HC Deb 09 November 1983 vol 48 cc342-78

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

6.20 pm
Mr. Robert Parry (Liverpool, Riverside)

I am pleased to be raising on the Adjournment the question of cuts in Liverpool area health authority's budget. I am delighted that the debate should be taking place much earlier than we had expected, and I hope that some of my hon. Friend's who represent Liverpool constituencies will have an opportunity to speak. Although the debate is concerned specifically with cuts in the budget of the Liverpool area health authority, I hope, Mr. Deputy Speaker, that you will allow it to range somewhat wider because some of my hon. Friends from Merseyside constituencies would like to take part. Two of them sat throughout the debate last week on the National Health Service but unfortunately were not called.

The cuts being imposed on Merseyside and in Liverpool are causing much controversy. Merseyside regional hospital authority recently instructed the area health authority to make a package of cuts, imposing cuts of £5.5 million over five years, and that obviously represents a cut of over £1 million a year. Despite protests from consultants, doctors, nurses and trade unions, the package was accepted by the area health authority on 25 October. The cuts are opposed by the community health councils in Liverpool, and Liverpool city council is strongly opposed to them. The cuts affect the sick right across the board.

There is to be a rundown of the Newsham general hospital leading to its eventual closure, and that will lead to the loss of 400 beds. At the Princes Park hospital, in my constituency, which deals with old people, 100 beds are to go. Under the Chancellor's instruction of a further per cent. cut in Liverpool's health budget, 24 beds will go at the Alder Hey children's hospital. Under the same instruction, the St. Paul's eye hospital, also in my constituency, will close a ward, in spite of the waiting lists. There is nothing more cruel than to make people go on fearing losing their sight. The Minister told me in a parliamentary reply on 3 November that 590 patients were awaiting eye treatment at St. Paul's, 181 of them women, and that 34 of the cases were considered urgent.

Anybody with feeling and compassion for the afflicted must condemn the cuts which are affecting these unfortunate people. The Prime Minister, who has had personal problems herself, should understand that more than anybody. Fortunately for the right hon. Lady, she was able to jump the queue and receive private treatment. Not many of my constituents are able to pay for their treatment.

In imposing the cuts, the Prime Minister has shown that she is unfeeling, uncaring and indifferent to the suffering of the people. She told lies during the general election campaign when she said that the National Health Service was safe with the Tories. I asked her last week in a parliamentary question whether she had any plans to visit St. Paul's eye hospital, and of course her answer was no. If the right hon. Lady had paid such a visit, she would be more aware than she is of the anxiety and fears of ordinary people.

The women's hospital in my constituency has a 21-bed ward which is to be closed, again despite a waiting list of nearly 500. The waiting list for general surgery in Liverpool is 1,747, 60 of them classified as urgent. As a result of this package of cuts, services will be slashed and 800 jobs will be axed, including doctors, nurses and ancillary, professional, technical and clerical staff, this in an area of very high unemployment. These are dedicated people who really care for the sick. I speak from experience because I have had the misfortune to have been a hospital inpatient four times in the past 10 years. I place on record my sincere thanks to these dedicated people for their care and attention during my hospitalisation. On each occasion I stayed in a National Health Service ward.

In a letter to me dated 28 October the Minister dealt with St. Paul's and the Royal Liverpool hospital. He stated that press reports of patients being treated in corridors at the Royal Liverpool were "misleading and exaggerated." He wrote that despite a report by a professor at the hospital that that was happening. The bed occupancy rate at the Royal Liverpool hospital is 94.5 per cent. One wonders what the situation will be when the other hospitals are closed and hundreds of beds disappear.

In a recent letter to me, the Minister suggested that I should write to the chairman of the Liverpool area health authority for certain information I wanted. I telephoned the administrator, a Mr. Derek Cumming, on 28 October and asked him for a copy of a recent health authority document following discussions on 25 October about the cuts. He informed me that he would have to discuss the matter with the chairman, a Mr. Pocock. I am still waiting for that report. It is a scandal that an elected representative of the area who asks for information from bureaucrats cannot get that information to enable him properly to raise the issue in the House. I hope that the Minister will look into that. I have been referring to documents which are public knowledge.

I understand that the chairman of the local area health authority is a former official of the Wirral Conservative Association. I wonder therefore whether that was one reason for what occurred. I also wonder whether he is supporting the cuts. The question of the Heswall children's hospital, which is situated in the heart of Tory land in Cheshire, is worrying. I do not like to see any hospital closed but that hospital, which formerly cared for 150 children as inpatients, now has fewer than 50. I understand that it is a millstone round the area health authority's neck. Indeed, I believe that it is costing over £1 million to maintain the hospital.

If there is no need for the hospital, why cannot the children be sent to Liverpool, at the Alder Hey children's hospital or the children's hospital in Myrtle street, because I understand that most of the 50 children at present at Heswall are from Liverpool? Why send them there from Liverpool? I hope that the Minister will give a clear view on that issue because it is causing much anxiety and strong feeling on the Liverpool side of the Mersey. Indeed, I am wondering whether, if this hospital had been situated in Liverpool's dockland, it would have existed this long. I doubt it.

If the chairmen of the Liverpool and Mersey health authorities are not prepared to oppose the cuts, I suggest respectfully that they should offer their resignation. Only this week I received from the plumbing lodge of the EEPTU a copy of a letter that it wrote to Mr. Wilson, the chairman of the regional health authority, asking for his resignation. The branch has a long history, for it was formed in 1865, which means that it has knowledge of Victorian values.

I have spoken to the Minister for Health and I shall be meeting a delegation of Wirral and Merseyside Members to discuss these matters. However, it is only right and proper that I should make my views known on the Floor of the House and make it clear that I am totally opposed to the cuts in Liverpool and on Merseyside.

6.30 pm
Mr. Eddie Loyden (Liverpool, Garston)

The Act setting up the National Health Service, which was established by the first post-war Labour Government, was in all probability one of the finest pieces of progressive legislation that we have seen. The post-war generation of children is living evidence of the benefits that accrued from the establishment of the Health Service.

I was born in the slum area of Liverpool and I lived in it for most of my working life. I lived there during a period when there was not a national health service. I lived in a street that ran near Lamkiln lane, which was overshadowed by the now extinct Tate and Lyle factory. The conditions that then prevailed in that area led to a hearse arriving at someone's door almost every week to take away a child who had died at a very early age. In addition, there was the extremely high birth rate in Liverpool, especially in the area of Liverpool in which I lived.

Those who were alive during that period have a greater understanding of the benefits and merit of the Health Service. It has been responsible for improving the health of the British people in a way that could not be imagined in the pre-war years. Those who lived in the years before the second world war without the National Health Service and after the war with it and all its benefits will, I am sure, be the first to defend to the death the Health Service and everything for which it stands.

We are all aware, regardless of what the Prime Minister says almost every week in the House, that the Health Service is not safe in her hands. The question which my hon. Friend the Member for Knowsley, North (Mr. Kilroy-Silk) put to the right hon. Lady yesterday made her stutter and stammer. My hon. Friend asked why, if she felt that the Health Service was safe in her hands, she did not feel safe in the hands of the Health Service. He was making an important point. Conservative Members who applaud the Health Service, and do so because it is the result of a piece of progressive legislation that has provided many benefits for succeeding generations, are by and large those who do not use it. They have been in the fore in driving NHS resources into the private sector. Until recently it was considered proper to make blood freely available from the NHS to the private sector. That is an illustration of the way in which the private sector is bleeding the public sector.

Mr. Robert Kilroy-Silk (Knowsley, North)

The dependence of the private medical sector on the NHS goes much further than dependence on it for supplies of free blood. My hon. Friend will know that all the doctors and nurses that staff the private medical sector have been trained in the NHS. Many of the facilities, technological changes and revolutionary processes that are important to the sustenance of the private sector have their origins in the NHS. In that sense, private medicine is parasitic on the NHS.

Mr. Loyden

I am grateful to my hon. Friend, for he has completed my argument about the parasitic nature of private medicine.

The people of Liverpool and the surrounding area were astonished when the health authorities raised no objection to the cuts that were to be imposed upon them. It is a shame that those who hold positions of responsibility and who should act in the interests of the health services in the area should see fit not to object in the strongest possible manner to the cuts that are to be imposed.

Liverpool, like many other cities, is faced with mass unemployment. It is the view of many experienced medical people that there is a correlation between mass unemployment and ill health. I share bat view. There is sufficient evidence clearly to show that places in which there is high unemployment have high incidences of respiratory diseases, cancer and many other diseases that are prevalent in industrial areas. At a time of high unemployment and social malaise, the people of Liverpool are to suffer an even greater blow because of the cuts that have been imposed by the Government on their health services.

The population of Liverpool is equally concerned about the attacks on its health services as it is about the shameful level of unemployment on Merseyside. It sees the cuts as a further attack upon the living standards of ordinary working people at a time when we should be increasing the resources that we make available to the Health Service to enable it to cope with the serious problems that cities such as Liverpool are facing. At a time of great need, the Government are imposing cuts that will undoubtedly lengthen the waiting lists for surgery and for other treatment.

I have had recently to attend the St. Paul's eye hospital in the constituency of my hon. Friend the Member for Liverpool, Riverside (Mr. Parry). The patients are having to wait for six to seven hours for treatment as some of the clinics have been closed because of staff shortages. About 75 per cent. of those awaiting treatment are in their sixties, seventies or even eighties. Eye afflictions are more predominant in that age group than among the younger generation. It is a disgrace that a hospital of international renown should be placed in a position in which it is virtually incapable of dealing with patients without causing them a great deal of distress. That shows what is happening to the Health Service in this part of the city. At the women's hospital beds have been closed. This means that patients will have to wait longer for treatment. There is a decline in the Health Service nationally which has serious consequences for those who depend on it for treatment.

It is the responsibility of the Government to take into account circumstances on Merseyside. The House has been waiting patiently for the Government to bring forward the third report on the environmental problems of Merseyside. When the report is published. it will show the depth of deprivation and social malaise in this beleaguered city. The cuts in the Health Service will have a serious effect on the health and well-being of the people.

I support wholeheartedly my hon. Friend the Member for Riverside in initiating this debate. The fact that the debate on the Oil Taxation Bill collapsed has given Merseyside Members of Parliament an opportunity to speak about circumstances in Liverpool and to recommend to the Government that they should think again about the Health Service in general and as it affects Liverpool.

6.42 pm
Mr. Robert N. Wareing (Liverpool, West Derby)

It is a pleasure to support my hon. Friend the Member for Liverpool, Riverside (Mr. Parry) in his attempt to bring home to the Government the reality of health provision in my native city, Liverpool. The cuts which are imposed on the Health Service in Liverpool can make sense only to one group—the dogmatic monetarists who seem to be to the fore in the Conservative party and the Government. They ignore completely the real needs of the people of Liverpool.

When one examines what has happened in the last few months, one sees that cuts have been made without reference to the needs of the area. The man who is managing Health Service provision for the Government is not the Secretary of State for Social Services but the Chancellor of the Exchequer. Initially the budget for the Liverpool health authority area was £117,352,000. The first cut of £960,000 took place because of the reallocation of resources formula—a formula which makes no sense to the people of Liverpool. The argument is that it is based on a falling population. No one could deny that Liverpool has a falling population but one of the reasons is the redirection of labour because of economic circumstances. Government policies have led to there being 140,000 unemployed officially on Merseyside, although there are many more who are not able to register. We are told that £5.5 million is to be cut in the next five years.

