NATIONAL HEALTH SERVICE (NORTH-WEST REGION) (Hansard, 10 May 1978)

§ Mr. Walter Clegg (North Fylde)

I am very grateful to be given the opportunity, at this early hour of the morning to be able to discuss some of the problems of the National Health Service in my constituency. I have given the Minister a rough indication of the areas which I shall be covering. I do not expect any off-the-cuff replies. I am merely bringing these matters to his attention.

The first question I should like to discuss with regard to the problems of the National Health Service in the Wyre 1364 District, which is coterminous with my constituency, is the casualty facilities at the Fleetwood Hospital. As the Minister will no doubt know, Fleetwood Hospital is a small hospital, and at the moment casualties are directed to the Victoria Hospital in Blackpool, some nine miles away. Victoria Hospital has much better facilities than Fleetwood Hospital for dealing with casualties.

The people of Fleetwood fear that the lack of facilities at Fleetwood Hospital, even though it be a small one, could lead to danger, and to possible maiming and injuring, because people's needs are not met straight away. The problem is that Fleetwood, quite unlike any other part of the Fylde Coast, is an industrial town. It is both a fishing port and a general cargo port. It is a roll-on, roll-off port which has heavy industries in the shape of ICI. It also has innumerable light industries. These industries give rise to possible accidents at work. I know that some of the firms in the town are perturbed that the basic facilities are as far away as the Victoria Hospital in Blackpool.

The Fleetwood Civic Society has carried out a survey of the problem, and I shall be sending the Minister some of the material which it has provided to me. As well as being an industrial town, Fleetwood is also a holiday resort. We have the problem in the summer of thousands of visitors coming to the town. This is also a problem for the Victoria Hospital in Blackpool, a town which has about 16 million visitors a year. This puts a tremendous strain on the hospital, especially on its casualty service. If facilities were to be given in Fleetwood, that would lighten the load on the Victoria Hospital casualty service.

It is not only firms that have expressed concern about the lack of facilities at Fleetwood Hospital. Concern is also shown by schoolmasters who are worried about their pupils being injured during school time. Concern has also been expressed by landladies as well as visitors to the town. I shall send these facts to the Minister so that he may consider them in due course.

The second general point I wish to raise concerns a remarkable constituent, Mrs. Pat Seed, who suffers from cancer and who about a year ago started out to raise £750,000 for the installation of an 1365 EMI scanner at the Christie Hospital in Manchester. I have an interest in the Christie Hospital, not only because of Mrs. Seed, but because it is the cancer hospital for the North-West area.

When I first met her about a year ago and she told me what he target was, I thought that she was taking on an impossible task. But the response has been quite remarkable, and the fund now stands at about £800,000. This has been achieved without any great organisation and at very low cost. Mrs. Seed has had a tremendous amount of help from ordinary people throughout the North-West area. It is remarkable how spontaneous the reaction has been. I can scarcely open a newspaper in my constituency without reading about some group that has been formed. For example, a small schoolboy made a boat which he will sell and the proceeds will go to the fund. We have also had the help of famous characters from the North-West, such as Ken Dodd and Red Rum. It is, however, quite remarkable that this lady, with all the odds against her, has raised such a vast sum in a short time.

Here I must pay tribute to the Minister of State. When we had a debate on the NHS in the North-West upstairs in Committee, to a certain extent he relaxed the rules about hospitals taking part in fund raising. I must tell the Minister that Mrs. Seed informs me that the relaxation of the rules at the Christie Hospital has helped the fund. Bearing in mind the success of the fund and the help that it has given at a time when funds for the NHS are restricted, I ask the hon. Gentleman to reconsider the rules to ascertain whether they can be further relaxed. There is a need to bridge the gap between public spending limitations and what people are prepared to give. There is no more remarkable example of what can be done than Mrs. Seed's example. People in other parts of the country have taken an example from Mrs. Seed's activities and have started their own funds. That is something from which we can learn and which can benefit the NHS generally.

