§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Brooke.]2.40 pm
§ Mr. Bob Dunn (Dartford)
In relating the problems of the Health Service in North-West Kent I am conscious that it has fallen once again to the Under-Secretary, my hon. Friend the Member for Ealing, Acton (Sir G. Young), to reply, as he has done on many occasions since his appointment. My apologies for detaining him are tempered by the knowledge that to reply on a Friday afternoon is infinitely more attractive than it is to reply at 2.30 am on a Tuesday, and that the problems facing us in North-West Kent are severe and serious, justifying debate.
The need for the debate was made crystal clear by the events leading up to the debate of 11 March 1980 on the Second Reading of the National Health Service (Invalid Direction) Bill. That debate arose because of the gross overspending, against the advice of both Labour and Conservative Secretaries of State for Social Services, by the Lambeth, Southwark and Lewisham health authority. The House will recall that the Lambeth, Southwark and Lewisham health authority overspent by about £9.3 million over two years. Such gross overspending meant the denial of much-needed resources to other authorities in the South-East Thames regional health authority.
The Kent authority suffered. The Dartford and Gravesham health district authority felt the effects of reduced resources severely. That is my district, which I share with my hon. Friends the Members for Gravesend (Mr. Brinton) and Sevenoaks (Mr. Wolfson).
The overspending, although calamitous in its effects on the Health Service in North-West Kent, merely serves to underline the historical trend of declining health facilities, due to under-funding of my area, in which the population is increasing and the demand on relatively poor facilities is higher than ever. There are nine hospitals in my health district, six of which deal with mental illness and handicap. Only two of those nine hospitals were built in the twentieth century. Five are well into their second century. The oldest hospital is St. James's in Gravesend. That hospital, which has 64 beds, was built in 1847 and serves as a geriatric unit.
The next oldest hospital, also in Gravesend, is the Gravesend and North Kent hospital, built in 1854. The third hospital is West Hill, Dartford, which was built in 1860 as a workhouse. Today, West Hill has over 160 beds and serves as a general hospital. The fourth hospital is known as Stone House and deals with the problems of mental health. It was built in 1866 and has 355 beds.
The fifth hospital is Darenth Park, which was built in 1878 and deals with the problems of mental handicap. It has 930 beds. The sixth hospital is Bow Arrow hospital which was built in 1893 and today offers a geriatric service and a service to the chronic sick.
The seventh hospital is the Livingstone, built in 1894. It offers 32 beds on acute service today. The eighth hospital was built as a fever hospital in 1903 and is known as the Joyce Green hospital. It offers a geriatric and psychiatric service, fields a small mental health unit and undertakes some general surgery. It is the first hospital to have been built in the Dartford and Gravesham health district area during this century. The ninth hospital, Mabledon, built in 1915, is only the second. Mabledon 1154 deals with mental illness and has about 130 beds. Since the war, it has begun to act as a treatment centre for Polish emigrés.
The point of that list is to remind the House that, although Dartford and Gravesham—North-West Kent, in other words—may appear to have a surfeit of hospitals, as a result of historical decisions by the City of London and other institutions and authorities, none is modern and very few were purpose built. My constituents who serve those hospitals are concerned that, despite the enormous expenditure each year, some of them are fast becoming medical slums.
The Dartford and Gravesham health district serves a rising population of over 200,000 and more than 5,000 people are employed in the hospitals themselves. I should pay tribute to the doctors, nursing staff, administrators, cooks and cleaning and maintenance staff who are responsible for the maintenance of the health function in those hospitals. However, without help, the conditions under which they work and patients are treated can only continue to deteriorate.
If the environment is so important for patients who undergo treatment for mental illness, entry to one of the gaunt Victorian buildings in my constituency can only result in slow progress; improvements to their health will take a long time.
Not only is it difficult for patients and their families to receive treatment in such difficult and indifferent surroundings, but it must be difficult for the staff either to maintain a real interest or to be retained by the authorities. The nearness of Dartford makes it difficult for the authority to retain staff, because of the obvious lack of decent staff accomodation in an area of high-priced housing and the temptations of the hospitals in London such as Queen Mary hospital, Sidcup, with its modern staff accommodation and the advantage of the higher London weighting allowance.
The cost of maintaining the fabric of these hospitals is high and will become increasingly so as they continue to age. On 8 December, I asked the Secretary of Stateif he will publish in the Official Report the amounts spent on repairs and maintenance for each of the hospitals in the Dartford and Gravesham health authority area for 1979-80 and for … preceding … years."—[Official Report, 8 December 1980: Vol. 995, c. 488.]The figures that I was given show that Joyce Green hospital spent £290,000 on building, engineering and ground maintenance in 1976–77. By 1979–80 that figure had risen to £396,000. West Hill hospital spent £187,000 in 1976-77 and £274,000 in 1979-80. Stone House hospital spent £160,000 in 1976–77 and £221,000 in 1979–80. Darenth Park, another large hospital, spent £292,000 in 1976–77 and £364,000 in 1979–80.
