§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Brooke.]
§ 3.29 a.m.
§ Mr. William Whitlock (Nottingham, North)So many times over the years have I raised in the House the problems of the hospital service in Nottingham that I am heartily sick of doing so—heartily sick, that is, of the need to do so. I had hoped very much that the need would never arise again. Unfortunately, it has and once more we have a crisis in the Health Service in Nottingham and even at this late stage I feel that I must impress upon the Minister the gravity of the situation.
Let me, as briefly as I can, recite yet once again some details of the relative deprivation of the Trent region as regards the provision of health services. I remind the Minister who is to reply that the Trent region covers an area which it not some remote, backward, underdeveloped, underpopulated part of the country. It is an important area of the country with a great diversity of industry and a population of 5 million people who deserve something much better from the Health Service than they are receiving at present.
Repeatedly I have pointed out that the expenditure per head of population in the Trent region was below the national aver- 1264 age when the National Health Service came into being and that situation has continued down the years.
In the Trent region waiting lists for hospital beds and outpatient appointments have been longer than those in the rest of the country. The number of doctors, specialists, professional and technical staff, nurses, midwives and ancillary staff per 100,000 of the population has been lower in the Trent region than the national average, and in some cases lower than the lowest figure in any region, while general practitioners have the longest lists of patients of any region in the country.
That is the picture when one compares the Trent region with other regions. If one looks at the region itself, one finds that over the years the further south one travels from Sheffield the smaller has been the expenditure per head on health services and the worse the staff position. So the city of Nottingham has not had its fair share of the cake within the region, let alone within the national context.
Minister after Minister, in both Conservative and Labour Governments, has had to concede that the Trent region is a severely deprived region and that the imbalance of provision between the regions should be eliminated. But always the day of justice was seen as coming some years from the date of a Minister's last publicly stated recognition of the need for it. It has always been jam at some ever receding date in the future and never jam today.
We then had the report of the Resource Allocation Working Party and with it the hope that the allocation of proportionately more of the annual development funds to the relatively deprived regions would bring financial equality within a short time. That was the hope. In the event, we have been disappointed.
It is true that in 1977–78 the Trent region received a 2.9 per cent. increase in resources compared with a national average of 1.4 per cent. The Trent region received 4 per cent. as against the national average of 2.3 per cent. in 1978–79, and this year it will receive 2.7 per cent. against a national average of 2 per cent. It is also true that, if one looks at the Nottingham city hospital site and the University hospital site, one cannot fail to see what significant developments have taken place in recent years, developments 1265 which have improved the standard of service in Nottingham.
So a beginning has been made to rectify decades of injustice, but it is not a large enough beginning. As I have repeatedly pointed out on the occasions when I have raised the problems of the Nottingham area, truly vast sums of money are needed to recompense us for the unfairness of the past.
That, then, is the scene against which the present crisis in the hospital service in the Nottingham area must be examined. Recently the Nottinghamshire area health authority produced a document on its operational plans for 1979–80 which shows that because of a cash shortage there are to be early closures of facilities where closures were already contemplated in the foreseeable future as improved services were to be made available, and there is to be postponement of the operation of plans for other services.
Probably the largest reduction in programmes is involved in the likely delay of one year in the opening of phase 2 of the University hospital and the postponement until next year of geriatric beds at the general hospital. These represent urgent needs, especially the geriatric beds, since Nottingham has barely 60 per cent. of the geriatric beds that it needs, even with the 60 extra beds that have just been provided at the Highbury hospital.
Going back to the time when the right hon. Member for Down, South (Mr. Powell) was Minister of Health, I have several times raised in the House the need for more geriatric beds in Nottingham. I was therefore very glad when in 1978, after there had been a bed crisis in Nottingham because large numbers of surgical beds were being blocked by their occupancy by old people needing geriatric beds, and after I had once more raised the inadequacy of the geriatric service, the area health authority decided that the provision of geriatric beds in Nottingham was a top priority. However, there is now to be a delay in the provision of some of those badly needed beds. So much for the priority.
Phase 2 of the University hospital is essential, not only to meet service needs but to enable the medical school to meet the national priority of teaching more doctors. Delay in its opening is, therefore, nothing less than a disaster. Another 1266 serious blow is the delay in the opening of the mental handicap unit at the Highbury hospital. Yet another is the postponement for at least six months of the opening of the H-block at the Nottingham city hospital. I can tell the Minister that this has aroused a great deal of bitter comment.