The second cut of £604,000 was to come from efficiency measures. I do not know what sort of efficiency adds to the waiting lists in an area that is already deprived.

The third cut was even worse, because it had no backing on Merseyside. It was the 1 per cent. across the board cut by the Chancellor, but on Merseyside it meant a cut of £1,059,000.

Therefore, the budget, which was initially over £117 million, has been cut to about £114 million. It is no use saying that all of this can be met by administrative cuts. Every time a porter is removed from the establishment at a hospital, such as Broadgreen, it means further delay in the treatment of patients. Porters are not simple accessories of the kind that one might find in private hospitals where the rich can afford luxuries. BUPA is a long way from most of the people we represent in Liverpool.

Next year worse is to come, because we are told that another £960,000 is to be cut and that, by another efficiency round, an extra £600,000 is to be lopped off the budget. It is as if someone in the Department said, "Let us think of a number and cut the budget by that amount so that we can fit in with the wishes of the Chancellor". What we require in the Cabinet is a Minister who will resist the Chancellor of the Exchequer and fight for precedence for the Health Service in the same way as the Prime Minister fights for cruise and Pershing missiles to be sited here and for an air strip in the Falklands, irrespective of the cost.

Some area health authorities have been given growth money for development. It is argued that in Liverpool there is an over-supply of beds, based obviously on the mystical formula that, because the population is falling, the area does not require so many beds.

The Under-Secretary of State for Health and Social Security (Mr. John Patten)

I am following the hon. Gentleman's speech with great care because he is making some important points. Does he recall that it was in 1976, under a Labour Administration, that the redistribution of resources within regions in the National Health Service began? The Government are simply following that work which was properly begun then.

Mr. Wareing

I was not a Member of Parliament in 1976. One of the reasons why I am here is that I replaced a Member who perhaps did not fight hard enough to change the decisions made by that Government. I do not in any way excuse what previous Governments have done. The hon. Gentleman should not fall back on the argument that there were cuts some years ago. I merely point out that Health Service workers received their greatest pay increases under a Labour Government. Liverpool has 20 per cent. unemployment compared with a much smaller percentage in 1976, but the Government are taking no account of the proportion of the population who need the National Health Service.

In Liverpool we have not only a falling but an ageing population. Only the younger section of the population is able to "get on its bike", as the previous Secretary of State for Employment recommended. That leaves the people who are ill because of age and, I might add, because of unemployment. Some people are committing and attempting to commit suicide in our city because of stress, illness and the problems of unemployment.

When people cannot get treatment in hospital, they fall back on primary care. In Gillmoss in my constituency there is little by way of primary care. Since 1979, infant mortality there has risen from 10 per 1,000 live births to 13 per 1,000 live births. That is the reality. Elderly people who are discharged from hospital too soon, simply because beds are in short supply, fall back on primary care.

A few months ago, shortly after I was elected to the House, I asked the Minister for Health whether he would seek to implement the Black report, perhaps as an experiment—that report underlined the inequalities in health care—so that preference could be given to areas, such as Merseyside and Liverpool, where there were appalling housing conditions and unemployment. I agree with my hon. Friend the Member for Liverpool, Garston (Mr. Loyden) that Conservative Members have not the foggiest notion of what it is like to represent a constituency in a place like Liverpool. They represent the leafier parts of the country. There is nothing wrong with that, but they should come and see for themselves.

Recently I had some correspondence with a Minister about housing. I took up the case of a constituent that he had referred to me. The lady concerned had to be moved from a flat—the only one which was tenanted for about a quarter of a mile around. All the other flats there were boarded up, because the Government would not provide funds to allow housing repairs to be carried out properly, efficiently and speedily. The Minister was sure that I could get the lady accommodated on a temporary basis in another flat, so that she could get further up the housing list. He told me that he had written to my constituent saying, "You know, there are some really nice council flats in Liverpool." I see wry smiles on the faces of my hon. Friends who represent Liverpool constituencies. There are very few nice flats in areas open to such a person. It shows that Conservative Members do not know the situation. If they would come to Liverpool, I would escort them—because they would need to be escorted—around parts of our city so that they could see the problem for themselves.

Mr. Parry

Does my hon. Friend agree that it would be far better for the Government if the Prime Minister paid a visit to Liverpool? The right hon. Lady has been in power now for almost five years, and she has made only one brief visit to Liverpool, following the Toxteth riots. She has not been back since.

Mr. Wareing

When the Prime Minister visited Liverpool, shortly after the Toxteth riots, it was in the early hours of the morning when there was no one to see her. I do not know whether that was fortunate for the people of Liverpool or for the Prime Minister. I agree with what my hon. Friend says, if for no other reason than that the Prime Minister would learn a lot. However, she would need my hon. Friend or me or my other hon. Friends who represent Liverpool constituencies to ensure that she was adequately safeguarded, because the people in Liverpool are outraged at the economic and social policies of this Government. The anger in the city has to be seen to be believed.

My hon. Friend the Member for Garston mentioned the third report of the Select Committee on the Environment, published shortly after the general election. It showed that the Think Tank report predicted the riots in Toxteth. That did not surprise me. I forecast even greater problems and social unrest on Merseyside unless matters such as this are dealt with.

We must look with sympathy at the needs of the people who are involved. There are 489 people waiting to get into the women's hospital in Catherine street. Twelve of them are urgent cases which cannot be dealt with now. These women need hysterectomy operations. Anyone whose wife has had that operation knows the desperate need that it involves. My wife was fortunate in being treated relatively quickly. Of course, that was in 1974—long before the infliction on this country of this Conservative Government.

St. Paul's eye hospital has been mentioned. There, 275 people are awaiting admission. That is hard for the people who in the meantime have to attend as outpatients, as my hon. Friend the Member for Garston said. They have to wait hours and hours, and after they are treated they wait hours and hours again to get transport home. After all, every Liverpool Member represents one of the first 25 constituencies in the country in the unemployment league table. In my constituency and the Riverside constituency there are parts where 75 per cent. of the people are without the use of a car. They depend on the ambulance service and on public transport.

The Government must study carefully the organisation of the National Health Service. They should not wipe off the board democratically elected councils, such as Merseyside, which have reduced fares for those who need the bus service to get to hospital. Instead, the Government should make the health services in the areas democratically accountable to the people. Then they will have people who can tell them what is really happening in places like Liverpool. As long as the Government appoint bureaucrats, they will have people whose jobs are in the gift of the Government and who will be only too pleased to keep their jobs by keeping quiet about the real needs of the people that we represent.

6.58 pm
Mr. David Alton (Liverpool, Mossley Hill)

I associate myself with what has been said in this debate, and I am grateful to the hon. Member for Liverpool, Riverside (Mr. Parry) for raising this issue. It is an important issue, and I am glad that Mr. Speaker has managed to find time for it and especially that there is an opportunity for other hon. Members to participate in it.

All of us who represent Liverpool constituencies regularly return home to find that yet another hospital or ward is under threat. Week after week we hear stories of worried people who work in the National Health Service whose morale is being sapped. They are worried about the future of their jobs and of the hospitals in which they work. That is something to which the Government must apply themselves.

I am not entirely critical of the Government, or indeed of the Labour Government, but there will be a challenge from Merseyside, especially Liverpool, that the Government must wrestle with. That challenge was mentioned briefly by the hon. Member for Liverpool, West Derby (Mr. Wareing) when he referred to the ageing population of Liverpool. The fastest growing age group in Liverpool is the over-80s. People over retirement age form about one-third of our population. That is no secret. The Minister is well aware that that will mean not only a greater strain being placed on the local authority for the provision of meals on wheels and social services, but, inevitably, a greater need for geriatric facilities.

Last year, and earlier this year, I met Dr. Jeremy Playfler and other geriatricians at the Royal teaching hospital in my constituency. As a result of that meeting I brought the problems of the geriatric services to the attention of the House in an early morning debate.

I thank the Government for responding to my requests over Mossley Hill and Broadgreen hospitals, and for announcing that major capital investment will provide extra facilities. However, there is still concern at the Park and Newsham hospitals about the future of patients. Although most Opposition Members would admit that facilities in the old Victorian hospitals at Newsham and Park are far from the greatest, they are at least better than none at all.

There is concern that, faced with tie challenge of growing numbers of people in the fastest growing age group, the over-80s, and with increased longevity we shall need more facilities rather than fewer. I ask the Government not simply to do what they are doing now, welcome though that is, but to think again about the future of Park and Newsham and to listen to what many of the hospital staff are saying.

There is concern about the future of the National Health Service. Much of it stems from the publication of the Think Tank report. Although the Government and the Prime Minister said that the Think Tank report was being abandoned, many were left wondering whether it had been buried for good. The 5 per cent. abatement in unemployment benefit, which was, admittedly, restored later, was an element in that. There have been cuts in the provision of social services. Liverpool alone has lost more than £100 million in rate support grant in the past four years. The Minister knows what effect that has had on all the services, including education, housing and social services. I do not blame the Government, because the same problem that I have mentioned — the loss of population in the past decade—is at the heart of their actions. We have lost people, as well as our rate support grant and funds.

That brings me to the loss of funds by the local area health authority and some of the effects that that will have. It will lose more than £1 million. Two weeks ago I met Leslie Pocock, the chairman of the area health authority, to talk about the effects of that loss. An effect that I discussed with the dermatologists at the new teaching hospital a month ago is that a post in consultant dermatology has not been filled. Filling that post could make a great deal of difference to the second largest group of people after casualties using that hospital. It will require a relatively small sum of money, yet, because of the savings that it has been told to find, the area health authority has been unable to fill the post.

Many of those affected could be at work, and doing useful things. I am glad to say that 80 per cent. of Liverpool's population is still in work, despite massive unemployment. Some are currently out of work because they cannot get treatment. There is a long waiting list in the dermatology department, stretching into 1984.

Professor Vickers and other dermatologists, including Dr. Julian Verbov, expressed great concern about that. Although the area health authority is also concerned, it says that some of the problems stem from cuts that it is trying to cope with. Mr. Pocock also told me in a letter that there will undoubtedly be effects on the health of the people of Liverpool as a result of the reductions in expenditure. I should like the Minister to tell us what those effects will be, and where the cuts outlined in the area health authority's report will be made. He is likely to approve that report.

I associate myself with the remarks of the hon. Member for Riverside. I hope that all Liverpool Members will be properly involved in the discussions before the Minister arrives at conclusions on these matters.

The NHS was founded on the principle of provision regardless of resources. However, there is a feeling that we are moving towards an American-style private insurance system. That worries people because it will be based on the ability to pay; it will be based on wealth. The NHS has always been managed on the basis that one will receive health treatment regardless of the means at one's disposal. In a part of the country where so many people are either out of work or are low wage earners, it will not be possible for them to invest in private insurance medical schemes. The Minister must realise what the consequences would be on the personal well-being and health of many Liverpool people if we were to move significantly away from the NHS, which my right hon. and hon. Friends and I support.

There is concern in Liverpool about the possibility of the closure of the Duchess ward in the women's hospital. As the hon. Member for Liverpool, West Derby (Mr. Wareing) said, many women rely on the services of that hospital. I have been inundated with mail from people who are concerned about its future.

