HC Deb 07 May 1985 vol 78 cc758-66

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lennox-Boyd.]

1.24 am
Mr. Tony Lloyd (Stretford)

The Minister has an advantage tonight because he is accustomed now to late-night Adjournment debates, operating as he does as the Government's rear gunner on such occasions.

It is stated in the Order Paper that I propose to raise the subject of the financial position of South Manchester Health District". There has been a change from what I wrote originally, but I make no complaint about that. I described the debate as one on "The crisis in the South Manchester Health District". Perhaps the Clerks have news that the Minister is about to make a major announcement. The Minister shakes his head, which causes me to revert to my original cynicism. The Government face all crises by refusing to recognise their existence.

There is a real problem of finance in south Manchester. When my right hon. Friend the Member for Manchester. Wythenshawe (Mr. Morris), the hon. Member for Manchester, Withington (Mr. Silvester) and I went with a delegation to meet the Minister for Health, the Minister responded in writing some time afterwards and claimed that there was no evidence of suffering within the south Manchester area. My right hon. Friend has given me a letter from one of his constituents, who was an experienced senior nurse at the Wythenshawe hospital. She was admitted recently to one of that hospital's wards for treatment. She had heard that the Minister for Health had claimed that there was no undue hardship caused by staff shortages in the Wythenshawe chest wards. She wrote: I beg to differ. I saw in one evening shift one sister and two auxilliaries with 29 acute patients in cubicles, not an open ward. Four-hourly treatment had to be done by SRN only. She referred to a number of examples of things going wrong with patient care. As I have said, she was an experienced nurse. The letter is revealing about the state of play within south Manchester and I am grateful to my right hon. Friend for allowing me access to this piece of information.

Mr. Alfred Morris (Manchester, Wythenshawe)

I am grateful to my hon. Friend for quoting my constituent's letter, which I allowed him to see for the purposes of the debate. As my hon. Friend has said, Mrs. Staniforth is a former senior nurse at the Wythenshawe hospital. She was the nursing sister who was in charge of the first cardiac clinic at the hospital. She wrote: I see in the not too distant future a tragedy happening, as staff are human beings and are asked to do the impossible. That is a voice of long experience to which the Minister must respond tonight.

Mr. Lloyd

In quoting his constituent, my right hon. Friend is entirely accurate about the real position that is facing south Manchester. That position is recognised by the many consultants I have spoken to recently as well as by those involved in the nursing side and in other sectors throughout the health authority. The Minister for Health claimed that south Manchester is better funded than ever before. That might be so in terms of pound notes, and the chairman of the health authority accepts that more money is going into the authority, but the chairman has observed that in real terms south Manchester has seen a 9 per cent. increase in the number of patients treated and, in effect, a static amount of money going into the services that existed two years ago. There has been growth money for cardiac surgery, for dialysis and for adult leukaemia, but it is not adequate to say that services are getting better when clearly they are not. What the chairman of the North Western regional health authority described as an overspend in south Manchester is more accurately described by the chairman of the South Manchester health authority as a shortfall that has been caused by underfunding.

It was claimed that south Manchester was heading towards a £2.8 million overspend. The region has been required to achieve efficiency savings of well over £500,000. There was no overspend. Salary increments for the staff within south Manchester amount to nearly £1 million. We are saying, in effect, that there is an overspend when the staff in a particular area under a particular authority become more experienced and more skilled and when they remain in post for more years. The salary structure of the NHS requires the staff to be given larger salaries to reflect its experience, skill and service, and that causes overspending. Every authority with a stable work force will therefore overspend eventually. That is nonsense. Of the £2.8 million, less than £500,000 can accurately be described as overspend. To some extent, south Manchester is penalised for its own success. The shortfall has had dramatic results, as the health authority has had to make some extremely unpalatable decisions which some people have described as butchery. Ony the regional chairman has been kind enough to call it a serious cut.

The authority has failed to maintain its property and it has decided, yet again, to cut capital spending and maintenance. That is an insane decision. For how many years can we fail to maintain hospitals? More serious is the decision to cut out 100 skilled and trained nurses, not as a result of rational planning of the nursing load but because they cannot be afforded under the mechanistic rubric put forward by the Government to the region. Another 200 jobs are to go in the service. The authority chairman has said: The loss of 100 nursing posts cannot be sustained if the present number of wards remains open. We have, therefore, decided that a number of wards must be combined or closed in order to allow the nurse reduction to take place. The lunacy is that ward closures are being dictated not by health need but by the need to reduce the number of employees on financial grounds. There is no health logic but a crisis management approach which bears no relation to the needs of people in the area.