I turn to a more personal matter that is of concern to my constituents as well as myself, namely, the pacemaker. I have a pacemaker myself. It was first inserted in December 1974. I am now on my third pacemaker. I am told that basically there are two forms of pacemaker that 1366 are being fitted under the NHS. One form of pacemaker is powered by a mercury zinc battery and the other by a lithium battery. The mercury zinc battery is cheaper to insert initially, but the lithium battery has a longer life.

I understand that practice varies from region to region in the NHS. However, I ask the Minister to consider the figures to which I am about to refer, which have been supplied to me, which relate to the long-term effect of using the shorter life battery as against the longer life battery. I am advised that over eight years the cost of installing a mercury zinc battery, taking into account hospital costs and loss of earnings, would be on average £7,196. For the same period the cost of the lithium battery, which would last longer, would be £2,971. That is a saving of about £4,000. That saving arises because over eight years the cheaper battery would have to be replaced three times against once for the dearer battery. The patient would have to undergo three operations for the cheaper battery to be inserted against one for the dearer battery.

I understand that the length of time spent in hospital for the replacement operation is five days. In the long run, the cheaper battery costs more because of increased hospital costs. However, there are other factors, too. I am told that, over four years, the patient has to attend 15 clinics as opposed to five clinics with the dearer battery. Again, there is a saving of hospital time.

Not only the economics of the situation are in question. There is a risk when a general anaesthetic has to be given, especially if the patient suffers from bronchitis or something connected with that. If the number of operations can be reduced, fewer lives are at risk.

There is also the human problem. A patient prefers to know that over eight years he will have to face only one operation as against three. It is much better for the patient to know that he has a long-life battery and that he will not have to keep on coming back.

There is another factor to be considered when taking into account the economics, although it is one that I find bizarre. It is said that there is an argument for inserting a short-term battery when the patient is an older man or older 1367 woman. However, I gather that the long-life battery should be and is recovered from the body in the event of a cremation and that it is used again.

I ask the Minister to give consideration to these matters to ascertain whether the use of the long-life battery would in the end be less costly to the NHS, be of greater benefit to the patient, and cause less anxiety.

Those are the matters that I wanted to raise. I do not expect replies immediately. If the Minister considers the points that I have raised, I shall be grateful.

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

First of all, Mr. Deputy-Speaker, I should like to say how glad I am that the hon. Member for North Fylde (Mr. Clegg) has taken this opportunity to raise some special problems affecting the National Health Service, both personally and in Wyre, which forms part of the Blackpool health district, which is in the Lancashire health area. I should like to express my personal thanks to the hon. Member for having given me notice of the special points that he wished to raise.

I should like to start with a few basic facts. I think that it is important, because the hon. Gentleman is representing one section out of three in the Blackpool health district.

The population of the Blackpool health district totals about 320,000 people, and is concentrated along the coast, where the major hospitals are situated. The district general hospital is the Victoria Hospital, in Blackpool, and in addition to meeting the needs of the residential population the hospital services have to cope in the summer months with a large influx of holiday visitors and in the winter with conference-goers. The coastal area also attracts a large number of retired people, who have often moved away from their families and may well impose a further strain on the health services.

The Wyre sector—to whose problems the hon. Member has referred—has no major hospital of its own, and therefore looks outside the sector for most hospital services. The hon. Member referred to a feeling among his constituents that a 1368 casualty unit capable of dealing with emergency treatment should be provided at Fleetwood Hospital, a 31-bedded cottage hospital in which general practitioners provide day-to-day medical care.

I am aware that this issue has a long history. In 1974 representatives of the trades council met the Blackpool district management team to discuss the situation at Fleetwood. The trades council representatives at that meeting accepted that it was impracticable to provide a full accident service at Fleetwood Hospital. Then, as now, all major accident cases were referred directly to Victoria Hospital for treatment in the accident department, 10 miles from Fleetwood.

This arrangement of accident and emergency services in Blackpool health district is in accord with the recommendations of the Platt Report on accident and emergency services. The Government's policy on these services is that they should be concentrated to provide a pattern of accident and emergency units staffed and equipped to deal immediately with major injuries and other emergencies at any time of the day or night. The aim is to ensure the availability of all the medical and nursing skills, supporting services, and the equipment needed for expert diagnosis and immediate life-saving treatment for injured patients and other emergency cases.

