§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Brooke.]2.31 pm
§ Mr. Greville Janner (Leicester, West)
I am pleased to have the opportunity to raise on the Adjournment the plight of Leicestershire in respect of the hospital services that are available to its citizens, and especially the threat of closure to the Glenfield district general hospital in my constituency, work on which has already begun. The expenditure upon the hospital is already considerable, yet it is threatened by the cuts in expenditure that will come through to the Trent area health authority, and of course to the Leicestershire district.
I am pleased to say that, whatever the many matters that divide hon. Members representing Leicestershire constituencies on other issues, we have long worked together to try to alleviate the plight of Leicestershire people, who have long been near the bottom of the league of hospital beds and services. The hon. Member for Harborough (Mr. Farr) has headed the efforts of us all to try to press upon successive Governments the need to bring help to the area. As recently as 21 February 1980 the hon. Gentleman raised the issue of Leicestershire area health authority finance in an Adjournment debate. He produced figures that were irrefutable to show that the area is extremely badly off. The situation has not improved. I thank the hon. Gentleman for attending the debate. I understand, Mr. Deputy Speaker, that he will wish to take part in it if he catches your eye.
I shall quote from the reply of the then Under-Secretary of State for Health and Social Security, the hon. Member for Ealing, Acton (Sir G. Young), in that Adjournment debate, who said:I readily concede that the Leicestershire area health authority has a very difficult task in attempting to improve health services in the county. There is no dispute that the area has suffered, and still suffers, from a legacy of low Health Service funding. No one could argue with the statistics that my hon. Friend produced.That is the hon. Member for Harborough. The Minister continued:The authority has the daunting task of undertaking new capital developments, including a major teaching hospital, as well as maintaining the growth of medical education.Later the Minister referred specifically to the third Leicester district general hospital on the Glenfield site among developments thatshould go a long way towards providing the people of Leicestershire with the health service that they have every right to expect".Later the Minister stated:My hon. Friend rightly reminded the House that a long period of under-investment in the Health Service, not only in Leicestershire but in the Trent region as a whole, is the underlying cause of many of the deficiencies he has described. The recommendations of the Resource Allocation Working Party aim 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.That was in 1980, and the rate was2.7 per cent. The Minister said later:I fully recognise that Leicestershire has suffered a legacy of deprivation of health services, and I am conscious of the difficulties that lie ahead."—[Official Report, 21 February 1980; Vol. 979, c. 806–810.]I trust that the Minister who has replaced him will in no way seek to under-estimate the problems that 584 Leicestershire faces with a growing population, served by doctors, nurses and ancillary workers in hospitals, with the greatest devotion and care, but with a low rate of hospital beds. The needs there are so mighty that on the latest figures showing acute specialties with significant waiting lists, 460 people have been awaiting acute orthopaedic surgery for over four years.
The figures spread through general surgery, ENT, orthopaedic surgery, ophthalmology, plastic surgery and even gynaecology. They are disgraceful in any decent and compassionate society. Successive Governments have done their best to try to bring the Trent area and the Leicestershire health authority to parity with areas that are more adequately and fairly served.
Unfortunately, only gradual improvements are being made. In 1981–82, resources available to the Leicestershire health authority were only 91 per cent. of the national average and 23 per cent. less than the average for authorities in the best provided region in this country. With a national growth rate of 1.5 per cent. for the NHS as the assumption upon which the projections were based, that would mean the injection of £44 million additional resources. The area with its expanding population received £3.8 million growth in 1982–83. If it is implied in the Government's figures that there is to be nil growth, the consequences for the continuation of the opening sequence of Glenfield district general hospital are bleak.
That hospital is to be large. It is to employ over 700 people in an area that needs a transfusion not only of health care but of jobs. It is an area where unemployment is staggering. It is higher than it has ever been and is increasing. I am informed that already £300,000 per annum is spent by Glenfield hospital for staff pre-recruited and in training, which is essential for nurses and other trained staff if the new hospital is to open quickly at an economic level of activity.
There is no question of just announcing that a hospital is approved today and that it will be opened tomorrow. There must be preparation. If the overall level of acute in-patient services which Leicestershire needs is to be improved the planning must proceed and the building must go on. The people must know where they stand.