I recently discussed this matter with consultants at the chest wards at Wythenshawe hospital. They are extremely angry because they are witnessing the dismantling of what has taken many years to build and because no logic underlies the decisions. They see no lack of demand for their services. Indeed, surrounding districts will not be able to cope with the increased demand once the 30 beds at Wythenshawe have gone.

When the cuts were announced, a spokesman for the authority said that patients from outside the area would no longer be able to come to south Manchester for treatment. The stupidity of it all is that that is not true. My constituency forms part of two other health authorities, and it is clear that doctors in Trafford or central Manchester will continue to refer to south Manchester because there is no mechanism in the NHS by which south Manchester can refuse. That being so, there will be increased waiting lists, and patients from south Manchester will be refused treatment in their own hospital. Indeed, they will be told to refer themselves to other authorities.

With geriatric beds, we are told that the closure is temporary as the beds will eventually be called upon to serve south Trafford. In a recent Adjournment debate, the Minister was at pains to tell the hon. Member for Altrincham and Sale (Sir F. Montgomery) that no decision had been made about south Trafford hospital. One thing is certain—until a decision is made, it would be the height of foolishness to take beds out of operation.

The authority says that the policy is to support patients in the community, for example through the community geriatric nursing team, yet anyone who talks to those who operate in the community—such as the district nurses and community psychiatric nurses—knows very well that although south Manchester has tried to increase those community services, it has not increased them anything like adequately enough to cope with the increase that will come from the closure of those geriatric beds at Withington, and the general demand for community services. The reality is that community services have been under more strain. That is not my view, but the view of virtually every district nurse——

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

indicated dissent.

Mr. Lloyd

The Minister shakes his head, but I invite him to come to south Manchester. He need not listen to me or Members of Parliament representing the area. He should go there instead. He need not listen to the regional chairman or the authority chairman. Let him talk to the consultants, the midwives, the nurses and the district nurses, and ask them whether they think that there has been an increase in community care and in the quality of services within the wards. They will tell him that there has been a deterioration and that they are working under greater pressure in that area, particularly in the community services on which we are now supposed to rely.

We are also told about the temporary closure of 21 surgical beds, and that they may be needed in future to help out in south Trafford. We are told that there will be an increase in the waiting lists because of such decisions and that general practitioners will be sent details saying where patients can be referred, in areas where waiting times are shortest. What a nonsense that GPs will operate on that basis. That concept is totally unknown in the NHS.

In his letter, the chairman of the regional health authority told me that there will be no great impact on patient care, which is a saving grace. Apart from those in the Government, the chairman is the only person who does not think that there will be a serious impact on patient care. He goes on to say: Closures and changes of use are of course subject to public consultation. That is not true. For example, the proposed transfer of the paediatric plastic surgery unit from Withington hospital to the Duchess of York hospital is not open to consultation because it is a transfer and not a closure, yet it is opposed by every plastic surgeon in that unit. It is no use offering consultation on the closure of the geriatric unit simply because that unit is now closed already, in effect locking the stable door once the horse has gone. The other wards will not close until the end of June, but once again it is meaningless to offer consultation there because there is not sufficient time for adequate consultation. Such a consultation would be bogus and have no impact.

Morale is now very poor in south Manchester. It was poor already at the recent round of talks. Many people have expressed the real fear to me that the amount of cuts being asked for this time round will not be enough to save the £2.8 million. Around October, the authority might have to look for further cuts. The fact that those rumours and fears are abroad means that morale continues to shrink. We are seeing the dissipation of the one thing that makes our Health Service tower above that of many other countries—the great dedication of those working in it. It is desperately important that that is recognised, and that the Minister recognises that I am not simply making a political point; it would be made by all those people.

Therefore, I appeal to the Minister, if he does not believe what I say, to come to south Manchester and talk to those most involved because we have gone beyond the point of the matter being a simple political shuttlecock. We have reached the point where I need to appeal, on behalf of my constituents, to the Minister and the Government to take seriously the impact of the present round of cuts upon that authority.

