HC Deb 18 June 1979 vol 968 cc1075-88

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wakeham.]

11.53 p.m.

Mr. J. D. Concannon (Mansfield)

When I applied for this debate in the middle of May, I intended to use it as a follow up to my work with the Department of Health and Social Security, correspondence between Ministers and myself and Ministers' visits to see conditions in the Mansfield district.

I intended to ask about the speeding up of the resource allocation working party's report on finance for the central Nottinghamshire area since the area would benefit from a steady increase in cash which would allow something to be done about the abnormal waiting times in the area. I have had other meetings with a number of bodies about the problems of the central Notts area.

At the King's Mill hospital, the waiting list for ear, nose and throat and children's surgery was 826 in March this year, and 521 of that number had been on the list for more than a year. The waiting list for general surgery was 848, of whom 271 had been on the list for more than a year. The waiting lists for gynaecology was 529.

Central Nottinghamshire covers a very heavily industrialised area, mostly coal mining, so that it gets more than its fair share of broken limbs, hernias and other things that go with heavy industry. I must stress at the outset that, if it were not for the work of the medical staff and administrators, many of the peole in that area would not be able to go back to work, fit and able, as soon as they do. I also stress that nothing I have to say about the medical services in the area is any reflection on the dedication and sense of duty and work of the staff, who work wonders in the buildings they have. The doctors, nurses, administrators, the League of Friends and all others concerned do their best to give the finest possible service. They have done wonders in keeping the service going with the resources at their disposal.

However, since I applied for the debate, things have happened at an alarming rate, and that has made by original intentions for the debate take a back seat. Since the announcement of the debate, I have had so much paper and advice sent to me that I probably have enough material for a three-hour speech. But other hon. Members wish to speak, so I shall confine myself to the bare bones of the case.

Central Nottinghamshire area health district is facing its most serious financial crisis since the inception of the National Health Service. For a considerable number of years, the health district has been severely under-funded. Although it provides health services for a number approaching 200,000, the level of funding is significantly lower than the national average. In the last financial year, only £65 per head per year was available for the hospital and community services in the district whilst the national average was about £100 per head, in the Trent region £90 per head, and in the Nottinghamshire area as a whole £80 per head.

There are two main problems. First, the district is short of facilities—for example, in bed provision for some specialties, outpatient facilities, and so on. In consequence it is not giving a full service to the community. Historically, it has not been funded to an extent anything like the national average. Secondly, the district is now seriously under-funded even for the support of the facilities and services that it does have. Indeed, we are talked of as a deprived area.

The buildings from which the health services are provided in the district are considerably below the standard we would all like to see. Nearly all the hospitals are coping with environmental problems. For example, wards for the mentally-handicapped at Victoria hospital were described as deplorable when last visited by the Minister of State. To all of us who know them—and I live quite close to the hospital—they are a fire trap and fit only for the bulldozer. I am sure that anyone who sees them would agree.

The geriatric patients are in totally unsatisfactory conditions. There is a ward which is little more than a tin hut which the hospital advisory service years ago recommended should be demolished. Outpatient facilities are overcrowded and cramped. Some are in buildings of which the NHS must be ashamed. All this is a complex which used to be, in the old terms in Mansfield, the workhouse. Indeed, to many of the elderly who have to go there it still carries that stigma. They do not talk about going into the Victoria hospital but about going into the workhouse. The staff and the administrators have worked wonders with the place, but they deserve better.

General hospital services are provided in an ex-American Army emergency hospital, built in the 1940s. It is of the old spider variety, well known to ex-Servicemen and not known for efficiency. The Americans, when they come back to Mansfield, must wonder at its still being in use. A great job has been done by the staff and the administrators.

We have also two small and somewhat old former voluntary general hospitals. The nature of much of the capital stock in the district, coupled with many years of financial restriction, has resulted in an enormous backlog of repair and maintenance work which can no longer be avoided if buildings are to be kept serviceable. This will cost the district many hundreds of thousands of pounds in the next few years.

The overall financial situation has reached the point at which the routine replacement of essential equipment cannot be maintained, let along the updating of general furniture and ward equipment. I am informed that essential equipment in the pathology department is now breaking down and, although it should be replaced, there are no funds available for these expensive items. I am told that difficulty is even experienced with the replacement of X-ray cassettes resulting in spoilt films and the necessity for repeat exposures which cannot be in the best interests of the patient.

