HC Deb 16 February 1983 vol 37 cc442-50

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

1.53 am
Mr. Laurie Pavitt (Brent, South)

As you know, Mr. Deputy Speaker, I have taken an interest in health matters ever since I came to the House. During the past 12 months—the latest occasion was on Tuesday of this week—Ministers have claimed that the National Health Service has been getting more resources and funds than ever before. Every hon. Member, however, is finding that in his own patch district health authorities are under acute pressure to cut patient care and services to meet the balance sheet demands of their accountants.

Last year Brent district had a cut of £200,000 in real terms in comparison with the 1981 allocation. This year the heart-breaking task of my district health authority is to find a cut of £750,000 in real terms for 1983–84. That is in complete contrast to the figures that we get from the Dispatch Box about the increase of resources for the Health Service.

The nonsense of the Resource Allocation Working Party formula falls hard on Brent. Because the North-West Thames region is one of the big spenders, there has been a cut of another £8 million this year. The RAWP formula fails to recognise that within a region there are areas of poverty and distress where the RAWP formula should not apply.

If fully applied according to present statistics, the options open to my district health authority are to close half of its one and only district general hospital—the Central Middlesex—or to close two thirds of the Shenley psychiatric hospital, the whole of the service for geriatrics and the service for the mentally handicapped. However, it would be no good trying to meet the demands of the balance sheet by closing down the whole general practitioner service, because we would need to do that twice to meet the present amount that is required in cuts. The regional health authority figures show that of all the hospitals in the region, my district general hospital, the Central Middlesex, is one of the top third for efficiency.

The Brent health district has been in a state of perpetual siege since its inception on 1 April last year. Brent borough has 250,000 inhabitants, and 43 per cent. are from the ethnic minorities. It is a classic inner city, rundown area from the point of view of industry, housing and amenities. From prosperity 30 years ago, when it was a highly industrialised area, it has declined to a twilight industrial desert in many industrial estates because of factory closures. We have the highest unemployment in the history of the borough. The housing shortage and homelessness of 500 people mean an extra charge on the community. Serious social problems prevail. Yesterday that was recognised by the Secretary of State for the Environment when Brent was declared to be one of the areas designated for urban aid.

That does not affect the basic problem of health. My concern is about the whole health provision—hospitals, general practitioners and the community. I shall concentrate on the hospital sector. I remind the Minister that the core of my area is the district general hospital—the Central Middlesex—with 650 beds. It is the only general district acute hospital in the area. Last year there were 17,000 inpatients and 170,000 outpatients and casualties. The hospital houses the only neuro-sciences department in the region.

I remind the House of the proud history of the hospital. Sir Richard Doll was one of our consultants. Sir Francis Avery Jones is perhaps the greatest gastroenterologist in Europe. The hospital also teaches students from the Middlesex hospital. The only occupational health service in existence was pioneered by the Central Middlesex hospital. There were two 25 years ago—one at Slough and one at the Central Middlesex. However, that at the Central Middlesex is the only one that has been retained.

I bring this matter to the attention of the Minister because of the acute anxiety caused by a secret document produced by his Department and the regional health authority, which was so secret that, like most of these things nowadays, it received publicity on BBC "Nationwide" and headlines in the national press the next day.

The authority claims that it is only a background paper, but it is a soulless statistical exercise with highly selective figures, many of which are inaccurate, and completely devoid of any real understanding of the health needs of my constituency.

Last night there was a special meeting of the district health authority with the regional health authority. We sought a guarantee that there was a future for the Central Middlesex hospital. The regional authority would give no such undertaking.

I therefore ask the Minister for a categorical assurance today that the Central Middlesex hospital will be retained, with all its many sectors and disciplines, as a continuing service in my area.

Most of us accept that there is no decision for immediate closure, but the uncertainty endangers the future of the hospital because blight sets in. Posts are advertised, but consultants do not apply for them. Medical posts remain unfilled. There is a general rundown and over a period of years viability will disappear. Already, when we were about to interview for two very important operating theatre sister posts, both applicants cried off after the BBC "Nationwide" report due to the fear that there might be no future career for them. The hospital had to readvertise.

I have been through this before. In 1968, when I was on the regional health authority, there were plans to close the Willesden general hospital. That hospital had 140 beds and provided a number of surgery and other acute services. In the event, the hospital was not actually closed—I raised the matter in debates and at Question Time on many occasions over a dozen years—but the nice little label "change of site use" in the end has achieved the same purpose. What used to be a general hospital in the heart of a densely populated community now has just 38 geriatric beds, with a further 20 beds, about which I am very pleased, about to be opened for the young chronic sick.

