§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]12.51 am
§ Mr. James Kilfedder (North Down)
I am glad, Mr. Deputy Speaker, that I was successful in obtaining this Adjournment debate, even though it is taking place at nine minutes to 1 o'clock in the morning after a fiercely fought Scottish debate.
Over the years I have taken many opportunities to draw attention to the parsimonious attitude of the Eastern health and social services board to the hospital and welfare services in the North Down area, and I make no apology for doing so once again. However, it is necessary for me to point out that in addition to the other parts of County Down, the Eastern health and social services board also takes within its jurisdiction the whole of the city of Belfast. Throughout the years this ridiculous situation has worked to the detriment of the people in my constituency and elsewhere in County Down. If it were a parliamentary constituency, the authorities would be accused of gerrymandering, because the boundary of the Eastern health and social services board is so eccentric. It works to the disadvantage of the health of those who live outside the city of Belfast, and it works particularly to the disadvantage of those living in the North Down area—an area of ever-increasing population which has already outstripped the available hospital facilities. This is due principally to the drain of finance and resources away from North Down and into west and north Belfast, two areas of declining population.
I blame the Eastern health board and the Department of Health and Social Services for the decline in hospital facilities in the North Down area, but in fairness to both it has to be said that the former Stormont Government began the rot. Direct rule is blamed nowadays for nearly every mishap which occurs in the Province, but we must never forget that it was the former Government at Stormont who agreed that Belfast should be included in the area of the Eastern health board, with North Down, Ards, Downpatrick and other parts of County Down.
The former Stormont Government decided in the early 1970s to build the enormously expensive tower block at the city hospital in Belfast. The cost of that development escalated from £14 million to £60 million. I cannot say that all that money would have gone to the rest of the Eastern health board area if the tower block had not been built, but I am certain that substantial sums and a new hospital have been denied to the North Down area because the tower block voraciously ate up a vast amount of the money available to the Eastern health board.
The former Stormont Government also agreed vast additional capital expenditure for the upgrading of existing hospitals in west and north Belfast, where the population has been declining for years. As a result of those decisions, severe limitations were imposed on the financial resources of the Eastern health board. That is reflected in the cheeseparing of the budgets for Ards and Bangor between 1983 and 1985.
The direct treatment costs at Belfast city hospital total about 55 per cent. of all its costs—about the fifth highest proportion in the Eastern health board area. So far, 454 no estimate has been made of the consequences of bringing the tower block into partial use later this year and into full use next year. If the experience of other hospitals is a good guide, we can expect the direct treatment costs to increase as soon as the new building is brought into daily use. The hefty running costs of the tower block will drain more vital money away from the North Down area, which desperately needs financial help to improve the health, welfare and hospital services of local people.
The people of North Down and Ards live in the fastest growing and most urbanised area of Northern Ireland, and everyone in Northern Ireland recognises that fact. The North Down area plan envisages growth continuing well into the next century. Everyone knows that the proportion of elderly people in the area has increased and is expected to continue to increase for the next few decades.
It is common knowledge that insufficient money has been spent over many years on hospital services for the elderly. I have drawn attention many times to the failure of successive Governments to recognise what is happening to the age distribution of the population, but no action has been taken to ensure that a sensible reallocation of funds is made to take account of the situation.
A few years ago plans were announced for an extension to the geriatric unit at Crawfordsburn hospital, but nothing has been heard of that recently. The plans have been quietly pushed aside and conveniently forgotten by bureaucracy, yet the proper care of the elderly is urgently required in the North Down.
While the Government are preaching that more of the elderly should be cared for at home, the health board's officials are announcing the curtailment of meals on wheels services, the closure of day centres and the cutting of other services intended to encourage our senior citizens to remain in their own homes.
Some people have made representations, as I have, to the Government on behalf of the elderly. We should pay tribute to the contribution to the community that elderly people made over the years of their active lives. I should like to think that in their declining years others would fight their battles for them to ensure their right to a decent life and adequate provision.