In this financial year, the district's problems have become extremely acute. The district is about £1 million adrift in this financial year and about £½ million in the following year. If this money is not put into the district budget, everyone is agreed that the patients will suffer. There is no capital development to defer to assist in balancing the books. This serious financial shortfall comes after many years of determined efforts to achieve economies. In these circumstances, it will not be possible to maintain present services and, being required to balance the books, the district management team has reluctantly suggested the closure of wards and units to the further detriment of an already deficient service.

When one considers the deprived state within the health services in our district, it is impossible to believe that such a situation can be allowed to develop.

The Trent region is seriously short of finance. Improvement of the region's resources by the speeding up of RAWP is an essential part of the solution of central Notts problems. I have today received a letter from the chairman of the area health authority which says: We are doing all we can to help there"— which is central Notts— but I don't pretend that services in Central Nottinghamshire can ever be brought up to the standard in other Districts, let alone other parts of the country, until its District General Hospital at King's Mill is both built and funded. The letter adds: unless money is allocated more quickly to Nottinghamshire, and unless the NHS as a whole is effectively protected against pay and price increases, the service may change shape but it won't improve much. This is what RAWP was all about; and anything you can do to speed up the process of reallocation and sustain the growth in NHS as a whole will be welcome to us. The subject of this debate has the backing not only of the mass of the population but also of the chairman of the area health authority and members of that authority and others. There are those in my area and the area north of Nottingham who subscribe to the view that not only does England finish at the River Trent but that Nottinghamshire also finishes there or at the city boundaries. This claim about the area north of the city of Nottingham is aired at all levels. On many occasions, it is unfounded.

However, with the inequality of finance allocation within Nottinghamshire, the development of the Nottingham university teaching hospital is taking a major share of the blame for the situation in central Nottinghamshire. This is unfortunate. I am sure that the hard working and dedicated band of area health authority and administrators would not want to be seen in this situation. But one senior nurse said to me over the weekend "What are we supposed to do? If they have all the money, they will have to take all the patients. We will have to take them to the university hospital by the busload". I am sure that she did not mean that and that she will continue her dedicated work. I quote her to prove the frustrations of such people.

It is not a short-term problem. There is an area and district deficiency in resources now and will be for the next 10 years. The development of the new district general hospital on the Kings Mill site is programmed to start soon. However, if substantial revenues are not made available soon there is a danger that this major development will be delayed. It is difficult to overestimate the damaging effect of such a delay upon local health services.

The health district needs a substantial injection of funds in the next decade to bring it into line. Without it the health services in the centre of Nottinghamshire will deteriorate quickly.

One can imagine my surprise when I received a document marked "In Strict Confidence"—but that was pencilled out. It was the district management's report to the area health authority. I understand the report was accepted reluctantly at the meeting on 7 June.

I shall deal only with the broad issues, not the details. The report first dealt with the concentration of services. It said that ward 4 of the Harlow Wood hospital was to remain closed. It mentioned the closure of the general practitioners' part of the maternity unit at Kings Mill hospital. Some children have to wait up to two years to have their tonsils attended to, but the report mentions that ENT and children's surgeries are to be combined to make two wards into one to save on staffing. The report talks of the closure of the two pre-convalescent wards at Newstead hospital. Debdale Hall hospital and the Langwith Lodge Diabetic unit was to close. The report also mentioned the closure of a geriatric ward at Forest hospital.

These closures will not meet the shortfall. If the district is required to balance its books, the report states that additional closures will have to be considered. It lists, the Forest hospital, a further ward at Harlow Wood, a surgical ward at Kings Mill, a medical ward at Kings Mill, the open access service for GPs to pathology and radiology and parts of the casualty service.

The effect on staff morale would be devastating. Such closures will not be allowed without struggle. The local press and television are joining in the fight. There is no way in which such savage cuts will be accepted. The community health council has already turned down the report unanimously.