It has been suggested that Donald Wilson, the chairman of the regional health authority, acted almost improperly by not creating a great fuss over the impending cuts in the Health Service. From my meetings with him a few weeks ago, I believe that the facts are not as they have been related to the House. Mr. Wilson acted with sincerity. He decided not to make a public fuss because he believed that, given the population decline that Liverpool suffered, the Government had gone out of their way to try to minimise the likely reductions that the regional health authority would have suffered. For that reason, he believed that it was not politic to make too much fuss about the impending cuts in case they were worse than he thought they would be. We must respect his sincerity and the reasons for his action.

The position of the regional health authority is perhaps exemplified in the way in which it is trying to dispose of land in Liverpool. I should like the Minister to consider that matter. There is a piece of land in my constituency that is just off Aigburth road, known as the Crofton hospital site. The land was given in the 1920s by the Rathbone family for the people of the district to use as a tennis club and allotments. Young people from all over the area benefited greatly from it. The land was subsequently vested in the regional health authority and has been held in trust by it since. Because it followed the directive issued by the Department of Health and Social Security and the Department of the Environment, the land is now to be sold on the open market. Tenders have been invited. There is likely to be speculative housing development.

The community will be robbed of a much-needed facility and amenity. It is Crown land. One could argue that the ruling by the Attorney-General earlier this year about the enhancement of the value of Crown land should apply in this case, as it did at the Fazakerley hospital site, and that the regional health authority is acting illegally in trying to develop it. One can also argue that the land should have remained for the use of local people as a facility. It helps many people to stay in good health. Many of them will have to rely on the services of the NHS if they do not get the chance of using the recreation facilities that the land currently provides.

It is appalling that a regional health authority has to act as a property speculator to try to raise the funds to carry out the business that it should provide regardless and that should be financed via taxation. It should be centrally financed. It cannot be right that the regional health authority chairman has to auction off plots of land to try to improve geriatric facilities. That is the dilemma that he described to me.

Many general practitioners in the inner city have long lists of patients. They say that if they could have the assistance of auxiliary nurses, and if they could be given improved facilities in their practices, they would be able to offer a better service to the people in their communities. One major problem that they face is security. In Liverpool we have a massive crime rate. There is one home broken into every 20 minutes and there is a crime committed every four minutes.

Many of the crimes involve the stealing of drugs. Hon. Members have already referred to that problem. The Government should give serious consideration to providing increased security for general practitioners.

Mr. John Patten

I am pleased that the hon. Gentleman has referred to the problems facing general practitioners in inner city areas. A week or 10 days ago, my right hon Friend the Secretary of State, following the report of Professor Acheson, announced a programme costing £9 million in the next three years which would assist general practitioners in inner cities with problems relating to practice premises, security and nursing services.

Mr. Alton

I am grateful to the Minister for his remarks. I will communicate that fact to local general practitioners in my constituency. I hope that many of them will take advantage of the new facility.

Liverpool city centre faces a major crisis, not just from a loss of population but because of the decision to create what was regarded as the great white hope—the new teaching hospital in Prescott street. Everyone on Merseyside admits that the great white hope has become a great white elephamt. The building of the hospital led to the various subsequent decisions to try to rationalise—a word used by many health chiefs—many other services which are required and rooted in local communities.

Throughout the country, about 9,000 qualified nurses are on the dole. The Treasury admits that the cost of unemployment is running at more than £17.5 billion annually. Each qualified nurse costs more than £5,500 to keep on the dole. That is a crazy waste of resources when so much work remains to be done. We should be expanding what I may call for want of a better phrase the caring industry.

Liverpool faces two great challenges. First, it faces the massive challenge of an aging population with increased health needs. Secondly, it has a massive unemployment problem. We should take those two challenges together. We should be providing jobs for people who can care for those in greatest need.

7.12 pm
Mr. Terry Fields (Liverpool, Broadgreen)

Unlike the hon. Member for Liverpool, Mossley Hill (Mr. Alton), I have not had the opportunity to meet top hospital officials and consultants, but I have certainly spoken to people at the sharp end—the young, the old and those on the estates who are suffering from ill health because of the health cuts that have occurred in the Liverpool area. Many people in valium valley suffer from nervous disorders, chest, heart and lung complaints as a direct result of bad housing and general unemployment in the city. We can only condemn past administrations as they are responsible for the deplorable conditions in housing stock, and that is one reason why people suffer from bad health. During the past eight years the local authority built no properties for rent in Liverpool. That fact has added to the problems faced by ordinary people.

I wish to deal with the drug problem. Heroin addiction is rife in Liverpool. Police resources are stretched in dealing not only with problems of drug addiction but with drug-related crime. Some young people who suffer from a drug habit—we must not forget the pushers—must find, by some method, £200 a day to feed their habit, thereby putting an extra demand on all resources. The Government have cut back on the miserly and niggardly sum which they provide for the care of drug addicts. That amount of money set aside for drug treatment would not even scratch the surface of the problem in Merseyside, let alone deal with the national problem.

Mr. Parry

Will my hon. Friend tell the the House of the growing problem of solvent abuse, especially among young children? The director of education in Liverpool has confirmed that such a problem exists.

Mr. Fields

My hon. Friend is correct in intimating that statements have been made about that matter. The problem is severe and must be dealt with. When we discuss bad health and nervous disorders, we must examine the root cause. One of the reasons has been the industrialisation of Liverpool during the past decade.

On the one hand, the Liverpool health authority is reacting to the fear and blackmail that the Government have imposed, by their monetary policies, not only on the health authorities and on the workers, but on every other authority with which they are involved, and especially on management and business.

We must pay regard to the non-accountability of some of those who serve on the health authorities, and who are, at the behest of the Government, carrying out the cuts. The cuts emphasise the scale of the problem in hospital treatment in Liverpool as well as increased demands on the social services. Manufacturing industry has been decimated. The decline has been almost 40 per cent. in the past decade. All four major industries in the city have suffered job cuts. I appreciate that it may seem that we are talking about the decline of trade and industry, but those are the root causes of sickness, nervous disorders and the rest.

Many of the large multinational firms have pulled out of Liverpool, and that has created a problem of fear and anxiety. The general psychology affecting those on the Liverpool health authority is fear for the future.

The Government must be warned. The fight back has already started in Liverpool. Although people are on their knees, they are prepared to struggle and to take on the Government and those acting on their behalf in their attacks on the Health Service. We must discuss the scale of the attacks. Liverpool has suffered a cutback of 422 hospital beds, including 20 per cent. of medical and geriatric beds. There has been a cut of 25 per cent. in surgical beds and 22 per cent. in children's beds. Also, 273 psychiatric long-stay beds have been phased out at Rainhill hospital, on the outskirts of Liverpool. The planned increase in day hospital beds for the elderly and mentally ill is a long way short of the recommended level. Newsham general hospital and Princess. Park hospital are to be closed. The Liverpool health area will suffer staff cuts of about 769. Having spoken to those involved, I believe that the figure will be closer to 1,000.

The Government say that the gap in health service will be met by an improvement in the social services provision as stated in their document "Care in the Community". I wish to deal with some of the charges as they affect present-day Liverpool society. The dramatic cut in hospital beds can only lead to a decline in patient care. Patients will be discharged early because of the need for hospital beds only to be met by inadequate social services support outside. The already long waiting lists will increase and loss of life will occur because of the inability of the hospitals to deal with the increases demand.

Old-age pensioners are increasing in number. At the same time, two geriatric hospitals have closed which will create an intolerable demand on the remaining beds. Community and hospital based care for the elderly will be especially badly hit. The hospitals need replacing and not closing down. Linked with the cuts in beds are cuts in staff, resulting in a decline in standards of care for those in hospital. More important for those employed in the hospitals will be the intolerable working conditions caused by the cuts. Everything is dependent on the planned expansion of the social services. The Government are already hacking away at the social services. The plan therefore falls apart immediately. The closure of hospitals and the loss of nurses and doctors will, supposedly, be covered by staff supplied from outside agencies. Such agencies do not exist. As a consequence, the health of our people will suffer.

We welcome the injection of capital into Liverpool. But much work remains to be done. Bricks and mortar are no substitute for caring personnel in hospitals of all types. Despite what the Government are attempting, I call on my local authority to ask the Merseyside health authority and the DHSS to identify Liverpool's special problems with the aim of achieving a more just allocation of funds to the Liverpool area.

I have spoken not to the consultants but to the workers, to NUPE and to COHSE. They are prepared to fight and struggle for their jobs, irrespective of whether the Government or the regional health authority are trying to take them away. They care about the people in their hospital beds and the people of Liverpool who will lose the services. They are prepared to take on the Government.

Mr. Parry

My hon. Friend is clearly aware of the Health Service trade unions' determination to oppose the closures and job losses. I am sure that he, like me, will support them if they are forced into industrial action or even the occupation of wards.

Mr. Fields

My hon. Friend is absolutely correct. We are on record as saying that, although we have to fight the Government's legislative proposals in the House. Liverpool Members will be back on the picket lines with those workers defending their jobs and the services in our area.

My hon. Friend the Member for Liverpool, West Derby (Mr. Wareing) is right about privatisation. One day we shall expose in the House the web of corruption and deceit that it entails. Grand Metropolitan has tendered for cleaning services throughout the country, and it is no coincidence that BUPA has shares in Grand Metropolitan. The Government are selling off the hospital services to private industry and at the same time subsidising their rich backers and friends.

Mr. John Patten


Mr. Fields

I have nearly finished.

We are prepared to fight for the workers. We warn the Government now that their policies will lead to confrontation in areas such as Liverpool. We shall he four square behind those workers.

7.21 pm
Mr. Robert Kilroy-Silk (Knowsley, North)

I congratulate my hon. Friend the Member for Liverpool, Riverside (Mr. Parry) on his initiative in seeking an Adjournment debate on this subject and on his good fortune in not just obtaining it, but obtaining it in prime time and for four or five hours instead of half an hour. Adjournment debates rarely take place in such circumstances. The opportunity has thus been given not only to my hon. Friend the Member for Riverside but to others to speak at first hand about the social, economic and health problems of Liverpool and Merseyside, to bring home forcefully to the Minister not just the problems of the area, but the views of Members from all parties representing Liverpool and Merseyside constituencies—

Mr. Terry Fields

Where are the Tories?

Mr. Kilroy-Silk

—and to insist that the Minister replies not with the platitudes that we have come to expect from him and his colleagues, but with serious proposals to deal with the fundamental and deep-seated health problems of our area.

As I am sure you are aware, Mr. Deputy Speaker—I hesitate to point it out in case you are not—the motion refers to Liverpool, and I do not represent a Liverpool constituency. I represent a Merseyside constituency, but my hon. Friends from the city will acknowledge that the overwhelming majority of my constituents seek and receive their health care in Liverpool and its hospitals. Therefore, I am as interested in the subject as they are and my constituents are as concerned and as deprived as theirs.

My hon. Friend the Member for Riverside and my hon. Friends the Members for Liverpool, Garston (Mr. Loyden), West Derby (Mr. Wareing) and Broadgreen (Mr. Fields) have all referred to the social and economic deprivation of Liverpool and Merseyside. That is perfectly proper as we cannot adequately deal with the Health Service in the region unless it is set in the context of the region as a living entity.

