HC Deb 25 May 1984 vol 60 cc1420-7 1.30 pm
Mr. Jeremy Corbyn (Islington, North)

I am sorry that this has to be such a brief debate on the Health Service in London, because it is a matter of the gravest concern to many people. There are thousands throughout London who fear for the future of their own local hospital. They fear that they will never be able to receive the sort of treatment that they believe is right and proper and what they deserve. In the midst of plenty in London, in the midst of wealthy private hospitals and prestigious teaching hospitals, we find that many local hospitals are being closed and that waiting lists are lengthening, especially for the elderly.

I shall quote from a statement issued by the north-east Thames regional health authority, which is the authority that has responsibility in my constituency. It is charged with the task of trying to provide health care in some of the poorest parts of London from an ever-decreasing share of the national cake. It is passing the cuts on to the district health authorities, which include the Islington district authority in my constituency. The statement reads as follows: Current planning guidance indicates that revenue for the Region will decline by 3 per cent. over the planning period. However, the view that no region regardless of its RAWP position"— that is the resource allocation working party position— should become actually worse off during a period of real growth to the National Health Service is gaining ground. The Government have been claiming for a long time that health spending in real terms is rising. However, the expectation of the people that they will gain the sort of service that they want from the service is declining. Local hospitals continue to be closed and people are having to wait longer and longer for minor operations.

The Government's argument that there is real growth in Health Service spending is fundamentally wrong, especially in London. Before the 1983 general election the Government claimed that the cost of GPs' drugs was a certain figure, which was clearly an underestimate. As most of the NHS budget was decided in advance, when the underestimate became apparent cuts were imposed in other areas to ensure that the NHS stayed within spending guidelines. After the general election, the Government admitted that they had not set aside nearly enough money for GPs' drugs. As a result, the NHS budget was changed in the middle of the financial year. The result was that £131 million was added to the drugs budget, but that sum was removed from the budget for the rest of the service. Cuts were made in the financial provision for hospitals, health visitors, ambulances and clinics. That cut amounted to 1 per cent. of the NHS budget.

The Secretary of State has made many statements about restoring Health Service spending, but the effect of his decisions has been to restore part of a cut. He has failed to provide sufficient money to cope with increased Health Service costs or inflation as it bears on the Health Service.

Secondly, there has been no evidence to suggest that the proposals for the London district health authorities are anything more than a perversion of the original stated intention of the RAWP formula. The working party was meant to ensure—this goes back to the mid-1970s—that Health Service spending throughout the country was allocated equally and that regions did not suffer undue cuts. It was intended that the areas with inferior health services should be able to improve them. There has been a perversion of the original intentions of the working party. Experience in London leeds me to believe that RAWP is a levelling down process, which means that areas that have slightly better health facilities than others are cut down to the lowest possible level. It creates a desperate positon, especially for the inner London health authorities.

I shall give an overall view of London. In 1984–85 the allocation of money to the London health authorities was £1,689,500,000. The amount needed to cover inflation over the previous year was £1,709,100,000, which amounts to a cut of £19,600,000 or 1.1 per cent. That figure is derived from calculations made by the GLC in its submission to the Minister about health services in London. Since 1982–83 the cut in allocation is a staggering £45,700,000. Those cuts have meant a loss of staff, and 2,584 whole-time equivalent jobs have already been lost last year. The truth is that even more jobs than that have gone because the figures for whole-time equivalent jobs understate the fact that many Health Service staff are in part-time employment. Many Health Service staff are women workers, many of whom have no opportunity of finding alternative employment.

Because of my association with the National Union of Public Employees, which sponsors me as a Member of Parliament, I have a great deal of experience of the fears and misery of low-paid health workers. Due to already under-staffed hospitals the number of jobs lost or not filled cannot be accurately calculated, but in real terms it is between 4,700 and 7,300. That information was provided by the GLC in its submission on Health Service spending.

Not only have staff numbers been cut, but beds have been lost. It is estimated that last year 1,876 beds were lost, mainly because of temporary emergency ward closures. A serious matter must be raised in this connection. Many hospital wards are closed because the district health authority feels that it does not have the revenue necessary to keep them open. The closure is claimed to be temporary, and therefore it does not have to go through the full statutory consultation process. The ward continues to be closed, as a temporary measure. All over London certain hospital wards are barred, locked and bolted, while outside there are enormous queues in the casualty departments and people who should be in hospital for operations sitting at home because their operations cannot be carried out.

The number of hospital closures in London is staggering. In 1968 there were 357 hospitals in London. In 1977 that figure had fallen to 299, and it is now 230. Since the Prime Minister came to power, London hospitals have been closing at the rate of 15 a year. Many of those hospitals are small and very valued. Much local fear is experienced with the closure of a small hospital, and that leads to a spiral of decline in local community feeling and increased costs for people who use the hospital.

