HC Deb 14 April 1986 vol 95 cc704-10

Motion made, and Question proposed, That this House do now adjourn.[Mr. Peter Lloyd.]

12.36 am
Mr. Cyril Smith (Rochdale)

Rochdale health authority faces a serious crisis. It is a crisis which threatens to close two hospitals, a home for the mentally ill, two departments — the ear, nose and throat and plastic surgery—and beds in the children's ward and to sack 150 employees, approximately 100 of whom will be nurses, and the balance may well include some doctors. It is a totally unacceptable situation and an utter disgrace. It is a scandal of the first order, and one can well understand why the Minister for Health is too ashamed to attend the House tonight to answer for the Government. I welcome his deputy and I am grateful to him for coming, but I am bound to say that the seriousness of the situation in Rochdale merited the engine driver rather than his mate.

I described the situation as a crisis. That is what it is, and that is why it needs the serious intervention of the Minister. The hon. Members for Heywood and Middleton (Mr. Callaghan) and for Littleborough and Saddleworth (Mr. Dickens) also hope to catch your eye, Mr. Speaker, during this short debate, so time forbids me from giving too many quotations from our local press, but I shall give the Minister one or two. Emergency admissions could grind to a halt if plans to close 98 hospital beds go ahead", Rochdale's top doctors warned on Monday. Dr. Jegerajah —a very respected physician in Rochdale and a much loved one—says: We feel we will be unable to admit acutely ill patients. They will be kept waiting and either die in the community or in the hospital corridor while waiting to be admitted to the coronory care or chest unit. He went on to say that 95 per cent. of admissions to the medical wards are emergencies.

Three experienced consultants, all household names to Rochdale people—Mr. John Main, Mr. Humphreys and Mr. Tony Higham—in a letter to the local press, said: The loss of these beds means that we will be unable to continue to offer the same service as previously. Patients with more urgent conditions will join an ever lengthening waiting list. We will be obliged to discharge patients from hospital before they are really ready. The local medical committee in Rochdale said:

If these beds go, the work of looking after the sick who would normally be in hospital will fall on relatives, friends and neighbours. Last Saturday I stood in Rochdale market with a group of nurses asking people to sign a petition in opposition to the closures. The hon. Member for Heywood and Middleton told me in the Lobby a few minutes ago that he had the same experience as I had—people queued five deep in order to sign the petition.

I could occupy the whole of my time giving similar quotes from equally eminent sources. It is an intolerable situation and an utter disgrace. I urge the Minister to set up an inquiry into the north-west regional health authority. Its financial strategy is flawed and its financial management of districts needs to be investigated. I understand that soon another six district health authorities in the region are likely to be in the same situation as Rochdale. The chairman of the authority, Sir John Page, in whom I have absolutely no confidence, is not concerned with maintaining the service. He told me, in the presence of two other Members of Parliament, that Rochdale's waiting list for operations, and so on, would have to grow longer to balance the budget. That is a disgraceful position for the chairman of a regional health authority to take. I despair of the man.

The chairman's strategy of developing new fringe services at the expense of old, but basic and essential ones, is like a fellow who is more concerned with double glazing the upstairs windows of his house than with the foundations that are rotting away. I question the need for a regional authority anyway. Its vast bureaucracy, its army of officers, the recent vast development of the public relations unit in the region and its occupation of lavish and expensive offices make no direct contribution to patient care. Rather than sack a nurse, I would sack the regional chairman and abolish his office.

The North West regional health authority is the most interventionist in Britain. That can be proved and demonstrated convincingly and clearly. It has robbed the district health authorities of much-needed cash to play around with new ideas, many of which are laudable but not at the expense of basic essentials. The region's financial strategy is flawed. It is trying to go faster than existing services can financially stand. Some of Sir John's children get fed while others starve. There is an ambitious capital programme, which is overspending even on its original targets, and, here again, the poor districts have to make up the balance. The basis of Rochdale's crisis is not its mismanagement, but the mismanagement and interference of the regional authority.