Over a period, creeping paralysis of that kind has exactly the same effect as the decision to close a hospital. I therefore ask the Minister again to give a definite reassurance to all those who work in the Central Middlesex hospital and all those who use it that its future will he as great as its past.

The district health authority now faces the awful necessity of closing another hospital in the area—the Leamington Park hospital, which has 95 geriatric beds and is bound to close within the next few months. The geriatrics will be sorted out to other hospitals in the area. Again, however, it means an enormous curtailment of the geriatric facilities available.

Wembley hospital, which was a district hospital with many specialties, is now being run down. To meet the savings demanded by the region, the district health authority is about to close the casualty department, trying to transfer the service to the Central Middlesex hospital on the other side of the borough and to absorb some of the geriatrics from Leamington Park.

Wembley hospital, again, is the centre of a residential community. It is esteemed and beloved by families who have usd it for generations, but it seems now to be a candidate for death by attrition.

I ask the Minister to consider two economic problems which to me are nonsense. The Central Middlesex hospital was encouraged to spend £250,000 on upgrading its laundry services on the understanding that it would be taking over the service of Northwick Park hospital, which at that time was under the same area health authority. That laundry is now being sent to a private firm in Birmingham, although I understand that that firm's tender was higher than that of the Central Middlesex hospital. That seems to go against all local government principles. There is to be a further tender in a month's time. I ask the Minister to examine this seriously so that the money invested by the National Health Service is not dissipated and the full laundry capacity at the Central Middlesex hospital is used.

The second economic problem is caused by the administrative nonsense of questioning people who might be foreign visitors to see whether they are entitled to treatment. At the Central Middlesex hospital, in the first half of October, 1,203 patients went through the stage one interview. Of those, nine needed to go to stage two, at which point a foreign student who had just arrived in the country was found to be ineligible for treatment and he went away. The other eight were all eligible, including one who would not have been eligible under the old rules. The number going to stage two was about the number that we would have expected to question more closely under the old rules. The effect of all this is that the queue of new patients has moved more slowly than it otherwise would and many patients have felt upset about being asked these questions. It seems a great deal of effort for little result. When one realises that 43 per cent. of the patients in that area are likely to come from the Caribbean, a racial problem is created at the same time.

I regret having to say that the Secretary of State and the Minister are such experts in statistics, politics and polemical debating points that they treat my health authority with contempt, as is shown by a letter written by the chairman of Brent DHA on 30 September last, to which the Secretary of State replied on 10 February—six months later—only with platitudes, in a brush-off letter.

The Ministers involved know little about ordinary people or patients, and I regret that their understanding and compassion about health and the National Health Service are woefully meagre.

2.06 am
The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)

The hon. Member for Brent, South (Mr. Pavitt) follows the example of so many of his colleagues in turning what could be a helpful debate into a foolish, political polemic. He should not pride himself on being the only person who cares about people or patients. Despite all the figures that he trots out time and time again, he knows full well that we are spending 6 per cent. more money in real terms than when his Government were in office.

Mr. Pavitt

Not in my area.

Mr. Finsberg

The hon. Gentleman will remember well that the Chancellor he supported had to rush back from the airport because of the financial chaos caused by him and his colleagues by irresponsible and gross over spending.

Mr. Pavitt

No, quite wrong.

Mr. Finsberg

The hon. Gentleman does not like the points he has made answered. I sat listening peacefully to some of the nonsenses he trotted out. He might now listen to some of the answers that I propose to give. He has said that there are problems in his health district. I agree with him, but he knows well, as has been said by successive Health Ministers in all Governments, that resources for the National Health Service are finite, whereas demand is infinite. We have to ensure that we make available as much as the national resources will permit. That is one of the reasons why we instituted, many years after it should have been done, charges for certain overseas visitors. It will be extra income for his health district. I note that he wants to chuck it away. That type of thing should be noted carefully.

There are one or two points that the hon. Gentleman raised in a more constructive manner, and I should like to deal with them. There are clearly many misunderstandings about the resource position of the NHS as a whole, and certainly of the way in which money is allocated to health authorities—some of these contribute fairly to the feelings of concern in Brent.