An obvious example is the Prince of Wales hospital in Tottenham, which is a much-valued local hospital. For perhaps the past 10 years there has been a continuous campaign for keeping that hospital going. All types of arguments have been advanced, but the most serious one is the loss of local health facilities, which would lead to unnecessary journeys by local people to the north Middlesex hospital and unnecessary costs imposed on them. The burden of travel costs is forced on to the lowest paid working class people in the south Tottenham area. There are many other examples all over London.

The current waiting list for hospital treatment is 109,000. On average, approximately two thirds of all urgent cases are on waiting lists for more than a month and a quarter of all other cases are on the waiting list for more than one year. In March 1983 in my borough of Islington—the figures cover the Islington health authority area, not just my constituency of Islington, North — 1,151 people were on the waiting list, of whom 114 had been on the list for more than a year. En March 1984 1,500 people were on the waiting list—a slight increase—of whom about 220 had been on the waiting list for more than a year.

Obviously, the figure varies across London, but my experience is that many people are going through terrible traumas waiting for hospital operations. Effectively, they are immobilised, prisoners in their homes while waiting for operations.

We must take account of the increasing needs of the elderly in London. The north east Thames regional health authority recently said in its forward-planning document: This region has had to plan for a high rate of growth in the elderly population. To cope with this considerable problem, rationalisation of its historically over-provided acute services must continue. That is a pleasantly worded, bureaucratic way of saying that, because of the increasingly elderly population with which the hospitals cannot cope, other services will have to be cut to make way for the elderly.

The DHSS tells us that it has priority groups—the elderly, the mentally ill and the handicapped. Of course, they are priority groups, but so are the other groups. The DHSS cannot cut funding for one group to provide for another and claim that it is providing the services that the people of London need.

Small cottage hospitals are being closed. That tends to affect the elderly more than others because of travel problems. Unfortunately, there are insufficient geriatric beds throughout London.

The GLC, in its submission to the Minister on the issue, said: It is also primarily the elderly who will suffer through the closure of small hospitals whose general wards have catered for the older stroke and bronchitis patients who tend to stay longer in hospital. 60 of the 90 beds at St. Leonard's, Hackney, which have been mainly used by older people, will be transferred to Baits, but it is well known that Baits is reluctant to take people over the age of 65. The mentally ill—another 'priority' group—are suffering too. The Royal Hospital, Richmond, provided a psychiatric and a community mental health unit, as well as a rehabilitation centre for the elderly and a physiotherapy and X-ray department. All these services will go when the hospital closes. The terrible story of insufficient care and support for the elderly goes on.

Another aspect of Government policy affects the way in which elderly people in London are treated. I refer to the cut in rate support grant for local authorities. Islington borough council has been told that under the grant-related expenditure allocation formula its social services budget is 31.8 per cent. over target. That means in real terms that it must make an enormous cut in spending on social services to bring it within Government guidelines. At the same time, the local social services department is in despair about how it can cope with the ever-increasing number of elderly people who cannot be accommodated by the National Health Service because local hospitals are over-burdened. Islington is not alone. Unfortunately, its plight is repeated in many places.

A letter published recently in The Guardian by my hon. Friend the Member for Oldham, West (Mr. Meacher) in response to the grant-related expenditure and rate support grant settlement said: Under this settlement £2,156 million is allocated for personal social services for 1984–85. However, the Association of Metropolitan Authorities' expenditure steering group estimates that simply continuing with existing policies, while taking account of demographic trends, would cost £2,305 million next year. The Government's RSG therefore involves a cut of £149 million or 6.9 per cent. This means the chopping of some 8,700 residential places for the elderly, mentally handicapped and others; of more than 7,500 day-care places; of some 42,000 home-help cases attended; and of about 48,000 meals on wheels served each week. That is the reality of Government policies for the Health Services and local authorities, which are inextricably linked. Local cuts such as those experienced by the Islington authority make the situation considerably worse.

Not only should the Government reverse their policy of penalising inner London authorities in their attempts to provide decent services for the people of London, they should recognise the growing causal link between health cuts and local authority cuts and the growing despair of the elderly with the social effects which that produces.

I meet many people throughout inner London. Many women have had to give up promising careers and jobs to care for elderly people at home because local social services departments and the National Health Service cannot do so. In a caring society everyone deserves to be cared for and to know that the National Health Service and the local authority social services departments are there to assist them.