The H-block project was twice postponed during the period of the last Conservative Government, and because of cuts imposed by the Conservative Budget of December 1973, it was postponed for a third time early in the days of the last Labour Government. In a speech in the House over four years ago, I showed how grossly unsatisfactory were facilities at the city hospital for the treatment of burns and plastic surgery cases, and for paediatric and neo-natal surgery. The H-block was designed to replace those inadequate provisions. Also included in the new ward block were facilities for chronic renal dialysis, a speciality in which the area sadly lags behind.
That new block has now been built, but because of the shortage of funds the Notts area health authority has postponed the bringing into commission of the badly needed facilities which that H-block would house. It is no exaggeration to say that a number of lives which would have been saved by these new facilities will now be lost because of the postponement of the H-block.
Other measures are contemplated by the area health authority, and, while it might be said that they involve less pressure on the users of the health services, they will undoubtedly cause concern. Among them are the progressive rundown of the services at the Firs hospital in advance of the time when there would have been a transference of obstetric beds to phase 2 of the University hospital, the closure of a ward at the famous Harlow Wood orthopaedic hospital that services a wide area and the closure of Newstead hospital that provides pre-convalescent beds for the North Nottingham district.
I see nothing in the area health authority's proposals concerning improved services for the deaf, but I hope that these improvements will not be delayed. There is most certainly a need for them, as I explained in the House some time ago, and for a good system of 1267 early identification of deafness. I asked that an outstation of the Institute of Hearing Research be sited in Nottingham. When that was agreed, I urged that comprehensive multi-disciplinary facilities be set up in close association with the outstation. I understand that the staff cost of one year of operation of a new assessment unit in an existing building would be only £25,000.
I hope that the area health authority will look favourably on that small but important development, and also that it is continuing to give active consideration to the need for a second accident and emergency department in Nottingham, a matter that I raised in the House in 1976.
On 18 June my right hon. Friend the Member for Mansfield (Mr. Concannon) initiated a debate on the crisis facing the central Nottinghamshire hospital services, and I sympathise with everything that he said on that occasion. He and my hon. Friend the Member for Ash-field (Mr. Haynes) tended to look with some envy at hospital provision in Nottingham, and they appeared to regard the University hospital as a monster sucking in funds which ought in fairness to go to improvements for their area.
I agree that the University hospital is too big. It is the manifestation of the dreams of planners and architects of a decade or so ago, and we should never again build anything so large. What must be realised, however, is that it is a teaching hospital which will be producing doctors for the nation, and that it will also increasingly contain modern diagnostic and treatment facilities to reduce existing outdated facilities elsewhere.
I feel sure that my hon. Friends will not spend their energies bewailing the fact that in some respects hospital provision in their area lags behind that in Nottingham, but that they will unreservedly join me in demanding for the Nottinghamshire area the long overdue justice for which I have been calling in this House for almost 20 years.
The present crisis in the hospital service in Nottinghamshire, involving as it does premature closures, postponements and a squeeze on staffing, is caused by a shortfall of funds amounting to a mere £1 million. I say to the Minister and his right hon. Friend the Secretary of State 1268 that they will be hated in Nottinghamshire if that comparatively small sum of money is not made available to the area health authority so that the proposed postponements, closures and squeeze on staffing need not take place. That sum is indeed a bagatelle when one considers the astronomical sums of money that would have been spent in the Nottinghamshire area over the past 30 years had there been in operation a scheme to correct the imbalance of provision between the regions.
We do not ask the Minister to perform the miracle of providing what might have been, but only to have the will to say that what has already been proposed by way of justice shall operate. If there are to be more cuts in expenditure in the Health Service in Nottinghamshire, they will be seen as doctrinaire sabotage of a service which, though chronically short of cash, is yet a boon and a blessing to all those who need the dedicated attention which our medical and nursing staff readily give.
Let the Minister bear in mind that his Department has accepted the need for the improvement of acute hospital services in the region, especially those needed for clinical teaching of medical students and those which are seriously under-provisioned. It has accepted the need for expanded hospital provision for the mentally handicapped and the need for substantial staffing increases. None of these things can be provided without more money. I hope that it will be made available.
I ask the Minister to remember all this and to bear in mind that, outside of London, the Trent region is unique. It contains three medical schools and it is therefore not only trying to serve the needs of its own districts but it is providing also a nationwide service in the teaching of doctors, with all the financial strains which this entails. For the sake of suffering humanity throughout the nation he must therefore see to it that the hospital services of the Trent region are able to do the job which is expected of them and which they are so very well able to do if they have the necessary resources. I hope that he will say that, following a meeting last week between the area health authority and the Trent region, moves are now being made to ensure those resources are made available.
