Corby Community Hospital (Hansard, 17 January 1983)

§ Mr. Bill Homewood (Kettering)

I am raising the subject of the proposed closure of Corby community hospital on the Adjournment first to bring formally to the Department's attention the acute sense of shock and anger that the proposal has aroused in the local community, and, secondly, to enable me once again to bring to the Department's attention the severe under-funding of the Oxford regional health authority and the effect on the district health authorities in the region which has given rise to the problems that the Kettering district health authority faces.

I have had reams of correspondence with the Ministry about funding and have raised the matter on the Adjournment of the House before. Northamptonshire Members of Parliament recently met the Minister and were given undertakings on two claims that were made. The first was that he would seriously examine our contention that Oxford regional health authority was unjustly funded under the terms of the resource allocation working party formula because the population figures that are used are always two years out of date and that the region, especially Northamptonshire, was one of rapidly growing population. The second undertaking was that the Minister would consult the chairman of the Oxford regional health authority about our belief that Kettering district health authority was further maligned in that its funding from the regional health authority was even more out of line than the rest of the region.

We have heard nothing of those undertakings. I hope that the Minister will address himself to them in his reply.

Only this morning I received a letter from the Northampton branch of the British Medical Association, once again drawing attention to the county's underfunding. I am sure that I do not need to remind the Minister of the draconian options that were drawn up by the Oxford regional health authority when it was examining its financial position for the coming year. I hope that in his reply the Minister can show not only his understanding and sympathy but his willingness to provide more practical help.

My immediate concern is about the consequences of those financial problems in terms of the Corby community hospital and its proposed closure by the Kettering district health authority, and to impress upon the Minister the fact that such a closure would be an injustice in any town the size of Corby. When Corby is seeking to prise itself from the ground following the industrial assault that it suffered after the closure of its iron and steel works, it would be nothing short of social rape and would be another nail in the coffin of the social fabric of the town that so many of its people are struggling to secure.

Why has the Kettering district health authority chosen to make the decision to close the Corby hospital? The basic answer is that it needs to trim £750,000 from its budget, in view of the underfunding that I have already mentioned. The reason why the closure of the Corby hospital is the largest single contributor to the saving, at £180,000, must be that that it was such an easy option. The £180,000 represents just three-quarters of 1 per cent. of the authority's expenditure. However, to find that amount 147 within its other services and hospitals would have involved a deep study and analysis of its activities. I accept that the authority would have had difficulty in carrying that out.

As its justification for the closure, the authority offers the subjective conclusion of those taking the decision that this way offers the least harm and the greatest benefit to patient care in the district. It is not easy for a layman to question medical opinions. They exist in that world of sophisticated elitism that can be compared with that of watch repairers and television mechanics. However, questions have to be asked. Did the least harm include the harm that would be done to the elderly relatives, and the neighbours of the elderly people who would now give the so-called community care about which we hear so much? The Corby community hospital's main activity is the care of the elderly.

I am an authority on community care. I have living with me a 90-year-old mother-in-law who is almost blind. All our community care comes from my wife. I have an 88-year-old father who is currently in hospital but who from time to time is discharged to his retirement bungalow and into community care, which amounts to meals on wheels four days a week and a home help twice a week. but for the existence of my wife and me, he would long ago have starved from Thursday to Monday and would never have had a change of clothing. My wife is 64 years of age. Had she been a nurse, she would have retired four years ago. Such are the circumstances of most of the people who will have to care for those who will not be able to be taken into the Corby community hospital.

I have expert opinion on my side about the trauma that will be inflicted. The Northamptonshire county council director of social services has said that more elderly people will have to be taken into residential care if the hospital closes. His committee's policy of keeping the elderly in the community will become unworkable because the home help organisers will be unable to cope.

Was the harm to friends and relatives taken into account by the health authority? Did the authority take into account the effect on the morale of people in Corby when they see that Kettering, Wellingborough, Rushden and Market Harborough—all within close proximity and much smaller than Corby—have their own hospital facilities?

