§ Motion made, and Question proposed, That this. House do now adjourn.—[Mr. Archie Hamilton.]
2.31 pm§ Mr. Roger Moate (Faversham)I warmly welcome the opportunity to debate the urgent need for additional financial resources for the Medway health district. I am pleased that my hon. Friend the Under-Secretary is here to reply.
I begin by asserting the fundamental and crucial fact that the Medway health district is by far and away the poorest in the south-east of England and, I believe, in the country. The Government should not tolerate that and should be determined to rectify the position as soon as possible.
The battle for extra resources for Medway has been long. We in the district have presented a united front for many years. I fear that we shall have to continue the campaign for many years. I welcome the support today of my hon. Friend the Member for Gillingham (Mr. Couchman) and say that my hon. Friends the Members for Mid-Kent (Mr. Rowe) and for Medway (Mrs. Fenner) wished to be here but were unable to be present because of previous commitments. I believe that my hon. Friend the Member for Mid-Kent is visiting one of the hospitals and that my hon. Friend the Member for Medway, w ho has been indefatigable on behalf of the hospitals, is at a school in her constituency.
We are united and determined that, ultimately, we shall succeed in obtaining greater resources for our hospitals. I accept fully that the Minister cannot wave a magic wand today, although I hope that he will make some encouraging noises. I hope, too, that he, the Secretary of State, or the Minister for Health will agree to meet all the Medway Members later to discuss some of the matters that we cannot present to the House today. We shall also be seeking a meeting with the regional chairman.
I shall not suggest that my right hon. Friend the Secretary of State or the regional chairman are the ugly sisters, but there is no denying the fact that Medway is the Cinderella of the hospital service. We are the poor relation. The figures are stark and explicit. The national average for the cost of health and community services per capita is about £162 a year; in Medway it is £78.50. I emphasise that that deficiency is in no way made up by services received outside the district. We would like to hear how the deficiency can be made up in the foreseeable future. The alarming proposition that we now face is that even 10 years' hence we shall still be way below the national target. Even that is on the assumption that year by year the present programme can be sustained.
I shall present more evidence of our deprivation, but it would be wrong not to welcome the plans that we have. They show that we are getting real growth, although it is not enough. We acknowledge that the situation is getting better, but progress is not nearly fast enough. The £31 million programme for the Medway hospital is in itself a dramatic investment in the future health of the people of Medway and Swale. The Medway strategy includes a second district general hospital in the Swale area, in my constituency. There is an urgent need to commence planning the first phase of Swale hospital so that building work can commence as soon as the capital finance is available in 1990.
609 I recognise that there are more real resources in the Health Service nationally and locally, more spending, more doctors and more nurses, but the fact remains that Medway is a deprived district in a theoretically overprovided region. With the best will in the world, the region can allocate extra resources to Medway only at the price of the closure of beds in other districts. That is a slow and painful process. We know how difficult it is to take resources from one district or to close hospitals in any area. It is a long and difficult process. With respect, I do not think that the Government recognise how difficult it is. If they did, they would not impose on the region the burden of trying to allocate additional resources to Medway within a reasonable time.
Without direct Government action, our problem of deprivation will not be resolved in the forseeable future. The Government should hold back from regional allocation funds a certain amount of money which they can allocate direct to deprived districts such as Medway. Otherwise, we shall go into the next century with districts such as Medway well below the national target. We should not tolerate that for one moment.
While asking for more money, Medway is demonstrating its belief in community self-help. It has an admirable record, which entitles us with greater force to ask the Government for more help. Only recently, new cleaning contracts were arranged which will save the dramatic figure of £1 million over three years. It is my hope and expectation that all that extra money will go into patient care.