§ 3.48 a.m.
§ The Under-Secretary of State for Health and Social Security (Sir George Young)I congratulate the hon. Member for Nottingham, North (Mr. Whitlock) on the very eloquent and reasonable way in which he has, once again, drawn the House's attention to the deficiencies in the hospital service in the Nottingham area. Nottinghamshire is indeed fortunate in having such stalwart champions in the House. Having listened to the hon. Gentleman tonight and recently also to other hon. Members with a local interest from both sides of the House, I am left in do doubt at all about the problems facing the area and its health authority.
I readily acknowldge that the AHA has a very difficult task in attempting to improve services for elderly, mentally ill and mentally handicapped people and to develop primary care services, whilst at the same time opening new capital developments including a major new teaching hospital and maintaining the momentum of growth of medical education. Like other area health authorities throughout the country, Nottinghamshire has to make difficult decisions on competing priorities against a background of rising demand and limited resources. We have to accept that such decisions, difficult and unpopular though they may be, have to be taken if health authorities are to manage within their budgets. I am afraid that it is inevitable in the present economic climate that some highly desirable Health Service improvements will take longer than we would all wish.
At a meeting on 7 June, the Nottinghamshire area health authority discussed the next steps in its operational plan in the light of the latest information on resource availability. I understand that, partly because of an overspend by the area in the past financial year, the districts are being asked to manage within tighter budgets this year. The hon. Gentleman has told the House of some of the consequences, including the postponed opening of a new ward block at the City hospital—block H—and of phase 2 of the Queen's medical centre in the new University teaching hospital. I know that for many years the hon. Gentleman has taken a keen interest in the development of block H. As the hon. Gentleman has said, this will provide improved Health Service facilities, include- 1270 ing a new renal dialysis unit which will be able to take 40 new patients a year compared with 20 to 25 in the temporary facilities now being used.
I fully understand the bitter disappointment which the hon. Gentleman and the people of Nottingham must feel on learning that the opening of the new block scheduled for November this year will have to be delayed. The area health authority shares this concern, but has to be realistic about its resource prospects this year. The opening of block H is one of the area's top priorities for 1980. The progressive opening of phase 2 of the University hospital to meet service and teaching needs is also a top priority for the area, but on present resource assumptions it will not be possible to bring it into use before 1981–82.
Another way in which the area is seeking to balance its budget is by rationalising the existing hospital services and subject, of course, to consultation with local interests and the agreement of the community health council, closure of under-used facilities so as to make more efficient use of scarce resources.
Despite the area's resource difficulties, the AHA is succeeding in making some progress in improving Health Service provision. The hon. Gentleman mentioned some improvements. For instance, great importance is attached to developing services for the elderly, and 100 geriatric beds are being opened during 1979–80 at Highbury hospital. The AHA has also asked the South Nottingham district management team to see whether sufficient savings can be made in support services and accommodation costs at Nottingham general hospital to enable 85 new geriatric beds in the hospital to be opened. In the longer term, the area strategic plan for 1979–80 to 1988–89 recommends an average increase of 40 geriatric beds a year over the next five years, and more if resources permit.
Services for the mentally handicapped cannot be developed as fast as the AHA would wish, but it hopes to open the day hospital element of Highbury mental handicap unit within the current financial year. At least part of the unit's new inpatient accommodation can also be brought into use this year, allowing patients to be transferred from unsatis- 1271 factory accommodation at Mansfield, Victoria and Balderton hospitals.
I understand that the new accident and emergency department at the University hospital, which replaces facilities at Nottingham general hospital, will open on 22 July, An evaluation team will be studying how the unit copes with the level of demand. There are tentative plans to provide a second unit, should it prove necessary, at the City hospital.
The hon. Gentleman will need no reminding that the central Government are at several tiers removed from where decisions are taken on the allocation of resources by AHAs, and I know that he will not expect me to say that there is any prospect of direct Government help for Nottinghamshire. Indeed, one of the keystones of our policy towards the Health Service is that decisions should, as far as possible, be taken not from a distance by people who are inevitably remote from local needs and circumstances but by those who have a first-hand knowledge of them. So although decisions on resource allocations to regional health authorities are taken by Ministers centrally, it must be for RHAs to determine allocations to the area health authorities and AHAs must be responsible for allocating funds to health districts.
