HC Deb 26 May 1978 vol 950 cc1983-92

2.47 p.m.

Mr. William Whitlock (Nottingham, North)

I am glad to have the opportunity of raising the serious shortage of geriatric beds in Nottingham. The need for more geriatric beds in Nottingham is not, unfortunately, a new one. We are suffering from the neglect of the past. What has not been provided on an adequate scale down all the years since the National Health Service has been in operation cannot now be provided suddenly and overnight.

When the National Health Service came into being in 1948 Britain, under a Labour Government, led Europe in postwar recovery. We topped every worthwhile table and became at the same time the Welfare State, the envy of the world. In 1951 began 13 years of Conservative Government, during which time Britain spent a smaller percentage of its national income on health, welfare and social services than did our Continental neighbours.

The neglect of those 13 years has left a terrible backlog of improvements which are necessary in the Service, and we are suffering from that today. On 20th April 1964, towards the end of those 13 years of uninterrupted Conservative Government, I put a Question to the Conservative Minister of Health, who is now the right hon. Member for Down, South (Mr. Powell), about geriatric beds in Nottingham and the waiting lists for those beds. I was told that there were 661 staffed beds available and that the waiting list was 253. There was a total demand at that time for 914 beds.

I asked the Minister whether he had estimated on population trends how many geriatric beds were likely to be needed in 1970 and what plans had been made for meeting the demands for such beds at that time and in the future. The answer I received was that a projection of population for 1975 indicated that about 1,060 geriatric beds might be needed by that year and that it was expected that 800 beds would be available in 1970.

The Conservative Government on that day were therefore planning to have by 1970 a number of geriatric beds which would not have taken care of the demand in 1964. That is why we have a shortage of geriatric beds in Nottingham and a shortage of all National Health Service provisions in Nottingham. Yet at that time I was rebuked by a local newspaper for raising in the House the deficiencies of the NHS.

On 30th November 1971 I put similar Questions to the then Conservative Minister of Health and was told that there were 631 geriatric beds in Nottingham—a fall from 1964. I was told that 92 people were on the waiting list and that 226 people had died while awaiting admission to geriatric beds in the year ending 30th September 1971. Of those 226 people, 97 had died in their own homes and most of the rest had died in hospital awaiting transfer to geriatric beds. It can be seen from those figures that, in that year, more than 100 people awaiting geriatric beds had died in other hospital beds. The problem of old people occupying beds needed for surgical and medical cases is not new, regrettable though it is.

At around that time, the chairman of the local medical committee made a statement about difficulties in the hospital service in the Nottingham area. He said: It should be recognised that all disciplines within the hospital service are working under considerable stress and, in many instances, to a degree which exceeds the obligations of contract. The unpalatable fact, however, is that the resources of the hospital service are stretched to the limit and are incapable of dealing with the legitimate demands on the service as expeditiously as the public has the right to expect. That was said at the end of 1971, yet if one reads the comments of some people it seems as though the crisis in the NHS came along like a sudden cloud in the sky only as soon as we had a minority Labour Government in 1974.

In January 1972 I said in the House: Will the Minister please do something urgently…before greater problems hit our hospitals? Will he badger the Treasury until adequate sums of money are made available to ensure that proper maintenance arrangements for our hospitals are made? Will he hound the Treasury night and day until in the Nottingham area we have a right, fair and proper share of the money that is made available for our hospital service?"—[Official Report, 26th January 1972; Vol. 829, C. 1580.] I did not receive a reply to those requests, but two days later the Minister answered another hon. Member from the area and said that he was quite satisfied that Nottingham was being allocated a fair share of resources. In all my time in the House, I have never heard a more ridiculous statement.

I have obtained information and figures about what is proposed to improve the position in regard to geriatic beds in Nottingham, but no doubt the Minister has more up-to-date and accurate information. I hope that he will tell us what improvements are planned for Nottingham.

The bed crisis which was experienced last winter in Nottingham because of the high number of surgical beds being blocked by their occupancy by old people needing geriatic beds has led to further proposals to bring about improvements this year.

