§ Mr. John Hunt (Ravensbourne)
I welcome this opportunity to draw Parliament's attention to a matter that is causing great local concern in the Bromley area. I refer to the proposal made by the Bromley health authority to close the Lennard hospital at Bromley common in my constituency and to accommodate the geriatric patients there in hutted wards at Farnborough hospital, the day hospital being relocated at Beckenham. I am pleased to see my hon. Friend and neighbour the Member for Chislehurst (Mr. Sims) present for the debate today. If he is able to catch your eye, Mr. Deputy Speaker, I know that he will want to make a brief contribution.
The history of this matter is that in May this year the Bromley health authority published its district bed strategy for the 10 years from 1983 to 1992. It is worth noting that it was stressed at that time that the document was essentially a discussion paper. It certainly aroused a great deal of discussion.
In my view, the Bromley health authority deserves full credit for presenting its strategy in this helpful and comprehensive way, although I am bound to say that I believe its subsequent actions and decisions may be open to question and criticism. I shall be developing that point during the course of my remarks.
The document set out five possible options for future geriatric care, but in the end the health authority debate on 20 September concentrated on option 2, the consequences of which I have already described to the House, and option 6, which was an additional option, put forward at the meeting, proposing the total transfer of geriatric care from the Lennard to the Beckenham hospital. There was a tied vote between those two options, but, because the chairman understandably wanted to avoid using his casting vote, the debate was allowed to proceed. After further discussion, one member of the authority changed her mind and option 2 was then carried by the narrowest majority. I recount that merely to emphasise that the health authority's decision in this matter was far from unanimous. Indeed, the authority, as I have shown, was almost equally split, and its final decision was taken against the advice of the medical advisory committee.
The measures now being taken by the Bromley health authority under option 2 are described as temporary, to meet an immediate financial crisis. But the fear of many, including the community health council and the Lennard hospital action group, which has wide support in the area, is that once the Lennard hospital is run down — I understand that it is due to close by 23 March of next year —we and, indeed, the Minister will be faced with a fait accompli. I hope that we may be able to have some reassurance about that matter in the course of my hon. Friend's reply today.
The purpose of this debate, therefore, is to alert my hon. Friend to what is happening and to secure more time for fuller consideration of all the implications of the policy on which the Bromley health authority has embarked. I understand that the authority will be initiating the formal consultation process early in the new year, but unless there is some immediate ministerial guidance, I fear that the proposal for the temporary closure of the Lennard hospital will, for all practical purposes, become irrevocable.
599 I must also report that at its meeting on Monday, the Bromley community health council put forward an alternative solution. As this affects Beckenham hospital, which is not in my constituency, it would be improper for me to discuss the merits or otherwise of its counterproposal in this debate today. However, I think that the community health council's views, together with the various options put forward in the health authority's original document, indicate that there are a number of viable alternatives to the plan that has been adopted. Therefore, I hope that my hon. Friend will look carefully at all of these possibilities before coming to a final conclusion.
The Lennard hospital is situated in my constituency in a pleasant rural setting on the fringe of the green belt, and anyone visiting it gets an impression of space and tranquility. It began life as a fever hospital, but since 1962 it has been used solely as a hospital for the elderly, with its dedicated nursing staff attracting international praise and respect. In 1972, the Lennard hospital introduced a new concept in nursing—the five-day ward—which was funded by the Queen's Institution for Home Nursing and the King Edward Hospital Fund for London. Under this arrangement, patients stay for five days in hospital and then go home at weekends. The average stay is just four weeks. This provision is meeting a real need. My worry is that, under the option 2 proposal, there is, as I understand it, no provision for a replacement for this five-day ward.
Perhaps the most distressing and regrettable feature of the option 2 proposal is the separation of geriatric patients frm the day hospital and the consequent loss of the invaluable interaction between the two.
I recognise that the bed strategy at Bromley must be seen in the context of the redistribution of National Health Service resources—the famous, or perhaps infamous, RAWP formula that decrees a reducing revenue allocation for authorities, such as Bromley, that are deemed to be over-endowed. That policy started a long time ago—it is by no means the responsibility of this Administration —and it is accepted, albeit reluctantly, by most of my constituents. Such a redistribution, however, imposes on us an obligation to make the most sensible and far-sighted use of the resources that we have, and I wonder whether the authority's present proposals for the replacement of the Lennard hospital do that.
Another important factor to be taken into account in hospital planning in Bromley is the present imbalance of hospital provision in the borough. Some 60 per cent. of the population live in the northern part of the borough, but most of the hospital facilities are in the southern part. Indeed, at the Lennard hospital, which is in the south, 72 per cent. of the patients come from the northern part of Bromley. That is clearly inconvenient for the patients and their visiting relatives. I believe that future plans and proposals for hospital provision, geriatric and general, should more closely reflect the population patterns in the borough. In that respect, there is a strong case for an expansion of the acute bed provision at Bromley hospital, but that is another subject and perhaps I shall be seeking another Adjournment debate in due course to explore more fully that aspect of hospital care in the Bromley area.
