§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Waddington.]
§ 1.19 a.m.
§ Mrs. Sheila Faith (Belper)
I am grateful to you, Mr. Deputy Speaker, for allowing me to speak at this hour, and to my hon. Friend the Under-Secretary of State for Health and Social Security, who is to reply to the debate, who I know has had a particularly tiring day. However, I can justify my calling upon you and taking your time, because a serious situation has arisen in my constituency.
The area health authority has ordered the temporary closure of a 94-bed 835 rehabilitation hospital in my constituency, and the nursing staff have now taken over the hospital and are staging a work-in, after conducting a poll that showed that 92.5 per cent. were in favour of doing so. The area officer of the National Union of Public Employees, who is in the Strangers Gallery tonight, has assured me that the activities will be moderate and that there will be no mass picketing. NUPE has asked the ambulance men to co-operate with it and not to transfer patients to other units.
When I visited the hospital recently I saw that the building was well maintained and structurally sound. I spoke to the doctors, nurses and staff, and I have received a huge correspondence. Everyone is agreed that the area health authority must be persuaded to reconsider its decision.
The hospital is situated two miles from Etwall, a pleasant village, which I believe my hon. Friend has visited, and it is surrounded by beautiful countryside. It has, therefore, a soothing atmosphere, which makes it eminently suitable for recuperation and convalescence, and it is also the ideal location for elderly people. Patients appreciate the peace and quiet of the countryside. Although officially named a rehabilitation hospital, it also caters for the young chronic sick and geriatric and psychogeriatric patients. The unit caters for the terminally ill, as well as those recovering from accidents and serious operations.
All the doctors, nurses and staff that I have spoken to say that they prefer to work in a small unit. They are all on friendly terms with the patients, and some of these patients have been resident for several years and have become accustomed to each other. Both staff and patients would suffer dreadfully if the link were broken.
Etwall hospital has become a prestigious rehabilitation centre for in-patients and out-patients with locomotor disabilities after orthopaedic surgery, accidents, strokes, amputations, arthritis, neurological and neurosurgical disease, and is recognised as a national rehabilitation centre.
The rehabilitation team consists of two consultants, nursing, physiotherapy and occupational therapy staff, in addition to 836 an engineer, speech therapist and social worker. This is a very skilled and dedicated team, which has been slowly built up over the years. If it were disbanded as proposed, it could not easily be built up again.
The hospital is pre-eminent in the Midlands as a rehabilitation unit for the heavily disabled patient and is the envy of large neighbouring teaching centres at Nottingham, Leicester and Sheffield, which have no comparable facilities. The hospital also provides care for the younger chronic sick.
An excellent feature of the hospital is the harmony that prevails among the staff. During the industrial trouble of last winter, disturbance at Etwall hospital was minimal. As is often the case in small hospitals, the auxiliary staff know the patients well and feel involved with them, and they refuse to take action that would be to their detriment.
The consequence of closing surgical and preconvalescent beds at Etwall will be a concentration of care upon Derbyshire Royal infirmary and the City hospital, and this will mean an accumulation of post-operative patients in the acute beds, less surgery will be carried out, and therefore waiting lists will lengthen.
There is an increasingly elderly population in Derbyshire, and the Derbyshire county council's homes for the elderly are already overcrowded. The closure of Etwall will cause a backlog of elderly people and add to the shortage of part III accommodation. The closure, therefore, will have an effect on already hard-pressed facilities, and this is particularly worrying because it is acknowledged that Derbyshire is already a seriously deprived area in the Trent region.
The nurses at Etwall, some of whom are in the Gallery tonight, are not staging this work-in because they are fighting for their jobs. They have all been offered alternative employment. They are fighting to save a hospital that they love and for the right to continue serving their own patients, for whom they have developed a genuine feeling of affection.