The difficulties for my constituents are further complicated by the difficulty of access for visiting and by the variable nature of waiting times. At the end of last year, a doctor in my constituency wrote to me:Thank you very much for your taking such an interest in the problems I mentioned to you. I would have to agree that the situation in other parts of Kent is definitely worse than it is in Dartford, but that does not allow us to forget that the situation locally as regards waiting times for certain appointments is unacceptable and potentially dangerous to patients.He went on:The root cause of the shortfall in medical services in Kent relates to the fact that the allocation is well below the target figure, presumably due to the failure of London hospitals to cut their expenditure in the way that was expected".1155 The waiting lists were very bad last October. In general surgery, non-urgent cases had to wait 14 weeks, and non-urgent gynaecological cases had to wait 29 weeks. In the department of ophthalmology last year, an adult patient had to wait 44 weeks for treatment. I recognise that there have been great improvements in waiting times for treatment in those categories and disciplines. None the less, research over the past few years demonstrates that waiting lists are a variable feature of medical life in North-West Kent. Clearly, action must be taken.
Rationalisation of hospital sites and buildings in my constituency is needed, if for no other purpose than to provide finance to construct better and more modern hospitals. I acknowledge that some improvements have taken place in the Gravesend and North Kent hospital and at West Hill hospital. I understand, too, that Archery House will be built next year.
I hope that my hon. Friend will accept the need to have an inquiry into the funding of my district. Only yesterday, I heard that the Bexley and Greenwich authority is now overspent. That means a further reduction of the finance that is available to my authority. I am sure that an inquiry and rationalisation would be the right steps to take to improve the service for my constituents.
Perhaps my hon. Friend will spare the time in the near future to visit Dartford and Gravesham and, in particular, the hospital that I mentioned.
In conclusion, I pay tribute to all those who work in the hospitals in the Dartford and Gravesham health authority area. They do a splendid job under very adverse and difficult conditions. If it is possible for my hon. Friend to improve the lot of these very old and, in some cases, almost derelict hospitals, he will receive a tremendous welcome in Dartford, if he can find the time to go there.
§ The Under-Secretary of State for Health and Social Security (Sir George Young)
I congratulate my hon. Friend the Member for Dartford (Mr. Dunn) on securing this debate on the National Health Service in North-West Kent and for the way in which he has pursued so plausibly the interests of his constituents. I endorse what he said about the NHS staff who work in his constituency and say how very much all Ministers appreciate the work that they do for the Health Service.
My hon. Friend has, I know, taken a considerable interest in the provision of health services within the South-East Thames health region and has drawn attention to the need for improvements in provision in Kent, and the Dartford and Gravesham health district in particular, on a number of occasions in this House. I am grateful to him for this opportunity to comment on some of the issues about which he and the local community have expressed concern.
My hon. Friend touched on a wide range of issues, and I hope to deal with them in the order in which they came. I start with the unhappy history of past overspending by the Lambeth, Southwark and Lewisham area health authority. My hon. Friend raised the matter in a debate a year ago, and he mentioned again today the effect that past overspending by one area health authority has had on the rest of the South-East Thames health region.
Shortly after coming into office we took firm action to deal with the situation by appointing commissioners. It is vital that all health authorites keep their expenditure under control and ensure that they do not spend money that has 1156 not been allocated to them. Despite the difficulties, the regional health authority has been able in recent years to make additional funds available to the Kent area health authority. I shall return to that subject later. I have no reason to believe that the area health authority in Lambeth, Southwark and Lewisham will overspend in the current financial year, though of course it will have to overspend from its own resources because of its past overspending. However, I understand that this year's spending is on target.
My hon. Friend then spoke about the age of some of the hospitals in his constituency. He drew attention to the age of the hospitals in the Dartford and Gravesham district. I am sure that he would not go so far as to say that all old buildings are bad and that only new ones are good. We only have to look at the tower blocks that have been constructed recently to know that that is not right.
The age of a hospital building is not necessarily a reliable guide to its condition. The building fabric of a solidly built Victorian hospital, for example, may well have deteriorated less than more recently built structures. As my hon. Friend will know, most hospitals contain several blocks or wings which will often have been built at widely different periods. I am sure that he will know that West Hill hospital, for example, has parts that date from the middle of the last century, but a substantial part of the hospital has been built since 1948. Very few of our older hospitals have not been substantially upgraded in their lifetime.
