§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Major.]
§ 10 pm
§ Mr. Ivor Stanbrook (Orpington)
I last called the attention of the House to the problems of Orpington hospital on 11 February 1982. On that occasion a consultative document issued by the South-East Thames regional health authority had suggested that the accident and emergency service at Orpington hospital could be reduced from the present full-time department to the status of a peripheral unit open only during office hours and not at all at weekends. The effect would have been to leave only one full-time accident and emergency service in the Bromley health district, that being the one provided by Bromley hospital.
That was a deplorable proposal. Bromley hospital alone could not cope with the out-of-office hours demand from the Orpington catchment area, which includes Sevenoaks and other areas to the south of Bromley. Moreover, Bromley hospital is located on a small island site in Bromley town. Its expansion is inhibited unless the district health authority wastes millions of pounds of its resources on acquiring the extra land nearby, whereas Orpington hospital is on a wholly-owned large 31-acre site with ample space for expansion.
The people who made this ill-conceived proposal were professional planners and certain medical people who were drawn from areas outside Bromley distict and other parts of the region. They used questionable statistics and were ignorant of many relevant facts and certainly of the strong feelings which people in the south of Bromley borough and in the Sevenoaks area have about keeping open the Orpington hospital casualty department.
As far as I can see, the only support they had was from some people who are naturally alarmed at the widening gap between resources and needs in the National Health Service and think that centralisation of all medical services in one hospital in the district would be in the public interest. They are wrong. The most furious opposition to the idea came from the inhabitants of the Orpington and Sevenoaks areas themselves. I organised a petition to the regional health authority against the plan and it speedily attracted over 7,000 signatures from local residents.
However, when one is fighting a battle of this kind one must expect the enemy to appear in a variety of guises. The formal proposal to downgrade Orpington hospital's casualty department has how been shelved. Instead, I discern evidence of trends which, if allowed to continue, could make that downgrading inevitable in time. I refer especially to the continual neglect of the need for an additional orthopaedic surgeon at Orpington and Sevenoaks hospitals. I am glad to see my hon. Friend the Member for Sevenoaks (Mr. Wolfson) in his place. No doubt he will be seeking to catch your eye, Mr. Speaker, to deal with this problem as it affects his own constituency.
For any department of a hospital to exist, I am told that there must be a consultant in charge of it. He is responsible for the running of the department. Mr. Soli Lam, who is the only orthopaedic surgeon at Orpington and Sevenoaks hospitals, was in charge of the accident and emergency department at Orpington hospital in a voluntary, unpaid, capacity for almost 14 years from 1969. During that time, the number of patients referred to him or treated by him 440 personally rose in volume 15 times. He has an excellent professional reputation and an enormous waiting list, so that a patient joining his waiting list may wait five years or more for what is known as "cold" surgery from the time when he first joins the list. By the end of 1981, at Orpington alone, Mr. Lam had a total in-patient waiting list of 458, including 144 day cases. I believe that that figure exceeds that of the rest of the hospitals in the district together, and it must be one of the highest figures for an individual consultant in the entire country. It derives, of course, largely from the fact that Mr. Lam has a very high professional reputation and that for all this time he has had no orthopaedic surgeon as a colleague to assist him.
In 1982, due to the pressure of his work as an orthopaedic surgeon, Mr. Lam resigned from the post of head of the accident and emergency department at Orpington hospital. As no other consultant of any kind at Orpington hospital is willing to assume that responsibility, the department is now being run by a "committee". No one consultant is in charge of the service regularly.
The only way to keep the department open permanently, whether as a full-time or a part-time unit, is by the appointment of an extra consultant for that purpose. Unless that is done, there can be no long-term future for the accident and emergency department at Orpington hospital.
The attitude of the Bromley district health authority is perplexing and typical of the authority's attitude to the future of Orpington hospital as a whole. When I first raised the matter of the proposed downgrading of the casualty service, the chairman of the district health authority, Mr. Peter Gibson, accused me in the local press of scaremongering. He said that it might never happen. All that I had done was to criticise an official recommendation to consider the downgrading of the casualty department of a hospital in my constituency. One would have thought that that was a perfectly proper thing for a Member of Parliament to do, but to Mr. Gibson it was an unwarranted interference in the bureaucratic process.