The Government rightly give high priority to geriatric provision in the NHS. In my view, the establishment of 600 this priority dictates that the proposals of Bromley health authority relating to geriatric provision should be considered with critical care.
In a recent visit to the hospitals in my constituency, I was repeatedly told of geriatric patients occupying acute beds which could otherwise be made available to other patients. That emphasises the continuing need for more geriatric provision and the importance of an expanded provision of part 3 sheltered accommodation, provided by the local authorities or housing associations. Greater emphasis on the provision of this type of housing for the elderly would do more than anything else to release acute beds in our general hospitals and relieve pressure on geriatric beds. At the same time, it would enable the frail elderly to live settled and contented lives in the community. I hope, therefore, that the Minister will consult his colleagues at the Department of the Environment to see what new initiatives can usefully be taken in that important area.
To return to the special problem of the Lennard hospital, I hope that as soon as the formal consultation procedure is initiated, the necessary local comments are obtained and the alternative proposals are submitted by the community health council, my hon. Friend w ill act speedily to resolve our local anxieties. In doing that, I hope that he will give full weight to the points that I have outlined today. I also hope that in reply to the debate he will give an assurance that there is no fait accompli and that the closure of the Lennard hospital will be sanctioned only when a viable and acceptable alternative has emerged. At present, I do not believe that the proposals of the Bromley health authority meet that crucial test.
§ Mr. Roger Sims (Chiselhurst)
I am grateful to my hon. Friend the Member for Ravensbourne (Mr. Hunt) and the Minister for allowing me to make a brief contribution.
My hon. Friend referred to the imbalance of provision in the Bromley district health authority area. As it happens, there is not one hospital in my constituency; all the medical facilities of that character are in the other three constituencies in the borough. Naturally they are used by my constituents, so I am concerned about the situation that has arisen. I do not intend to refer to any particular hospital for that reason, but I shall emphasise some of the points that my hon. Friend made, in particular the fact that Bromley district health authority has been placed in a very difficult position. To meet the financial limits it has been faced with various options, all of them unpalatable, and my hon. Friend described how hard it was for the authority to reach its recent decision.
The financial problems facing the authority stem from various causes, one of which is the so-called Lawson cuts, which did not make life any easier for the authority, particularly coming mid-year and without warning. Then there was the 0.5 per cent. cut in staff, which again appears to have been imposed in a rather overall manner and without consideration of the extent to which staff economies may have been effected in the past. I appreciate that the Department is now implementing so-called performance indicators, which may in the future give some idea of how well one authority is run compared with another, but for the time being these cuts are imposed on an overall basis.
Then there is the problem of the application of the RAWP formula, to which my hon. Friend referred. I am 601 sure that the Minister will say that the financial allocation to each district is a matter for the region, and that is true, but the allocation to the region is a matter for the Secretary of State, so the way in which RAWP works out is eventually a departmental responsibility.
I realise that there is a disparity between regions and a disparity between districts within regions. But the theory, after all, of RAWP was that the well-endowed areas, such as Bromley, should stand still to allow the less well-off areas to catch up. The reality of the situation is that there is a loss of hundreds of thousands of pounds in real terms to areas such as Bromley, and I ask the Minister to have another look at the way in which the RAWP formula is affecting areas such as Bromley.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)
I am pleased that we heard this morning from my hon. Friend the Member for Ravensbourne (Mr. Hunt) and that my hon. Friend the Member for Chiselhurst (Mr. Sims) was able to make his voice heard on behalf of his constituents. Although they do not have a hospital, they have an interest in the hospitals in the Bromley area. My hon. Friend the Member for Ravensbourne made a forceful case, and I know that there is considerable local feeling about the Lennard hospital. That depth of feeling has been reflected in the robust way in which my hon. Friend has brought the case to the notice of the DHSS and discussed it with Ministers. I hope that what I can say in the brief time available to me will provide some reassurance to him, even if I am not able to go in great detail into the issues of RAWP.
All hon. Members would agree that the Bromley health authority has a difficult task, and we should collectively pay tribute to the chairman and members for the way in which it has faced up to it. I appreciate that my hon. Friends are not criticising directly any individual on the authority, and I am glad that both my hon. Friends assent to that assertion.
The decisions made on 20 September were caused by the urgent need to bring the authority's expenditure level within its cash limit. Mr. Deputy Speaker, as you know from listening to many other Adjournment debates—they normally occur not when daylight is coming into the Chamber but much later, at night—I have said that temporary closures can be made because of the urgent need to bring the authority's level of spending within its cash limit. The Department of Health and Social Security accepts that point.
My Department's guidance to health authorities such as Bromley clearly stresses that, where there is any prospect of temporary closures becoming permanent, consultations under the established procedures must occur as quickly as possible. The Bromley health authority proposes that all the temporary closures on which it has recently decided should become permanent. In accordance with our strict guidance, it proposes in January next year—only a couple of weeks' time — to issue a consultation document that fully explains its proposals and the reasons behind them.