It must be acknowledged that Liverpool is increasingly becoming the most deprived and disadvantaged of our cities and Merseyside the most vulnerable of our regions. As has already been said, hardly a day goes by without further substantial job losses and closures of large factories. Added to the deprivation and the inadequacy of employment opportunities and educational and housing facilities, we have a seriously underfunded Health Service. The Under-Secretary of State shakes his head, but that has always been so. If he bothers to consider the facts, which have no doubt been provided for him, he will find that historically Liverpool and Merseyside have been under-resourced. One of the reasons for the RAWP programme is to redistribute money from the better off regions, especially London and the south and south-east, to regions such as Merseyside and the north-west which have not had their fair share of the nation's resources in the past.

My hon. Friend the Member for West Derby referred to the Black report and the picture painted by it of the inadequacies in Health Service provision in the region. The Minister persists in shaking his head, so I shall give him the facts that he provided to the House. He produced evidence showing that there was already a deep and serious crisis in the Health Service on Merseyside. In a written answer on 28 October he said that on 30 September 1982 there were 2,018 urgent cases on the hospital inpatient waiting list in the Mersey region, of whom 1,418 had been on the list for more than a month. They may be figures only to the Minister, but to us they represent constituents in pain, distress and agony. The Department determined that they were urgent cases. The definition is not mine but that of the Department and the regional and district health authorities. It is intolerable that so many of our constituents should have to wait so long for urgent inpatient treatment.

Mr. John Patten

I share the hon. Gentleman's concern about those figures as representing individuals not just statistics, but I remind him that inpatient waiting lists were shortening rapidly between 1979 and 1982—until the health workers' strike. Waiting lists were shorter in 1981 than for many years previously. They are still shorter than they were in 1978, but unfortunately we are still making up the backlog. The National Health Service suffered as a result of the strike, but patients suffered far more.

Mr. Kilroy-Silk

I knew that the hon. Gentleman would say that. He made the same point in a written answer on 8 November, to which I shall refer in due course, but he has not answered my question. I was not going into the reasons why the waiting lists were so long. I was simply stating that they existed. If the numbers have increased slightly due to industrial action, I do not seek to deny it, but that does not answer the point that there were and would be in any event a large number of people waiting for urgent inpatient treatment. It is scandalous that at such a time the Government make pious noises about the Health Service being safe in the Prime Minister's hands while cutting expenditure on the service to the greater detriment of our constituents.

The 2,000 or more urgent cases are not the whole picture of the waiting list on Merseyside. There are 35,656 more individuals waiting for inpatient treatment, of whom 11,630 have been waiting for more than a year. Several thousand of those are fairly urgent cases. All those people are still waiting not because there was industrial action a year or more ago but because of the inadequacy of the services on Merseyside. They will have to wait in greater distress, pain and agony because waiting lists will increase and waiting time will lengthen as a result of recent Government action.

A more graphic demonstration of the problem is provided by the figures given by the Minister in a written answer to my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) on 8 November. In St. Helens and Knowsley district health authority there were 3,558 people waiting for hospital treatment on 30 September 1981, but on 30 September this year the figure was 13,288. That is a dramatic increase in the number of my constituents in that district health authority area who are waiting for hospital treatment. The Minister does not like the figures, but they are important. Whatever their origin or cause, the figures show the scale of the problem and are a starting point. If we go behind the figures—[Interruption.] If the Minister wishes to intervene he knows the procedure. I shall gladly give way, but I cannot answer him while he is muttering.

Mr. John Patten

I am sorry for having shouted across the Chamber to the hon. Gentleman. I should have asked him to give way. The hon. Gentleman is talking about the need to deal with the problems that face us. He says that those statistics are a measure of the problem. That is an incontrovertible fact. However, that demonstrates more clearly than anything else the need for the National Health Service not only to spend adequate sums of money but to spend that money wisely, and the need for a more efficient National Health Service, which the Government are committed to bringing about.

Mr. Kilroy-Silk


Mr. Deputy Speaker (Mr. Paul Dean)

Order. I hope that the hon. Gentleman will not stray across the border. We are discussing the budget of the Liverpool area health authority.

Mr. Kilroy-Silk

You know me well enough, Mr. Deputy Speaker, to know that I never stray in any circumstances.

The Minister has made a pertinent point. I do not know whether he is accusing the doctors, nurses and ancillary workers in the Health Service of being inefficient. I would not make that accusation, and I doubt whether his hon. Friends would — [Interruption.] That is what the Minister implied. He said that the figures point to the inefficiency of the National Health Service. The NHS represents people — patients, doctors, nurses and ancillary workers. If the Health Service is inefficient, it must mean that they are inefficient. I have no evidence of that, but I know that the only answer to the problem of long waiting lists is an increase in resources.

I shall give the House an example from Liverpool, just to prove that I shall not stray from the subject of the debate. My maiden speech in the House dealt with the problems of children with holes in the heart—they were called blue babies—who were dying in my constituency and in Liverpool because of long waiting lists. That did not need to happen, as was confirmed by the fact that London hospitals offered me places for my constituents because they had empty beds and idle nurses and doctors. With the help of Ministers in the Labour Government, I transferred to London dozens of young people who would otherwise have been disabled or who would have died because of long waiting lists in the north-west. The problem was recognised and we spent more money to provide new surgical facilities in Liverpool and Manchester. That was a clear demonstration of the inadequacy and paucity of services in our region compared with those of other regions. It showed that our region had been neglected and poorly treated.

If the Minister wishes to go beyond the figures, as he undoubtedly does because they are embarrassing, we can examine reports on the conditions in some Liverpool hospitals, most notably the Royal Liverpool hospital, which is the one—other than perhaps the hospital at Walton—that is most used by my constituents. I am sure that the Minister has seen the article in The Sunday Times of 14 August this year, which reported allegations that, because of the shortage of beds, the Royal Liverpool hospital had to turn away patients from the accident and emergency units. When those patients were finally admitted, they were more seriously ill than when they first appeared at the units. Does that show an efficient Health Service or adequate services and resources in the area? Of course not.

The problem has become worse. We now hear of consultants sending out scouts to walk round the wards in a bid to find beds for their patients. We have heard of the controversial practice whereby in-patients were moved into chairs during the daytime while their beds were used for day surgery cases. In its report on the practice, the General Nursing Council described it as a "common operational feature" and "an unsafe practice". That happened in a major hospital in Liverpool because of inadequate resources. The same report stated—the point was also made by my hon. Friend the Member for Riverside — that the bed occupancy rate was 96 per cent. That is a staggering figure when compared with any other hospital in Britain. It is no surprise that Dr. Austin Carty, the chairman of the Royal Liverpool hospital, in the article in The Sunday Times, said: We are in a state of crisis. The crisis involves 37,000 people on the waiting list, several thousand of whom are urgent cases and about 1,000 of whom have been waiting for more than a month in great pain and distress. Yet the Government say that they will cut resources. Whatever the Minister and his senior colleagues in the Department may say, the health authority is not keeping pace with demand. The Minister knows very well that the derisory 1 per cent. increase in National Health resources does not compensate for the increased demands either of an aging population or of technological change. In real terms, on the scale of increase given by the Government, the Health Service will be substantially worse off during the next two years, and, if the Government go their full term, at the end of the next four years, worse off than it was when they came to office. The Health Service is not safe either in the hands of the Minister or those of the right hon. Lady who put him where he is.

Unfortunately, despite that background, Mersey regional health authority and Liverpool district authority, which are staffed by Tory place men, have not only been prepared to accept and to impose cuts on the Health Service, but have enthusiastically and gleefully accepted them. It was a disgrace to them, and it caused me great disgust, that the Mersey authority was the first in Britain to acknowledge publicly that it would accept the cuts imposed by the Government and would co-operate in imposing them.

Mr. Loyden

Is my hon. Friend aware that the only people in the regional health authority who opposed the cuts were its Labour members?

Mr. Kilroy-Silk

My hon. Friend is correct, and the Labour members of the regional health authority and the district health authorities still oppose the cuts. They know, as do my hon. Friends, what will happen at the sharp end if the cuts are implemented.

Mr. Alton

I am sure that the hon. Gentleman will accept that others outside the Labour party are also opposed to cuts in the Health Service, but they recognise that the regional health authority has been placed in a major dilemma. It is not just a question of talking to the workers, important though that is. Those who have taken the trouble to talk to the chairman of the regional health authority realise that he has been placed in an impossible dilemma. He should not be vilified and criticised for trying to discharge his duties to the best of his ability and in a sincere way.

Mr. Kilroy-Silk

I am sorry, but I disagree with the hon. Gentleman. Other people may oppose the cuts, but they are not doing so as effectively or vociferously as Labour Members both in the House and outside. The hon. Gentleman is saying that one should understand the difficulties in which the chairman has been placed by having to impose these cuts. I am sorry, but the problems he faces in imposing the cuts decided by his friends in Whitehall and Westminster are nothing compared with the problems that confront my constituents, who will be in pain, distress, end up disabled and die while still on the waiting lists because the chairman of the regional health authority has been embarrassed. My god, we should be talking about something more important than the slight embarrassment of a Tory chairman of a regional health authority.

We are talking about the health and lives of our constituents, for whom it is our duty and obligation to fight. Whatever his political point of view, one would have expected a regional health authority chairman to have taken the same view and to have been prepared to fight to sustain these services. He has at his fingertips a clear picture of the demands that are made and the lack of resources to meet them. He must know better than anyone how irrelevant these cuts are and how damaging they will be to the Health Service on Merseyside and the welfare of the people there.

Not only are we damaging the Health Service, but jobs are being lost. The regional health authority estimates 500, but according to every other informed estimate, including the trade unions, the figure is 900 to 1,000. That is a disgrace. It is a scandal that at a time when 37,000 people are on the waiting lists, thousands of whom are awaiting urgent surgery, we should as a deliberate act of policy put nurses and doctors on the dole. What kind of society is that?

Any reasonable or sensible community would admit that on Merseyside there is a horrendous problem of mass unemployment, yet there are empty hospitals, unused beds and people in pain and distress on the waiting lists. It is only sense to put the doctors and nurses to work in those hospitals and to use the beds for the alleviation of the distress and suffering of those individuals.

As we heard in the previous debate, the Government are receiving £8,000 million more a year in the tax take from oil revenues than the Labour Government received when in office. With that money they could pay the entire salaries of every person in the health and social services. They could pay for every doctor, nurse, ancillary worker, home help and physiotherapist. That is the amount the Government received in 1982–83 from North sea oil revenue taxes over and above what the Labour Government received in their last year of office.

That is the scale of the problem and the size of the resources at their disposal, yet they spend £17,000 million a year to keep people in idleness on the dole and on bombs and weapons of destruction both here and abroad. That shows the disgrace of the Government's health priorities as well as their general economic and industrial policies. The way in which they have treated Merseyside and the rest of our people who depend on the NHS is nothing less than criminal.

Nowhere is that better demonstrated than in the priority, support and sustenance that they are giving to the development of private medical practice and their opposition, which they manifest on every occasion, to the NHS. They are not content just to snub it and treat it with contempt, like the Prime Minister who constantly goes out of her way to belittle its achievements and efficiency. They are doing everything possible to create a crisis of confidence in the NHS so that more people will take out private medical insurance.

That is not an accident. It is a deliberate policy of trying to convey an impression that the Health Service is being dismantled and destroyed so that as a consequence frightened people will financially support the private medical sector. It is no accident that the NHS is declining at the same time as private medical practice is increasing.

Mr. Terry Fields

Is my hon. Friend aware that a private hospital in Peterborough is being used for NHS patients? Earlier my hon. Friend the Member for Liverpool, West Derby (Mr. Wareing) mentioned his wife's hysterectomy. The current rate in that hospital for such an operation is £2,000. That is the threat posed to our constituents as a result of private medicine.

