§ Sir John Farr (Harborough)I congratulate my hon. Friend the Under-Secretary of State on the stamina that she is showing tonight. She gave a concise and telling reply to the earlier debate, and we are grateful for the fact that she has undertaken at this hour to discuss our special problems in the east midlands, of which she has had adequate notice.
I want to raise with my hon. Friend the application of RAWP in the east midlands to the Trent regional and Leicestershire health authorities. I have addressed a succession of Ministers on this subject over a number of years and, whether Labour or Conservative, their replies have always been kind, conciliatory, well-intentioned and encouraging. However, I cannot think of a single Minister who has had the practical experience of my hon. Friend and I know that she will probably appreciate better than some of her predecessors the telling importance of my remarks.
In the Trent regional and Leicestershire health authorities, RAWP is 96 per cent. of national average. In fact, Trent region is 96 per cent. of national average and, within Trent region, the Leicestershire health authority has 96 per cent. of the allotment for Trent. My colleagues in the House and elsewhere in the constituency say that that is good because when I first raised the matter, well over 20 years ago, the Leicestershire health authority was languishing at the bottom of the heap with only 73 per cent. of RAWP. I am not encouraged, because, although we are 96 per cent. of RAWP today, that is 96 per cent. of a figure which has massively increased over the past 20 or 25 years. It is not all that much different from 73 per cent. of a much more modest sum in the 1960s when other Members of Parliament and I repeatedly tried to raise the matter.
The fact remains that 25 years ago the Leicestershire health authority, with 73 per cent. of the national average, was bottom of the league. Even though today it sounds much better to say 96 per cent., it is still bottom of the league. There has been consistent underfunding.
At a meeting in the House of Commons which was attended by a number of my colleagues in the House, the Leicestershire health authority, its chairman and senior officials, a fortnight ago—I am glad to see my hon. and learned Friend the Member for Leicester, South (Mr. Spencer) here—keen representations were made about what is regarded as a unique tragedy for the Leicestershire health authority—the continuing and consistent underfunding.
As I told the Minister only last week, unless RAWP is improved for the current financial year, before March 1987 there will have to be cuts. Spending within the Trent and Leicestershire health authorities is running about 5 per cent. above their allocations, despite stringent economies and the best use of centrally made provisions.
During the past week I was lucky enough to visit Leicester general hospital and I was kindly received by Mr. Inman, who is the general manager. I am sure the Minister will confirm that that hospital is almost like a town. The general manager is responsible for a wages bill of over £20 million per annum.
Leicester general hospital has certain specialties, including its renal and bone transplant units, and it is one 1170 of the leading hospitals for hip transplant operations. Apart from having a close look at Leicester general—I was not able to see it all in the time allotted and I hope to go back for a much longer visit shortly—I went along because of complaints that I had received.
One such complaint concerned one of my constituents who was admitted to Leicester general hospital. It does not have an accident or casualty reception, but it does have important and busy operating theatres. There are constant arranged admissions but certain emergency cases are admitted if a patient requires immediate attention. In this case the patient was wheeled out of the ambulance and on to a stretcher. Unfortunately, he was left for up to 10 minutes before somebody could be called to move him to the theatre, where he needed the urgent attention of the doctor. As a result of this wait, despite the presence of relatives and friends, the man caught a chill and as a result died.
This problem could be eradicated if the entrance hall at Leicester general were cleared and an annex built where patients could be placed on a stretcher while they waited for a porter to transport them. There is over half a mile of corridors on the ground floor alone. Such an annex would enable a patient to be kept warm at modest expense. It is that sort of improvement to the existing facilties at Leicester general that is necessary to preserve the lives of constituents.
What impresses me most—notwithstanding the fact that there are not so many now—are the regular complaints that I receive at my surgery and from constituents' letters about the long waiting time for admission. I was interested to hear the reply that my hon. Friend the Minister gave to my hon. Friend the Member for Uxbridge (Mr. Shersby). It is important that we, as a Government, are determined to try to eradicate the waiting times wherever possible. Of course, a reasonable amount of time must elapse so that patients get the most efficient treatment available. It is not right, however, that there should be delays of perhaps three or four months before there is a consultation, followed by a further wait of several months for some specialty treatment. I welcome the remarks made by my right hon. Friend the Secretary of State the other day about the Government's effort to make a big drive in the immediate future to reduce the waiting lists at NHS hospitals.