The Minister has a straightforward decision to make—either cash or closures. In the area there is a health finance action group comprising doctors, social workers, trade unionists and nurses. They state that the proposed cuts mean redundancies. They have produced three editions of "Health News" and have organised a petition. I shall be overwhelmed by the number of signatures and letters which I receive on this subject. The petition reads: We, the undersigned, demand that Her Majesty's Ministers correct the serious underfunding in the Central Nottinghamshire Health District as a matter of urgency and in accordance with the expressed intention to provide adequate health care for all of Her Majesty's subjects. I was a Minister for a considerable time and I answered many an Adjournment debate, so I do not expect that the Minister—or I would be very suprised if he had after the Budget and the vote we have had tonight—has got within his brief the will, or the finance, to give me an injection of £2 million tonight. But I trust that he will agree to meet me and discuss what I have said with the hon. Members for the area. The hon. Members who cover that area, my hon. Friend the Member for Ashfield (Mr. Haynes) and the hon. Member for Newark (Mr. Alexander), and myself are all members of the area health authority at present, and my hon. Friend the Member for Ashfield is a past chairman of the community health council itself.

I would like the Minister to meet the three of us, plus the chairman of the community health council and the area health authority and anyone else the Minister would care to bring along.

Thank you, Mr. Deputy Speaker, for allowing us to have this debate. It is not the one I originally intended, but things have increased in pace in central Nottinghamshire and I hope everyone understands

12.11 a.m.

Mr. Richard Alexande (Newark)

I have a very short time at my disposal, so may I underline everything that the right hon. Member for Mansfield (Mr. Concannon) said about the great shortages in the central Nottinghamshire district? In Newark general hospital in particular there are some identifiable dangers to patients which ought to be added on to what the right hon. Gentleman has said. I am instructed that there are live terminals exposed at thermostatic controls; there is, therefore, a fire risk. These things have openly been said by the Health and Safety Executive and of course there is no money within the budget to comply with the recommendations of that executive, so patients' lives there are at risk.

I must underline what my hon. Friend has said about work and staff morale. It is bound to be poor, and they are working in extremely bad conditions. The situation is not good enough. I support the call for a meeting. Our district is pared to the bone. It is not a poor district in terms of the people who work there and who contribute to the national budget. But it is poor in terms of the service that we get for that contribution. People are working there against very poor odds indeed and doing valiant work. Something must be done quickly for them, and I hope for a favourable response from the Minister this evening.

12.13 a.m.

Mr. Frank Haynes (Ashfield)

You will have seen, Mr. Deputy Speaker, from what has been said this evening that we have a desperate situation in the central Nottinghamshire district. I have been involved with it personally as an ex-chairman of that particular community health council, and the figures that have been explained to the House tonight clearly indicate the problem.

A 4 per cent. growth is needed there to make any progress at all in providing for the growing community. What are they offered? They are offered 1 per cent. They need 1½ per cent. to 2 per cent. to maintain present day services. That is the desperate situation we have in these three constituencies and I am appalled at the decision made by the area health authority on 7 June. I am of the opinion that the area health authority is not being fair to that district. There is an unfairness in the distribution of the finance across the whole of Nottinghamshire which seriously affects central Nottinghamshire. It must be realised, and I reiterate what my right hon. Friend the Member for Mansfield (Mr. Concannon) said, that the Trent region itself is desperately under-funded and so is Nottinghamshire. So, the central Nottinghamshire district is hit twice

I would like the Minister seriously to consider disbanding the area health authority. I think that it has thrown away the responsibility that it holds. That is what I feel about the position. The work is being done in the district, but the people doing the work need the finance to do the job properly. I hope that the Minister will seriously consider what is being suggested. I may have gone a little too far but that is how I feel. We have been in this situation for too long. It is getting worse every day.

I stand here a disappointed Member of Parliament. On 8 June I sent an urgent telegram to the Secretary of State. He did not have the decency to reply. If that is the way a Secretary of State carries out his job I believe that it is time for him to get out. This is an appalling situation. The right hon. Gentleman could at least have sent a letter. There was nothing. I hope that the Minister will seriously consider what has been said, in the hope that we can get round the table and sort out this problem.

12.16 am.

The Under-Secretary of State for Health and Social Security (Sir George Young)

The central Nottinghamshire district is fortunate in having three Members of Parliament with such a commitment to, and knowledge of, the health problems in their area. I shall do what I can in the time that has been left to me to deal with the many points raised in the debate.

I deal first with two points made by the hon. Member for Ashfield (Mr. Haynes). As for the status of the area health authority, we must await the report of the Royal Commission before we decide on the future of the AHA level. Dealing with the telegram which he send to my right hon. Friend, the answer which the hon. Gentleman sought in that telegram will be found in what I have to say this evening.