Mr. Deputy Speaker

Order. I hope that the hon. Member for Knowsley, North (Mr. Kilroy-Silk) will not refer to Peterborough, which is a long way from Liverpool.

Mr. Kilroy-Silk

It is, however, interesting to compare Peterborough with Liverpool, and my hon. Friend makes an important point.

It is all very well for the rich and privileged in Peterborough if there is a decrease in NHS facilities, but it is no good for my constituents in Kirkby, Cantril Farm, Prescot or Knowsley village. They do not have the wherewithal to take advantage of the marvellous new hospitals that are being built throughout the country, and neither do the constituents of my hon. Friends from Liverpool.

That is why we support my hon. Friend the Member for Riverside. That is why we are present tonight. It is not surprising that we feel deeply and strongly on this issue. Our constituents can go nowhere other than the NHS. Our duty, which we shall not shirk, is to ensure that each service provided is the finest that can be given. If the Minister has any real feeling for the Health Service, he will do everything in his power — and back it up by providing the money—to reduce the waiting lists and waiting time for the people of Merseyside substantially, permanently and immediately.

7.47 pm
Mr. Tony Marlow (Northampton, North)

The hon. Member for Knowsley, North (Mr. Kilroy-Silk) spoke eloquently of the people who used the hospital service in Liverpool. He spoke of their concerns, delays, pain and suffering and the concern of their families. I assure him that hon. Members from other parts of the country feel just as deeply about their constituents. I also assure him that my hon. Friend the Minister is concerned to ensure that the Health Service in Liverpool is among the finest in the country.

The hon. Member for Knowsley, North has identified the problems and seeks solutions to them. He wants resources for the Health Service. We all do. However, there are more resources per head of the population for the Health Service in Liverpool than, for example, for the Health Service in Northampton. Therefore, in many respects Liverpool is not under-resourced.

There are two ways of obtaining those extra resources. We can either ask the taxpayer for more money—

Mr. Gerald Bermingham (St. Helens, South)

Does not the hon. Gentleman agree that in Northampton, an area that I know fairly well, certain psychiatric services are available—at St. Andrews hospital among others? Is he further aware that the psychiatric hospital at Broadgreen in Liverpool is not scheduled for development until about 1992? Therefore, does he not agree that the provision of psychiatric services in the Liverpool district health authority area is vital and necessary and that eight to 10 years is too long to wait?

Mr. Marlow

I cannot be specific about the point that the hon. Gentleman makes, except to say that the provision of adequate psychiatric services in Liverpool, as elsewhere around the country, is obviously very important.

If I can come back to the point made by the hon. Gentleman, it is a question of resources. How are we going to get the resources? There are two ways. One way is to go to the taxpayer to ask him for more resources, but before we do that we have got to look at what we are getting at the moment.

Mr. Bermingham


Mr. Kilroy-Silk


Mr. Marlow

I am coming to Liverpool. This Government, in general, are providing, for every £5 we asked from the taxpayer in 1979, £1 extra. That is a considerable amount of money that the taxpayer is paying towards the hospital service in Liverpool and elsewhere. We are asking every person in work for £14 a week in taxation for the Health Service. We are asking every family of four for £20 a week in taxation towards the Health Service. We have 200,000 more people in the National Health Service than we had 10 years ago. The resources are there and must be there in Liverpool as they are anywhere else.

We must concentrate on the efficient and effective use of those resources. Goodness me, people in the Health Service work and they work hard, and I am sure that they work as hard in Liverpool as they do anywhere else. The people are there and they want to do an excellent job for their patients. Those resources must be better used.

I shall give an example to the hon. Member for Knowsley, North so that he can take it back to Liverpool and use it there. In Northamptonshire, we have moved from having one area health authority and two district health authorities to having two district authorities. In the changeover, at the administrative, bureaucratic level there was no saving in staff, which should have been effected. There must be the scope for savings there so that the money can be spent on patient care. There must be scope in Liverpool and elsewhere for savings on bureaucracy, secretaries and administration, so that the money can be spent elsewhere. If the hon. Gentleman were to ask anybody in Liverpool in the Health Service whether there was any waste of money in the Health Service, that person would have to say, in all honesty, "There is a great deal of wasted money. There is a great deal of inefficiency."

Mr. Kilroy-Silk

I am sorry to slop the hon. Gentleman as he was getting steamed up—we all know how he gets steamed up. Can we have an example of the waste in Liverpool?

Mr. Marlow

I said to the hon. Gentleman that if he were to ask anyone in Liverpool where there was any waste-

Mr. Kilroy-Silk

Give an example.

Mr. Marlow

I shall tell the hon. Gentleman where I expect there will probably be waste. Although I cannot give specific items, I can say where there might be waste. In terms of secretarial work in the health authorities, if the hon. Gentleman went round and were to see how many secretaries were employed and how heavily they were employed, he would probably find that savings could be made that could be spent on patient care. He would probably find that there are consultants who sometimes indulge in an expensive course of treatment when the best buy might be a different course of treatment, so that more money could be made available for the kidney patients in his constituency.

Mr. Kilroy-Silk

The hon. Gentleman is fantasising.

Mr. Marlow

If the hon. Gentleman thinks that I am fantasising, Liverpool must be quite different from anywhere else in the country. If one asks any other health authority, or anyone who works in a health authority anywhere in the country—

Mr. Alton


Mr. Kilroy-Silk


Mr. Marlow

I shall not give way because I am just about to finish.

I advise the hon. Member for Knowsley, North, if he is concerned, as I am sure that he is, for the health and welfare of his constituents, to follow the course of the optimum utilisation of the Health Service resources in his area. That is the way in which he should move and that is the signal service that he would be able to do to his constituents.

Mr. Bermingham

Clutching at straws.

Mr. Marlow

I suggest to the hon. Gentleman that he should go and clutch at a few straws in his own constituency because he will find that some of those straws will have silver linings, if not gold ones, and the money and the resources can be made available.

The Griffiths report has put forward suggestions and proposals have been made for increasing efficiency and the management skills in the Health Service. I suggest that the hon. Member fo Knowsley, North follows that up for all he is worth in the interests of his constituents and the Health Service.

7.55 pm
Mr. Gerald Bermingham (St. Helens, South)

I listened to the hon. Member for Northampton, North (Mr. Marlow) but I did not comprehend what he said, because I cannot reconcile it with statistical facts. As I understand it, we spend approximately 7 per cent.—I am open to correction—of our total costs on administration. That figure is lower than for many equivalent European countries and one that reflects a good rate of return.

I mention that purely to answer the comment made a few moments ago, as the hon. Member for Northampton, North would not give way when I asked him to do so to give him the figures.

Mr. Dave Nellist (Coventry, South-East)

Is my hon. Friend aware that the administrative costs in hospitals in America are about 25 per cent. of the total costs?

Mr. Deputy Speaker

Order. I hope that hon. Members will not attempt to stray from the debate, which is on the Health Service in Liverpool.

Mr. Bermingham

I have no intention of straying, but my hon. Friend is correct.

Mr. Marlow

If the hon. Gentleman wants to put the matter accurately, I suggest that he looks carefully at some Health Service accounts. They would cut out the administrative expenditure, as he says, at the level of 7 per cent. If he goes further through those accounts and asks how much is spent on secretarial, accounting procedures and various other things, he will find that those figures come well above 7 per cent. It depends where one draws the line.

Mr. Bermingham

I think that the point has already been well made.

It is a well-established and well-known fact that psychiatric medicine is a growing part of the Health Service, but it is a Cinderella part. I see that the Minister is nodding his head in agreement. Investment in this part of the Health Service is desperately needed, yet we cannot invest because once a capital structure is built there will be administrative and running costs, which means increased funding, and so on, and the funding is not available without taking it from another part.

As the Department is well aware, on 24 October I asked a series of written questions, reported in column 59 of Hansard, about psychiatric services. One of the matters that I raised in particular was that of psychiatric services for the elderly. It is regrettable to report that in that Cinderella part of our society there are an increasing number of people in desperate need, and in Liverpool and Merseyside generally those numbers are steadily rising. I shall have to concede that £6 million of additional moneys has been put in last year, but that is just a drop in the ocean of need.

Mr. John Patten

It is a start.

Mr. Bermingham

It is a start, but it is nowhere near adequate, and that £6 million would not even be adequate to deal with the needs of Merseyside, Liverpool in particular. That is the background to our debate.

The development of psychiatric services in Liverpool has a direct relevance to my constituency because it is proposed to build a psychiatric unit in the Broadgreen hospital within the Liverpool conurbation. I am told that even if planning started tomorrow, it would be at least one to two years before the first sod had been cut in the development. It would then be, roughly, another six to eight years before the unit was ready. The proposed unit at Broadgreen is pencilled in for 1992, and we are in 1983. With the growing problem, that is the suggested solution for Liverpool. I hate to say that it was suggested that the unit should be put near the mortuary, and I leave it to the House to draw its own conclusion on my feelings about that matter.

This is a part of medicine that is neglected. As a result, Liverpool patients are sent, as the Minister will be aware, to Rainhill, another hospital in my constituency. It needs considerable capital moneys spent upon it. The March intake of trainee mental health nurses, of which we are desperately short, has been deferred. There is a growing problem, so training is stopped. That directly involves patients in Liverpool. They have to go to that hospital, which is about 13 miles away.

The Government may admit that the facilities and treatment available for the mentally infirm and elderly mentally infirm are inadequate and that further investment is needed, but they then talk about funding regions and districts in such a way that hospitals will not be built until 1992. How are we to meet the need? What is to happen to the people of Liverpool between now and 1992? Where is the treatment to come from? Can such a policy be right? Much has been said about the availability of resources. We all know that they are there, but it is just a matter of priorities. In our society, priority should be given to looking after the sick, the disabled and the elderly. The Government should accept that our mental health services are poor. We should be ashamed of the facilities now available.

Mr. John Patten

I have listened carefully to the hon. Gentleman. Setting aside his general strictures on the Government's policy towards the National Health Service in the Liverpool region, will not he recognise that there has been a massive change of attitude towards mental illness and a great structural change in the way in which mental illness is treated? Rightly, there has been a decline in the number of large long-stay hospitals and an increase in care in the community. However, in all reason, such a change cannot be achieved overnight—or perhaps even within a considerable number of years—whichever party is in power.

Mr. Bermingham

I welcome what the hon. Gentleman has said. I agree that the philosophy about long-term, long-stay patients has changed and that that change was much needed. However, that requires resources. We must have various facilities, such as secure and intermediate units in the region. The Minister will be well aware that the first such unit was recently opened in my constituency. It has 40 beds, which could easily be filled. However, we need more than that in Merseyside and Liverpool. The patients exist and the catchment area will be very wide. There are not enough facilities. Modern thinking says that there should be treatment in the community. However, that requires district and other nurses, halfway houses, feed-back accommodation, outpatient clinics and a thousand and one other facilities. For all of them, we need resources.

The Government are committed to cutting the funds of regional and district health authorities, so how can the desperately needed resources be found? There is no logic to it, unless it is said that psychiatric care means that we must give up renal units, surgery and paediatric units, in addition to cutting staffing levels in major hospitals and general expenditure on health, so that resources can be channelled into that needy area.