The hospital is an economic way of providing treatment, as the cost per in-treatment day is £44.60 at the Derbyshire Royal infirmary, whilst it is only £22.92 at Etwall. The patients do not 837 all require the complex equipment that is available at the larger hospitals and, indeed, some may be transferred to Derwent and Bret by hospitals. These units are also more costly per patient—day than Etwall.
The local community takes a most active interest in Etwall hospital, and the league of friends makes its own contribution, not only by providing facilities—for example, equipping day rooms and giving television sets and so on—but by bringing moral support to the patients. There is an amazing degree of local enthusiasm for and loyalty to this hospital.
I have spoken to patients and ex-patients who have contacted me and they all say that the closure of Etwall hospital would be a tragedy. They tell me that the hospital has given them a new lease of life. They all say that they know of waste in administration and organisation and they are appalled that little has been done as yet to reduce the bureaucracy. Doctors associated with the hospitals in the area insist that savings could be made by cutting down unnecessary tests and X-rays and by making changes in prescribing. Constituents have written to me telling me of waste in the ambulance service, as ambulances are being used by mobile people, and I feel that great savings could be made in this way throughout the country.
My colleagues, my hon. Friends the Members for Derbyshire, West (Mr. Parris) and for Derbyshire, South-East (Mr. Rost), are supporting me tonight, and they have put many ideas to me of ways in which further cuts could be made. I know that they would like to say a few words later. I have also been supported by my hon. Friend the Member for Burton (Mr. Lawrence) and the hon. Member for Derby, North (Mr. Whitehead).
The strange thing is that all my letters, including those I have received from doctors and nurses, blame the administration and wonder whether it fully comprehends the consequence of its action. They all say that the bureaucrats are making a poor job of being their own executioners and there is much disappointment that firm Government action has not already been taken.
838 We know, of course, that the National Health Service is one of the largest enterprises in the world, and therefore change cannot happen overnight. We also know that the Government have produced a consultative document, "Patients First", which has set out plans for changing the organisation of the National Health Service and to abolish a tier of administration. I am glad to see that this document shows that the Government also intend to strengthen management at hospital level and to see that doctors' and nurses' voices are more fully heard by the health authorities.
The current situation at Etwall hospital demonstrates clearly the need for these changes, and I hope that it will be recognised that had the document already been presented to Parliament, perhaps hospitals and other services would have been saved, including Etwall.
Everyone knows that the Government inherited a depressing economic situation and that a Labour Government would have also had to make cuts in expenditure or alternatively imposed very righ rates of taxation.
The previous Government said that there would be no increase in cash limits to cover inflation. As a result of last winter's action, the Government have had to honour the results of the Clegg Commission, and therefore it was obvious that some cuts in services would be inevitable.
The feeling in my constituency is that there are far too many administrators, and that this makes the system clumsy and immobile and unresponsive to changing situations.
The area health authority should have known since last winter the financial implications of increased pay awards, and it has no excuse for not having gone ahead with making cuts in its own staff. In other parts of the country the delay in shedding staff is more understandable, but in the Derby area the rate of unemployment is 3.6 per cent. lower than most other parts of the country.
Employers tell me that skilled jobs are available in the building, engineering and other industries and are going begging at salaries of between £120 and £200 per week. When I visited the local skillcentre in the summer, I was told that there were vacancies for engineering training. The 839 Derbyshire area health authority could therefore lead the country in encouraging people to relinquish jobs in the bureaucracy, without the fear that they will create long-term unemployment.
I ask the Minister to speak to the Derbyshire area health authority and persuade it to cut its staffing levels. It is the fit and able who should be asked to make sacrifices and changes in their lives, not the sick and elderly.
I hope that the Minister will do all that she can to save Etwall hospital, even at this eleventh hour.
§ Mr. Matthew Parris (Derbyshire, West)
My constituency adjoins Belper. I am grateful to my hon. Friend the Member for Belper (Mrs. Faith) for allowing me time to comment. I am glad to see on the Opposition Benches the hon. Member for Derby, North (Mr. Whitehead). Concern about closures in Derbyshire transcends political differences.