It is not possible for every hospital to be staffed and equipped to the necessary high standard to deal with emergency cases. Concentration of services is therefore in the best interests of patients with serious injuries or other emergency conditions. It also benefits such patients to be taken direct to a major department where the necessary skills are available, even though this may involve a longer ambulance journey, rather than being taken to a hospital which does not have those facilities and then being transferred elsewhere. Health authorities have to balance ease of local access against the advantages of concentrating resources in a fully staffed and equipped unit which can cope with any emergency. If, through dispersing these resources, a less effective service was provided, it could be that lives would be lost.

It is true that if a patient presents himself at a hospital which is not providing 1369 an accident and emergency service, health authorities have been advised that essential first aid should be given by the staff available. In such circumstances it is in general unlikely that medical staff or experienced nurses will be available to deal effectively with patients attending casualty, particularly out of normal working hours. Therefore, it may fall to other members of the staff to advise these patients on the whereabouts of the nearest accident and emergency department and of the alternative possibility of contacting a general practitioner.

When immediate first aid can be provided this will usually be no more than can be given by a lay person with first aid training—in other words, placing unconscious patients in a position in which they can breathe freely, or bandaging wounds.

This brings me to the second part of the district's problems, which has a bearing on the hon. Gentleman's first point. It is not only the influx of visitors in the summer who place a strain on the health services, but the high percentage of elderly people living in the district. This section of the population tends to make increased demands on the district general hospital in the winter months so that it is working at full stretch throughout the year.

In the Blackpool health district 21 per cent. of the residents are aged over 65 as against a national figure of 16 per cent. The figure for Wyre alone is 19 per cent. For the health district as a whole it is estimated that the proportion of people aged over 65 will have increased to 29 per cent. by the 1980s. The Blackpool Victoria Hospital already provides 60 geriatric assessment beds, and I am told that there are plans—admittedly at a very early stage—to provide a further 144 geriatric beds at the hospital by the end of the 1980s. The health district also has 112 beds for the elderly at Rossall Hospital, Kirkham—in the Fylde sector—and 315 beds at Wesham Park Hospital near Fleetwood—in the Wyre sector. There are schemes in the capital programme to provide 48 beds and associated day places by 1981 at South Shore Hospital in Blackpool, a further 48 beds at a new community hospital in Poulton-le-Fylde and 96 beds at Devonshire Road Hospital, Blackpool. This is, I think, an encouraging picture and there 1370 will be benefits for all the parts of the health district, including Wyre. I might also add that the regional health authority's capital programme includes a proposal to build a unit for the elderly severely mentally infirm at Fleetwood Hospital. This will provide 56 beds and 50 day places. The authority hopes that building will start in 1979–80.

The North-Western region, of which Blackpool health district and the Wyre sector are part, is recognised to be a needy region. This Government are the first to have recognised this and have started to put this right. The revenue growth rate for the region in 1977–78 was 3.2 per cent. and in 1978–79 it is 4 per cent. The regional health authority has worked out the extent of deprivation in its areas according to the principles defined by the Resource Allocation Working Party. Lancashire has been identified as one of the needier areas and the Blackpool district is also one that is relatively deprived. In practical terms, this means that the health district has received an above average rate of growth in its revenue allocations. I know it will be some time before anyone can say that the health service available to the people living in the Blackpool health district is all it could be, but progress is being made. The North-West Region is not ignored by Whitehall and Westminster. Our policy is designed to come to its relief, and we shall do our utmost, so long as we have power, to keep faith with the people in the North-West, including the hon. Gentleman's constituents.

I should like at this point to return to the problem mentioned earlier—that is, the influx of holiday visitors in the Blackpool health district each year. I understand that a survey carried out by the British Market Research Bureau for the Blackpool Corporation and the English Tourist Board in 1972 estimated that about 3 million visitors stayed in Blackpool each year. I do not have figures for coastal districts in Wyre, but holiday visitors there would, when ill, go to the Victoria Hospital in Blackpool.