Given the overall position of the Liverpool area health authority, it is obvious that there is no way in which it is possible to marry successfully the services that are needed with the funds that are provided. The need far exceeds the funds. That health authority has had its funds cut. It does not have adequate funding with which to meet the area's needs.

The subject of mental health is dear to my heart. It directly involves my constituency. The principle that I enunciate tonight is simple. In a caring and civilised society, the mentally handicapped and sick need the investment and resources that will give them the health care that they deserve. I lay this charge at the Government's door. They walk a path to an uncivilised society.

8.4 pm

Mr. Eric Heffer (Liverpool, Walton)

This is the first chance that I have had to speak on Merseyside affairs from the Opposition Front Bench since being appointed to my job by the new leader of the Labour party. I do not have a specific brief that deals with national health and medical matters. Nevertheless, I have an opportunity to join in the debate, and I am delighted to do so.

I am sorry that the hon. Member for Northampton, North (Mr. Marlow) has left the Chamber, although I did not want to become involved in a great argument with him. However, I am sure that he and the Minister both believe that the NHS must, at all costs, be made more efficient than it is.

I should like to relate a little story about the previous Minister for Health who visited Walton hospital. I happened to be with him, and met him together with the shop stewards and representatives of the unions and management. I went round the hospital with him. In a geriatric ward he became rather angry, saying that there were too many people in it. He said that they were staying there for too long and that people should be returned to society much more quickly. I had to point out to the Minister that many of those old people had left houses that were in very bad repair and in a condition that the hon. Gentleman would not like to live in. If patients were returned more quickly, they would have to return to the same rotten, lousy conditions. The next time they came to hospital would probably be their last, because of those conditions.

The Government have clearly developed a policy that compassion and care should be sacrificed on the altar of efficiency. I hope that that philosophy will be refuted once and for all.

The Labour party built the NHS in 1948—that is when it came into operation—because it was necessary for our people to have for the first time a decent health service throughout Great Britain. In case there should be any misunderstanding about what the Conservative party did then, I should add that it opposed the introduction of the NHS. It is all very well for Conservative Members to say that the NHS will be safe in their hands. If they had been committed to it from the word go, we might have believed them. I related that story about Walton hospital because it embodies the difference in attitude and philosophy between Labour and Conservative Members.

Some interesting points have been raised tonight. One of them will no doubt be raised again. It is that Merseyside has the same sort of funding as everywhere else. In reply to my hon. Friend the Member for Liverpool, Riverside (Mr. Parry), the Minister for Health said: In view of the projected decline in the city's population and changes in the authority's catchment area for patients, Liverpool would be considerably overfunded in comparison with other health districts by the end of this decade if no action were taken. The RHA has decided that Liverpool's revenue budget should be reduced by 6 per cent. by 1988–89 against a background of a projected 9 per cent. decline in population." — [Official Report, 24 October 1983; Vol, 46, c. 53.] I find this a worrying philosophy.

Of course there has been a decline in the population, but the hon. Member for Liverpool, Mossley Hill (Mr. Alton) made the important point that we have an ageing population which needs greater care than a younger population. Therefore, it is not necessarily logical to say that because there is a decline in the population the requirement for health care will diminish. It may mean that resources should be shifted from one aspect of health care to another and it could mean that in the long run the amount of health resources needed for Liverpool and Merseyside as a whole will increase because, while the population of Liverpool may decline, the population of the Merseyside conurbation may increase. The hospitals are used by the conurbation and not by the population of Liverpool alone. That is an important point.

Mr. Parry

I congratulate my hon. Friend on his appointment to the Front Bench to speak on behalf of Liverpool and Merseyside, which he has done for many years. Does my hon. Friend agree that Liverpool has been written off by the Government not only in terms of employment but in health care? Is he aware of the Government's recent decision, which I fully support, to give £650,000 to bone marrow transplant clinics in London but not to give a penny piece to the Liverpool unit which is subscribed to by the ordinary people of Liverpool?

Mr. Heffer

My hon. Friend is absolutely right. He has underlined an important point that was made earlier in the debate.

On 8 November my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) asked a comprehensive question. He asked the Secretary of Slate to list the private hospitals in England which offer acute medical and surgical care, giving for each hospital the number of beds and the owner." —[Official Report, 8 November 1983; Vol. 48, c. 57.] I looked with great interest at the position in Liverpool and discovered that there are eight private hospitals in Liverpool but that their total number of beds at this stage —I am pleased to say—is 285. I also looked at the waiting list for inpatients for National Health Service hospitals and discovered that on 30 September the number—

Mr. John Patten

Which year?

Mr. Heffer

In 1981. The number was 7,172. On 30 September 1982 the waiting list had increased to 8,553. Very few of those people will have enough money to go into the 285 beds in the private hospitals. The people of Liverpool rely almost entirely on the National Health Service. Most of the people in Liverpool want to rely on the National Health Service and they want to rely on the hospitals in their area. They do not wish to go into private hospitals, unless, of course, they are rich and decide that that is the solution for them.

The Secretary of State announced on 30 September this year the revised manpower targets that had been agreed by each regional health authority. We know that they were somewhat lower than had been originally expected. I shall give the full figures. The staff employed in Merseyside hospitals numbered 44,844. The target for 31 March 1984 is 44,338—a reduction of 506. Those 506 members of staff will not all be administrators; they will be nurses, ancillary staff and doctors, the very people concerned with the care and health of the people. That is why we are so deeply concerned.

The Merseyside regional health authority has instructed the district to cut the number of jobs by March 1984. The bulk of the cuts will fall in Liverpool and Wirral. The cuts will cost the Liverpool district health authority £1.6 million between now and next March. Above and beyond that figure, the long-term strategy will cost £5.5 million over the next five years, and 735 beds and more than 800 full time jobs will be lost. In practice, the cuts will mean that Newsham hospital in my constituency will lose 15 orthopaedic beds while it has a waiting list of 509. The women's hospital will lose 21 gynaecological beds—one quarter of its total—while it has a waiting list of 629. It must also lose 10 geriatric beds. St. Paul's eye hospital is to lose 11 beds — the waiting list is 275. Alder Hey children's hospital is to lose 24 paediatric and orthopaedic beds—the waiting list is 72.

I thought that the Government understood the special problems of Liverpool. If we do not have special problems, why have the Government agreed that there should be a Minister with responsibility for Merseyside? One does not appoint a Minister for one part of the country unless there are special problems in it. The fact that the Government have appointed a Minister with responsibility for Merseyside is a recognition of Merseyside's special problems. Some of those special problems have been brought out in this debate. What precisely will the Government do?

I have been disappointed by the failure of those who make up the regional and district health authorities to make a stand on these issues. I appreciate what the hon. Member for Mossley Hill said about the chairman of the regional health authority, but if I felt that strongly, and if I were facing such a dilemma, I know what I would do—I would resign. If one feels that strongly about something, one gets out of the job and explains publicly why one has decided to do so.

Mr. Alton

I am glad that the hon. Gentleman phrased his remarks in the way that he did. Does he accept that some of the remarks made earlier tonight about the chairman of the regional health authority were unwarranted? If he were to resign tomorrow, he would say to the hon. Member for Liverpool, Walton (Mr. Heffer) and to other hon. Members that he would be replaced by someone worse, that the cuts would still be made whether he was in the job or not, that he had no party political affiliations and that he was trying to do a good job, just like every other regional health authority chairman in the country. The chairman was trying to cope with difficult problems. Therefore, it is not he who should be vilified as he was tonight.

Mr. Heffer

Not only the chairman but the whole committee should resign. Of course, I know that the hon. Gentleman is right: it would undoubtedly be replaced. However, it would not be responsible for what is happening. The majority of people in the area would know what was happening if the committee had taken a stand against policies that it could not accept.

Although the committee has not made a stand, many people recognise that the cuts are not generally accepted. Indeed, a delegation from the British Medical Association recently discussed the matter with the Secretary of State. Members of the delegation said that they were profoundly depressed by the current financial economies and that the cuts would affect patient care. That is the opposite to what the Government are arguing. They claim that they are carrying out efficiency moves to help the patient. It is a strange way to help patients if it means removing doctors and nurses and causing great worry to the personnel in hospitals. Almost 4,500 staff will be lost throughout the country, and many believe that that could be only the beginning. Such a policy has a bad effect on the morale of any organisation.

We want answers from the Government. There is a great feeling of distress and anger in Merseyside. People are angry about the high levels of unemployment—the highest in Britain. They are angry about the Government's cut in rate support grant, with its effect on housing conditions. They are angry about what the Government are doing to the NHS.

If the Government really mean that the NHS is safe in their hands, the Minister should assure us that the Government will tell the regional health authority that it does not have to carry out the cuts. The Minister should assure us that the Government will reverse their policy and initiate inquiries into how improvements can be made to the Health Service in Liverpool.

8.23 pm
The Under-Secretary of State for Health and Social Security (Mr. John Patten)

In the brief two hours and seven minutes that remain to me to reply to the debate, I shall do my best to answer most of the points raised in what has been an interesting debate! I am grateful to the hon. Member for Liverpool, Riverside (Mr. Parry) for initiating the debate. When he applied to Mr. Speaker for an Adjournment debate, he could not have expected a half-day Supply debate.

A chance but happy occurrence has led to the House discussing the health problems of one of Britain's major regions. It is not often that we have an opportunity to discuss health care within a regional framework. During the 18 months before I went to Stormont Castle—which I left for the Elephant and Castle—I tried to listen to debates on regional issues. I remember some fascinating debates on the economic problems of the northern region and the west midlands. To my knowledge, this is the first time that we have had an opportunity to discuss the health care problems of one particular region. I hope that fate, the Leader of the House, the Opposition or the alliance will provide us with a similar opportunity in future.

A good number of hon. Members have taken part in the debate. I pay tribute to the force that lay behind the speech of the hon. Member for Riverside. Two points that he raised caused me special concern. I cannot answer either of them tonight but will write to him as soon as possible. First, he suggested that he had approached the district health authority and asked for public documents, but they were not made available to him. That is a disturbing suggestion. I shall make inquiries and write to him. I also wish to consider in detail his point about the movement of patients between catchment areas — especially young people and children in his constituency — over considerable distances. I do not know the facts about the cases that he mentioned, but again will make inquiries and write to him.

The hon. Gentleman has given the House an opportunity to look at the whole range of health care problems in the Liverpool region. The hon. Members for Liverpool, Garston (Mr. Loyden) and Liverpool, West Derby (Mr. Wareing) both contributed to the debate. The hon. Member for Liverpool, Mossley Hill (Mr. Alton) struck a balance in his contribution. It was good of him, in his almost bipartisan position tonight, to come to the aid of the regional health authority chairman, Mr. Don Wilson. I believe him to be an excellent chairman who serves the interests of the public to the best of his abilities. It is not seemly to attack people who give up so much of their time and energy to public service for precious little recognition or personal reward. This Chamber is not the place for public attacks on people who do not have the right of reply here.

The speech of the hon. Member for Mossley Hill was a sharp contrast to that of the hon. Member for Liverpool, Broadgreen (Mr. Fields). I have not been fortunate enough to hear him speak before. I fully appreciate his strength of feeling about the welfare of his constituents and his views about those who work in the Health Service and trade unionists. But I hope that, when he reads his speech in Hansard tomorrow, he will reconsider some of his aspersions against consultants in the NHS. After all, they are at the sharp end. They make physical judgments and undertake surgical operations. They are as important as any other group in the NHS. I do not suggest that they are necessarily more or less important, but they are important.