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

I am glad that the hon. Member for Stretford (Mr. Lloyd) has raised this important question. He has been supported by the right hon. Member for Manchester, Wythenshawe (Mr. Morris) and the hon. Member for Burnley (Mr. Pike). He characterised my role at the end of the parliamentary day as that of a tail gunner, who was the most lonely member of an air crew during the second world war. Happily, my loneliness is assuaged by the presence of my hon. Friend the Member for Manchester, Withington (Mr. Silvester), who has come to listen to the debate.

Health authority finance is a legitimate and important matter for public debate. The Government are responsible for the way in which the considerable and rising sums of money being spent in the NHS are distributed to different parts of the country. We have difficult decisions to make about the apportionment of funds between the different health authorities. We are ultimately responsible, and I do not dispute the fact that we should be discussing the important points that the hon. Gentleman has made. However, in any organisation as large as the NHS, spending so much money—a record £14.5 billion this year, which is more than 20 per cent. ahead of the rise in prices since 1979—regional and local determination must play some role. We cannot second guess from the Elephant and Castle every spending decision taken by a regional or district health authority.

However, regional and district health authorities should live within their means and their cash limits. Cash limits are not some new, draconian and Conservative introduction into the running of the NHS. They were rightly part of the last Labour Administration's way of running things. Health authorities must manage within the sums of money that they have, but there is always room for legitimate debate about whether the sums of money are large enough, given the health care needs of the district.

Resources are not limitless, but demands are. The hon. Member for Stretford and I probably agree that the demands on the NHS are almost infinite and that they could grow way beyond the capacity of this or any other country to fund. One of the main reasons for this is the very success of modern medicine, together with the much wider range and scope of treatment that modern medicine can offer.

In south Manchester, about which the hon. Gentleman painted an unnecessarily gloomy picture—although he pointed briefly to one or two sectors where he thought that things were going well—the district health authority is treating many patients who, only a few short years ago, had no hope. That is putting additional pressure on the system, to which the Government have responded by massive investment in the district. While I appreciate the hon. Gentleman's strength of feeling, and his care and concern for his constituents, there is no way in which south Manchester could be described as an area of deprivation and need compared with the rest of the north. It is one of the best funded districts in the whole of northern England.

In the NHS, the process of redistribution of resources to where the patients are is continuing. There is broadly a bipartisan agreement across the Floor of the House on this. We might disagree about the rate and the pace of redistribution, and say that it is going too fast relative to the sums of money in the NHS—those are matters for debate—but most of us realise that it makes common sense to put the money where the patients are. Money should follow patients, beds should be where patients are, and we need to redistribute money between the relatively well off and the poor areas.

That process was started by the Labour Government, and we are aware that the historically deprived—I do not blame any previous Administration for this—northwestern region needs our special attention. It is with that in mind that the total additional revenue allocation for the region this year alone is £43 million, which is a 5.5 per cent. increase in the cash available for 1984–85. That is a formidable real increase in revenue.

The north-west's capital allocation is, for the second year running, the second highest in England. The capital moneys are intended to make up the historic deprivation of the north-west, in terms of capital stock. The pressing need to rebuild older hospitals and units has been recognised by this increased capital allocation. The region is moving quickly, under the Government's policies, towards its revenue target, and this financial year it will be only 1.8 per cent. below that target. That compares with a figure of about 11 per cent. below target just six years ago.

Whatever else has happened in the region, vis-à-vis the rest of the country it has been brought pretty close to its revenue target quickly during the past six years.

Mr. Alfred Morris

Will the Minister give way?

Mr. Patten

I do not have much time, and I must reply to the hon. Member for Stretford. I intend no discourtesy to the right hon. Gentleman.

Mr. Morris

My constituency is involved.

Mr. Deputy Speaker (Mr. Ernest Armstrong)

Order. If the Minister does not give way, the right hon. Gentleman knows that he cannot intervene.

Mr. Patten

The right hon. Gentleman knows that I intend no discourtesy. It would be a greater discourtesy if I were unable, because of the lack of time available to me, to reply in full to the points of the hon. Member for Stretford. I shall certainly write to the right hon. Member for Wythenshawe in reply to any points that he wishes to raise.