I support the remarks of my hon. Friend the Member for Belper. Our area health authority has been misguided and its members have been weak. Derbyshire has always believed in centralising health care. Its financial problems are real. But these provide a ready-made excuse for accelerating a campaign of closures already under way long before the present Government came to power. That is what the authority believes in doing. It has told me so.
At the time of the election, the axe was raised over Parwich, a village hospital in my constituency. The reason given was staff shortages. But nurses have been turned away since then. Now the Smedley Memorial hospital in Matlock is also threatened. As at Etwall, temporary closure is sought to reverse the status quo, to shift the burden of proof and disperse the evidence. It is called temporary closure. The furniture was taken away from Smedley this afternoon.
As at Etwall, members of the authority were reduced to a rubber stamp. Incredibly. I believe, no paper on the Etwall closure was provided for members beforehand. As at Etwall, public support has been overwhelming. Our meetings at Parwich have attracted more than 1,000 people. Hundreds have written to me. If the Minister could meet the 840 nurses and patients involved, and if she could have seen the crowds standing quietly outside packed village halls at Parwich on a bitter winter's night, she would see that Government and people are of one mind. It is health bureaucracy that has come between us. Our town, our district and county councils and our Peak Park planning board all support us. Our community health councils feel isolated and exposed. In a few months it will be too late. We appeal to the Minister not merely for a generalised expression of support for small hospitals but for her help in saving ours.
§ Mr. Peter Rost (Derbyshire, South-East)
I congratulate my hon. Friend the Member for Belper (Mrs. Faith) on raising this important issue. I thank her for allowing me to support her. We are aware—I know that the Minister is—that the Trent area has been the Cinderella in the national allocation of funds. The matter has been raised several times in the House in recent years. We now have an understanding that the Government are allocating increasing amounts to put that situation right over forthcoming years.
It is not a deprivation of cash that has created this crisis. Increases in VAT have added to pressures on the budget. Pay increases resulting from the strikes of last winter and the subsequent inflation have added to the considerable pressures. But that is not an adequate excuse for what is happening to health provision for patients in Derbyshire.
It is not only Etwall that is affected. In my constituency, Draycott hospital is being temporarily closed. I understand that it is to be a 15-months'closure. I wonder what is the definition of "temporary" when we are talking in terms of 15 months. The real cause of the trouble is that the area health authority has not provided early enough for the inevitability of tighter budgeting.
It has continued overspending. It has not done enough to improve its efficiency, cut out waste and top-heavy administration. I should like to put some questions to which I hope the Minister can address herself or make subsequent inquiries.
What administrative savings have been made by the area health authority over 841 the past year since it became aware that pressures were building up on the budget? What could be saved by better hospital management—I am referring not simply to management but to administration in the hospitals—if a real economy drive were undertaken? I found the answer, as anyone could find it, by speaking to nurses and staff in hospitals. All can point to areas of waste in the daily administration of hospitals.
Thirdly, why is it that the Draycott hospital is fully staffed, yet half the beds are empty? This is another post-operational hospital, just like Etwall, which could have been reducing the pressure on Derbyshire hospitals, where there are long waiting lists. Yet Draycott hospital has been starved of patients who must be waiting.
Fourthly, I think that we are entitled to know why, at the Draycott hospital—I cannot speak for others—in recent months there has been a considerable amount of capital expenditure of a maintenance and repair nature that was not essential but has been carried out. The area health authority must have been aware that the budget was tight and that other hospitals were about to be temporarily closed. Why, during that time, was expenditure of an unnecessary and inessential kind continued? I maintain, and the area health authority has admitted, that the financial crisis, as it describes it now, was anticipated. If so, why were precautionary measures not taken earlier to cut some of the spending?
Fifthly, why were the community health councils not consulted properly and their constructive advice taken on how economies could have been made to avoid these closures?