Mr. Terry Fields

I do not know why the Minister thinks that I was attacking consultants. I was referring to the fact that the hon. Member for Liverpool, Mossley Hill (Mr. Alton) had been speaking to tops in hospitals. I simply said that I have not spoken to such people but to ordinary working people in the street. I was casting no aspersions on anybody.

Mr. Patten

I am glad to have that assurance. I have never met a toff in a hospital—

Mr. Fields

I said "top", not "toff".

Mr. Patten

I apologise. I have never met a toff but I have met several top people in hospitals.

The hon. Member for Broadgreen made a serious allegation and I am not sure whether it applies to the Merseyside region generally. He said that there was a corrupt relationship between the private sector and the NHS. If that is the case and he wishes to draw some allegations to my attention. I hope that he will do so either now or subsequently in writing. I assure him that they will be urgently considered. We keep the highest possible standards of public probity in the NHS and I should not like it to be felt that an hon. Member had criticised people in the NHS in Liverpool for something that might have happened between it and the private health sector. I should like any information that the hon. Gentleman has in order to clear up that point.

Neither the hon. Member for Knowsley, North (Mr. Kilroy-Silk) nor my hon. Friend the Member for Northampton, North (Mr. Marlow) has been able to stay in the Chamber. They were kind enough to tell me that pressing constituency business took them elsewhere. We have had a notable contribution from the hon. Member for St. Helens, South (Mr. Bermingham) who has a particular interest in mental health.

The hon. Member for Liverpool, Walton (Mr. Heffer) in his new role placed the problems of Merseyside in a broad regional and historical perspective. I was in the House when my right hon. Friend the Secretary of State for Defence, who was then the Secretary of State for the Environment, made his first ever announcements about Merseyside and its environmental problems in particular. I well remember the generous response of the hon. Member for Walton to those announcements that afternoon. I understand that he wants to see the Government's response improved in various ways and I listened to what he had to say about Merseyside, having represented a constituency there for so long, with respect.

In the NHS generally, and in the Liverpool area in particular, it is easy to spend more but it is not necessarily so easy to spend well. That sentiment underlies everything that I have to say about the NHS and the Liverpool health authority's budget. It is not just how much money is available for the NHS in Liverpool that is important but how that money is spent, which is almost as important. That theme will also underlie what I have to say this evening in discussing the health authority's budgetary problems. After all, that has been the underlying theme in the speeches of Labour Members tonight.

Three factors must be taken into account. First and foremost, as Labour Members know, the Liverpool health authority has just completed consultation on a long term and important strategy for the Health Service in Liverpool. That strategy will take into account the views of the regional health authority and the Government that have been assembled through the regional review system which is such a notable part of the way in which the NHS is being run. It is a modern and coherent method by which the Department of Health and Social Security examines once a year what happens in each of the 14 regions of Britain, just as each region goes on to examine what happens in each district of each region.

In the course of the regional review, those who attended were the first to say that there were inefficiencies in the system upon which improvements could be made. The hon. Member for Knowsley, North is not in the Chamber at the moment. He explained that he had to leave to deal with urgent constituency business. He took me to task for suggesting that efficiency was a nasty concept which attacked individuals such as nurses, doctors. administrators, ancillary workers and others in the NHS. That is not what the Government mean when they talk about efficiency. When the Government talk about efficiency, they mean making the best use of available resources to save the maximum sums that are available for better patient care. All the efficiency savings that have been made in the Liverpool district are returned to be spent on care within that district.

There are in Liverpool, in the Mersey region generally as throughout the country, a number of old and outdated hospitals which do not give a high standard of patient care but which cost the Health Service dear because of the inefficiencies inbuilt into running them, such as the design of the building, the heating, floor levels and so on.

Mr. Alton

While no sensible person could take exception to the Minister's argument that where efficiencies can be made they should be made, how can he justify the closure of, say, the Duchess ward of the women's hospital, the orthopaedic ward for paediatrics at Alder Hey hospital or the non-replacement of the dermatologist to whom I referred in my remarks about the new teaching hospital? Does the Minister disagree with the sentiments expressed by the chairman of the area health authority that inevitably the £1 million-plus cuts that will have to be made will have an effect on the health of the people in the care of that authority?

Mr. Patten

It strikes me as peculiar that all the time when, nationally, one is spending more one is accused of cutting. What is happening in the National Health Service is a continuing process of rationalisation. The hon. Gentleman raised two ward closure issues and I shall come to those later in my speech.

Mr. Parry

Can the Minister explain why not a penny piece has been given by the Government to run the new bone marrow transplant unit that has been subscribed to—indeed, it has been built and opened—by the general public through a Liverpool Echo campaign? The public having paid for this unit, I cannot understand why the Government cannot at least fund the running of it.

Mr. Patten

My hon. and learned Friend the Minister for Health announced a few days ago a considerable increase in the amount available for bone marrow transplants in the current financial year, plus the promise of further sums in future years to enable a number of regional centres to carry out transplants in the future, and the hon. Gentleman's point must be seen in the context of that announcement.

The hon. Member for Riverside mentioned hospital closures, and I must remind him that they have been going on for a long time. It is not a phenomenon invented after 1979. It causes me a wry smile occasionally to reflect on the fact that between 1974 and 1979 the Labour Government shut 272 hospitals, a number of them in Liverpool, more than double the number of hospitals that have been closed since 1979. That figure must be set against the biggest hospital building and planning programme in Britain since the inception of the NHS in 1948, with more than 140 new hospitals being planned and built, such as the hospital to which the hon. Member for Mossley Hill referred, the name of which he might care to remind me.

Mr. Alton

I referred to the capital programmes to improve geriatric facilities at the new unit at Mossley Hill hospital and the steps taken to improve the wards for geriatric care at Broadgreen. I paid tribute to the Government because those steps are welcome.

Mr. Loyden


Mr. Patten

I must first reply to the hon. Member for Mossley Hill because he leads me to dilate further on the importance of rational hospital planning, in Liverpool and elsewhere.

As new capital developments take place—about £31 million worth of capital developments are planned for the Liverpool area in the next 10 years—it is only natural that outdated capital stock should be closed down, and that stock is one of the major problems facing the NHS. That is why the Ceri Davies report — nationally, not in a regional sense—pointed out that there was a backlog of maintenance going back decades, accounting for about £2 billion of NHS property needing improvement.

Mr. Loyden

The Minister has referred to hospital closures during the period of the Labour Government, but in Liverpool the closure of the Stanley, northern and southern hospitals were all long overdue closures. It is misleading to argue that the closures, which happened to be prior to the building of new hospitals in Liverpool, were not an essential exercise that the then Government had to undertake.

Mr. Patten

I do not want to be led over the bounds of order, Mr. Deputy Speaker. I know that you would call me back sharply, if I were to do so. The hon. Gentleman is propounding an interesting new thesis which, basically, is that Socialist closures are good and Tory closures are bad. There is nothing more that I can usefully say other than that I do not agree.

Mr. Bermingham


Mr. Patten

I shall not give way and I hope that the hon. Gentleman will forgive me. I should like to make some progress in my speech before giving way to him.

Mr. Heffer

Will the Minister give way to allow me to intervene on the capital programme issue?

Mr. Patten

I shall address myself to the capital programme shortly. I hope that the hon. Gentleman will allow me to give way to him at that stage. I do not want to fire all my shots so early in my speech.

I said that there were three factors which we had to bear in mind when considering the Liverpool health authority's budget. The first factor was its plan, the second was Liverpool's population decline and the third is the extent of new hospital provision elsewhere in the Mersey region, which must be taken into account. When we were examining the regional pattern it was clear that Labour Members were considering Liverpool's hospital provision without recognising that new hospital provision was being made available within the rest of the region.

Current projections show that Liverpool's resident population will decline by 9 per cent. from 503,722 in 1981 to 456,500 in 1991. I have given the detailed figures in the light of the new role of the hon. Member for Walton. Accompanying the population decline will be the provision of major new hospitals in Runcorn, Southport and Warrington. These hospitals will be completed in the rest of the decade. That will result in a reduction in Liverpool's patient catchment population of about 10 per cent. to 15 per cent. in certain specialties. It has not been possible in the NHS since 1948 to provide every specialty in every hospital in Britain. It is necessary for patients to travel to avail themselves of certain specialties.

In the technical sense of the word it still remains the fact that the health authority is overfunded compared with other authorities in the Mersey region. [Interruption.] I know that Labour Members do not agree with that but I shall be grateful if hon. Members will allow me to put my side of the case. In my phraseology I am drawing on the excellent plans introduced in 1976 by the then Labour Administration to redistribute resources about the geography of the NHS. That was the resource allocation working party process. There were references then—I am going right back to 1976 — to underfunded and overfunded regions.

It is my contention and the Government's that if the funding of the Liverpool authority had not been adjusted to take account of demographic change and important new developments elsewhere, which in all fairness Labour Members should take into account in their regional analysis, the district would have consumed an ever increasingly disproportionate amount of resources compared with that consumed by other districts within the rest of the region. Accordingly, the regional health authority decided last year to reduce the revenue available to Liverpool by about 6 per cent. by the financial year 1988–89.

Mr. Heffer

I find what the Minister has said about overfunding remarkable. I could take him now to Walton hospital, where there are two geriatric wards for men and women. They have one toilet unit with three toilets. I have been complaining about this for a long time. They have made one slight improvement. They put up—

Mr. Terry Fields

A roll of paper.

Mr. Heffer

That is right. They put up a few bits of paper here and there and laid carpet in the middle of the ward. There has been a slight improvement but the toilet facilities are the same. Then the Minister has the audacity to say that we are overfunded.

Mr. Patten

We face a considerable problem in Liverpool as we do elsewhere with finding available resources. If the hon. Gentleman has other problems doubtless he will write to me about them. He should also note that the cumulative total of reduction of revenue available to Liverpool by 1988–89 compares with a 9 per cent. reduction in population. So there will be a 6 per cent. reduction in resources compared with a 9 per cent. reduction in population. That will still leave that authority funded by about 5 per cent. more than the average for all the other authorities within the Mersey region.

Mr. Bermingham

Would not the Minister agree that the projected figures for the population are about as reliable as undertakings by the Government to fund the Health Service? Figures have been calculated on the population in 1976.

Mr. Patten


Mr. Bermingham

I am sorry, 1979. It is now 1983. No doubt the Minister could have corrected the figures if there had been an intermediate count. While there may be a change in population because the inner city will be rebuilt and there may be slum clearance, there is a semi-urban development around the city spreading out towards the Knowsley and St. Helens area. Some of those people will have to be served by Liverpool district health authority. The other point is that we must not forget that inflation is running at about 6 per cent. and we await with interest to see what will happen.

Mr. Patten

Several interesting but not totally inter-related points have been raised. I fear that if I were to reply to some of them I would be called to order.

Of course, demographic projections are notoriously difficult. However, they have been rather more successful since the 1971 census. We have much better planning figures. As you know, Mr. Deputy Speaker, I have got only another hour and three quarters in which to sum up the debate so I hope that Opposition Members will permit me to make a little progress before I give way again. I have found this regional debate so interesting that I want to give way as much as possible to give hon. Members the opportunity that people in my regional health authority area, Oxford, have never had to debate such issues.