Good maintenance practices will also help us to make the best use of existing buildings. Many of our hospitals, including some which were first put up 60 or more years ago, are perfectly capable of being adapted to meet the need for new services, and at a capital cost much lower than that for providing new premises. Our Health Service buildings are a valuable resource and their proper upkeep is an important responsibility and one to which health authorities need to give a proper share of finance. Health authorities are also mindful of the need to dispose of redundant buildings and land when there is no longer any need to retain them. They are aware of the financial benefits that can accrue to them from the sales of redundant property. But the path of property disposal is not always a straightforward one and protracted arrangements may result in the property concerned being run down.
My hon. Friend spoke about the problems associated with maintaining so many old hospitals within his district, as he did in the debate on 11 March last year. It is worth pointing out that much work has been done in the last 30 years or so to try to bring this stock of property up to date. About a quarter of our hospital buildings have been built since 1950.
The maintenance of hospitals is crucial. After all, they comprise the very fabric within which a great deal of health care is delivered. The management of these buildings is not an isolated activity of a purely technical nature, but an indispensable part of the overall aim of providing patients with a proper standard of care and treatment.
I think that my hon. Friend will agree that very few public buildings have to suffer the continuous occupation and high degree of wear and tear to which hospitals are subjected. Nor are they required to house, with the least possible disturbance from those carrying out maintenance work, facilities for such a wide range of activities and highly complex processes affecting patients, staff and 1157 visitors. The requirement to be operational for 24 hours a day throughout the year presents difficult, problems for maintenance staff.
I think my hon. Friend believes that maintenance in the Health Service has been a "Cinderella" activity, and that when cuts have been made maintenance has been the easiest area in which to find those cuts. The argument has been put forward that we should earmark funds for maintenance work. In difficult times this is the sort of decision that health authorities have had to take, not because they are neglectful of their duties—they know only too well that the deferment of maintenance can be a false economy—but because they have had no option. But the earmarking of funds for maintenance would not help in the long run, and Ministers are opposed to such action because to intervene in this way, by diverting funds from other activities more directly concerned with patient care, would reduce the responsibility which we have placed on health authorities to manage their own affairs.
I should not deny for a moment that there is a backlog of maintenance work, and there has been a backlog ever since the inception of the National Health Service. I do not see it disappearing in the foreseeable future. But it is being tackled, and substantial sums of money are spent each year on maintenance—£259 million in the year ended 30 March last year. I think that each health authority knows the problem in its own locality, and we must allow authorities to deal with it, along with the many other pressing calls on their resources.
My hon. Friend touched on the problems of providing services for the mentally handicapped and the mentally ill in his district. As he knows, there are important improvements in hand. The RHA had hoped to be able to replace Darenth Park hospital by 1985 by selling the site for chalk extraction and using the proceeds to build replacement facilities, which would include hostels, residential centres, group homes, regional centres and day centres. Its aim is to provide care for the mentally handicapped on a district basis. Considerable progress has already been made. Work on new purpose-built accommodation to serve the Dartford and Gravesham health district, known as Archery House, should commence next year, as my hon. Friend mentioned. Replacement provision has already been opened at Grove Park hospital, and schemes for other areas are in various stages of planning. In the meantime, some upgrading work is to be undertaken.
I think that the important thing is that a start is being made, and the Darenth Park hospital replacement plans are a good example of the determination which exists to make progress.
§ Mr. Bob Dunn
On the question of the sale of Darenth Park, my hon. Friend will be aware that there was an inquiry by the Secretary of State for the Environment, which turned down the application for the purchase of Darenth Park, and it is the absence of resources because of that lack of sale that has tended to crystalise events in Dartford.
§ Sir George Young
My hon. Friend is right. I know that that decision was a disappointment to those concerned with health services. The regional health authority and the other authorities have had to develop alternative plans, to which my hon. Friend referred. He spoke of the problems 1158 of recruiting staff when there is competition from other areas where London weighting is received. He said that National Health Service staff in the Dartford and Gravesham health district receive a lower rate of London weighting than do staff in some neighbouring districts and that this was a reason for the difficulty experienced in recruiting staff.
London weighting is a matter for negotiation with the Whitley councils. I understand that agreement has been reached with the general Whitley council on the establishment of a London weighting consortium to negotiate London weighting on behalf of all NHS staff groups, and that both sides are committed to a review of the London weighting boundaries. I understand that the problems expressed by the Dartford and Gravesham health district, which lies just outside the GLC boundary, will be considered in the course of that review. I hope that that will be of some consolation to my hon. Friend.
My hon. Friend talked about the problem of waiting lists. The problems associated with waiting for hospital treatment have been with the Health Service since its inception. It is not so much the number of people waiting as the length of time that some of them have to wait that causes concern. There are many factors affecting waiting times that vary markedly according to a patient's diagnosis. There are often different pressures in different areas.