While this tourist industry is no doubt beneficial to many of the people living in the district, it presents problems to those responsible for planning and managing the health services, particularly the hospitals. I understand that the regional health authority, in calculating both the 1371 funds which are distributed on a population basis to the AHAs and then to districts and in deciding what population figure to use for planning purposes, makes allowance for the fact that so many people holiday in the Blackpool health district. There is no doubt, however, that the great number of holidaymakers places a burden on the health services. The problem inevitably centres on the acute hospital services. When people fall sick on holiday, that is where they go. It is nearly always an emergency.

The district management team has carried out research which reveals that between June and September one in four of the people attending the Victoria Hospital's accident and emergency department are visitors. One in six of those admitted as emergency in-patients between June and September were also visitors, and extra beds are put up to cope.

The health authorities have identified this problem and have given priority to the need to develop the Victoria Hospital, Blackpool. The regional health authority is proposing in phase IV of the development of this hospital—which is in the capital programme to start in 1982–83—to provide more acute beds, intensive care units and more theatres. There are also plans for a possible phase V towards the end of the 1980s, and this will include more acute beds and more theatres as well as a geriatric unit and rehabilitation unit.

I turn now to the second matter that was raised. The hon. Gentleman has rightly praised the courageous efforts of Mrs. Pat Seed and the appeal fund Committee in raising money for an EMI body scanner at the Christie Hospital, Manchester. I have unqualified admiration for the success which Mrs. Seed and her appeal fund committee have achieved. This equipment is, I understand, still at an early stage of development as a clinical tool. It is not yet clear what difference detection of cancer by one of these highly sophisticated machines makes to patient management and recovery compared with detection by other cheaper and readily available diagnostic scanning procedures.

A number of hospitals and medical education establishments are at the moment carrying out research in the 1372 hope that the clinical role of body scanning will be more clearly established. The hon. Gentleman may not know that there is already a body scanner at the Manchester University Medical School which is partly funded by the North-Western Regional Health Authority and which provides a service for some patients from the Christie Hospital.

We all know that health authorities have to make difficult choices in setting priorities for spending the funds available to them—and these are necessarily limited. These body scanners are very expensive, not only to buy—they cost about £400,000—but also to run. Current estimates suggest that running costs covering medical, technical, nursing and other staffing needs, consumable items, servicing contracts and so on can come to over £50,000 a year.

I know that both the North-Western Regional Health Authority and the Manchester Area Health Authority (Teaching)—the area responsible for the Christie Hospital—have a great deal of admiration for Mrs. Seed and her efforts. But in accepting the gift from the fund they have had to stipulate—I am sure that it was done with reluctance—that the capital and running costs should be met from private funds.

There is in this country a well-established tradition of co-operation between the statutory authorities and voluntary initiatives, and these bodies often supplement the services provided by statutory authorities such as the NHS. I think that this sort of initiative is very valuable to the NHS as a whole and to the local communities. In this connection, I shall look at the point made by the hon. Gentleman and write to him in due course.

I now turn to the subject of pacemakers, on which the hon. Gentleman asked about our policy. Two types of pacemaker, as he said, are at present supplied by the National Health Service. The difference between them is the type of battery; one is lithium battery powered and the other is mercury battery powered. Mercury batteries are considerably cheaper than lithium ones. A mercury battery powered pacemaker costs £380, while a lithium battery powered pacemaker costs about £700. It is true to say however, that in the long run the lithium battery powered pacemaker may be cheaper, since the life 1373 expectancy of a mercury battery is two to three years, while a lithium battery is believed to last between five and 10 years.

There is no central policy saying which type of battery should be preferred, although I understand that there is often a clinicial preference for the lithium battery powered pacemaker, very properly, for the reasons the hon. Gentleman outlined. But it is a matter for health authorities to decide, in the light of their available resources.

I shall conclude with one further comment which may help the hon. Gentle- 1374 man. Hopes have been placed upon the isotope powered pacemaker, which would have a much longer life span than either the lithium battery or the mercury battery. The isotope powered pacemaker is still at a very early stage of development in this country, and its effectiveness is still being evaluated. It would, however, undoubtedly be considerably more expensive than the two existing types of pacemaker, which is obviously a consideration to be taken into account.