The third major factor that we have to bear in mind when we consider the issues facing the health authority is that there are a number of indicators that make us realise that Health Service provision in the Liverpool area needs a fresh look. There is widespread agreement that community health services and local services for the mentally ill, already mentioned by the hon. Member for St. Helens, South, and also the mentally handicapped in Liverpool, require improvement. At the same time there is evidence to suggest that there may be an over-provision of certain types of hospital beds, particularly acute beds, in the city. While we do not believe that Health Service planning should be tied to norms of a certain number of beds per thousand population, we have evidence which shows rather startling figures for Liverpool. For example, in 1981 there were 589 general medicine beds in the district, whereas medical planners estimated that 319 beds will be needed for 1991.

Of course, we can debate endlessly whether the medical planners have got it right, and of course we must take into account the important issues raised by the hon. Member for Walton about the home conditions of the people who go into hospital and the problems that face them when they return home. That must explain some of the length of stay periods in Liverpool. None the less, in a strict analysis of the need for acute beds in Liverpool there are considerably more than the planners suggest are necessary. For general surgery, the comparable figures are 442 and 331 beds respectively.

The excellent new performance indicators that we are developing in the DHSS show that in 1981 Liverpool had the second longest length of stay and the third lowest throughput of patients per bed in the country. I suspect that there is considerable agreement across the Floor about the reasons for that, but that should not prevent us from examining the situation closely. I do not seek to argue that such indicators prove good performance or bad performance for Liverpool, bearing in mind the social problems that exist there. However, many patients, in ideal circumstances, want to get home early. They do not want to spend a long time in hospital. That is why the development of five-day wards, for example, is a great and continuing improvement in the NHS, and we are grateful to the nurses and consultants who make those wards work so well and get people out for the weekend.

Against the background of those three factors, the Liverpool health authority, as has already been said by a number of hon. Members including the hon. Member for Riverside, produced a consultation document on its long-term strategy. Hon. Gentlemen will be familiar with its general thrust: a reduction in bed numbers in most acute specialties, recommended for inner city areas, as much in London as in Liverpool; the development of community-oriented services particularly for the elderly, the mentally ill and the mentally handicapped; and a recommendation to close Princes park and Newsham general hospitals. I do not intend to discuss those closures in detail tonight. It would be premature to do so. The Liverpool health authority endorsed the strategy at its October meeting I dare say that hon. Gentlemen are familiar with the procedure. The recommendations now go to the regional health authority and then land, if they get that far, on Ministers' desks. At that stage Ministers are required to make an objective judgment on the closures. I do not intend to prejudge any of the proposals, in advance even of the comments from the regional health authority, which has not yet considered the document, and certainly has not passed on any comment to me.

Mr. Terry Fields

How does the Minister make his objective judgments? When was the last time he spoke to a home help? I speak as someone who is married to a home help, and I know the difficulties that are caused by the cutback in resources. The emphasis should be shifted from hospital care to community care, because the resources and staff are not available in the hospital and old people and those in need will suffer.

Mr. Patten

In using the phrase "objective judgment", all I was saying was that in my opinion it is extremely important for Ministers, faced with the difficult problem of evaluating closure proposals, not to make any prejudgments about the rights and wrongs of the closures, and certainly not to give the impression to anyone in this Chamber or in Liverpool that any such prejudgment has been made.

Mr. Heffer

I am sorry to keep interrupting the Minister, but may I put a question to him? Before the decision is finally made, will he or the Minister of State or, preferably, the Secretary of State come to Liverpool, see for themselves the hospitals that are likely to be closed, and speak to the staff, the trade unions and the local authorities about the services that they provide? In fact, I hope that he will speak to all the people who are involved before the decision is made. Can he assure us that he will do that?

Mr. Patten

I cannot give an undertaking tonight. It is some time since a Minister from the Department of Health and Social Security visited a hospital in Merseyside. I have not been there since I was appointed to my new job in June, and I want to pay such visits. In recent months, when hospitals have been threatened with closure, I have visited hospitals such as the Prince of Wales hospital in Haringey. I spent some time talking not just to consultants, nurses and adminstrators but to shop stewards and trade unionists. I was a member of a trade union in my previous profession. I am always happy to talk to trade unionists about such problems.

In case hon. Members think that we are dealing with a litany of despair and criticism, I must draw their attention to the positive aspects of health strategy in Liverpool and the Merseyside region, which were mentioned only in the interesting contribution by the hon. Member for Mossley Hill. I hope that all this praise and thanks is not doing his political career any damage. I promise not to thank him again during my speech. I always listen with interest to what he says.

Substantial capital developments are pledged for the city over the next decade — £31 million worth. In addition to major redevelopments at Broadgreen hospital and Alder Hey children's hospital, there will be a subsequent expansion of day places for the elderly and the development of community units for the mentally handicapped.

Moreover, the cumulative revenue reduction of £5.76 million a year by 1988–89 will be offset by extra earmarked revenue of about £2 million a year for mental illness and mental handicap services. I hope that the hon. Member for St. Helens, South, who raised that point, will welcome that extra earmarked revenue. There are many positive benefits for the people of Liverpool in that strategy.

Mr. Heffer

Will the Minister give way?

Mr. Patten

I have already made the joke twice that I could speak until 10.30. I now have one hour and a half left to finish my remarks. I shall have to keep the House until 10.30 pm, on what is an important issue, unless I can make progress.

Mr. Heffer

The hon. Gentleman must understand that we are concerned about his figures. Is the £31 million in addition to the present allocation or is it part of the overall cash? That is important. A report by the works officers in the district health authority argued that £11 million was required for outstanding maintenance. If the £31 million is in addition, we shall welcome that. What exactly is the £31 million? Where is it coming from?

Mr. Patten

I am happy to clear up that point. The £31 million is exactly what I said it was. It is the plan for capital spending within the boundaries of the city of Liverpool until the end of the decade. It is the planned sum of money that will be spent. I hope that the hon. Gentleman welcomes that, as well as the £2 million earmarked money, which is extra money. It will go towards developing services for the mentally ill and mentally handicapped. I would be sorry if people in Liverpool did not welcome that, but I am sure that they will.

Hon. Members have mentioned certain wards. I refer first to the 16-bed orthopaedic ward at Newsham general hospital. Occupancy of that ward was low, despite what we heard about waiting lists. Occupancy was between only 54 per cent. and 67 per cent. That is not a very satisfactory state of affairs. The ward catered principally for elderly patients who had been transferred from Broadgreen hospital after surgery. The geriatricians at Broadgreen have been able to increase the number of patients accepted from orthopaedic wards and therefore the district health authority, which is charged with hospital planning in the area, considered that the Newsham ward was, for the moment, surplus. The ward has been temporarily closed, as it was operating at a 54 per cent. to 67 per cent. occupancy rate. I am sure that it would not be suggested for one moment that such an occupancy rate is desirable in our modern Health Service.

The women's hospital has excited a considerable amount of interest. The hon. Member for West Derby referred to it. Occupancy at the women's hospital is low, at 66 per cent. Turnover is slow and length of stay well above the national average. The authority has decided, I think rightly, as a temporary measure, that it can provide the same level of service with fewer beds.

Mr. Terry Fields

The bandying around of statistics is intended to confuse people. The Minister seems to be saying that an occupancy rate of 65 per cent. or 70 per cent. entitles the authority to close down the ward. As a result of the Government's economic policy, trade and industry are now operating at 60 per cent. or 70 per cent. Do the Government therefore intend to close all trade and industry? We need good trade and industry, just as we need good hospitals.

Mr. Patten

I am not trying to confuse anyone with statistics. I am trying to put before the House the incontrovertible fact that the occupancy rate in the women's hospital is low at 66 per cent. The hon. Member for Broadgreen and I can draw different conclusions from that, but it is a fact.

Mr. Wareing

If the occupancy rate is only 65 per cent., why is there a waiting list for the Catherine street women's hospital? Why are 12 urgent cases still waiting treatment?

Mr. Patten

I cannot deal with those questions tonight. I am not aware of the details of such a waiting list nor of the 12 cases to which the hon. Member for West Derby refers.

A decision must be made on a 10-bed female long-stay geriatric ward at Newsham general hospital. This ward was already closed temporarily due to staff sickness and the consultant concerned — we must depend, quite rightly, upon consultants for clinical judgments—said that he hoped to be able to maintain normal levels of service without the use of the ward. In that case, we took medical advice.

We must deal with the important matter of the internal redistribution of beds at St. Paul's eye hospital. I am afraid that I must give another "clarifying" statistic, although it is not aimed to confuse. I am not the only hon. Member who has used statistics. Almost every hon. Member who has taken part in the debate has read out rows of figures, mostly from parliamentary answers that I have given in the past two or three weeks. Occupancy at St. Paul's eye hospital is only 70 per cent. and the ophthalmic waiting list in Liverpool has been decreasing in recent years, with the unfortunate exception of the period during last year's industrial action. The sooner we forget about that, and the less said about it, the better. The authority considered that beds could be reduced without a substantial reduction in work load.

Mr. Parry

I wrote to the Minister about the waiting list and the Minister replied to me on 28 October. I included a letter from a patient stating that her appointment had been cancelled because of insufficient staff. She said in the letter that she was grateful to the staff of St. Paul's eye hospital as she feared that she was going blind. How can the closure of a ward be justified when the Minister's reply indicated that nearly 500 people are awaiting admission?

Mr. Patten

I have just explained the circumstances surrounding the closure of that ward. I can only refer the hon. Gentleman to tomorrow's Official Report.

There are also very low occupancy levels on paediatric orthopaedic wards. That, too, has caused concern locally. In June this year, the waiting list was only 75 and there were no urgent cases. Contrary to the gloomy picture painted by Opposition Members, in this area the vast majority of cases are treated within six months of appearing on the waiting list. Again, therefore, the authority considered that the closure of a 24-bed ward would not affect services. That change is certainly in line with the long-term strategy being developed.

None of the measures that I have mentioned constitutes a savage reduction in services of the kind suggested by the Opposition.

I stress one point about temporary closures, which I hope will reassure hon. Members and their constituents. The closures were effected before the full consultation process had been undertaken because the authority believed, as it is entitled to do, that urgent action was necessary in the interests of the service as a whole. We have always recognised that in the very short term there may be circumstances—including financial pressures, but sometimes other problems such as illness of individual specialist consultants—which justify authorities acting in that way. I reassure the House, however, that before the closures can be made permanent — if, indeed, it is proposed that they should be permanent — the full consultation process must take place. If the community health councils object, the matter will come to Ministers in the normal way.

Mr. Alton

The Minister referred to statistics. Florence Nightingale once said that statistics were important because they were a measure of God's purpose for us here on earth. They are also a measure of the challenge. Many Opposition Members have put it to the Minister that there are grave problems in Liverpool, especially for elderly people. One statistic that we tried to impress upon him was that the fastest growing group was the over 80-year-olds and that one third of the population was over retirement age. What increased provision will there be, not just in capital schemes but in increased revenue expenditure, to provide for those people?

Mr. Patten

Part of the regional strategy adopted by the Merseyside regional health authority is to switch resources within its substantial budget away from always providing acute care and towards providing better community-based provision for the elderly, the mentally handicapped and the mentally ill. The overall strategy is most interesting, but it is fraught with difficulties. The difficulties are compounded by the environmental and social problems of Merseyside. Nevertheless, I believe that the health authority is being thoroughly realistic in its approach to the problem in the interests of people who count most—the patients.

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