Increased expectations of what the Health Service can achieve have contributed to increases in waiting lists, despite the fact that the number of people receiving hospital treatment has continued to rise. In a service that is continually developing, but for which resources are necessarily limited, it is inevitable that there will always be those who are waiting for hospital treatment. That does not mean that we are complacent. We are not. However, it must be recognised that there are limits to what the Government can do.
We are aiming to secure the most effective use of the resources that are available to us, including the contribution to be made by the private sector of medicine. This largely depends on the measures that clinicians and administrators in individual hospitals are prepared to take. Many improvements can be made to reduce waiting times to a more acceptable level, even within present financial restraints.
The Department has given health authorities advice on good practice, including the advantages of holding waiting lists for hospital in-patient admission that are common to a number of consultants within one specialty, increased use of day surgery, five-day wards and the provision of regular information about waiting lists to consultants, management teams and GPs so that patients can be given the opportunity of accepting earlier treatment at a hospital further from their homes.
My hon. Friend mentioned the allocation by the Resource Allocation Working Party. No debate on the Health Service would be complete without a reference to that. The policy of the South-East Thames regional health authority in recent years has been to allocate all of its growth moneys to the Kent and East Sussex area health authorities. In 1978-79 the Kent AHA received growth moneys totalling £3.65 million, an uplift of 3.34 per cent. Last year it received growth moneys totalling £3.12 million, an uplift of 2.8 per cent. This year the comparable figure was £1.02 million, an uplift of 0.67 per cent. That 1159 means that in each of the past three financial years the Kent AHA has received development additions not less than twice those for the region as a whole.
The South-East Thames regional health authority hopes to discuss its strategy for the allocation of financial resources in 1981–82 and 1982–83 at its next meeting on 19 February. I shall ensure that what my hon. Friend has said this afternoon will be available to the members of the RHA before they reach their decision.
I turn to the allocation to the Kent health districts. Due to the imbalances of Health Service provision within Kent, the effect of the AHA strategy is that the Dartford and Gravesham health district can expect little growth, if any, in 1981.82 and in the financial years immediately beyond, but in terms of the RAWP criteria, with which my hon. Friend may not agree entirely, it is better provided for than any of the other health districts in Kent. The AHA hopes to determine allocations for the coming financial year and for the next two or three years in its meeting in March. Before it reaches decisions it will, I am sure, take carefully into account the needs of all its six districts.
I refer to the key to the way forward in my hon. Friend's district, and in doing so I shall develop one of his arguments.
There can be little doubt that the key to early improvements in health care within the Dartford and Gravesham health district lies in the rationalisation of existing provision. Various, adjustments in the level and pattern of services which take account of over-provision in some specialties can be made. We can do something about vacant hospital accommodation which could be used following renovation and upgrading. There is the desirability of concentrating certain specialties on fewer sites, and the possibility of selling land. All these are under consideration by the district management team and officers of the area health authority.
The aim of these adjustments must be to enable more effective use to be made of existing resources, including the capital stock, and to produce financial savings which could then be devoted to improving the local health services and the maintenance of the fabric, and to some of the other good ideas that my hon. Friend mentioned.
1160 In order to provide pump-priming funds for this rationalisation programme, the possibility of an initial transfer of some revenue moneys to capital is being investigated. Any proposals for substantial variations in services will be the subject of formal consultation, in accordance with the well-established procedures.
I assure my hon. Friend that my colleagues and I are conscious of the problems of increasing demand, old buildings, neglected services for the mentally ill and handicapped and the elderly, long waiting lists, and the need to maintain progress in redistributing resources. My hon. Friend kindly extended an invitation to me to visit his constituency and see some of the problems that he described so graphically this afternoon. Subject to arranging a suitable time in a rather heavy diary, I should very much like to accept my hon. Friend's invitation.
Improvements can always be introduced, of course, given more money, more staff and more facilities. But, sadly, there will never be enough money available to satisfy all the demands for health care. That is why we must ensure that we make the best use of the resources at our disposal. That is why we are restructuring the Health Service, introducing new management arrangements, and revising the planning system.
With regard to the new district health authorities that will be established in Kent, if my hon. Friend is concerned about the management and maintenance of the hospital stock, he may like to consider putting forward to the regional health authority the names of some people who might be able, as members of the new district health authority, to contribute in that area of hospital management.
I am convinced that the policies that we are adopting will be to the benefit of patients in all parts of the country, including those in my hon. Friend's constituency. I hope that I have been able to allay some of my hon. Friend's fears. I shall ensure that the points that have been raised here today are brought to the attention of the regional health authority and the area health authority. I am certain that each authority will give them full consideration.
§ Question put and agreed to.
§ Adjourned accordingly at seven minutes past Three o'clock.