In raising the matter of the application of RAWP to the Trent regional and Leicestershire health authorities, I should like to touch on a matter in which I know my hon. Friend the Under-Secretary of State will be interested. Does she share the view, which has been expressed by some regional health authorities, that bigger is best? The idea is that there will be the massive general hospital in Leicester or Nottingham with the latest machines and highly skilled professional staff. To many people it is common sense to centralise all local medical services. The temptation seems to be to centralise all the specialised medical services in Leicester. I am not sure that that is a good inclination for health authorities to follow.
Often, in country towns, long-established cottage hospitals which are much smaller than the great city professional institutions have for generations been playing a vital and proud role in the fabric of the National Health Service. I think that they can feel sure that they will have an equally important role to play in the future. These smaller hospitals, which are outside the big city centres, specialise in, for example, maternity services.
1171 In Market Harborough, in my constituency, there is a cottage hospital with an excellent maternity service. It has one of the lowest infant mortality rates in the country—indeed, much better than the national average. It is a centre of excellence. I find it difficult to appreciate that the current Leicestershire health authority's long-term plan will not involve the expansion of that centre of excellence for which one would hope. The plan does not even imagine the continuance in the next 10 or 15 years of the same level of maternity services. The hospital is due for a substantial downgrading and a big percentage cut in assistance. It is difficult to understand that policy, which applies not only to Market Harborough but to many small country towns, such as Melton Mowbray and Loughborough, where for generations there have been excellently run hospitals with a small but adequate number of beds. They have been held in high regard by local townsfolk.
Of course, we need the big centres in the cities for complex cases. They should always exist, and I hope that they will always continue to be funded adequately, but many mothers and would-be mothers to whom I have talked feel that they should not have to undertake a journey of 20 or 25 miles from the town in which they live to Leicester or Nottingham, unless there is a severe complication. In Market Harborough, in particular—I shall not mention the names of the thousands of people who have signed a petition to this effect—there is a tremendous attachment to the local little cottage hospital. The people are proud of their hospital. It is spotless and the staff are very professional. I hope that the Conservative party and, through it, the Government will continue to encourage these little centres of excellence all over the country. The Conservative party must seek to preserve and enhance treasures such as the cottage hospital in Market Harborough, rather than see their role eroded.
We are lucky in Leicestershire, in that over the past two years a new district general hospital has been opened. It is beginning to play a very big role in the health of those in the area. Indeed, phase 1 has been opened and phase 2 is due to be opened shortly. It is important that we should continue to have specialty hospitals near city centres and do our best to fund them and see that they are properly maintained and, at the same time, keep our local country hospitals viable as well.
In the Leicester area we are very proud of the NHS and the feeling of my constituents is that they wish to see a thriving NHS which continues to provide as good a care as can be found or bought anywhere. I am impressed by the plans of my right hon. Friend the Secretary of State and my hon. Friend the Minister to engage in a big building programme and for the improvement and recruitment of staff. We should speed that work, but not at the expense of smaller centres of excellence such as the Market Harborough cottage hospital.
§ Mr. Derek Spencer (Leicester, South)When my hon. Friend the Under-Secretary of State was in Leicester recently, speaking about a specific project, she said that it was up to the Leicester Members of Parliament to fight for the money. We are trying to live up to her injunction tonight. I apologise if we have taken her advice too literally and detained her rather longer tonight than she anticipated.
Glenfield general hospital opened relatively recently in Leicester. It is a jewel in the health care service. One of my 1172 constituents who was treated there recently said that it gave him "five-star treatment". If only those who criticise the closure of outdated and outworn health service facilities spent as much time glorifying what has actually been built, they would do a service to the community.
In 1987–88 there will be new capital expenditure in the Leicestershire health authority amounting to £1.4 million. There will be an increase in revenue expenditure of £3.8 million and 274 full-time equivalent posts will be added to those already employed by the Health Service.
We are talking about success. Just because we are here tonight like Oliver Twist with our hands extended for more money does not mean that we are anything other than anxious to reveal and proclaim how successful the increase in spending in Leicestershire has been in order to raise it so far up the league in the way in which my hon. Friend the Member for Harborough (Sir J. Farr) has already shown.
Four projects are planned over the next four years at at the Leicester Royal infirmary, each with a capital value in excess of £1 million. At the Leicester general hospital, there are two such projects and at the Glenfield general hospital we have not stood still. In addition to the scheme to which my hon. Friend the Member for Harborough (Sir J. Farr) referred, there is to be a new cardiothoracic department. Work is due to start on it in the winter of 1990.