I am glad that increasing use is to be made of accommodation at the Highbury Hospital. The Minister will recall that when people were incorrectly suggesting last September that the Highbury Hospital was to be closed, I said, having long pressed for more geriatric beds in Nottingham, that I hoped that the Highbury Hospital's beds would be retained for as long as there was a need for them—and there was obviously a continuing need.

Under this Government the NHS is receiving more money than ever before, despite the fact that we entered a worldwide slump at a time when we were left by a Conservative Government far less prepared for that slump than was any other country in Europe.

The Trent Regional Health Authority, for so long the Cinderella of all the regions, is now receiving one of the largest allocations of cash in the country. I congratulate the Minister on the fact that a start has at last been made towards correcting the unfairness and injustices from which Nottingham has suffered for too long.

However, I want to remind my hon. Friend that there is an awful backlog of neglect and unfairness to make up, and I shall not be satisfied until I can say and see that full justice has at last been done to the Nottingham area. Among the the services that must benefit from increased resources is that which caters for old people. Improvements are not needed only in the number of geriatic beds. It is inevitable that as the number of elderly, and particularly very elderly, in the population increases, there will be greater demands on the health and social services.

I understand that the Government are proposing to issue shortly a discussion document on a number of issues arising from the increased number of elderly people in the community and will be seeking the views of all interested people before issuing a White Paper early next year.

The hospital service will have to meet a share of the increased demand, but only a small proportion of elderly people are in hospital at any one time and the aim of the health and personal social services must be to enable as many elderly people as possible to remain in their own homes. Some will undoubtedly need the sort of continuing care which can be provided only in hospital, but the majority of families are willing to look after elderly people if they are given the proper assistance to do so.

It is important that we should assist families by providing improved domiciliary support services in the shape of home nurses, home helps, night-sitters, laundry services for the incontinent, and so on. I know that the DHSS is aiming to find the most effective way of supporting families who need that sort of help.

There are already two allowances intended to assist people who are caring for severely disabled or elderly relatives in their homes when certain conditions are met. They are the attendance allowance and the invalid care allowance. I understand that the financial position of elderly people will be one of the subjects in the discussion document. We shall have a wide-ranging discussion on provision for the elderly. Perhaps my hon. Friend the Minister will be able to say something more about those matters as well as about the need for more geriatric beds in Nottingham.

2.59 p.m.

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

I congratulate my hon. Friend the Member for Nottingham, North (Mr. Whitlock) on the way in which he terrier-like sinks his teeth into the problem and hangs on until something is done about it. He is the most effective guardian in the House of Health Service interests in Nottingham. He has again raised an interesting problem.

I fully accept that the level of services provided for the elderly in Nottingham by the health and local authorities is not as high as those authorities—the Nottinghamshire Area Health Authority and the Nottinghamshire County Council—would wish. It is not as high as I should like it to be, but I hope that I can lighten the somewhat gloomy picture which those remarks might appear to indicate.

There is no doubt that nationally the growing proportion of the population aged 65 years and over will place an increasing strain on most health and personal social services in the next 20 years or more. In 1951, shortly after the foundation of the National Health Service, there were just over 4½ million people aged 65 years and over in England. Now there are 6½ million, or one in seven of the population.

In the next 10 years there will be even more elderly people than at present. The substantial increase in the past 10 years might slow down, but over the next 20 years a greater proportion of the elderly will be very old. By 1986, 20 per cent. more people will be aged 75 years or older. By 1996, there will be 60 per cent. more people aged over 85. The numbers of the elderly are growing. They are heavy users of health and social services.

The Government's aim is to enable the elderly to maintain independent lives in their own homes for as long as possible. That is what most elderly people want, and they are therefore likely to be more healthy in that environment than in any other for a longer period of their lives.

We must ensure that health and local authorities jointly plan an effective network of hospital, residential and domiciliary services. In order to effect that, our priorities are, first, the rapid development of the domiciliary services of the personal social services. Our second priority is the development of acute geriatric units in general hospitals with immediate access to full diagnostic, therapeutic and rehabilitation facilities and the replacement as fast as possible of the old long-stay geriatric hospitals. That doctrine might explain some of the differences in figures which were regarded as inadequate in the early 1960s and the figures which are likely to be regarded as adequate in the 1980s, under the new policy.