Sixthly, why has no effort been made to use more voluntary support? The league of friends of the Draycott hospital—an excellent organisation—would have been prepared, and still is prepared, to provide more support rather than see the hospital close.
Finally, if the pay awards of last winter resulted in budget excesses—which they have done—why have there not been more reductions in the service staff rather than a closing of the hospital beds?
Until these questions are satisfactorily answered, the suspicion must remain that 842 the area health authority has mismanaged its finances and is now, in an unnecessary and unacceptable way, depriving Derbyshire of services and taking it out on patients. This is not good enough. I hope that the Minister will call in the area health authority to account for its present position.
§ The Under-Secretary of State for Health and Social Security (Mrs. Lynda Chalker)
I am grateful to my hon. Friend the Member for Belper (Mrs. Faith) for raising this issue, which I know is causing so much concern, not only to her but to the hon. Member for Derby, North (Mr. Whitehead) and to my hon. Friends the Members for High Peak (Mr. Le Marchant), for Derbyshire, South-East (Mr. Rost), for Derbyshire, West (Mr. Parris) and for Burton (Mr. Lawrence), all of whom are here at this late hour because of their concern about what is happening to hospital services in Derbyshire.
I fully understand the feelings of all who are confronted with the closure of hospitals to which they have contributed so much over the years. I know that I do not have to remind my hon. Friend the Member for Belper of the Government's firmly held view that health authorities, many of which we know are facing severe financial difficulties, should look first to administrative and other items of expenditure not directly related to the provision of patient services to see what savings can be made. The closure of hospitals or other reductions in services direct to patients should not be countenanced until every other avenue has been thoroughly explored.
It may be helpful if I go over the background to the decision of the Derbyshire area health authority to close Etwall hospital temporarily. I must stress the word "temporarily", because I think that there may be misunderstanding locally about it.
The Trent region and the Derbyshire area have suffered from a legacy of funding considerably below the national average, to which my hon. Friend the Member for Derbyshire, South-East referred. Although a certain amount of progress has been made over recent years towards rectifying the balance, there is still some way to go.
843 This financial year Derbyshire AHA is heading towards an estimated overspending of about £1.4 million. The Government have told all health authorities that they must be prepared to grapple with the problem of living within their cash limits, difficult though this may be in some cases. I am glad to say that the Derbyshire AHA fully accepts this. It aims to meet its cash limit by March 1981, but, to do so, it has decided that some hospital closures are inevitable. I know that it has not considered the closure proposals lightly. Each of the three health districts is heading for an overspend this year, the biggest being in south Derbyshire. This has resulted in the proposals that were approved at the area health authority's meeting earlier this month.
We fully appreciate the difficulties that all health authorities and their districts face—especially those which have been under-resourced as in this case—in absorbing the effects of excess pay and price inflation, but, given the serious economic and financial situation that we have inherited and the urgent need to reduce the burden of public expenditure overall, I do not think that anyone could reasonably expect the National Health Service to be wholly exempt from general financial pressures. Nevertheless, the current arrangements for adjustment of health authorities' cash limits are distinctly more favourable than for other areas of Government spending.
Etwall is, of course, not the only hospital that will be affected in Derbyshire, as has already been mentioned. The AHA aims to save £½ million in a full year from these closures, permanent or temporary, and £300,000 from the temporary closure of Etwall hospital. Consultation documents have been issued on the closure of Parwich hospital and the Smedley Memorial hospital at Matlock. Both of these are proposed for permanent closure. I understand that Smedley hospital is now empty, and the AHA proposes to keep it closed in the new year while consultation takes place on the proposed permanent closure.
In addition to Etwall, the other hospital to be closed, at Draycott, and the theatre and surgical ward at Derwent hospital, will be closed temporarily. I can well understand that, given the position in which the AHA finds itself that there 844 are fears that, once closed temporarily, these hospitals will not be able to open again—or worse, that the AHA is merely using temporary closure as a cosmetic to disguise the eventual permanent closure.