The Corby hospital is vital. It is the only hospital facility in a town with a population of 53,000. There can be no doubt about full use being made of it. Already it has cared for 1,200 patients since it was opened only three years ago. That statistic can only reflect the great convenience and security and the allaying of anxiety both for the patients and for their families. The hospital has become an integral part of the town's services.

In very practical terms, the 1981 census revealed that Corby has the highest incidence of non-car-owners in the county—46.3 per cent. The bus journey to Kettering general hospital takes 50 minutes and costs 88p for a single journey. In this respect, it must be remembered that those who are caring for the people in community care are already elderly and will have to make the journey to Kettering general hospital to visit if those for whom they care have to be hospitalised.

The consequences of closure are self-explanatory. There will be direct effects on patients and their families. It should also be remembered that, since the steel industry 148 closures, unemployment in Corby has never been less than 20 per cent. In other words, one in five are out of work—the ninth highest level in the country.

The measure of support for retention of the hospital is clearly demonstrated by the fact that a petition with 9,000 signatures has already been delivered to the Minister's office. I believe that, come what may, justice will be served only if the Minister intervenes to keep the hospital open. If, having received those 9,000 letters, the Minister in his wisdom determines that the hospital should close, it will be a savage blow to Corby—comparable to the closure of the iron and steel works—and will negate most of the Government's other activities in the area. The Government have been fairly good in helping us to achieve an industrial base to solve the unemployment problem, but if they close the hospital they will undermine socially all that they have done industrially.

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

The hon. Member for Kettering (Mr. Homewood) has spoken frankly and movingly in support of the Corby community hospital and in opposition to its closure. He has certainly taken the issue up passionately and wholeheartedly on behalf of his constituents and I have been left in no doubt about the strength of local feeling on this issue. Indeed, as the hon. Gentleman said, he and his colleagues have seen my hon. and learned Friend the Minister for Health about National Health Service resources in Northamptonshire and he and those hon. Members who accompanied him will hear shortly from my hon. and learned Friend in response to their meeting with him.

The hon. Gentleman also brought a delegation representing local interests to see me and presented a petition with some 9,000 signatures. As he has said, by any standards a petition of that size is both compelling and impressive. It certainly impressed itself on my officials who had to stagger back to their building with nine boxes of it. It is not the only petition that we have received about the Corby hospital and there has been a steady flow of letters and comment about the proposal to close it.

I would like to say a word here about my own interest in Corby. My previous post was as a Department of Environment Minister with responsibility for new towns. I know Corby well. I have been interested in its growth and development for many years, and I visited the new town in 1979. Of course I sympathise with the wider problems it has faced and, although I readily appreciate the local feeling that a series of economic body blows has sapped the morale of the community, all the indications are that the spirit and enterprise of Corby is enabling it to cope and survive in a far more convincing way than many other communities.

The hon. Gentleman certainly acknowledged the fact that central and local Government have not abandoned Corby to its fate but have put a great deal of effort and money into the town. There are promising indications of the impact that this is having on the economic future of Corby. I do not want to overstress this point in any simple way, because the stress and burden of unemployment and economic uncertainty are a very real problem in Corby, but I must make it clear that the possible closure of the community hospital cannot be portrayed as yet another savage blow by an uncaring Government.

149 As I want to explain clearly, the critical decisions about the future of the hospital are yet to be made. I have to make it crystal clear, as I have done in more than one Adjournment debate in this House, that I have no intention of prejudicing the possible involvement of Ministers by getting closely involved in the detailed arguments during this debate. The statutory process has to be worked through. However, it is important that the basis of the decision-making process is made clear. This has to rest on the best, the most appropriate and the most efficient way of providing health care facilities to a community within a given level of resources, and it must be remembered that the responsibilities of Kettering health authority extend far wider than Corby. No matter how much local loyalty, commitment and strength of feeling there is in regard to a hospital, and no matter how much it is a part of a community, I am sure that the House understands that these considerations must be related to those of service and resource.