Rochdale has the worst community services in the region, but it is a deprived area. As soon as the Rochdale authority tries to re-deploy money from hospitals into this service, the region withdraws saved finance to support its pet regional schemes. For example, there has been a 25-bed reduction in 10 years. The region conned us into believing that 56 bed closures would mean that the savings would go into the Rochdale service. Instead, this year it is taking the money that accrued from those savings away from us. That alone amounts to £385,000 per annum. Last year, the trimming of bureaucracy by the Rochdale health authority released £415,000 in a full year. Surely, that is evidence of the commitment of the Rochdale authority to live within its budget. There is no way, certainly in the long term, that the Rochdale authority can live within the region's allocated cash limits without damaging patient services. That is the crisis that I put before the Minister.

We have a legacy of old and scattered buildings in Rochdale, yet we have a regional allocation policy that ignores the facts. For example, a district with a £20 million redevelopment scheme gets its capital for basic maintenance on the same basis as Rochdale, despite the fact that Rochdale has the old buildings. Such economic management defies common sense. Rochdale is in the bottom six for proportionate expenditure on maintenance and equipment. These cuts will push us to the bottom.

We have had underfunding of price increases and pay awards in four out of the past five years, and that is costing Rochdale over £1 million a year. The 1.2 per cent. cash limit increase that the north-west received was not given out on a proportionate basis, and that cost Rochdale another £31,000 per annum. Other authorities — for example, Salford—were allowed time to balance their books. The region is financing last year's overspendings, but not Rochdale's. Why will Rochdale not get full funding for its elderly severely mentally infirm unit when every other authority in the region will? The fact is that we are being penalised for being too progressive in the past.

Why should Rochdale have to pay part of the cost of computerising medical records when it is doing that as a pilot scheme for the region? Frankly, if I were the Rochdale health authority, I would tell the region to go and get knotted.

Rochdale needs help now. It needs more cash to provide an adequate service. I hope that tonight the Minister will undertake to consider the position in Rochdale, allocate Rochdale temporary help for the short term and investigate the regional authority and its financial strategy. Nothing less will do.

Some of us feel passionately about the Health Service. We are proud of it. No one denies—certainly I do not—that more money is being spent on the Health Service. The issue is not whether more money is being spent but whether that which is being spent is adequate to meet the needs and provide the basic services.

I am proud of the Health Service. It is the finest in the world. The medical and other staff are dedicated people. Frankly, I am unprepared passively to watch it being destroyed at its roots by any Government, region or anyone else. Rochdale is not getting a fair or adequate deal, and the north-west region is not pursuing a wise financial policy. That is why tonight I plead with the Government for some real help and response to that plea.

12.46 am
Mr. Geoffrey Dickens (Littleborough and Saddleworth)

I am deeply grateful to the hon. Member for Rochdale (Mr. Smith), first, for securing the debate, and, secondly, for allowing me two or three minutes in which to speak.

Rochdale's excellent performance in regard to hospital services is a remarkable achievement that should receive immediate financial recognition from the regional health authority. I say "remarkable" for two reasons. First, Rochdale treats relatively more people in hospital. In fact, Rochdale's hospitalisation is in the top 7 per cent. of the country. Secondly, the actual throughput of patients compared with the expected throughput shows that significantly more patients per bed are treated—that is efficiency — than the regional or national average and Rochdale's performance rate is in the top 25 per cent. for the country. The shorter the length of stay in hospital, the more care and attention is required of the community services. Rochdale has a first-class district nurse team, but it is hard worked, and there are too few health visitors.

Rochdale has achieved such excellence despite a legacy of old and scattered buildings in Rochdale, as my hon. Friend — I mean to call him that — the Member for Rochdale said. The region's capital allocation policy is not sensitive to that because the formula does not reflect new or old buildings or development in progress. A district with a £20 million redevelopment scheme receives its capital for maintenance on the same basis as Rochdale.

Rochdale needs special help and relief immediately. If its debts were wiped out by Her Majesty's Government, it would be able to stand on its own feet with pride as an example of excellence to others. I fully support the hon. Gentleman.

12.48 am
Mr. Jim Callaghan (Heywood and Middleton)

I thank the hon. Member for Rochdale (Mr. Smith) for allowing me two or three minutes in which to reinforce his case for extra financial assistance for the Rochdale health authority.