I am told by the AHA that this is not so. It is its firm intention to reopen Etwall and Draycott hospitals and the theatre and surgical ward at Derwent hospital as soon as circumstances permit. The AHA hopes that this can be done early in 1981. Meantime services will be kept under review.
The other point that I should make about Etwall hospital is that the temporary closure will be phased. Closure will not take place until the end of February 1980 at the earliest. The AHA, after full consultation with and on the advice of the consultative medical staff, has decided that admissions to the hospital should cease from yesterday, Tuesday 18 December. It will clearly take time for arrangements to be made for the transfer from Etwall of those patients who will not be able to be discharged during the next few months.
My hon. Friend the Member for Derbyshire, South-East asked a number of detailed questions. I think that at this late hour and with the information that I have to hand I should be foolish to try to answer those questions, in case I misled my hon. Friend and the House. I assure him that my colleague the Under-Secretary of State for Health and Social Security—my hon. Friend the Member for Ealing, Acton (Sir G. Young)—will write to him and to other hon. Members involved in this debate as soon as he can.
All the points that have been made, whether bound up with the temporary closure of Etwall or the permanent closure of Parwich, are bound to have an effect on services to patients in south Derbyshire. We know that there is very little slack elsewhere in hospital services in this district and in the wider area. Although the AHA cannot at this stage be specific about the precise extent of these closures, waiting lists are bound to be affected.
None of us likes to see proposals for the closure of hospitals that have given such good service in the past, but some closures may from time to time occur. I think that we all accept that. Area 845 health authorities such as Derbyshire face a difficult task. Not only do they have to grapple with the cash limits that have been set; they have been told to plan on the basis that cash limits will be increased to cover most of the excess cost of pay awards. We have been able to provide an extra £250 million for this purpose but we must face the fact that there is no more money available in the NHS this year.
Next year, we envisage small growth in real terms in the amount of money available to the NHS—about 0.5 per cent. overall. We are of course aware that regions like Trent and areas like Derbyshire will be looking for continued redistribution of resources between health authorities, but the exent to which this can be done will clearly be restricted by the amount of overall growth money available next year and thereafter.
I return to the particular case of Etwall hospital. I am told that the staff are reluctant to accept the decision of the area health authority. I can understand their concern but I hope that good sense will prevail and that the planned meeting between the AHA and hon. Members, which is to take place shortly, will bring together the facts and the impressions that hon. Members have gained. I hope that this deep problem will be resolved. Much is to be gained by both sides in discussing the nitty-gritty in greater detail than we are able to do in the House, where the AHA cannot speak up for itself.
I welcome the meeting. If, after the meeting, areas of doubt and difficulty remain, my hon. Friend the Minister for 846 Health has said that he will meet those concerned and consider what further can be done, within available resources, by the Derbyshire AHA to overcome the difficulties facing health services in that county. I realise that little that I have said will do much to lessen hon. Members' anxiety. The only way that I could do that would be to hold out a promise of substantial extra resources. That I cannot do.
The Government have asked all health authorities to look first at administration and other items of expenditure which are not directly related to the provision of patient care in making the savings. I hope that when the meeting takes place between hon. Members, the AHA and others who are concerned about hospital provision in the area and the present financial plight of the authority, the argument of the Minister of State and others will be considered in a constructive spirit.
Above all, the lesson that we all have to learn, whether in the Government, local government or health authorities, is that we must manage within available resources. It is up to all good men and women to ensure that every idea is brought to bear upon the problems of the health services in the area. If the meeting does not resolve the issue, my hon. Friend the Minister for Health will readily meet those concerned to see what might further be done. We hope that it is possible to resolve the problems locally without intervention by the Minister.
§ Question put and agreed to.
§ Adjourned accordingly at twelve minutes to Two o'clock.