The overall level of acute in-patient services available in Leicestershire can be judged from the discharge rate per 1,000 of population. In 1980, the discharge rate was 74.4 per 1,000 in Leicestershire compared with a national average of 91.4 per 1,000. That is only 81 per cent. of the national average. In every specialty we have the same problem. In our surgeries we all have to say to people who come to us with acute conditions believing that they are not being served properly that they are right, that the Trent area is at the bottom of the league, and that the Leicestershire part of it is at the bottom of the Trent region.
Why do we come to the Government and not to the Trent area? The answer is that it is the allocation of money by the Government to the regional health authority which determines what it has available for allocation. The regional authority can then decide how to allocate those funds among its various district authorities. In the Trent region every district health authority is below the national average. Every authority in the region is below the national average, which is almost automatically the target figure in terms of resources per capita, with the sole exception of Sheffield, which is exactly on the national 585 average. It follows that no district health authority in the Trent region has any excess funds above its target figure which could possibly be transferred to Leicestershire.
The latest statistics for the year 1980–81 show Leicestershire at only 91 per cent. of the national average—one of the lowest figures in the Trent region, a region which itself is poorly off. If Trent were to assure Leicestershire that it could proceed with the Glenfield development and that a period of minimal growth is predicted by the White Paper, the money would have to come from other district authorities, all of which, with the exception of Sheffield, are below the target figure. That is something that no authority could contemplate.
It is impossible and wrong for the Government to say that all that is needed is a transfer of resources within the local authority. The Trent authority itself is made up of districts, each of which is below the national average and in need. It is a deprived and disadvantaged area. I ask the Minister not to say that we are going to the wrong place and that we should refer our inquiries to Trent, because Trent is in the hands of the Government as to what it can allocate.
I raise this matter because of apprehensions which emerged only last week, when we were told for the first time that the Glenfield district hospital might not proceed. I understand that if work is stopped now, the expenditure necessary to mothball the development of the hospital, which is already well under construction, would be about £400,000 a year simply in rates and maintenance costs. So we would be paying £400,000 a year to maintain an empty shell which was treating no patients at all.
Therefore, I ask the Minister to give us an assurance which hon. Members from Leicestershire can pass to our constituents, not least in the city which is the worst-off part of the worst-off area in the Trent region. We can tell them that the Government will ensure that the hospital will go ahead in accordance with the plans, and that the authority will not be starved of the funds that it needs. I hope that the Minister will not reply that funds should be taken from other parts of Leicestershire which themselves are far below the average provision which, as his predecessor rightly said, the citizens of the county are entitled to expect.
§ Mr. John Farr (Harborough)
I congratulate the hon. and learned Member for Leicester, West (Mr. Janner) on raising this matter on an Adjournment debate, and I thank him for giving me a moment or two in which to support his efforts. In Leicester and Leicestershire we are united, if on nothing else, about the inadequate health facilities of the city and county. For years the hon. and learned Member and I and most of our colleagues on both sides in the Leicester area have complained to successive Ministers for Health that for years the city and county have been disadvantaged in health spending. Only two years ago I found it necessary to raise the matter on the Adjournment. The hon. and learned Gentleman has followed that today.
On 18 March the chairman of the North-West Leicestershire community health council, Canon George Crate, was reported as saying:Everyone in Leicestershire should be concerned about the low funding of the health service in the county compared with other parts of Britain.586 In the same report, the treasurer, Mr. Wilf Taylor, was said to have warned thathardly any growth in the service was expected over the next couple of years, although Leicestershire was now receiving a slightly improved allocation of money from the Trent Regional Health Authority.The treasurer was reported to have continued:Even with the most favourable circumstances, Leicestershire would only achieve an equal share of funding compared with the rest of the country, by 1990. At regional level, more than £38 million extra was needed to achieve the national average and £140 million to reach the spending level of the best funded parts of the country.We have had a Conservative Government for three years. I confess that whatever improvement has taken place in that time has been microscopic. Any progress towards more equal funding for Leicestershire has been so slow as to be not worth while.