Administration costs are often—rightly so—the butt of criticism. In Medway, they are well below the national average. It sets a good example to others of how the community can work for its health service. Our voluntary fund raising has been superb. I shall mention just two examples, but there are many more. Money has been raised for the renal dialysis unit at Keycol and no less than £650,000 was raised for the Wisdom hospice—a superb achievement. Despite all that effort by the local community, there is a sense that the Government and the region are not doing enough to deal with deprivation.
Our population has increased by 28 per cent. since 1961. However, in the same time the number of acute beds dropped by 7 per cent. We are short of 150 acute beds. The waiting time for routine surgical outpatient appointments is three months, but in the same region, in a London teaching district, it is one week. That is quite intolerable. Many doctors give more alarming figures for waiting times, but I shall quote just that one. The number of cases per nurse is useful for showing the work load borne by the staff. In the acute sector, it is the seventh highest out of 193 districts in the United Kingdom.
We are short of 55 maternity beds. Medway has only 56 per cent. of its projected bed need in all specialties. On average, staffing levels are just 55 per cent. of the national average. Those figures are unacceptable to us and they should be as unacceptable to the region and Ministers. We want to hear how we can conceivably, in the foreseeable future, remedy these failings.
I greatly welcome the expenditure that has been committed to the Medway hospital and the benefit that it will bring towards the end of the next decade, but I do not welcome the proposals to hold back the growth money that will ultimately flow — because of that hospital 610 construction—until that development is completed. The process of reallocation of resources should start now and not wait until the end of the 10-year programme which we are now seeing, which will involve the completion of the Medway hospital. Then, progressively over the next few years, the extra money should be available for the many other urgent needs of the Medway health district.
The money is needed now, particularly to develop the community health service, services for the mentally ill, the elderly and the mentally handicapped, and for urgent maintenance, as well as for sustaining and maintaining our present hospital service. All that is vitally needed.
It is because we recognise the problems facing the region in redistributing resources that I believe we are entitled to ask my hon. Friend to engage in some lateral thinking. Will he bring a new mind to look at how we can redistribute resources more effectively, more efficiently and more determinedly in the coming decade so that we do not have to come back year after year complaining about the deprivation of our region? I ask my hon. Friend to have a fresh look at how to solve the problems of Medway today, so that we can build a stronger hospital service for the future.
§ Mr. James Couchman (Gillingham)rose—
§ Mr. Deputy Speaker (Mr. Paul Dean)Order. Does the hon. Gentleman have the agreement of the hon. Member for Faversham (Mr. Moate) and the Minister to intervene?
§ Mr. CouchmanYes, Mr. Deputy Speaker.
I should like to add my support to my hon. Friend the Member for Faversham (Mr. Moate) in all that he has just said. It has been said with some justification that people have to be more ill in Medway to be admitted to hospital than in any other district in the country. Part of the problem, as my hon. Friend said, lies in the dramatic rise in population over the past 20 years. We are to see a further increase of about 7 per cent. before 1992. With almost the highest fertility rate in the country — live births per thousand 15 to 44-year-old females—and a higher than average number of 15 to 44-year-old females, the deficiency of 55 obstetric beds—more than 30 per cent. of the required number—leads to very short stays in hospital and a very high throughput of hospital beds. The shortage in that specialty typifies the gross inefficiency in health services in Medway.
Probably the simple answer is that the provision of health care has failed to keep pace with the growth of population over the past 20 years. There is a substantial shortfall in almost every acute specialty. I shall not burden the Minister with a stream of statistics showing just how deprived are the acute services. It is when we look at the provision of services for the priority care groups that the real shocks come.
Out of 231 mental handicap beds for children and adults needed, the present provision amounts to just 20 children's beds. Out of 307 acute and long-stay beds needed for the mentally ill, the present provision is 56 acute beds in a Dickensian building on an urban site. For the psychogeriatric, with a need of 116 acute and long-stay beds, there is no present provision, and there are no beds for the young disabled.