I am grateful to the right hon. Member for Mansfield (Mr. Concannon) for having brought before the House the question of funding within the Health Service. He has eloquently described the problems facing the central Nottinghamshire health district. I can assure him that my right hon. Friend the Secretary of State is aware of the tough decisions which health authorities throughout the country have to make in keeping within their budgets and determining which of the many competing demands on their limited resources should be given priority.

Those hon. Members who have spoken are realistic enough to acknowledge that this district has suffered from a long period of under-investment, which lies at the root of the problems described. The new system of allocation of resources within the Health Service designed to put this right is a matter of some complexity and it may help the House if I explain briefly the principles governing resource allocation nationally.

Revenue allocations to regional health authorities are based on the recommendations of the resource allocation working party—colloquially known as RAWP. The object is to secure a pattern of resource distribution based on relative health care need. Each year a decision has to be taken by Ministers on how much progress can be made in closing the gap between existing allocations to regions and targets calculated by the RAWP formula. I have noted that the former Administration, in reaching decisions on the 1979–80 allocations, found it necessary to slow down the pace of change towards targets. RAWP can flourish best in the context of economic growth which we are determined to restore.

My right hon. Friend is in the process of reviewing the present arrangements for resource allocation. I am not able, therefore, at this point, to say what changes, if any, will be made. Trent region has emerged as one of the most needy and has consequently received a large share, in percentage terms, of available new resources. In 1977–78 it received a 2.9 per cent. growth in resources compared with a national average of 1.4 per cent. It received 4 per cent. against 2.3 per cent. in 1978–79 and this year is receiving 2.7 per cent. against an average of 2 per cent.

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 in 1979–80. This year, with a weighted population of 9.5 per cent. of that of England, Trent's capital allocation is 10.9 per cent. of the total.

The hon. Member is, I am sure, aware that responsibility for allocation of resources to area health authorities rests firmly with regional health authorities. There can be no doubt about the Trent AHA's intention to pursue these principles. But there are a number of constraints which prevent Trent from moving as fast as it might wish. It must not be forgotten that Trent has a legacy of widespread deprivation in terms of National Health Service resources and this has meant the need for a programme of urgent capital developments throughout the region for new hospitals. In order to bring these into use in Nottingham, Leicester, Sheffield, Rotherham and Barnsley, funds have had to be found from within the region's overall revenue allocation. I am sure that hon. Members will agree that there is no point in building these much needed new hospitals only to allow them to stand idle.

Another major constraint is the commitment, endorsed by successive Governments, to the expansion of medical education. Hon. Members will know the reasons why medical education has been concentrated in the Trent region, and I shall not elaborate on them now. But in making allocations, the additional service provision arising from an authority's commitment to provide facilities for teaching medical students is taken into account through what is known as the service increment for teaching—an allowance based on the future number of students undergoing medical training in hospitals administered by the authority.

Bearing in mind the constraints to which I have referred, Trent RHA is making every effort to eliminate inequalities of health provision within the region against a background of rising demand and limited resources, and the RHA recognises the difficulties which Nottinghamshire faces in attempting to alleviate the acknowledged deficiencies in the non-teaching districts while at the same time bringing into use the Queen's medical centre and 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 annual percentage growth on present assumptions about future resources is expected to be about 3 per cent., second highest of all areas in the Trent region. Within this period Nottinghamshire is expected to reach 95.9 per cent. of the RAWP national target, again the second highest in the region.

The area health authority is very conscious of the need to improve health services in central Nottinghamshire. The forceful speech of the right hon. Gentleman can leave no one in any doubt that the district is under-provided. Waiting times for hospital admissions are long and have unfortunately been aggravated by the industrial dispute this winter. Medical staffing levels are low. There is under-provision of hospital beds in some specialties, and many Health Service buildings are old and of poor quality. No one disputes this.

The right hon. Gentleman raised a number of specific points. I say at this stage that I should welcome a meeting at the Department with him and the two hon. Members who have spoken tonight, I shall certainly do what I can to help.

The hon. Member for Ashfield (Mr. Haynes) has drawn attention to some other consequences of the resource difficulties in his correspondence. In North Nottingham district the opening of a new block at the city hospital scheduled for November this year has had to be delayed by about six months. My hon. Friend the Member for Beeston (Mr. Lester) has also contacted me about the newly completed city hospital at—

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 twenty-three minutes past Twelve o'clock.