§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Archie Hamilton.]
§ 10 pm
§ Sir Fergus Montgomery (Altrincham and Sale)
I am very glad to have this opportunity to raise an entirely local question that concerns my constituents and those of my hon. Friend the Member for Davyhulme (Mr. Churchill) and the hon. Member for Stretford (Mr. Lloyd)—the future of the Trafford health authority.
I had an Adjournment debate on 25 April about the long-promised south Trafford district hospital—a promise that has been made over the years but which, for some reason known only to itself, the regional health authority has squashed. That decision has caused enormous aggravation in my constituency, and has been assailed from all sides and all political parties. My hon. Friend will guess that I am not altogether what is known as a member of the fan club for the officers of the regional health authority.
I criticised those officers for not sending a representative to put their case at a large public meeting held in Sale town hall. Many people turned up, but no one from the regional health authority bothered to show his face. Surely if the authority's case was a good one, its representatives would have attended the meeting. Its case has gone by default because of non-attendance.
At that time, I accused the RHA of lack of consultation, and I regret that that is the accusation that I make against it tonight. Its inept and inappropriate use of the consultation process has caused a great deal of anxiety among my constituents. On 22 October my health authority members had to fight off a cavalier and determined attempt by the chairman of the regional health authority to abolish the Trafford health authority. That arose because of a decision reached in February this year to reject the long-promised district hospital. It was determined that our future hospital needs would be met by developing services at Wythenshawe hospital—which is not in Trafford, but in Manchester—and by the rebuilding and improving of hospital facilities at two hospitals in Altrincham. That represented a change in policy.
Trafford health authority, quite rightly, asked the regional health authority to ensure that the management arrangements for Wythenshawe hospital were reviewed. I think that my hon. Friend the Minister would agree that that makes good sense. Under the change there will be increased use of Wythenshawe hospital by residents of Trafford. My health authority felt that the management of Wythenshawe should be transferred from the South Manchester health authority to the Trafford health authority.
A panel of five members of the RHA, including the chairman and the vice chairman, met on Friday 11 October to consider their response to the consultative document. The report was made public on 16 October and was to be put to the RHA on 22 October, less than a week later.
The report recommended the abolition of Trafford health authority, which was to be carved up and annexed to South Manchester health authority and Salford health authority. My hon. Friend has seen the report and will know that scant justification was offered for that recommendation, but unsubstantiated assertions were 402 made about considerable savings and better health care for patients. I have to tell my hon. Friend that that did not go down well with my constituents.
From the time that the report was published I was bombarded with telephone calls and letters from angry constituents. I held an advice bureau in Altrincham town hall on 19 October, and two separate delegations came to see me. They comprised physiotherapists, speech therapists and chiropodists. They were all reasonable people and put their views sensibly, but they were worried about their jobs and lack of security. They were rightly angry. They were furious that there was less than a week between the publication of the report and the vital meeting of the regional health authority.
Because of the ham-handedness of those in charge of the regional health authority, unnecessary alarm and aggravation were caused. I am glad to say that when the meeting of the regional health authority took place on 22 October sanity prevailed and the majority of regional health authority members refused to accept the strong recommendation from their chairman that the proposal should be adopted. That was mainly due to the lobbying of every member of the regional health authority on the case for the Trafford health authority.
Had it not been for the vigilence of local organisations, and of the majority of the regional health authority members in vigorously and successfully opposing the move, the proposal by Sir John Page, the regional health authority chairman, could have resulted in chaos and confusion, such was his apparent lack of appreciation of how health and social services operate at a local level.
Without doubt, the regional health authority must constantly review the organisation of its services to ensure the most cost-effective means of providing health care. Nobody will dispute that, because it is one of the regional health authority's jobs. I have no argument with that, because in the long term it must be in the best interests of patients. However, it is equally essential that the regional health authority should act in a caring and competent manner. The standards that one would expect to be applied in a large public service organisation have been totally missing. The consultation process initiated by the regional health authority seemed to be excellent at the time, but many of my constituents will, cynically, believe that their views were treated with contempt and dismissed as being of no account.
The criteria selected by the regional health authority to judge the relative merits of the various options were misapplied, misconstrued or ignored. The criteria were the rules of the game and were based on formal DHSS guidelines. Not only were the rules changed half way through the game, but the goalposts were removed.
The benefits claimed for the proposal were given no substance. First, it was claimed that substantial savings would be made, but that claim has never been assessed in detail. There was never an intention to undertake a financial evaluation between the various options. Secondly, it was claimed that patients would benefit. That claim was so hollow that not a single concrete example could be offered in answer to the question: how will the changes benefit the people of Trafford?