I was interested in the report by my hon. Friend the Member for Ravensbourne on the outcome of the community health council's meeting on Monday. I was not aware of that meeting or what it decided. We may hear 602 more at a later stage in writing about what occurred at that meeting. I was pleased also to hear what he said about his deep anxiety, and long-term views, which I know have been reflected in correspondence with my Department, about the pattern of care within the Bromley area as a whole. I urge him to make those views known forcefully, first to the health authority as the local body having the job of deciding the pattern of long-term action.
§ Mr. John Hunt
I assure my hon. Friend that the health authority is well aware of my views and is responsive to them. I believe that he is thinking along the same lines as I am, and I am sure that that will be reflected in the proposals that are put to his Department.
§ Mr. Patten
I am reassured to know that my hon. Friend and the health authority are working closely on those issues. I am convinced that, from time to time, Ministers must intervene in such cases, especially when closure proposals are brought to them. Those decisions are best made in the local context within the framework of local feeling. I do not intend to bore the House by going through a lengthy discussion of consultation procedures that must be carried out. I suspect that you, Mr. Deputy Speaker, has heard them on many occasions in the past.
I make it crystal clear that where proposals are referred to Ministers, they will not—I stress the word "not"—agree to any closure or any change of use unless it is clearly demonstrated to be in the best interests of local health services and the communities they serve. I am happy to give that assurance. It would not be appropriate for me to intervene at this stage as the consultative process on the proposed permanent closures and changes of use in Bromley has not yet begun, and I must not prejudice our ministerial position. I am advised that the consultation document will set out all the implications of the various proposals. My hon. Friends the Members for Ravensbourne and for Chislehurst will both automatically be invited to comment when the document goes out for consultation.
I am happy to assure my hon. Friend the Member for Ravensbourne that he need have no fear that, because these proposals have been made and temporary closures have taken place, the consultation process is in any way pre-empted or that temporary closures will automatically become permanent. If the proposals come to us for decision, the long-term interests of the Health Service in the Bromley district will be our primary concern. We shall make those decisions in that light if such matters come to Ministers for decision, as I suspect they will because of the strength of local feeling.
To reinforce that point it is important to remember why the Bromley health authority has been faced with such problems. There are the implications of the RAWP process, to which my hon. Friend the Member for Chislehurst has drawn attention. I reassure him that we shall keep the RAWP formula constantly under review. I shall bear his points in mind.
My hon. Friend the Member for Chislehurst made important comments about the changes in expenditure patterns, introduced following the announcement in July by my right hon. Friend the Chancellor of the Exchequer. I know that my hon. Friends the Members for Chislehurst and for Ravensbourne are aware of the impact of that announcement on the Bromley health authority.
Nursing costs in Bromley — my hon. Friend the Member for Chislehurst dealt with this—which will be 603 illustrated by the performance indicators, when they are available, are above average for the south-east Thames region. Performance indicators do not answer any questions, but they take us into certain directions and enable us to ask some pertinent questions about those costs. Budgets for 1983–84 nearer the regional average were set by the authority, but it became clear during this financial year that the required reductions were not being made. There has been a forecast of net overspending by the end of this year for which provision has been made. The authority responsible for the allocation of resources within the districts that make up the south-east Thames region has acted promptly and increased Bromley's cash limit this financial year by £500,000 — a not inconsiderable sum—to try to help the Bromley health authority, on condition that it undertakes a programme to recover the deficit.
Bromley needs to consider how it can most effectively use its resources for the benefit of patients. In that context, I am especially glad to note that the authority intends to make savings of at least 10 per cent. this year on catering, cleaning and laundry by going out to competitive tender. The health authority was one of the foremost in the country in making those plans, and it is to be congratulated on what it is doing to save money for patient care, which is as necessary a process in Scotland as in England, as the hon. Member for Fife, Central (Mr. Hamilton) and the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes) have just heard. The authority has decided on the temporary measures that I have outlined and will consult about making them permanent.
The authority believes that the proposed closure of the Lennard hospital could have advantages for patients. It believes that there is a much wider range of back-up medical facilities available at the Farnborough hospital to which beds might be transferred in due course. Farnborough hospital has claimed — I use the word "claimed" because the DHSS has examined no options, and has come to no decisions—to be more convenient in terms of public transport than Lennard hospital. I do not know about that, as I am not aware of the bus services in the area.
The authority also believes that its proposals are consistent with—[Interruption.] I had hoped that the hon. Member for Fife, Central might restrain himself until the next debate, because the Government are examining an issue that concerns all hon. Members. I should be grateful if I could continue to discuss the issue in a responsible way.
The authority also believes that its proposals are consistent with its strategic aim of improving health care facilities in the north of the district, where the bulk of the population lives. If proposals eventually come to Ministers, they will be looked at afresh. We have considered no options and we have ruled out no options. We are not committed to any course of action. I hope, therefore, that my hon. Friends the Members for Ravensbourne and for Chislehurst will accept that in this context a temporary closure does not mean a fait accompli.