In the famous Dickens novel, Oliver Twist went to the beadle and asked for more. We all know why. He asked for more because he was given insufficient. Hon. Members are coming to the Minister, just as Oliver Twist went to the beadle, but we hope that we will not get the reaction from him that Oliver Twist received from the beadle.

In the short time at my disposal I cannot do justice to the full case for Rochdale. The Rochdale health authority is being required by the North-West regional health authority to reduce its cash basis to a balanced budget in in only one year. To do that the Rochdale health authority is required to make a cut of over £2 million in a budget of only £26 million—a cut of almost 8 per cent. It is an amputation, no a cut. The cut can be achieved only by the closure of 150 beds or the sacking of 100 staff.

The required cut is the most drastic asked of any district health authority. Whenever cuts are made, they are unacceptable not only to hon. Members but to the Labour party.

The changes will have a dramatic effect on the health district with the least developed community health services in the north-west. Does the Minister realise that Rochdale ranks 15 out of the 19 hospital districts in terms of being badly off in numbers of health visitors and that it is the worst district in terms of district nurses?

One of Rochdale's most senior social services officers has said that Rochdale is the most deprived of deprived areas. I agree with him.

Rochdale is already the bottom of six districts for its low proportion of expenditure on maintenance equipment and other non-staff budgets. Further cuts will push Rochdale's hospital services to the bottom of the heap.

The Rochdale area health authority is now finding that the cost of patient services can be contained within present cash limits only at the expense of severe reductions in patient care and services. The finance allocated by the North-West regional health authority to the Rochdale health authority is inadequate to maintain current services at present levels, so patients will suffer.

I fervently oppose the proposed cuts and ask the Minister to examine the faulty financial strategy of the North-West regional health authority as it applies to the Rochdale health authority.

12.52 am
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

The hon. Member for Rochdale (Mr. Smith) said that he was a passionate defender of the National Health Service and that he was proud of the service. He was good enough to recognise that the Health Service has benefited in real terms under this Government by the transfer of additional resources well above the inflation rate, which this year will be 24 per cent. above. He also said that the Health Service was being destroyed at its roots. That is a travesty of the truth and does great harm to the Health Service, whether in Rochdale, the north-west or the country as a whole.

I shall put one or two facts to the House to substantiate my assertion. The north-west has far fewer problems today than it had when the Government took office. It is better funded and better managed — I pay tribute to the regional chairman, Sir John Page—and it has certainly treated more patients than ever.

Since 1978–79, Health Service spending in the region has more than doubled, from £380 million to £809 million in 1984–85. That is growth in real terms of 19.6 per cent. If we take that with the region's allocations for 1985–86 and 1986–87, we see that the real term expenditure is forecast to rise by about 21 per cent. overall. That is not by any means destroying the whole service at the roots or at any other point. This year's allocation has brought the region to within 0.8 per cent. of its Resource Allocation Working Party target, compared with 9 per cent. below in 1978–79.

Patients, of course, and not sums of money are the issue. The number of patients treated has grown from 3.7 million in 1978 to 4.267 million in 1984, the last year for which figures are available. There is no doubt that in the north western region as a whole the health services, the Government, and the authority and its chairman have a good story to tell.

Rochdale has always been relatively well provided for. One of the best indicators of this is that Rochdale people find it easier to gain access to hospital services than do people in many other parts of the north-west region. Waiting lists for many specialties are below the regional and national average. In 1984, 9 per cent. more patients were treated in Rochdale than were treated in 1982. Unlike the region as a whole, Rochdale has long been at or above its RAWP target. Despite what the hon. Member has said, Rochdale is not underfunded. Rochdale people have good health services and I pay tribute to all who work in the Health Service in the district for the care that they give to the constituents of all hon. Members who have spoken in the debate.

There is a problem that has grown since 1981, when warnings were first sounded. The authority has not acted in time or effectively to avoid overspending its cash limits. All Governments must insist that health authorities live within their cash limits. The problem is not cuts. We are building, not cutting in the north-west region. The problem in Rochdale is resource management. Demand exceeds the resources available. The position in Europe and the United States of America is no different. Although we are ensuring that a growing share of national resources are available to the Health Service, that resource, nevertheless, has to be carefully managed. The north-west region, as I have said, is doing particularly well out of this. The task is to choose priorities in putting these resources to best use for the benefit of local peoples. That is what resource management is all about. This is what Rochdale has been asked to do repeatedly since warnings were first given in 1981.