Brent, as the hon. Gentleman said, is one of the larger health authorities, and its statutory responsibilities encompass the health needs of a population of about 250,000 people and the management of eight hospitals. They include two very large hospitals—Shenley with more than 1,000 beds for mentally ill patients drawn from a wide area, and the Central Middlesex hospital which provides, in theory at least, general acute hospital services for the district's population. That the Central Middlesex hospital treats almost as many people from outside the district as from within, and that more of Brent's population is treated at hospitals in other district health authorities than in Brent, are important anomalies that underline the planning problems about which I shall talk later.

Brent has significant responsibilities, and to discharge them it has an annual budget in excess of £40 million. I repeat that, to place this discussion in a national context, the NHS has never before had so high a level of resources as it has now. That is not just in money terms—the number of doctors and nurses is also higher than it has ever been. Despite the world economic recession, we have not reduced the funds allocated to the Health Service. On the contrary, total expenditure has nearly doubled from £6.5 billion in 1978–79 to nearly £12 billion in the current financial year.

However, the hon. Gentleman said that the Brent health authority faces the need to reduce its expenditure. That is correct, although I disagree with the figures that he quoted. The regional health authority has not yet completed its sums, and Brent's allocation for the financial year 1983–84 has not yet been finally worked out. But it may well be that the quoted figures are not far off the eventual outcome and, although the scale of figures is important, we are considering the principle of why and whether a health authority's revenue allocation should be reduced.

The most important reason is the Resource Allocation Working Party. I remind the hon. Gentleman that RAWP was introduced by the Labour Government when he was still a Whip, and I do not recall him making loud protests—

Mr. Pavitt

I spoke about it.

Mr. Finsberg

I do not recall the hon. Gentleman making loud protests when he was a Whip. Perhaps he did so when he was released from those onerous responsibilities, but he cannot get away from the fact that RAWP was the creature of his Government. RAWP recognised that there were significant inequalities in the geographical distribution of NHS resources. It recommended a way of calculating health authorities' allocations, based on the population served, with adjustments designed to take account of the varying health needs of populations of equivalent size in different parts of the country. The mechanism proposed by RAWP, although no one has ever acknowledged that it was perfect, has not been seriously challenged as the most practical way—

Mr. Pavitt

In the Black report.

Mr. Finsberg

No one has ever seriously challenged it as the most practical way of changing the allocation of funds to achieve the objective that all of us wish of having the same figures overall.

Mr. Pavitt

Read the Black report.

Mr. Finsberg

I have read the Black report frequently. The hon. Gentleman knows very well that what he is saying comes, not from a proper reading of the Black report but from selective quotations.

Brent district health authority is currently funded at a level significantly above its target calculated according to RAWP criteria. According to the region's most recent calculations, Brent is currently 16 per cent. above its target on a regional basis, and almost 30 per cent. above its target calculated on a national basis. Overall, the region is significantly over target by 11 per cent. It means that even if Brent met its regional target, it would still be much better off than many health districts.

What do the factors that make up those calculations show us? They show clearly that they are designed to take account of relative social deprivation. The North-West Thames regional health authority considers the proportion of ethnic minorities, elderly pensioners living alone and households lacking amenities when calculating its districts' targets. As the hon. Gentleman said, those factors are evident in his district and they are taken into account when North-West Thames authority works out the RAWP position for its region. Cross-flows of patients between districts are also taken into account and, as I said earlier, about half the patients who attend Central Middlesex hospital are not from Brent district.

The operation of RAWP has and will have a significant effect on North-West Thames region and on Brent. The region has received only a quarter of the average development increase available to the NHS as a whole during the past five years. Not only that, but for this year and next year we have agreed with regional chairmen that an element of NHS development money can be funded from money saved by making more efficient use of NHS resources, one aspect of which is the significant reduction in the number of chief officer posts in the NHS consequent on the changes in NHS management structure that we introduced last year.

Based on the region's calculations following the provisional allocation figures issued in July, the most likely pattern for Brent is a reduction in real terms of £200,000 in the current financial year, and a further £500,000 in 1983–84 and in 1984–85—at least half of which the district will fund from increased efficiency in the provision of services. However, based on the region's calculations following the provisional allocations figures issued in July, the most likely pattern is that Brent will need to find efficiency savings of £700,000 in the current financial year and about £250,000 in 1983–84 and in 1984–85. In addition, it will also be required by the region to release a further sum in 1983–84 and 1984–85—of about £250,000 in each year—reflecting its distances from its RAWP target. This money will be used, for example, within the region to enable major improvements in services to be made in Bedfordshire and Hertfordshire, which are seriously underfunded even on a national basis.