I therefore did not expect much response when I asked about our missing consultant. The casualty department at Orpington hospital has now been without a consultant for 12 months and Mr. Lam is still coping single handed with his enormous waiting list. Mr. Gibson assures me that he shares my concern about the problems in this specialty, and says that measures are in hand to see what more can be done for the orthopaedic services.
I got more help out of Sir John Donne, the chairman of the South-East Thames regional health Authority, who has been an excellent chairman and whose recently announced retirement is a grievous blow to the region. Besides expressing his anxiety, Sir John told me:Mr. Lam actually works in two Health Districts, at Orpington and Sevenoaks Hospitals. There are two other surgeons working within the Bromley Health Authority and the equivalent of a little over two (in terms of sessions) in the Tunbridge Wells Health Authority. You will appreciate that it is the responsibility of District Health Authorities to finance the cost of Consultant posts, and the question of whether or not to appoint an additional orthopaedic surgeon between those two Health Authorities has to be determined by them. Both Districts recognise that their waiting lists for orthopaedic surgery are far too long, but neither District is in a position to finance the appointment of an additional surgeon, either whole-time or part-time.441 He added that it would be wrong in principle for the regional authority to provide additional funds for this purpose to any one district authority, with which comment I am bound to agree.
The ball is firmly in the court of the Bromley district health authority. What is it doing about it? Like many other health authorities, it has devoted much time, energy and resources to deciding its priorities for expenditure. It has produced a mountain of paper, and I can speak with feeling about this because I receive much of it. However, it still does not seem to have grasped the point that, when it decides its priorities for expenditure, the last department in which cost-cutting should be exercised is the delivery of clinical services to the patients. The administration seems to grow bigger and bigger, but we hear about cost-cutting only on the clinical side. What the proportion of costs due to administration is to the whole no one seems to know, but I believe that it is large and growing. I suspect that there is a whole army of people in the Bromley district, including highly paid doctors, engaged on producing circulars, memoranda, directives, guidelines, strategic plans and consultative documents and spending many man hours serving on working parties and medical committees, while poor Mr. Lam works himself to a frazzle giving treatment to his patients.
The latest example of this imbalance is the rumoured reduction of junior house surgeon posts at Orpington hospital as a result of a decision taken by the manpower control committee. If it is true that there has been such a cut, it represents a serious decline in medical standards at Orpington hospital generally. There is a point to put to Bromley district health authority—it has not yet put out to tender its laundry and catering services. It has not yet found out whether it might make any economies itself. Until this is done, it cannot say that it cannot find money from savings if that is the reason why it has been unable to provide an additional orthopaedic surgeon.
The people of Orpington take a close interest in their hospital. There is even a local voluntary organisation, the Orpington Nurses and Citizens Association, which monitors the work of the hospital and keeps me informed. Not surprisingly, it has been denied a place on the community health council. What they and the rest of us in Orpington fear is that, despite all the past protestations about the projected status of Orpington as a district general hospital and the building of new wards, the Bromley district health authority, or at least some of its members, would like to concentrate on Bromley hospital and transform the nature of Orpington hospital from an acute general hospital to a largely geriatric one. That has never been stated openly, but it seems to be the logical end of the present policy. Orpington's representatives are a minority on the district health authority and its medical committees and on the community health council. It is therefore naturally up to me to try to restore the balance by exposing the facts in the House.
I therefore earnestly request the Minister to press the district health authority to appoint a second orthopaedic surgeon to be shared between Orpington and Sevenoaks hospitals. Mr. Lam deserves relief. The Orpington casualty service needs a leader. The consequences of not acting soon in terms of human misery and suffering could be immeasurable.
§ Mr. Mark Wolfson (Sevenoaks)
I am grateful to my hon. Friend the Member for Orpington (Mr. Stanbrook) for giving me an opportunity to participate in the debate and also to my hon. Friend the Minister for giving me time to do so. My hon. Friend has spelt out clearly the seriousness of the position and how it could affect the long-term viability of Orpington hospital. I associate myself with all the points that he has made. Sevenoaks hospital depends for the more serious accident and emergency services and for a number of its consultant services on Orpington hospital.