The regional chairman apparently set great store by the good will on which the proposed arrangements would depend for their success. Good will follows in the wake 403 of trusted leadership. It is a mistake to expect good will in response to an imposed, unwarranted and unwanted solution.
The strength of feeling locally against the proposal and the manner in which it was presented is vividly illustrated in a remark by a member of the district health authority who met the regional chairman shortly before the meeting of the regional health authority. The member of the district health authority was attempting to understand the thought processes that led to the recommendation. She said:
It is incredible that the health of the people of Trafford depends on such inept, perfunctory and arrogant decision making.If my hon. Friend thinks that such language is intemperate — and I am sure that he is used to intemperate language, because he and I occasionally play bridge together and on occasions when I have trumped his ace his language has not been particularly mild—it is worth remembering that the proposal to eliminate an employing authority of 2,900 people was made public without advance warning to representatives of that authority a matter of only six days before a decision was due. It had not apparently occurred to anyone at the regional health authority that our health service staff, who give such dedicated and loyal care to those in need in the community, deserved similar consideration.
I have mentioned the enormous anger of people in my constituency. I would like to tell my hon. Friend that one of the Conservative councillors in my constituency called for the resignation of the chairman of the regional health authority. While I do not think that this is likely to happen, I hope that by now my hon. Friend has heard the message loud and clear, that the Sir John Page fan club is devoid of members in the Trafford area. Two enormous kicks in the stomach in one year are more than enough, and they certainly have not made him the pin-up boy of the people in my constituency.
The fact that the recommendation was overturned by the regional health authority, despite the most determined last-ditch stand of the chairman of the RHA, is the most welcome demonstration that the majority of its members have a clear grasp of the fundamental principles on which health care must be based, and of the vital importance of conterminosity between health authorities and local authorities. The regional health authority, however, has acknowledged that while Trafford health authority is regarded as sacrosanct, important organisational issues in Manchester and Trafford still need to be ironed out. I am concerned—and this is the reason for the debate tonight—that these issues are considered in a proper fashion.
I hope, therefore, that when my hon. Friend winds up the debate tonight, he will be able to assure me that the proper administrative processes will this time be observed when the regional health authority makes its assessment of these outstanding issues.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
I am very happy to have this opportunity to respond to the powerful speech of my hon. Friend for Altrincham and Sale (Sir F. Montgomery). I know well how carefully and with what great concern he follows the issues of health service provision within his constituency and in the Trafford health authority in particular, and, of course, I am very concerned indeed to learn of the points that he made 404 tonight, and dismayed by the tale that he had to tell. There are, of course, a number of points where I would, with respect, have to part company with my hon. Friend, but let met start with a point on which we can be in wholehearted agreement.
As I understand it, my hon. Friend said—I think that I quote him correctly—that the regional health authority must constanly review the organisation of its services to ensure the most cost-effective means of providing health care. That is the starting point for all of us. As my hon. Friend knows very well, the immense amount of public resources devoted to our health services — resources which are increasing in real terms and, since we came to office in 1979, on a national level—has increased by 20 per cent. in real terms. The north-west has had its share and, according to the RAWP formula, has been improving its share. So there we start in agreement.
My hon. Friend, however, was not entirely fair in some of his other remarks about the way in which the regional health authority has handled this undoubtedly difficult and very sensitive matter because, after all, it was required by the very criteria which my hon. Friend himself enunciated to look very carefully at the services that are provided and that are to be provided in the future. As part of that, it indulges in the consultation process. I cannot accept that the consultation process was in any way inept or inappropriate, to use my hon. Friend's words. It was an open consultative process, and was not conducted behind closed doors. I admit that it was conducted with due speed, but lengthy consultation is always much more difficult. Both the timetable and the method were entirely appropriate.
The particular consultation document was issued on 27 June 1985 with the request that comments on the proposals should be submitted by 27 September. To ensure that the bodies and individuals that were consulted were provided with as much information as possilbe, they were also informed in a letter of 6 August 1985 of the results of the option appraisal for the provision of mental illness services to the Trafford and south Manchester health districts, which had been approved by the regional health authority at its meeting on 18 June. As a result of that process a total of 308 bodies and individuals were consulted, and 46 responses were received, one third of which made no comments on the consultation document.
Thereafter, the consideration of the responses was undertaken by a special member panel which comprised the chairman and vice-chairman of the regional health authority, Mr. R. E. Hodd, Councillor Leck, and Councillor Mrs. Oldham. That process was duly undertaken in accordance with the normal consultation procedures, which are well laid down and established.