Medway is presently provided with 77 per cent. of the estimated resource needs in accordance with the resource 611 allocation working party formula. That translates to 70 per cent. of its projected 1992 needs. I agree with my hon. Friend that there are major development plans for the Medway hospital site in my constituency. The phased development of that site, costing £31 million, is the cornerstone of the region's plan to bring Medway health authority's provision to about 95 per cent. of its RAWP needs by 1992–93.
However, in the meantime Medway struggles on with perhaps the most deprived health provision in the country. There is an irony in the situation, because the Medway health authority lies within the south-east Thames region, which is thought to be one of the over-provided regions. The region will get none of the £83 million of new resources, recently announced by my right hon. Friend the Secretary of State, for next year. Because of the so-called demographic factor and the high-cost, high-technology medical advances—medicine is nowhere more advanced than in London—next year's allocation will represent a cut of about 1 per cent. in the region's resources. That will make its efforts to redistribute resources to Medway from the well-provided districts even more difficult.
As the recently resigned chairman of a neighbouring health authority in the region, I sympathise with the over-provided districts because of the problems that they will face as a result of the cut in their resources. However, my sympathies for the west Lambeth district, which has 140 per cent. of its RAWP target, are tempered by my acute concern for the strained resources for health care for my constituents.
This debate is part of a continuing campaign by my hon. Friends the Members for Medway (Mrs. Fenner), Mid-Kent (Mr. Rowe) and Faversham and myself to obtain a much fairer deal for the Medway health authority as soon as possible.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)I congratulate my hon. Friend the Member for Faversham (Mr. Moate) on obtaining the debate. He has a long-standing interest in this matter and I listened to him carefully. I also listened with care and respect to my hon. Friend the Member for Gillingham (Mr. Couchman) who had long experience as chairman of a district health authority and has given great service to the NHS.
My hon. Friend's campaign is reinforced by my hon. Friends the Members for Mid-Kent (Mr. Rowe), who is visiting a hospital in the district today, and Medway (Mrs. Fenner). They make up a formidable gang of four from the Medway district and I am pleased to have the opportunity to listen to the views of two of them today and to offer to meet one or all of them to discuss these matters.
My hon. Friend the Member for Faversham fairly described the problems of the Medway district and the developments that are to take place there. It is important that we realise that, difficult though the present situation is — I am the first to acknowledge that — considerable improvements will be made in the next few years.
My hon. Friend the Member for Faversham mentioned the new hospital that is to be built at Medway and I remind my hon. Friends that in 1983–84 there was a revenue growth of about 4.5 per cent. for the district. In addition, and in keeping with the Government's wish that the so-called Cinderella services — the non-acute hospital 612 services—should be given a fair crack of the whip, we are doing our bit with the district health authority to help a number of important developments.
Medway will be receiving extra funds in the next two years under the initiative launched by my right hon. and learned Friend the Minister for Health in November to support projects for psychiatric services for elderly people. We have approved and will be financing the authority's proposal to appoint a psychiatrist with particular responsibility for psycho-geriatric services and to provide the necessary clinical assistance sessions. That again demonstrates the movement in the Medway district.
Finally, in this list of more than just rays of hope is the activity that the health authority has been engaged in, which has been referred to by my hon. Friend the Member for Faversham. That is under the excellent chairman of the district health authority, and there has been considerable progress throughout the NHS in the competitive tendering and the contracting out of certain services. Considerable savings will be made for the NHS by competitive tendering, and nowhere is it better illustrated than by the predictions of the savings given by my hon. Friend the Member for Faversham. I reassure him that all such savings from competitive tendering exercises will he kept within the district health authorities and will be made available for improvements in health care.
Having picked on those four particular developments to demonstrate the advances in health care for the people who live in the Medway district, I should be the first to say that we all recognise the problems that face the Medway district. My hon. Friend the Member for Faversham has vividly described some of the problems arid his descriptions have been enforced by the statistics given by my hon. Friend the Member for Gillingham. Those who study this Adjournment debate afterwards will be well advised to look at those statistics, which are telling of the curious relative deprivation that affects the Medway district.