The problems facing Nottinghamshire go back some time. The hon. Gentleman quite rightly reminded the House that a long period of under-investment in the Health Service, not only in Nottinghamshire but in the Trent region as a whole, is the underlying cause of many of the deficiencies he has described. He referred to the new system of allocating resources within the Health Service based on the recommendations of the Resource Allocation Working Party which aims to secure a pattern of resource distribution based on relative health care need. Under the RAWP formula, Trent has emerged as one of the most needy regions and has received the third highest growth rate this year—2.7 per cent, compared with a national average of 2 per cent.—and the second highest in the previous two years. The result has been a steady move towards target from 10.1 per cent. below average following the 1977–78 allocation to 7.25 per cent. below this year.
1272 It is always an unenviable task to have to decide the fairest way of allocating new resources, particularly, as in present times, when they are so scarce. Not only is it impossible to satisfy everyone. It is scarcely possible to satisfy anybody. It has come as no surprise to hear of the difficulties of the better-off regions in making ends meet from a position of virtually nil growth in the past, and from the less well endowed regions, such as Trent, about the need from their point of view for a much faster redistribution of resources. This year, with a weighted population of about 9.5 per cent., of incomes, Trent's capital allocation is 10.9 per cent. of the total sum allocated.
Let me say, however, that my right hon. Friend supports—and intends to pursue—the principle of a fairer distribution of health care across the country. I envisage that the RAWP process will continue to play a major part in this, since it is the best objective measure of health care need we have available to us at the moment. But the ultimate decision has to lie with my right hon. Friend as to how quickly we can sensibly move resources around. I can assure the hon. Member that the points he has made will be brought to his attention and taken very much into account in our consideration of national policies on Health Service resources. My right hon. Friend cannot afford, however, to ignore the fact that the former Administration, in reaching decisions on the 1979–80 allocations, found it necessary to slow down the pace of change towards targets. This was mainly because of the very real problems being experienced by the relatively well-off regions, which found it impossible to rationalise their services and redistribute resources to their deprived areas on the very small growth in resources that had been allowed to them in the previous years. We must not lose sight of the fact that in well provided regions there are still areas which are deprived even by national standards.
Our ability to continue the process of redistribution will depend crucially on the additional resources available nationally. We have inherited from the previous Government public expenditure provision for the hospital and community health services which, for next year, gives us growth nationally of less than half a per cent. This is not enough to cope with 1273 demographic demands and advances in medical technology, and obviously will set back the redistribution process. The provision of more resources will come from a stronger economy, which the Government are aiming to create the right conditions to bring about and are determined to achieve.
As for RAWP principles below regional level, regional health authorities have been asked to apply them in their allocations to areas. I know that Trent regional health authority is making every effort to achieve a fairer distribution of Health Service resources within the region, but there are constraints on the rate at which the legacy of inequalities within regions can be eliminated. A major building programme is under way in the region and new hospitals are being opened, not only in Nottingham, but also in Leicester, Sheffield, Barnsley and Rotherham. Funds to open these have to be found from within the region's overall revenue allocation. Another major constraint is the commitment, endorsed by successive Governments, to the expansion of medical education. Trent is unique outside London in that it contains three medical schools—Sheffield, Nottingham and Leicester.
The RHA fully recognises the difficulties which Nottinghamshire faces in attempting to alleviate the acknowledged deficiencies in health services whilst bringing into use the new university teaching hospital. The region has set a minimum growth rate for all areas, but in addition, in recognition of the particular needs of the Nottinghamshire area, it has consistently maintained its development rate above the regional average. During the next four years the area's average 1274 annual percentage growth rate is expected to be about 3 per cent., the second highest of all areas in the Trent region. Within this period, Nottinghamshire is expected to reach 95.5 per cent. of the RAWP national target, again the second highest area in the region.
In addition, I understand that Nottinghamshire AHA has recently submitted a case to the regional health authority claiming that it needs an additional £5 million over and above its notified resource assumptions for the next five years in order to meet its teaching commitments and implement all the national guidelines relating to priority health care groups.
I am fully aware of the concern that is felt in the NHS about the pressures to which the hon. Gentleman referred. The Chief Secretary to the Treasury in the previous Administration laid down that there would be no increase in cash limits for excess inflation and he introduced the exception to increases for pay. The Chancellor of the Exchequer made clear when we assumed office that we had inherited a significant number of pay commitments for which no provision had been made and a public expenditure programme far in excess of what the country could afford. Even in what is a difficult year we have afforded the health programme a considerable degree of protection.
§ The Question having been proposed after Ten o'clock on Monday evening and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at one minute to four o'clock a.m.