I do not oppose the report of the joint review team in its entirety, as some people do. It contains a few good and sensible ideas, but it has its limitations. Some of its proposals are wholly unacceptable, such as the envisaged community hospitals to replace the existing hospitals at Bangor and Ards. During the seven years that the team took to report, millions of pounds were spent on carrying out new building programmes and on equipment in the north and west Belfast areas. Those programmes helped to consolidate the outmoded policies and thinking which had already deprived North Down of a proper hospital service.
The compiling of the report began seven long years ago. It alleges that it deals, not with the cost of hospital services, but solely with the hospital requirements for the next 20 years, and how the assessed needs can or should be met within that period, on the basis of the physical resources presently available and which can reasonably be made available.
I do not believe that the joint review team had coxed the availability of finance and general economic trends at the fore when it considered the facilities required for the area. Central to the thinking of the report is the concept of the community hospital. The fact that that concept has 455 not yet been fully accepted or properly thought out has not deterred the team from relying on it. I have not come across one general practitioner in North Down who sees himself helping to staff such a hospital in future. Some doctors, if they have the time available from general practice, are prepared to visit their patients in hospital, but they are not prepared to mislead their patients into believing that a community hospital with the type of profile envisaged by the joint review team report is as good as the present hospital services—bad as those facilities may be in the Bangor hospital.
One of the most valuable aspects of general practitioner services at present is home visiting by consultants. The family doctor finds that sort of support invaluable. It is available because consultants are located in the local hospitals. If changes are made and the consultants then become located in large teaching hospitals, home visiting will be continued with great reluctance. Moreover, visits to local health centres will eventually come to an end.
The financial reality is that the Bangor, Ards and Downpatrick hospitals cost considerably less than any of the hospitals in west and north Belfast. The Royal Victoria group of hospitals consistently overspends its allocation. The Mater hospital now costs more per patient than the Ulster hospital at Dundonald. The waste of money that continues at the Royal Victoria hospital can be gauged from the document entitled the "Redeployment of Resources", which was published in July 1985.
According to the report, the Royal Victoria hospital has been asked to reduce its overspending by £1.5 million. If any further proof were needed to show that the Royal Victoria is the most incompetently managed hospital in Northern Ireland, the report provides it. Yet it is the cost-effective hospitals of the North Down area that are being compelled to make yet another large saving this year, to the grave disadvantage of the people of the North Down area, who deserve better from the Eastern health and social services board.
The board has been less than honest with the report of the joint review team. It has said repeatedly that the report is not a statement of policy and that it is a consultative document only. The consultation period is stated to last until 30 September. That is what the board says, but in his latest letter to me of 5 July the Minister rather gives the game away. He says that he cannot intervene to stop the board taking irreversible decisions. It appears from his letter, however, that he is happy to accept the main thesis of the joint review team's report and that he actually supports it. I hazard a guess that since 1977 the Minister's departmental officials have been pushing that line of hospital development which the report advocates.
§ Mr. Kilfedder
I have told the Minister in correspondence that I do not believe that the report of the joint review team is impartial, unbiased or genuine in its examination of the hospital needs of the North Down area over the next—
§ Mr. Kilfedder
—20 years. I urge the Government to guarantee adequate hospital facilities at the Bangor hospital and the provision of a casualty department. It is extraordinary and unacceptable that there is no casualty department in an area with a high density population, and a population growing year by year.
I urge the Government to provide a new acute hospital in the area between Bangor and Newtownards for the people of North Down. Until such a hospital is built, I urge the Government to designate the Ulster hospital at Dundonald as the hospital for the people of Dundonald and the North Down area. That will prevent patients from being sent to the Belfast hospital, which causes even greater difficulty and stress for their relatives in their efforts to visit them.