I wish to associate myself also with my hon. Friend's point that large units are not the way forward for the National Health Service. Sevenoaks hospital is an important part of our community and one that we cherish and about which I have spoken previously in the House.
A second orthopaedic surgeon is needed to service Sevenoaks as well as Orpington. I am advised by general practitioners in Sevenoaks that the current waiting time there for hip operations is three years. Mr. Lam is the only surgeon at Sevenoaks able to carry out those operations. This compares with a waiting time for similar operations at the London teaching hospitals of 12 to 18 months. I also understand that only and one other orthopaedic surgeon in the country cover such a large area.
Mr. Lam's involvement with Sevenoaks hospital is that he runs a clinic on one half day a week, an out-patients fracture clinic on another half day and operates on a third half day.
I should like to finish by bringing the human factor into the debate by demonstrating what long waiting lists mean to patients, because I am certain that it is the Minister's intention that patient care will have priority over all else in the National Health Service.
I shall quote from a letter from Mrs. Smith in Otford. She says:Dear Sir, I wonder if you could help me. I am writing on behalf of my daughter Pauline, aged 16. Over three years ago she started having pains in her right knee. After two years of being on crutches, going backwards and forwards to the … clinic, Mr. Lam decided to operate and found that she had a badly torn cartilage. Last Christmas it was wonderful to see her walking about without aid. June came and she started swimming. After ten minutes in the pool, the pains returned. After two trips back to Sevenoaks outpatients, Mr. Lam said that he would do an exploratory operation. I am now in hospital recovering from a car crash. I asked the nursing officer if she could find out when Pauline could be admitted and was horrified to find her card had been pushed back and will have to wait another year. Pauline is heartbroken. Four years, and no teenage life. Can you help me in any way?That is the challenge of the debate, and is what the House and the Government have to be about.
Pauline has not been pushed back. I have ascertained that. The problem is the length of the waiting list. Mr. Lam explains the position. My hon. Friend has specified that the increase in demand has been 15-fold since 1969. Mr. Lam says:Because of this dramatic increase in demand I get at least 10 to 12 requests per week from patients, relatives and even some MPs and general practitioners to expedite, or review, or other euphemisms, patients in order that their operations may be done more quickly.Mr. Lam cannot meet those requests and should not, for all have their own priorities. He says:This is a patent impossibility if the establishment remains the same and the volume of demand continues to increase as it is doing.443 I join my hon. Friend in requesting the Minister to take all the steps that he can to ensure that our health authorities give priority to providing an additional surgeon at the Orpington and Sevenoaks hospitals.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
I congratulate my hon. Friend the Member for Orpington (Mr. Stanbrook) on securing this Adjournment debate about a second orthopaedic surgeon to serve Orpington and Sevenoaks hospitals. I know that he has already been extremely active in approaching the chairman of the South-East Thames regional health authority and the Bromley and Tunbridge Wells health authorities. The debate is clear evidence of his dedication to his constituents' interests. I have listened to the problems that he has described with much feeling and, although I have no easy answer, because it must be for the health authorities themselves to decide on their priorities, I should like to try to explain some of the national and local background. I shall also cover the points that were raised by my hon. Friend the Member for Sevenoaks (Mr. Wolfson).
I remind the House that in spite of serious economic problems the Government have managed to make available to the Health Service resources that are 5½ to 6 per cent. more in real terms than when we came to office. Therefore, we have created a larger cake. However, it is for the regions, with the allocations that they are given, and the districts, to decide how they shall cut it up. That is why in the end the Government cannot say to a particular hospital that it must have three of these and two of those.
Alas, the problem of orthopaedic waiting lists is not unique to these hospitals. Techniques have developed dramatically in recent years, but we are still nowhere near the position where everyone needing them has fast enough access to them. The long delays in obtaining some type of orthopaedic treatment cause us considerable concern, particularly when one considers the pain and anxiety of the individuals involved. The young girl whom my hon. Friend the Member for Sevenoaks mentioned is, alas, only typical of so many. That is why we are doing all that we can to reduce waiting lists for orthopaedic surgery.