Corby community hospital is a small hospital within the Kettering district health authority. It has 20 GP beds. It was originally planned to provide medical and surgical treatment of a straightforward and non-specialist kind to patients of all ages. In practice the hospital has provided care mainly for the elderly—for convalescence after discharge from another hospital, holiday admissions, social admissions and family relief admissions.

It is widely acknowledged, and I would like personally to endorse the view, that the hospital provides a valuable and efficiently used resource. I must also stress though, that the majority of people needing hospital care—especially of a more serious kind—use the other hospitals in the district, particularly at Kettering.

The Kettering health authority is faced with a potential overspending of about £0.6 million this year, 1982–83. The reasons for this are complex and lie in the historical patttern of resource allocation within the Oxford regional health authority and, before April 1982, within the Northamptonshire area health authority. There would be little argument about the suggestion that Kettering has been an underfunded part of an underfunded area health authority in terms of its distance from its target allocation. The regional health authority, whose job it is to allocate resources to its constituent health authorities, adopted a sound policy of moving all of its area health authorities to within plus or minus 2½ per cent. of their targets.

They achieved a great deal of success in Northampton which, by April 1981, had moved from 11.19 per cent. below target to 3.97 per cent. below. This was at area level. Kettering district became an authority in its own right in the 1982 restructuring exercise, and the RHA is carrying out further research to determine district targets. There has long been an expectation on the part of the district of an upturn in its financial position, and there has been a corresponding tendency to move to an overspending, albeit within a manageable margin, although this has been monitored by both the district and the region. The health authority was faced this year with last year's overspend being the first charge on its new allocation of resources. Unless it can bring its overspending under control, this situation will be compounded in future years.

That says something about the history of how the present situation has been reached. We come now to the attempts made by Kettering to deal with its problems. First, I must stress that the Kettering health authority has 150 an overriding statutory responsibility to live within its budget, and it has had to face this responsibility squarely in the face of the present potential overspend. I should say that the search for economy and good housekeeping is not new to Kettering. It is a process that it has been going through for many years.

The authority was therefore faced with the need to realise substantial savings in an already lean service. In coming up with this package, it kept a number of basic principles in mind—in particular, to spread any reductions in services as widely as possible, both geographically and across the range of services provided and, secondly, to minimise the diminution in patient care. The decision which has been put forward to close Corby community hospital—at a saving of some £180,000 a year—has been taken not in isolation but as part of a total package which was designed in accordance with the principles already mentioned.

The health authority considered a list of some 28 options before deciding on a package of eight which included the closure of Corby. The decision to close Corby has been taken reluctantly by the health authority, and it has announced a firm intention to re-open it as soon as funds are available. The decision has been endorsed, with equal reluctance, by local GPs, the hospital medical advisory committee, the GP advisory committee, and the district medical committee. They have all recognised and acknowledged that the alternative ways of saving £180,000 would be more damaging to patient services across the district than the closure of Corby community hospital. Indeed, serious damage would be done to services on which the population of Corby in general rely, rather than the mainly elderly patients who are cared for so devotedly in the community hospital by their GPs.

Having explained how and why the present situation has developed, I want to repeat the procedures involved in the closure of health facilities so that the House understands fully the role of Ministers in the process. A health authority cannot just say "We need to do this, therefore, we shall". The Government have laid down that any proposals must be consulted upon, even those which have to be implemented quickly as emergency measures. They, too, must be consulted on as soon as possible.

This consultation is normally in two stages. There is an informal sounding out of local interest groups either in the context of general planning proposals for the development of services in the district or, more directly, as has already taken place in this case, by focusing on a number of options designed to meet particular objectives. Views and comments received during this stage will clearly influence the final package of proposals again as they did in this case. Then the health authority must move to formal consultation on one or more specific proposals. This must be centred around a formal consultaion document. This document must be circulated to a very wide range of bodies locally—community health councils, local authorities, staff representative committees, family practitioner committees, local medical advisory committees—medical, nursing, paramedical and so on—local professional representative committees, other health authorities affected by the proposals, the regional health authority and local Members of Parliament.