I must stress that consultation in itself is not a referendum. The consultation process exists better to inform the decision-makers, and the exercise greatly assisted Trafford. I know that Trafford wanted to make a special presentation of its case, but that is impractical and would have been unfair to other interested bodies with views. Instead, an assistant general manager held detailed discussions with Trafford and south Manchester to ascertain any special points that they wished to make. They were reported fully to the RHA panel set up to consider the matter. A Trafford health authority delegation met the chairman of the regional health authority, Sir John 405 Page, before the full regional health authority considered the panel's report. Having considered it, they reported to the full authority about three weeks ago.
Trafford's claim that the management of Wythenshawe should pass to it was considered in detail. Trafford argued in a detailed submission that more of south Trafford's residents used the hospital than residents of any other area and, therefore, Trafford should manage the hospital. However, the regional health authority found that, although south Trafford people might form the largest single block, most of the Wythenshawe users—60 per cent.—came from elsewhere. It was felt, therefore, that the case was not proven. The regional health authority decided to maintain the status quo in managing Wythenshawe, that is, to quote the consultation document,
that Wythenshawe Hospital, when developed to provide facilities for South Trafford, would continue to be managed by South Manchester Health Authority".The great concern centred on the other suggestion before the RHA. The panel asked the region to consider transferring the management of south Trafford to south Manchester, and north Trafford to Salford. It foresaw substantial savings and the prospect of other management efficiencies without any deterioration in services, which it believed would benefit patients. However, as my hon. Friend told the House, those options were not accepted and, therefore, are no longer on the table. It is entirely right that they should be considered precisely in the spirit of the doctrine that I quoted, and on which my hon. Friend and I seemed to be in agreement.
As I say, it is recognised that there should always be full local consultation at any stage in any of these issues. If, for example, later on there were to be proposals to change any health authority boundaries, those district health authorities concerned would certainly be given a full opportunity to put forward their views. If, following such consultation, the regional health authority wished to go ahead with boundary changes, the matter would come for final decision to the Secretary of State. If the Secretary of State agreed, statutory instruments would be needed to implement any such proposals. The Secretary of State would have his own separate consultation and those concerned would again have the opportunity to put forward their views before the instruments were laid.
This is all entirely speculative, because no such proposals are being made. What I should like to stress to my hon. Friend, and I would be grateful if he would pass it on to his constituents and the health authority concerned, is that built into all out actions there is a wide allowance for the maximum degree of consultation. I know that my hon. Friend accepts that the proposals that gave him and his constituents concern are no longer on the table.
I hope that my hon. Friend will recognise his good fortune in having the Trafford health authority, because it is one of the highest funded districts per head in the north-west region. This year the Trafford district will be 15.23 per cent. above its resource allocation working party 406 target. That is as far above the RAWP target as other districts such as Blackpool, Wyre and Fylde and Bolton are below it. More importantly for the man in the street, because these RAWP calculations are of an abstruse nature known only to hon. Members and Health Ministers, is the fact that the residents of Trafford find it easier to get into hospital as inpatients than do most other people in the north-west region.
I hope that my hon. Friend recognises that the provision of health services in the Trafford region is of a high standard. We certainly pay tribute to that and to the good service given to us by the workers at all levels in the health authority to which my hon. Friend referred. At no time was there any question of a threat to the jobs of the 2,900 people to whom he referred. The only thing at issue was the authority staff. None of that came to pass. As I understand it, the health services themselves were not under threat; the issue was the organisation of the health authority. I should like to pay my own tribute to the contribution made by workers in the health authority in Trafford and in health authorities elsewhere.
I should like to remind my hon. Friend of the good work that has been carried out in the north-west region as a whole. Some of the statistics and figures in the latest report of the north-western health region will, I am sure, be familiar to him, but they deserve wide publicity and recognition to show what that region as a whole has achieved in recent years. We have seen a steady rise in the number of people receiving hospital treatment, and between 1978 and 1983 for example, the number of inpatients admitted to hospital increased by something like 14 per cent. from 511,000 to 585,000.
The number of outpatients increased by 11 per cent. from 3.1 million to 3.4 million. The number of day cases shot up, showing a rise over that same period of 53 per cent. Those figures indicate a well-run region. The skills and dedication that they reveal have also been applied in the administration of health care in the Trafford health authority.
I hope that the flurry that has been caused by the affair will now subside. I hope that the sincerity and integrity of the consultation process will be accepted, because it was certainly genuine and in all these cases it will always be followed. But at the end of the day we come back to the starting point at which my hon. Friend also began. The regional health authority—and, indeed, the district, and the DHSS, for that matter—all have a duty constantly to review the organisation of our health services. That is what is happening, that is what we shall continue to do at national level, and I hope that that will continue to be the yardstick by which the region and the Trafford health authority conduct their affairs. It is only in that way that we can continue to make the progress that we are now making in revitalising the health services in Trafford, in the north-west and in the country as a whole.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes past Ten o'clock.