The British Orthopaedics Association is considering the report of the Duthie working party. The association has sent this report to all orthopaedic surgeons, asking them to evaluate their services in the way recommended by Duthie to see whether changes in practice could reduce local waiting times. This will be followed up by a questionnaire, again from the association, to all orthopaedic surgeons, asking what use they have made of the report's recommendations. Because of the importance that we attach to solving the waiting lists problem, this questionnaire will go out with a letter from my hon. and learned Friend the Minister for Health; commending the Duthie report's recommendations. I hope that surgeons will give those helpful recommendations very positive consideration.
As to the matter that my hon. Friend has described, services at Orpington hospital are, as he knows, the responsibility of Bromley health authority. At present, three consultant orthopaedic surgeons are employed in the Bromley district. Two work at Farnborough and Bromley hospitals and one at Orpington hospital. He also carries out two sessions a week for Tunbridge Wells health authority, at Sevenoaks hospital, in the constituency of my hon. 444 Friend the Member for Sevenoaks. It must be clear that neither Bromley nor South-East Thames disputes the desirability of having a second consultant surgeon at Orpington hospital. They accept that waiting lists at Orpington and Sevenoaks are too long and that the number of orthopaedic surgeons in the Bromley district is below the national level. But the problem is finding the resources to pay for another surgeon.
I noted with interest, as I am sure the chairman of the authority will note, what my hon. Friend said about putting out to tender to test whether they are getting value for money in what I call the support services. Until one has tested them, it is impossible to say, hand on heart, that we have made every effort to spend the money available in the best possible way.
The cost, which would fall mainly to Bromley, could be considerable because it would be much greater than just an additional consultant's salary. Although he would be using existing beds, he, or she, would generate additional activity, giving rise to increased spending on secretarial and nursing support and of course on materials. Some of the equipment used today is very expensive. Whether money should be spent in this way or on another service for which there is an equal, if not even greater need, must be for the health authority and not Ministers to determine. I should explain that Bromley must decide on its priorities against a background of resource constraint, which I shall examine briefly.
Bromley is in the South-East Thames area, which is well provided with health care facilities in comparison with the rest of the country. I am leaving in about half an hour for Newcastle, which has special problems. The authorities there believe that they are under- resourced compared with what they will tell me tomorrow is the lush South-East Thames health authority. We are committed to moving towards a fairer distribution of resources in the NHS and a provision of services that matches need and demand throughout the country. It must be the aim of Government to ensure that there is, broadly speaking, equality of access to care and treatment for all patients. This policy means in effect that South-East Thames receives a smaller proportion of growth money—I stress those words because it is extra money—than do regions less historically well-endowed with hospitals and other services.
Even within South-East Thames, there are wide differences in the allocation of resources between the 15 districts. That is because districts, such as Bromley, in or near to London are—again for historical reasons—comparatively well provided in health care terms in contrast with some other districts in the region, such as Medway. My hon. Friend will know that my hon. Friends from Medway are rather unhappy with their position, and that they would consider that Bromley is better off than Medway. There are very serious deficiencies in the service at Medway, which is why the region is rightly committed to a policy of redistribution between districts. What this means for Bromley is that, working on the formula used, it is regarded as being 15 per cent. above its resource target. It must make savings to come back within those targets.
There are already important calls on Bromley's resources. One of them is the need to ensure that funds are available to meet the running costs—estimated at an additional £140,000—of the new development to be commissioned shortly at Orpington hospital. This 445 development, I know, has had from its inception my hon. Friend's warmest support and encouragement. Another priority for the health authority is one on which we place great emphasis at national level. That is the need for a redistribution of resources from the acute sector towards the Cinderella services—those for mentally handicapped, mentally ill, and elderly people. I know that Bromley takes this need seriously and is involved, for example, in the move to run down the large mental handicap hospital at Darenth Park and make provision for its residents within the district.
I understand, as a London Member, that, despite all I have said, my hon. Friends' constituents may not feel that 446 they are especially over-provided with health care. I certainly do not suggest that the district is free of problems. It has its share, including that of orthopaedic waiting lists. The matter is being considered. I cannot promise an easy answer, but I hope that I have been able at least to explain that even deserving cases such as the one put tonight must compete alongside other national and local priorities, and so cannot always be put into instant effect. At local level, health authorities must be allowed to determine their priorities within national guidelines.
The Question having been proposed at Ten o'clock and the debate having continued for half an hour, MR. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at half-past Ten o'clock.