The saddest aspect of all recent public expenditure cuts has been the shabby treatment of the elderly in our society. It is indefensible for the Eastern health and social services board to contemplate closing Crawfordsburn hospital, which provides vital geriatric beds in the area. More geriatric beds should be provided at the Ulster hospital at Dundonald, but only in addition to those provided already at the Crawfordsburn hospital.
It is lamentable that the board, which has the Government's backing, has failed to provide sufficient opportunities to give relief to unmarried daughters who have sacrificed their lives for the sake of their elderly parents, looking after the parents when they are no longer able to look after themselves. Those supportive daughters would benefit from a holiday if their relatives could make regular, short-term stays in a geriatric bed in a hospital.
The savage reduction in the home help service has meant that elderly people living on their own do not have sufficient help to enable them to manage. One of the many letters that I have received on the subject of home help and welfare provision for the elderly states:My wife suffered a severe stroke 2 yrs. ago, she is now 75 yrs. old, she was in the hospital for a time, until she was over the worst. The stroke left her without power in her left side …We have no home help. only a nurse coming once a week to bathe my wife … I will be 80 yrs. old next month and 3 months ago I hurt my back while attending to my wife.That letter describes the agony and strain suffered by many people who need assistance.
The cuts in the meals on wheels services and the closure of a number of vitally needed community centres for the elderly in North Down will make life more difficult for our senior citizens, who deserve better from bureaucracy and society. One senior citizen wrote me a letter stating:Dear Mr Kilfedder The senior citizens of Kilcooley,"—in my constituency in Bangor—who attend the centre, in Carnalea Meth Church hall, have been told that the centre is closing down. They only have a few hours on Wednesday, and enjoy the activities and lunch (50p) provided. At the moment, they have a quiz going and have got into the finals and are pleased at this achievement, a simple pleasure which costs nothing, so they are to be deprived of even thatby the Eastern health board. The lady mentioned that most of the folk in the centre are in their 70s and 80s.
The public expenditure cuts have not even left out the mentally handicapped in North Down who need more money. The chairman of the Bangor and District Society for the Mentally Handicapped, Mr. Matt Murray, sent me a letter regarding the summer activities scheme at Clifton 457 school for the mentally handicapped at Bangor. The school was told that the health board had decided to cancel the scheme. The chairman of the health board stated:The Board regrets any reduction in services to the mentally handicapped but, as you are aware, the Eastern Health and Social Services Board is required to make efficiency savings on an ongoing yearly basis. The Board is doing its upmost to protect priority groups like the mentally handicapped but it is not always possible for them to totally escape the effect of savings.Eventually, as a result of offers from Barnardo's, it was possible for arrangements to be made for a shorter and less adequate period of summer help. That help is needed by parents to enable them to have a holiday during the nine weeks' summer holiday when their mentally handicapped children would normally be at home. The parents need that period of respite to renew themselves to look after their relatives.
I plead with the Under-Secretary of State to help the people of North Down. who desperately need proper hospital facilities and welfare services.
§ The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Chris Patten)
The hon. Member for North Down (Mr. Kilfedder) has covered a lot of ground. and I do not have much time in which to reply. He has dealt not only with the long-term proposals for development of hospital services in the area of the Eastern health and social services board, contained in the report of the joint review team, but with the more recent proposals of the Eastern board contained in its consultation document, "Redeployment of Resources." In both cases he has quite understandably concentrated on the effect on the North Down area, which he represents with such distinction.
The first point that I wish to make concerns the status of the different proposals. The development of hospital services in the Eastern board area is essentially a matter for consideration in the first instance by the Eastern board itself. The board is seeking to establish a pattern of hospital provision which will meet the needs of the people of its area in the years ahead, and to that end it is considering the development of hospitals throughout its area, including North Down. The JRT report deals with those long-term considerations and makes a number of recommendations. The board is consulting on those recommendations, and those consultations will continue until 30 September, after which the board will reach decisions on future hospital provision in its area.