Officials of my Department are also informed so that consideration can be given at that stage to any national implications of the proposals. Consultation is not confined to formally constituted local bodies such as I have 151 mentioned. The health authority normally sends copies and invites comments from all relevant voluntary bodies, and of course it is open to anyone to request a copy of the document from the health authority and to submit comments.

Once the comments have all been received the health authority must then re-examine its own proposals in the light of those comments. In particular we attach particular weight to the views of community health councils in their role as watchdogs for the local consumer interest—patients and potential patients and clients of the NHS. If the CHC is unable to agree to the main substance of the proposals the health authority cannot implement them. They must be referred first to the regional health authority—which will look for a compromise acceptable to the CHC yet which will still achieve the original objectives of the proposals—and if the CHC still objects Ministers must take the final decision.

I should emphasise that the CHC's power carries with it certain responsibilities. The main one is that the CHC's objection should not be trivial. We expect the CHC to submit a constructive and detailed counter-proposal which considers fully all the factors that have led the health authority to make the proposal. It may be that this counterproposal will enable a satisfactory solution to be achieved. In this particular case, the formal consultation period ends tomorrow, 18 January, and the CHC will be considering its position on Thursday. This should enable the Kettering district health authority to take final decisions at its meeting on 25 January.

If the case then has to go to the RHA and subsequently to Ministers, it will be for my right hon. Friend and me to take the decision. I can assure the hon. Member here and now that we shall take full account of all the views presented to us and pay particular attention to his words today.

The hon. Member may find it helpful if I talk for a little about the allocation of resources in the NHS in general and in Oxford region and Kettering in particular. I welcome this opportunity because I am concerned that resource allocation in the NHS is a complex subject not well understood by people outside the Service itself, and, indeed, many of those working in the NHS would not claim more than a fairly superficial understanding.

The essential problem is that we do not have any objective measures to show with precision the right level of resources to make available for health services in any particular locality. There is a great deal of truth in the comment made many years ago by a former Minister of 152 Health that the demand for health services is potentially infinite. The only real limit on the size of the NHS is the quantity of resources any Government are prepared to make available for health care.

More resources have been made available. Money for the NHS has grown about 16 per cent. faster than the retail price index and since this Government came to power the share of the gross domestic product spent on the NHS has increased from 4.8 per cent. to 5.5 per cent. A great deal of this has gone on better pay and conditions for staff, but even so services have grown—by at least 5.5 per cent. since 1978–79. Even so, the amount of growth or development moneys available to the NHS is finite and there is historical inequality in the way that money has been allocated in the past. The fact remains, however, that the region is responsible for allocations to districts. As the hon. Gentleman will know the Minister suggested that the hon. Gentleman would perhaps wish to take up Kettering's case with the region direct. I am sure that he has done this on more than one occasion. I thank the hon. Gentleman for raising this particular subject at this time.

Proposals made by health authorities in relation to change of use or even closure of health buildings raise important issues for the relationship between local democratic processes and the policies of central Government. This debate provides a way for local concern about the way in which a local health authority is seeking to implement the Government's policies regarding the NHS to be expressed to those of us responsible for those policies. I am pleased to have the opportunity to expand in some detail on these national policies, the reasons why we and previous Governments have adopted them and the way in which they affect the particular case before us today.

I hope that the hon. Gentleman will feel that the representations that he has made tonight and those made by the very impressive deputation that he brought to see me will be properly considered if, as I said, there is a dispute over this closure and the CHC maintains a view and the matter comes to Ministers for their ultimate consideration. We shall look at the matter in great detail and with great care. I hope that the hon. Gentleman will feel that, by having set out the arguments tonight and by having heard the views that I have expressed as to the position in which Ministers are now and the position in which they will be if the matter is referred to them, the interests of Corby have been very much to the forefront of all our minds this evening.