Mr. Chris Smith (Islington, South and Finsbury)

Will my hon. Friend reflect on the fact that in inner London every Tory and Labour controlled borough, according to the GREA formula laid down by the Department of the Environment, overspent by 16 per cent. or more on their social services? That should demonstrate that the figures that the Government produce about what social service departments should be doing in those inner London boroughs are completely wrong. Every borough agrees with that.

Mr. Corbyn

My hon. Friend is right. The vast majority of London social services departments have been told that they are overspent. Social services directors have made the strongest possible representations to the Government about that. The result is isolated elderly people, social workers and home helps being thrown out of work, and the ending of meals-on-wheels services. Those are the desperately needed services that the Government are trying to cut.

The House must recognise that appalling aspect of Government policy. I hope that when the Minister replies he will tell us that he is prepared to reconsider Health Service spending in London and the way in which the GREA formula operates against inner city local authorities and the social services departments. It is the greatest scandal that such cuts should be forced on local authorities.

I hope that the Minister will also mention the present unsatisfactory condition of Health Service administration in London, which deserves re-examination. Many people in London, including the GLC, have called for the establishment of a London health authority, so that instead of being covered by four regions — the four Thames regions—London would have a democratically elected health authority instead of an authority made up of handpicked people appointed by the Department.

I hope that the Minister will also tell us that he has further considered representations made by my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) and myself about the need for a secondment of an official from his Department to study the link between social services cuts and Health Service cuts in our borough, where there is an increasingly elderly population. If the DHSS can second people to private cleaning companies to examine what goes on, the least it can do is to second people to inner London boroughs which need a great deal of help.

There is dispute about privatisation at Barking hospital. It has already been brought to the attention of the House, and my hon. Friend the Member for Barking (Ms. Richardson) and I will continue to bring it to the attention of the House. The dispute demonstrates what is going on in the Health Service. The Government send out circulars to tell local health authorities that privatisation is a good thing. Crothalls has won a contract which it maintains at Barking hospital. It has cut the wages of hospital staff by up to 41 per cent. The staff take strike action; the Minister washes his hands of the matter and says that it is nothing to do with him; the contract cleaning company and the local health authority says that it has nothing to do with them. Those women who have been on strike for so many weeks are determined to win their battle for fair pay. One cannot have fair pay or fair play when the health authority is there to provide a service whereas the contract cleaning company is there to make money out of the National Health Service.

I hope that the Minister will recognise that there are two other important areas which need further examination by his Department. The first relates to mental health. There are many Victorian mental health institutions in London—Friern Barnet, Claybury and Napsbury. They are all scheduled for conversion, change or closure. The DHSS and the regional health authorities say that they will transfer those patients to the district health authorities. If the district health authorities are to have sufficient money to cope with those psychiatric patients there will have to be further cuts in other parts of the Health Service, and the community care will mean the confinement of psychiatric and geriatric patients to their homes.

Another area that needs considerable research is the link between bad housing conditions, unemployment and people's eating habits and the Health Service. A couple of years ago the community health council in Islington produced a remarkable poster, which showed factories belching smoke from their chimneys, representing poverty and unemployment. At the top of the poster it said, "The National Health Service is great, but it can't consume all their smoke." There is a link between many social problems and people's health in any urban area, but particularly in London, which is the subject of the debate.

There is a contrast between people who are struggling to defend St. Leonard's hospital, the Prince of Wales' hospital, the south London hospital for Women and Children, the royal northern hospital and the Highgate wing of the Whittington hospital, which are threatened with closure; between working class and elderly people who are waiting at home for operations that do not take place, and the growing wealth of places such as the Wellington hospital, where wealthy people using private patient schemes can buy their way past the hospital queue and into quick treatment. That is a scandal of the highest order.

We want one Health Service that treats everyone equally, irrespective of their wealth and background. Freedom of choice does not exist for the majority of the population. It exists only for those who can buy their way past hospital queues. We need the determination to provide all the resources that are needed to care for the health of everyone, irrespective of their ability to pay. That is what the debate is about, and that is why the issue is so important.

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

By leave of the House, may I say that I am grateful to the hon. Member for Islington, North (Mr. Corbyn) for initiating the debate. I have only nine minutes in which to reply to the substantial range of points that he made about the national picture of the NHS and the picture in London and his constituency. Put a case that can be argued in front of the hon. Gentleman and he takes the opportunity to overstate it. In doing so he does two things. First, he ignores the facts about what has been happening in the NHS, particularly its growth. I shall attempt to put him right in a national and a local context. Secondly, the hon. Gentleman misses the point of substance of the argument about the relationship between Health Service expenditure in London and that in the rest of the country.