The hon. Member referred to what I had said to him in a letter. He was selective in his quotation, because I said that where any decisions taken by the Eastern health board involved the closure or change of use of existing facilities, the formal approval of the Department of Health and Social Services would be required. Where the board decides to close a hospital, there are formal procedures that must be gone through.
Meanwhile, the board has certain financial responsibilities. In common with the other health and social services boards, it is responsible for balancing its budget, for deciding priorities and for living within the available resources. To enable it to live within its enhanced financial allocation for 1985–86, the Eastern board has decided that it needs to look for additional economies. Proposals for achieving them are contained in the document "Redeployment of Resources," and, again, comment from interested parties has been sought by 30 September 1985. 458 It is reasonable to consider both sets of proposals at the same time. It would have been curious had the board decided act in any other way.
I should like to deal, first, with the recommendations in the JRT report specifically—to give it its colloquial name—specifically those which affect the hon. Members constituency. In doing so, I should say once again that these are not proposals of the Eastern board; they are recommendations of the joint review team upon which the Board is currently consulting.
The review team has recommended that Ards and Bangor hospitals should cease to provide acute care and that the main specialties presently provided should transfer to the Ulster hospital at Dundonald. Both hospitals would adopt a supporting role to the Ulster hospital and fun the broad functions of community hospitals providing post-operative treatment and convalescent care. In addition, they would provide day surgery and outpatient clinics. Minor casualties would continue to be treated at Ards hospital, but all major casualties would go to the accident and emergency department at the Ulster hospital.
The hon. Member for North Down has talked about the drift of population away from Belfast to areas such as North Down and argued that as a consequence acute hospital facilities should be provided as close as possible to the areas where they are needed. I agree. It is of course. a fact that extension of the catchment population of the Ulster hospital—a point that he mentioned—to include most of the North Down and Ards local government districts is one of the recommendations of the joint review team. The Ulster hospital is accessible to the people of the North Down area. With increasing efficiency in the utilisation of available beds in other Belfast hospitals—a point he properly made—it will surely be a natural development for the Ulster hospital to take an increasing proportion of its work load from the North Down and Ards area.
On the question of geriatric provision, the hon. Member has rightly drawn attention to the importance of providing an adequate number of geriatric beds for the North Down area. In proposing that Crawfordsburn hospital should close because of its unsuitability for the care of long-stay geriatric patients, the joint review team recognised that the inpatient services currently provided there would have to be relocated at the proposed community hospitals in Newtownards and Bangor, and that capital investment might be required to provide some new accommodation for geriatric patients. That recommendation is included in the consultative process which the Eastern board is currently undertaking.
Perhaps in the two minutes that remain I can make some general observations on what the hon. Gentleman said. It is completely untrue for people to suggest that the Health Service or the personal social services in Northern Ireland in the past few years have been subjected to cuts. We have seen a real increase in expenditure on the health and personal social services of about 8 per cent. Per capita spending on the health and personal social services in Northern Ireland is 25 per cent. higher than it is in England and Wales, and in the Eastern board area it it 25 per cent. higher than the average for Northern Ireland. We have maintained capital spending in Northern Ireland over the past five years. None of that suggests cuts.
We have to make more efficient use of the money that we spend on the health services. There is at present an imbalance between acute care and community services.
459 We have 30 per cent. more acute care beds in Northern Ireland than on this side of the water. I am very keen to see us develop acute care facilities so that they are nearer to patients, and I am keen to see us develop the role of community hospitals.
I think that whoever stands at this Dispatch Box answering debates such as this for the next 10 years will be making much the same point—that we need to get a 460 better balance between acute care and community services. That is in the interests of the people of the hon. Gentleman's constituency and in the interests of people throughout Northern Ireland. I believe that even if the hon. Gentleman were making this speech—as he might perhaps one day—he would be driven to precisely the same conclusions as I have reached this evening.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-one minutes past One o'clock.