The Medway district is one of the most deprived districts in the country in resource terms, and that has been demonstrated by what has been said by my hon. Friends the Members for Faversham and Gillingham. This is complicated by the fact that the South-East Thames region is comparatively well provided for in resources, particularly in London. Just as we are committed to national redistribution, so we support the policy, adopted by the South-East Thames region under its new chairman Sir Peter Baldwin, of internal redistribution between the 15 districts, again with the aim of achieving greater equality of access to health care for the whole population. This is an extremely difficult process, a process that began in 1976 under the previous Labour Administration. It continues now and is being continually examined and revalued. We are, and have been, carrying out revaluation of the capital resources within the resource allocation working party formula. I do not wish either of my hon. Friends to think that the RAWP formula, either nationally or locally, is set in concrete. It is constantly being re-examined, both by us in the Elephant and Castle and by the 14 regional authorities, of which the South-East Thames is one.
We leave the relative distribution of resources within districts to the regional health authority because when the relative needs of the districts are being set that job cannot be done adequately from the centre, from the DHSS, because of the complexity of the problems that face the 613 different districts. If the system were running that way in future, either of my hon. Friends the Members for Faversham and Gillingham might be the first to come back and complain that the man from Whitehall does not know best and has not appreciated the nuances of the problems that face any one district, such as the Medway, which I would be the first to admit has particular problems.
It is a difficult task to get the right scale of planning and the evidence is that, by and large, the regional district relationship is the best relationship and that judgment needs to be based on local knowledge. The more local the level of allocation to be made, the more important local knowledge becomes. Similarly, judgments need to be made as to how quickly resources can be drawn from over-provided districts and redistributed. My hon. Friend the Member for Faversham was right when he said that this was a most difficult task for both parties involved in the same process, both the loser and gainer districts. Those who are losing resources do not wish to lose them so fast, even though they recognise the justice of the resource allocation working party principle. Those who gain are naturally impatient to have the new gains of resources of capital and revenue as quickly as possible. We do not think that it would be right for the Department to substitute its judgment for that of the regional health authorities and district health authorities.
South-East Thames and other regional health authorities up and down the country are not only engaged in the task of redistributing within their constituent districts resources for acute services and hospitals—what the general public so often think of as making up the National Health Service. They are also concerned to improve facilities for those groups to which we attach special priority — the mentally ill, the mentally handicapped and the elderly. Services for these people are 614 in urgent need of development not just in under-target districts such as Medway but also right across the region including some of those districts which are over-funded.
Reconciling the twin goals of geographical redistribution and the redistribution between services is not an easy task, but it is one on which South-East Thames must make its own decisions. At the moment I do not think that there is a case for the Department intervening to direct the region or to direct additional resources into the district, although I shall consider my hon. Friend's arguments about this issue carefully and draw them to the attention of my right hon. and learned Friend the Minister for Health. In saying that, I realise that there will be less comfort for Medway than the comfort that I was able to offer in my introductory remarks about some of the important developments which will be going on in the short to medium term.
Any centrally devised and operated system would not have the necessary sensitivity. It would distort the present allocation process for which there is more or less a national consensus in the whole of the National Health Service. That is rare and not to be given away lightly.
My hon. Friend asked me and, through me, my hon. and learned Friend to indulge in a little lateral thinking about the problems facing Medway. We do little else at the Elephant and Castle than indulge in lateral thinking, despite appearances. We need all the help that we can get in that process, and I welcome the advice that we have been given thus far by my right hon. Friends.
I give one undertaking in addition to the one that I have given already to see a delegation of hon. Members representing Medway constituencies at some date in the future. It is to pursue some of the very important matters raised by my hon. Friend the Member for Faversham with the chairman of the regional health authority during the regional health review process in 1984.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes to Three o'clock.