In November 1982 the district treasurer warned the district health authority of a potential overspend of £700,000 by year end if no action was taken to reduce spending levels. The district chairman subsequently wrote to members expressing her concern at the financial situation and drawing attention to their obligation —enforced by all Governments—to live within their cash limits. In May 1983 the treasurer again warned the authority. It was forecast at this stage that the budgets required by service managers exceeded allocations by £1.3 million — 6 per cent. — and that some adjustment in service levels was inevitable.

Subsequently, and after local consultation, Ministers agreed to the authority closing 56 acute beds to save £418,000. Despite these savings, the DHA was forecasting an overspend at the end of 1983–84 of £750,000, of which £440,000 was accumulated overspending brought forward from 1982–83. The authority was therefore overspending at an annual rate of £310,000–1.5 per cent. Further savings were proposed of approximately £300,000 to bring the current annual spending level into line, but the accumulated overspending would have been untouched. These savings included, as the hon. Member knows, the authority making some headquarters staff redundant last year.

Warnings were given again last year of a year-end shortfall of up to £1.5 million in the absence of corrective action. In spite of this, I understand that the Rochdale health authority adopted a budget for 1985–86 which, from the outset, showed overspending of £380,000. Part of this overspend was £330,000 brought forward from 1984–85, so it could be said that at that time the budget was expected to overspend only marginally in current terms. However, the district treasurer has assessed that, by the start Of the current financial year, spending levels had to be reduced by 6.1 per cent. to achieve a balance. I understand that, after discussions with the regional health authority, Rochdale now estimates a lower deficit of about £1.5 million. Rochdale health authority is to consider recommendations on achieving a balanced budget in 1986–87 at its meeting on 22 April.

I understand that the hon. Member, with my hon. Friend the Member for Littleborough and Saddleworth (Mr. Dickens) and the hon. Member for Heywood and Middleton (Mr. Callaghan), with councillor Mrs. Hawton, the Rochdale chairman, met the regional chairman on 14 March. Afterwards, Mrs. Hawton took her own deputation to Sir John. Several questions were put to Sir John, asking for more money and drawing attention to the DHA's view that it is an efficient authority. The hon. Member has had his answers. In summary, Sir John and his team at the region assured him that Rochdale was being treated fairly—indeed, Rochdale is better advantaged than many north western districts—and that it is up to Rochdale to put its house in order. I understand that that is what the authority plans to do on 22 April.

Hon. Members have mentioned proposals that worry them, but they should be addressed to the authority. The hon. Members for Rochdale and for Heywood and Middleton mentioned redundancies. I understand that there is no question of compulsory redundancies.

Mr. Cyril Smith

That is not true.

Mr. Whitney

That is my understanding. I also understand that there will be consultation on any envisaged hospital closures, which, in any case, follow new facilities or improvements in service. If closures were recommended and the community health council had objections, Ministers would take the decision anyway. I am advised that Rochdale will benefit from reinvestment of the proceeds of land sales.

No one is being inflexible. If a district is allowed to overspend, it is at the cost of much needed developments locally or in other less well provided parts of the region. Rochdale must agree a programme with the region for balancing its budget. Of course, there will be difficult choices, and everything must be done to avoid affecting patients' services. If the nettle is not grasped, however, all that has been achieved in Rochdale and the north-west will be undermined.

Rochdale health authority is to decide how to tackle this problem on 22 April. It is a responsible authority I have confidence that it will now take the right decisions to put Rochdale's health services on a firm financial foundation for the developments ahead. It is important that we recognise what has been achieved. The resources that have been devoted to Rochdale and the north-west—

Mr. Smith

They are not enough.

Mr. Whitney

The hon. Gentleman must take account of major transfers of resources. If he is interested in yet more resources, he must consider how much heavier a burden he is willing to put on his constituents or the country.

The resources that have been transferred to the National Health Service will increase by 24 per cent. in real terms this year, and Rochdale and the north-west have had a very fair share.

Question put and agreed to.

Adjourned accordingly at four minutes past One o'clock.