The next priority is the development of a network of local authority residential homes geared to local circumstances and special in-patient and day hospital units for the elderly and severely mentally infirm in community hospitals as part of a district psychiatric service.

My hon. Friend's chief concern is with hospital beds for the elderly, although he raised other subjects with which I shall deal later. What sort of hospital care do the elderly need? Mainly, they need acute treatment and effective rehabilitation rather continuing long-term care.

In the early 1960s the theory was that, if one became old and geriatric, one went to an institution where one was fed, watered and kept warm and dry. Not much else was done, and one was expected to stay there until death. We wish to get away from that concept. We are quite a long way from it. But too many people still associate hospital care of the elderly with the longer-stay units—the old chronic wards.

A number of elderly people will continue to need long-term care and a slower pace of rehabilitation, but the majority of those admitted to geriatric departments in hospitals now leave hospital in less than four weeks. Only 10 per cent. stay for longer than six months. That is the fundamental change that has taken place since my hon. Friend has been a Member of the House.

I turn to the detailed position in Nottingham. The responsibility for the health services in Nottingham is that of the Nottinghamshire Area Health Authority (Teaching), which leaves much of the day-to-day running and short-term planning of the Health Service to the management teams and the city's two health districts, the North and South Nottingham health districts. They work very closely together, and this is particularly so in the case of services for the elderly, since, apart from 22 geriatric beds at Highbury Hospital, the South Nottingham district looks entirely for in-patient facilities for the elderly to the North Nottingham district. Therefore, the geriatric hospital services for the city are, in effect, at the moment managed by the North Nottingham district on a cross-district basis.

Compared with recommended levels of provision—that is, recommended by my Department—Nottingham, with its present complement of 452 geriatric beds for a population aged 65 and over of 80,000, has a deficiency of about 360 geriatric beds. This deficiency is exacerbated by a shortage of hospital day places and by deficiencies in the local authority's residential and day centre provision.

Only in the number of beds for elderly patients with severe mental infirmity is Nottingham above recommended levels, and even those 463 beds are situated mostly in the two large mental illness hospitals at Mapperley and Saxondale, which, in accordance with our present policies, we do not regard as ideal.

Against this background of inadequacy, the prospect is not good because a substantial increase in the city's elderly population is projected, from its present figure of 80,000 people over 65 now to some 87,000 over 65 in 1986–87. Within this overall figure, the number of those aged 65 to 74 is expected to decrease a little from 52,900 to about 50,000. Therefore, the number of those aged 75 and over, those who make the heaviest demands on the health and personal social services will increase from about 27,700 to 37,000 in the same period.

Therefore, the problem is substantial. The area health authority nevertheless has plans to increase the number of geriatric beds in Nottingham from the present figure of 452 to 598. First, there will be 144 new geriatric beds at the Queen's Medical Centre and a further 60, together with a rehabilitation department, at the General Hospital.

It is planned to provide 40 day places as part of phase 2 of the Queen's Medical Centre, and this will double the number of day places in the city. The area health authority is also drawing up proposals to make good the deficiency of 140 day places by establishing day beds at the General Hospital and the Highbury Hospital in the early 1980s.

The area health authority has also found it possible to bring forward to 1978 provision of a geriatric orthopaedic unit of 18 beds, again with rehabilitation, at the Highbury Hospital, before transfer to the General Hospital in the second half of 1978.

Those provisions, however, are for the longer term. There is a short-term problem, too. The area health authority is considering making good some of the deficiency in geriatric beds in Nottingham, in both the short term and the long term. Fortunately, the teaching authorities had the good sense some time ago to set up a special planning team for the elderly in Nottingham.

The planning team's view for the short term is that the existing facilities for geriatric patients are unlikely to cope with the additional pressures already outlined for the next few years unless they get some further underpinning. So the area health authority is already considering the possibility of using Highbury Hospital for increasing the number of geriatric beds in the immediate future.