The purpose of the NHS is not to employ people, whether they are Ministers or members of the union that sponsors the hon. Gentleman; it is to serve patients. Therefore, money and NHS facilities should go where the patients are. In London, there is 15 per cent. of the national population, but 20 per cent. of the national expenditure on health care. I thought that the hon. Gentleman was a great egalitarian and that he liked the redistribution of resources around the country. The point of the modern NHS is to make sure that patient care is given where patient care is needed. It is needed in London. I am not manipulating the statistics; since 1978–79 there has been a real growth of resources in London of about 1.5 per cent. London has also made its contribution according to the formula laid down by the previous Labour Government, following the recommendations of the resource allocation working party to the Health Service in other parts of the country.

Therefore, I did not recognise the validity of the hon. Gentleman's case because of his overstatement. He talked about national as well as London figures. Over the past five years, we have doubled expenditure in the NHS in Great Britain to some £15.5 billion. That is the highest expenditure that the NHS has ever seen. It is an increase of 18 per cent. compared with the retail price index. It has allowed substantial real improvements in services in London and in the country as a whole, and it allows for more substantial real improvements that are planned in London, including—I am sure that it was an oversight that prevented the hon. Gentleman from mentioning it— the planned improvements and redevelopment of the Whittington hospital in the hon. Gentleman's own constituency. That seems to have slipped his attention in his total condemnation of the National Health Service in London and nationally that he has offered this afternoon.

It is wrong to talk about cuts in the face of the facts that I have given. It is correct and reasonable to argue about the proper rates of growth, and I am prepared to enter into that argument, which is worth having. Perhaps the hon. Gentleman has a case about the rates of growth of the National Health Service — we can argue about that question—but to talk about cuts is phoney and wrong.

Let us look at the evidence. In the past five years the number of inpatients and clay cases has increased by 500,000 nationally, and the figures have gone up in London. It is a fact that 2¼ million more outpatients and emergency cases are being treated each year. That means more outpatients and emergency cases in the hon. Gentleman's constituency and in my constituency. Nearly 500,000 more people are being visited at home by health visitors and nurses. The list is considerable.

I will give a couple of detailed examples. Coronary artery bypass grafts are up by 90 per cent., and London is the great centre of experience for that form of operation. In the last debate we were talking about orthopaedic matters. Total hip replacements are up by 30 per cent. arid the number of kidney patients has increased by about 50 per cent.

By all means let the hon. Member criticise the Government because the growth has not been fast enough—that is a debate worth having—but let him not deny that that growth is taking place, because that is simply wrong.

According to the latest provisional figures, waiting lists are coming down. The figure is now nearly 50,000 lower than it was in 1979. Under the last Labour Government it rose by nearly 250,000. It would be much lower now if it had not been for the unfortunate industrial action in 1982.

I could hardly believe my ears when I listened to the hon. Gentleman painting a picture of hospital closures in London. Of course, outdated hospitals need to be shut. Of course, places that provide an inadequate standard of care need to be closed as patients are transferred from hospitals to the community. Indeed, the last Labour Administration managed, while they were in office, to shut approximately twice as many hospitals as have been closed by this Government. I pay tribute to them for doing it, because it is part of the massive structural change that is taking place in the modern National Health Service as we move away from a purely hospital-based National Health Service—a national sickness service, to to speak — towards a National Health Service that is based as much in the community and in community care as in hospitals.

We have seen the development of community care. I have been to the hon. Gentleman's borough and talked to representatives of the borough. When we have a new policy such as this, of course it will mean that individual hospitals will be closed. The hon. Gentleman gave a list of those that were being closed. He omitted to give us the list of those hospital construction schemes in London that are going ahead or are about to go ahead. There is a massive development at St. George's in Tooting. There are developments at St. Mary's in Paddington, at Lewisham and at Homerton. A few months ago I visited the Newham hospital. There is also the hospital redevelopment scheme in the hon. Gentleman's own constituency.

In a period of structural change, there will be hospital closures. If the hon. Gentleman wants to argue the case about hospital provision in London, he must get back to the drawing board, realise that he is arguing about growth and the proper rate of growth, and set that against the context of the structural change that we see at the moment in the National Health Service as a whole.

I turn to the question of the growth available to the four Thames regions. I am sorry to have to disappoint the hon. Gentleman. It is not the Government's intention to introduce a Greater London health authority—elected or otherwise. The management problems of the four regions are great enough already. Individual expenditure is fast approaching £1 billion in each of them.

We have confidence in the health care that the NHS gives in London. It will be improved. Because of historic factors of over-provision in London, it is going through a difficult time. I pay tribute to those who work in the NHS in London for their contribution to solving the considerable problems of care.

As time is short, I will write to the hon. Gentleman on all his other points as soon as I possibly can.