What, therefore, we are saying to my hon. Friend the Minister is set against the background of very great achievement and budgeted growth for the next four years, especially on the capital side. It is in marked distinction to what we saw under the Labour Government of the 1970s. Let nobody forget that for a moment.
The next feature against which we set the background of our plea is the impressive record of cost improvement programmes and Rayner scrutinies in which the authority has indulged. It has rolled up its sleeves and put out a variety of its services to competitive tendering, which in the years 1985–86 and 1986–87 will result in a cost saving of approximately £1.4 million. It is saving about £37,000 for recruitment advertising, £60,000 on fuel cost savings, £150,000 on nurse shift arrangements and £100,000 on management costs. It is not only a question of more money being spent; it is also a question of more money being spent better. The authority also intends to put out more of its services to competitive tendering. In the year 1987–88 that should result in a further saving of £750,000, which means that more money will be available for patient care.
My hon. Friend could therefore be forgiven if she were to say, "What are you grumbling about? Surely you have done very well indeed." As she will know, coming as she does from the east midlands, we are not easily satisfied. Good is not good enough. We want to be the best. That is why we are here tonight.
I want to add my voice to what has already been said by my hon. Friend the Member for Harborough, but also to direct attention to the problems in my constituency, especially to the burdens that are placed upon it by the fact that, in part, it is an inner-city seat.
First, a considerable problem is the high incidence of coronary disease among the Asian population in Leicester, where there are at least 45,000 people of Asian origin. There is proven evidence of a high incidence of coronary complaints in that community. That has been recognised by the authority, and it has already put forward bids for two separate projects under the inner area programme to 1173 the Department of the Environment. We await in hope the outcome of those submissions. Even if they were to be granted, as we hope they will, that does not distract attention from the fact that they are symptomatic of the special problem under which the Health Service in Leicester has to labour.
Secondly, when the Asian community first came to Leicester in any significant numbers, about 20 years ago, virtually all the women were of child-bearing age. But those people are now a little older. In the years to come, there will be a considerable bulge in the number of old people in Leicester of Asian origin who will require treatment from the services that concentrate on the elderly. Thus, once again, we shall be placing a greater burden on existing facilities. We should have an eye to that now, and should be planning for it, instead of letting ourselves be overtaken by events.
We have other problems that merely reflect problems that every constituency has to bear. For example, the health authority has already laid down a programme to deal with AIDS. An agenda has been drawn up, and various counselling services have been put into place. The infectious diseases unit has taken appropriate steps. But yet again, I fear that we must anticipate increased expenditure in the years to come.
Although Leicester is a fair city, and a city of enterprise, not even that city can manage to avoid the effects of drug abuse. We have already had allocated to us the not inconsiderable sum of £94,000 in order to set up facilities, including counselling and advice centres, and a scheme to train volunteers. That money is in the pipeline.
It was in regard to that scheme that my hon. Friend the Minister said that we should fight for the money. When I heard her casting her bread upon the waters, I took advantage of the opportunity that she so propitiously offered, so I apologise for the fact that it has come back to her almost a thousandfold. However, the problem of drug abuse will eventually cast its shadow across our health facilities.
There will also be increased expenditure over the computerisation of records for cervical cytology and the recall scheme. That computerisation has not yet been carried out, but we foresee increased expenditure. The regional specialty services that we are proud to have within the city's bounds were also mentioned by my hon. Friend the Member for Harborough. We can foresee them expanding in several areas in which they are outstanding.
Only a short time ago, I went to a function put on by Moslem Aid, which is a charity of distinction in Leicester. It was donating a considerable sum to the renal unit and the work that it does, which is work of a high order. Once again, it is a facility where the demand exceeds the supply. There is an increased call for services.
That is the picture that I wish briefly to sketch. There is much more that could be said, which would present a most impressive case on behalf of the area health authority for an even greater complement of resources than that which we have already received. We do not come in any grudging spirit, but in one of optimism. We hope that fighting for the money will pay in the long run.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)It was with great 1174 pleasure that I heard that my right hon. Friend the Member for Harborough (Sir J. Farr) had been successful in his request for the second Adjournment debate. It was a great pleasure too to hear my hon. and learned Friend the Member for Leicester, South (Mr. Spencer) supporting my hon. Friend. I thank my hon. Friend and my hon. and learned Friend, but especially my hon. Friend for his kindness to me since I became a Member of this place. No one could have been more kindly, courteous, friendly and helpful to someone arriving here for the first time. It is the greatest pleasure for me to be able to put that on record.