To set this in perspective, in 1980–81, the then Brent and Harrow area health authority spent £170 per head of its resident population on health service provision—compared with only £100 per head available to Bedfordshire area health authority. A similar contrast exists between Brent and other over-funded London health authorities and many health authorities elsewhere in the country.

The really important point, however, is that the problems faced by Brent health authority are not simply about the level of resources available, nor are they problems unique to this health authority. The major problem is a planning problem, and it is one experienced by many other health authorities in London. Put very simply, in common with many other health districts in London, Brent has a much higher per capita expenditure on NHS services than most—even taking account of its level of social deprivation—because of a higher than average level of provision of expensive acute hospital services, arguably higher than is needed. An illustration of this is provided by the fact that there are 10 other major acute hospitals—including four teaching hospitals—within a five mile radius of the Central Middlesex hospital. These 11 acute hospitals between them provide more than 7,000 beds.

The hon. Member referred to press reports of a possible threat to the future of the Central Middlesex hospital. I am not aware of any specific proposals to close or change the use of the Central Middlesex. Indeed, I understand that the region has, over the past few years, invested significant capital funds in upgrading most of the wards in the hospital to provide a much needed improvement in the services provided there, and officials in my Department are currently considering proposals for an acute psychiatric unit to be built there.

I suggest that if the hon. Gentleman wishes to help morale and job applications he should stop saying that he has read the reports in leaked documents to the effect that the Central Middlesex hospital is under threat of closure. That does more harm than anything else. If he were to rely on published information instead of on leaked documents, he would be able to do a better job for his hospital, for which he cares so much.

However, I must underline the complexity of the planning problem in this part of London. Partly because of the historical concentration of medical teaching in London and partly because significant advances in medical knowledge and technology in recent years have changed the basic requirements for an effective pattern of health services, there is now significant over-provision of acute hospital services in Inner London, matched—it must be said—by insufficient provision for certain of the priority services, particularly services for elderly patients. Other factors—such as the quality of primary health care services and those services provided by local authority social services departments—are also relevant.

The steps that we have taken will help to ensure that the plans made to change the present pattern of services to accommodate these changes properly reflect local needs, but we cannot stand still, and this may mean that in some cases well-loved hospitals and institutions will need to undergo changes of use or structural changes to accommodate different functions.

Brent cannot be exempt from this process, but I emphasise that I have received no firm proposals. It is the regional health authority's job to develop a strategic plan for the region's services, and the work is still at its early stages. However, the local health authorities—including Brent—will be given a full opportunity to participate in this process. Indeed, much of the strategic planning carried out by the region will be based on proposals generated by district health authorities themselves. In view of the complexity and importance of this, I am delighted that the regional chairman made it clear to my hon. and learned Friend the Minister for Health—when they met to review the region's activities last year as part the new accountability arrangements—that she considers the production of a proper strategy to be a top priority for her authority.

The hon. Gentleman has also referred to his concern about the specific changes proposed by Brent as part of its operational plan for the coming year. In particular, he has raised the proposal to close Leamington Park hospital, a geriatric hospital situated just outside the territory of the district. As he must know, there is a formal consultation procedure which health authorities must follow when they intend to close or change the use of health buildings. One of its basic tenets is that health authorities must seek ministerial approval if their proposals meet objections at local level from the CHC which they are unable to accommodate. This means that it would be premature for me to comment on the detail of the proposal. However, it may be helpful if I put on record at this stage what I understand to be the basis of the authority's proposal.

I understand that the building itself is in poor condition, and it is estimated that it will require approximately £1 million to keep the hospital open. Empty wards at Willesden and Neasden can be used to rehouse the patients, and two wards have already been upgraded for this purpose. There will be no reduction in geriatric provision, but a reduction in acute beds, of which Brent has an excess of 130 over regional guidelines.

The facts speak for themselves. The hon. Gentleman knows full well that the resources available to the nation are limited. The resources that we have made available are a larger share of the cake than any previous Government have been able to put forward. If districts and regions work in the most efficient and effective way—making full use of private contractors where that will save money and give additional money for patient care—that is the way forward. It does no good for Labour Members constantly to repeat the falsehood that we are cutting the NHS. That is not so. We have provided a larger cake, and it is for the regions, under the NHS system, to allocate the slices according to local needs.

Question put and agreed to.

Adjourned accordingly at twenty-three minutes past Two o'clock.