I tabled a question recently, to which the Minister replied:The revenue allocation of the Trent regional health authority in 1982–83 is 5.5 per cent. below the national average represented by its target share of resources under the RAWP formula. This represents £37 million at 1982–83 cash limit levels. The Trent region continues to receive one of the highest levels of growth in its revenue allocation of all regions. The future rate of progress will depend on the resources available nationally."—[Official Report, 29 March 1982; Vol. 21, c. 32.]I intervene to support the hon. and learned Member for Leicester, West. I am completely dissatisfied with the snail-like progress in Leicester. The area has been, and still is, considerably disadvantaged. That has been admitted by successive Ministers for Health. I hope that the Minister will not disappoint me. I hope that he will make a good effort in the district and at least spend as much there as is spent in the rest of the country so that we may have a chance of reducing our waiting lists instead of seeing them growing longer.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
The hon. and learned Member for Leicester, West (Mr. Janner) and my hon. Friend the Member for Harborough (Mr. Farr) have described eloquently the current position of the health services in Leicestershire. Nobody will dispute that Leicestershire has been and remains, by national standards, one of the country's deprived districts. However, Members must recognise that the position of Leicestershire has improved substantially in recent years. It was in recognition of the fact that resources had been distributed very unevenly that the system of differential resource allocation was introduced in 1976. This RAWP system has continued in every year since then. Under that policy the Trent region has been a major beneficiary and has received considerably greater growth in real terms than the country as a whole. In the five years from 1976 the Trent region has had revenue growth in real terms of 14 per cent. as against 8 per cent. for England as a whole and in this year, 1982–83, the Trent region is receiving 3 per cent. growth as against 1.7 per cent. nationally.
The Trent RHA pursues a policy of resources equalisation within the region, and Leicestershire has been a major beneficiary of that regional system. I do not decry what the hon. and learned Gentleman and my hon. Friend have said, but it does not help to overlook the considerable achievements that have been made possible since the RAWP system started.
587 In the period up to March 1981, Leicestershire enjoyed real growth of 21.8 per cent., compared with the regional total of 13 per cent. This year, it is receiving 4.3 per cent., compared with a regional total of 3 per cent. It is one of the highest growth rates in the region.
As I have said, I acknowledge that Leicestershire still finds itself short of its RAWP target, but over that period it has improved its position substantially, from being at 82.8 per cent. of its target in 1976 to being at 91 per cent. of its target in 1981. Again, that is one of the fastest rates of progress towards target in a region where every area health authority was below target at the outset. Important new developments at the Leicester royal infirmary and the Leicester general have been achieved during that period.
In 1978, the DHSS asked all regional health authorities to prepare detailed strategic plans for the 10-year period from 1979–1988. As a basis for those plans we issued resource assumptions to regions. They were forecasts of the revenue that would be available over that 10-year period. The Trent region was told to assume that it would receive on average 2.4 per cent. per annum new money—that is money for developments of services.
In accordance with the RAWP policy, that increase was substantially higher than the national average, which was set at 1.5 per cent. It was not a guarantee. The advice that we issued also suggested that allocations might vary. The Trent regional health authority produced a plan based on that assumption of 2.4 per cent. per annum on average.
To date, up to and including this financial year, those assumptions have been fulfilled. In fact, the Trent RHA has received slightly more than it was told to assume and to date the RHA has been able to fulfil most of the things that it planned to do. That is not a bad record, although it is one that is often forgotten. There has been real growth in the NHS in every year since the Government came into office. We are now spending more money on the Health Service than at any time in the past, and 6 per cent. more in real terms than when we came to office. It does not help to talk of cuts, as did the hon. and learned Gentleman, when the opposite is the case.
I am asked to gaze into the future and to give absolute guarantees about the level of resources that will be available. Those I cannot give; no one can. The future is more than usually uncertain.
The Government's recent public expenditure White Paper set out our view that plans for future health spending must be formulated with strict regard to the total public expenditure that the economy can sustain. The continued control of public expenditure is an essential feature of our battle against inflation.
The White Paper also sets out our belief that the best way of meeting new needs in the Health Service is by increasing its efficiency. We believe that health authorities should be able to increase efficiency enough to provide further growth in services of about ½ per cent. per year in 1983–84 and 1984–85. The Government will consider whether the provision should be revised in the light of the availability of resources and the scope for increased efficiency.
I appreciate that the Trent region's plan, which was based on a revenue assumption of 2.4 per cent. per annum on average, includes the development of the new hospital at Glenfield which was scheduled to open in 1984. I also accept the RHA's assurances that if that assumed level of 588 revenue were to materialise the hospital could open on schedule. I cannot give hon. Members any guarantees about when it will open. Nobody can give such guarantees until the financial situation for the next few years becomes clearer.