How has south Manchester benefited from all this? First, it has benefited through the district's development of teaching, which has continued apace. Secondly, during the past two years, nearly £5 million worth of capital spending has occurred in the district, which is a substantial sum. Thirdly, there is a new day unit for the elderly mentally infirm. Fourthly, £1.25 million has been spent on cardiac services and on kidney dialysis and associated renal services, which the hon. Member for Stretford was good enough to mention as improvements in his district. Fifthly, it is an incontrovertible fact that the district is one of the best funded in the region; it is the highest funded per head of population of the north-west's three teaching districts. That is reflected in the fact that, in relation to where it should be according to the calculations of the regional allocation working party, the district is expected to be about 12 per cent. above target this year. That is as far above target as, for example, a deprived district such as Bolton is below target.

I recently visited Bolton, at the invitation of two of my hon. Friends and one Labour Member, to see the problems there. I was with them for some time that day, and I saw the problems of a district such as Bolton, which is so much below target. I shall certainly consider the hon. Gentleman's invitation to pay a similar visit to his constituency.

One of the best yardsticks by which levels of service can be judged is the access to hospital inpatient facilities for bread-and-butter health services. In south Manchester at present, it is considerably easier to obtain hospital treatment quickly than it is in other districts, such as Bolton.

What are south Manchester's problems? We have had a mixture of fact and anecdote from the hon. Member for Stretford. I do not think that anyone can seriously argue that the district is under-funded. I do not agree with the hon. Gentleman. South Manchester's financial problems stem from overspending in previous years and from accumulated overspending. The hon. Member for Stretford referred to my shaking my head in disagreement; I see that he is now shaking his head in disagreement with me. We shall have to disagree. The district is facing accumulated overspending of £2.8 million. It would be surprising if a component of that overspending were not attributable to the cost of staff. The cost of staff in the NHS accounts for more than 70 per cent. of total revenue expenditure. Of course, staff costs will always be part of that overspending.

The district is facing this accumulated deficit. We cannot simply wipe the slate clean. How would we explain that to patients in Wigan, Bolton and other deprived districts in the north-west? I have to speak for them as well. All Governments, including Labour, have required health authorities to live within their budgets. This Government's intention is to continue to ask them to do so.

The health authority, under its excellent chairman, Sir John Page, is working the district trying to find ways of reducing the accumulated overspend while continuing to provide the current excellent service. Until that is achieved, it will put in jeopardy all the progress that south Manchester has made, undermining the foundations of the district's development in the future as a centre of lifesaving surgery.

South Manchester is certainly a responsible health authority. It has set a budget for 1985–86 which it thinks can be contained within its cash limits. It is considering making a number of service changes to make all that possible. The regional health authority has agreed to some of those changes and has asked for others to be re-examined. All this consultation is a critical part of the process. The hon. Member for Stretford is not being fair to the way in which the consultation process is carried out. If he really feels that consultation is not being carried out according to the rules, it is important that he should write to me or to my right hon. and learned Friend the Minister for Health to point out exactly where and how the procedures are not being followed.

Mr. Tony Lloyd

Once a ward is closed—as with the geriatric ward at Withington hospital—what meaningful purpose can consultation have, even if it is carried out with the best will in the world? We all know that it will not reopen the ward.

Mr. Patten

It is not always the case that wards closed under the emergency procedures are thereafter closed permanently. There are a number of examples where wards have been closed temporarily by health authorities pending the consultation process. After consultation, because of the view of the health authority or of the Minister to whom the matter has gone on appeal, the decision has gone the other way and the wards have been reopened. The consultation process is extremely important, and I hope that people will take part in it wholeheartedly, where there have been short-term or temporary closures.

A number of changes in the district will be beneficial to patient care. Some of the suggested changes will mean, if approved by the region and followed by the district health authority, that people will receive treatment much closer to home. If people receive closer to their homes the care that they need, this is a change for the better. Neither my right hon. and learned Friend the Minister for Health nor myself approves the wholesale shipping of patients over substantial distances when they can be treated closer to their homes.

There are a number of beneficial effects in the proposals. The district treats a high proportion of elderly patients in hospital—much higher than the national average. I do not think that that accords necessarily with good, modern practice. It is sensible that the district wants to shift resources to treat those who do not genuinely need to be in hospital. I do not think that community care is a cheap option or that the transfer from hospital to community care is an easy transfer to make. We are living in a period of change, and community services are adopting and adapting practices. Of course, there will be problems in south Manchester, as in other areas of the country—

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned accordingly at six minutes to Two o'clock.