From reading the Nottingham newspapers, I note that there seems to be a feeling that the Highbury Hospital is about to close. That is just not true. There is no question of closing Highbury Hospital. If anyone is saying that the Highbury Hospital in Nottingham is to close, I can conclude only that that person is deliberately setting out to mislead public opinion in the city.

In addition to the geriatric orthopaedic unit of 18 beds at Highbury Hospital, the area health authority is now hoping to convert other under-utilised accommodation at Highbury Hospital. This involves 25 beds for use by geriatric patients before next winter. It can fund this development out of its existing resources. It also seems likely that it will be possible to make further wards at Highbury Hospital available for use by geriatric patients in 1979–80, in addition to the 80 beds to be opened that year at the General Hospital and in advance of the 144 new beds in phase 2 of the Queen's Medical Centre.

The Trent Regional Health Authority now has a revenue growth rate of 4 per cent. this year. It is probably as good a growth rate as it has ever had in the history of the National Health Service. It has a capital sum of about £1.7 million earmarked—to date unspecified—in 1981, 1982 and 1983 for provision of additional geriatric beds in Nottingham. That will be available for financing the short-term plans, or at least part of them, that I have just mentioned.

To summarise, after such a welter of detail, of the present 452 geriatric beds in Nottingham there are 22 beds at Highbury Hospital, 104 beds at Basford Hospital and 326 beds at Sherwood Hospital, and I understand that both Basford and Sherwood Hospitals have a wide range of supporting rehabilitation and assessment facilities. Indeed, I can confirm this in the case of Sherwood because I visited it last year at the invitation of my hon. Friend.

About 150 of the Sherwood Hospital beds are regarded as acute assessment beds for geriatric patients. If the plans about which I have talked come to fruition, the long-term position is likely to be 200 beds on the Sherwood-City District General Hospital campus, 144 beds at the Queen's Medical Centre, 104 beds at Basford Hospital, and 150 beds at Highbury Hospital—totalling 598.

In addition, Nottinghamshire and Derbyshire Area Health Authorities and the Trent Regional Health Authority are discussing the possibiilty of the provision of a community hospital with some 60 to 80 geriatric beds as well as accommodation for elderly severely mentally infirm to serve the populations of Long Eaton, Beeston and Stapleford for a possible start in the 1980s. This again will relieve the city of some pressure.

I should like to turn briefly to the social services, which provide an important back-up Helped by joint finance, for example, the county council plans to start building in the very near future an old people's home of 50 places at Marmion Road, due for completion in 1980, at a cost of about £1½ million. That will be financed by joint financing allocations from the area health authority. The AHA has also earmarked a further £50,000 to provide an extra 12 to 15 health visitors.

Other developments in the local services for the elderly to be funded in 1978–79 through joint financing arrangements include schemes to improve the staffing levels of the social services department's domiciliary services and support for the provision of a disposable bed linen service to the elderly incontinent.

I turn to the social services which are financed entirely by the local authority. They are still insufficient to meet all the demands made on them. But the Nottingham City division of Nottinghamshire County Council's social services department is providing 741 long-term residential places in old people's homes and some 21 shorter-stay places. About 180 day places for the elderly mentally infirm or physically disabled are provided.

The provision of meals on wheels is well regarded, with over 304,000 meals delivered in the year ending 31st March 1978 and a further 100,000 meals served at luncheon clubs. In the same period, 631 home helps provided 14,000 hours of assistance per week, making an average of 3.3 hours per client per week. The county council has also appointed a domestic services manager to each of the six areas in the City division to co-ordinate and integrate delivery of domiciliary services. The Nottingham District Council also provides about 44 schemes of sheltered housing, with an average of 26 units of accommodation in each and providing for about 1,140 residents in all.

There is, therefore, quite an extensive service building up in Nottingham, and of course, as a result of the Chancellor's Budget Statement, the Trent Regional Health Authority has received an addition of £3.8 million to what it already thought it would get as its share of the additional £44 million for England allocated in the Budget Statement, the Trent Regional Region's revenue growth rate this year from 2.8 per cent. to 4 per cent.

On the whole, the positions at present is not good and there are great gaps, but there are substantial and realisable plans for an effective service developing in future.