I am acutely conscious of the fact that the current uncertainty about the level of revenue funding for future years will cause concern to all authorities and particularly to those that have substantial revenue commitments, such as opening new hospitals, immediately ahead of them. But I can give some assurances. The first is that the Secretary of State will issue advice on the likely level of resources for next year as soon as he possibly can. We intend to discuss the question of resource allocation with the chairmen of regional health authorities at a meeting shortly and it is our hope that the resource assumptions for the financial year 1983–84—the year in which the hon. and learned Gentleman is most interested—will be issued to health authorities around the end of May. This will do much to clarify the immediate position.
Secondly, I can assure my hon. Friend and the hon. and learned Gentleman that we have not in any way lost sight of the position of those authorities such as Leicestershire which are still under-provided in many important services, and the benefit that would accrue to them from the continuation of the RAWP system of distribution of the available resources. On that basis, Trent region could expect to receive an above average rate of growth in its revenue allocation in the next few years. However it is inherently more difficult to carry out a substantial measure of redistribution when the overall level of resources is not growing as fast as it did.
Thirdly, some people argue that efficiency savings are less readily obtainable in those authorities that have long been funded less generously than some of their neighbours and that a standard requirement to find efficiency savings places a proportionately greater burden upon them. We shall be discussing the whole question of efficiency savings with regional chairmen at the forthcoming meeting to which I have already referred.
So we shall be doing all that we can to remove the uncertainty which at the moment surrounds resources for future years. It is presently difficult to make reliable forecasts even for one or two years ahead. It is proportionately very much more difficult to make reliable forecasts for 10 years ahead. The fact that the assumptions that were issued in 1978 have been confirmed over the period since then is a matter for congratulation, but it would have been remarkable if they had been precisely accurate over the whole 10-year period.
It is, therefore, incumbent upon health authorities to devise their plans in such a way that they can adapt to changing circumstances. This is a subject that I discussed with the chairman and officers of the Trent RHA when we recently had one of the first of our accountability meetings with them. We have asked them to consider the dependence of their plan on the continued fulfilment of assumptions issued some years ago.
§ Mr. Greville Janner
I accept that there has to be flexibility, but will the Minister accept that one cannot have flexibility in building a hospital? One has to plan ahead and spend, for example, £300,000 a year on pre-training for nurses and staff. Then one has to spend a 589 similar sum in order to mothball the hospital. Surely the Minister does not apply that principle of flexibility to a hospital that is half built.
§ Mr. Finsberg
What the hon. and learned Gentleman has not taken into account—although he referred to it at the beginning—is that the Government make a capital allocation to each region, and the region has steadily been getting closer to its RAWP target. Within that allocation, according to statute and the will of this House, the distribution within regions is a matter for them. The priority and the flexibility will have to be worked out by the regions. The figures that the hon. and learned Gentleman has put forward are important, and I am sure that Sir Sydney King and his colleagues will be looking at them.
It is, alas, not the only case that we have in the country where hospitals have been built and are still in some cases standing with beds empty. We are desperately trying to see what can be done. We are trying to ensure that proper planning takes place, so that we do not find, at the end of the period when resources have been committed and spent on building a property, that more money has to be spent on what the hon. and learned Gentleman has called mothballing.
I can sympathise with the views expressed by my hon. Friend and by the hon. and learned Gentleman. The Health Service in Leicestershire is underprovided in many respects, and the people there naturally hope that these deficiencies will be remedied as soon as possible. They 590 can rest assured that the Trent region is likely to receive a bigger slice of the Health Service cake than most other regions, whatever happens in the future. But these are difficult economic times and we cannot guarantee that the cake will always be of such generous proportions as it has been in the past.
I believe that the Trent RHA and the Leicestershire health authority, which is now some three weeks old, will approach these difficult times with sense and responsibility and will do all in their power to improve the services where they are most needed, within the resources that we are able to allocate to the region. I hope that they will at the same time scrutinise and rescrutinise their own operations to seek ways of improving their efficiency and cost-effectiveness and will look at privatisation of cleaning, of laundry and of catering to see whether it is possible to reduce costs. I hope that they will look at the possiblility of disposing of surplus, unused and often under-used land, which can be used to give them additional finance. All these are ways in which I hope they will operate. That is the duty that we have placed upon them. That is the duty placed upon all of us in present circumstances.
I hope very much that it will be possible for the Trent authority to work out something that will fit in with the order of priorities that it has mentioned, and that will recognise the problems of Leicestershire which my hon. Friend and the hon. and learned Gentleman have raised this afternoon.
§ Question put and agreed to.
§ Adjourned accordingly at Three o'clock.