt with in three respects under the RAWP formula. The standardisation of mortality ratios and the allocations to it will be improved because of the high age figure in Cornwall. The growth of waiting for the over-65s will be taken more and more into account as well as the net target position in which Cornwall finds itself. In the future the Cornwall Area Health Authority will find these matters improved under the RAWP formula.

Mr. Penhaligon

Will the Minister of State say a few words about the effect of summer visitors on the health facilities in Cornwall?

Mr. Moyle

I am glad the hon. Gentleman raised that point. While the health facilies in Truro, for example, may be reasonably sufficient for dealing with the winter population of Cornwall, there is no doubt that they are under considerable strain in the summer. For that reason they need further development. They are under strain because a large number of people retire to Cornwall. These days, if one is ill one is also likely to be elderly. That builds up the pressure on the Cornish health resources.

I was very impressed when I went to Cornwall—despite the major problems—with the way in which the health staffs were tackling the situation. I well understand the difficulties which the staffs experience and the difficulties that have been expressed to the hon. Gentleman and myself in recent days.