I thank my hon. Friend for his kind remarks about my experience before coming to the House. I must tell him that being a chairman of a health authority for some years before coming here does not make my job any easier. As one's sympathies are often already established, and as I have to take decisions for the National Health Service, I think that sometimes my experience makes my job a little harder.
My hon. Friend has said that he has been raising the issue of NHS funding for Leicestershire for about 28 years. I asked him who had responded to the first Adjournment debate that he raised on the matter 28 years ago, and it seems that the Minister's name has been lost in the mists of obscurity. I hope that the same thing will not happen tonight.
I share with my hon. Friend and my hon. and learned Friend the privilege of being a Trent Member. As has been said, I visited Leicester recently and saw the Glenfield hospital. I was most impressed. I had an enjoyable and stimulating discussion with members of staff of the different disciplines. I wish to thank and congratulate them on the first-class service that they are providing for the people of Leicestershire and for those further afield.
My hon. and learned Friend spoke about coronary disease among Asians. He may recall that during the most recent Question Time for my Department I answered a question tabled by the hon. Member for Southwark and Bermondsey (Mr. Hughes) on this topic. My hon. and learned Friend might like to read my response to it.
I have seen the results of a survey on heart disease by an organisation that is called the Confederation of Indian Associations, which were published in May. The survey revealed that there is a problem and that there is a high incidence of coronary heart disease among the Asian population. It is higher among Asians than among the population generally. The evidence and the research are patchy and, therefore, it is difficult to establish the pattern of causality. For example, the research on diet that has been undertaken tends to be confined to London. It has tended to concentrate on groups such as Gujaratis, who are substantially vegetarian. It is difficult to establish from their rather good diet whether there is an influence of diet on heart disease.
Against that background, it is not possible to say that Asian communities generally have a better or worse diet than other groups, especially when we think of the delicious samosas, fried foods, pastries and sweet desserts with which I have been delighted to be regaled at the Indian banquets which I have attended.
The report states that there appears to be a high level of heart disease in urban Asian populations thoughout the world. There may be something more serious. We do not know the level of heart disease among the Asian population in the countries from which they come. We cannot tell at the moment whether it is simply a cultural 1175 pattern that they bring with them, or whether their level of heart disease here is higher than at home, or possibly lower than at home. We need to know a lot more about that matter. I am delighted that my hon. Friend has taken the interests of his constituents so much to heart that he has raised this matter tonight. I commend to him the publication that I mentioned.
My hon. Friend also mentioned problems in Leicester, including AIDS, drug abuse and the cervical call and recall scheme. He will know, of course, that overall the Government have put an additional £1 billion into the Health Service for the year starting in April, and that will cover not only hospitals but the full range of health services. Active discussions are going on as to how to allocate that money—first, for top-sliced activities and, secondly, for what is left to the regional health authorities. It will then be for regional health authorities to decide how to allocate money between the districts. In that sense, I regret to say that my three hon. Friends who are here tonight are in competition. The region will decide how to allocate the money between the districts. That is right because of cross-boundary flows and the movement of population that might continue.
My hon. Friend the hon. Member for Harborough raised another important and difficult matter. He asked, "Is bigger best?" I hope he will accept the view that there is no simple formula. No simple rule or pattern of activity could be best. Indeed, if it was best at the time it was planned, it probably would not be best at the time it finally was implemented. By the time it was implemented, needs might have changed. Therefore, it would be foolish to say that one pattern of work is best. A difficult dilemma exists. Within the Health Service there are centripetal and centrifugal forces. The centripetal force—seeking the centre—is that for many of our activities we need expensive equipment and scarce skills. Therefore, they need to be concentrated in magnificent and, very often, modern hospitals.
In those hospitals, staff have to work that much harder to be human. They have to work that much harder to bring things to the human scale and to enable patients to feel that they are not part of the machinery but are being treated, first and foremost, as people. In many parts of the country—Trent is one—this matter is being taken seriously. Staff are being assisted and trained to ensure that the body on the table is regarded, first, as a person and, secondly, as a medical problem.
The centrifugal forces are just as strong as we push for care in the community, as we push for more day cases, which means that a person will go into hospital only for day treatment and then go home and get further assistance at home. We expect our GPs to do more work in their surgeries, and they are willingly doing that. There is a force away from big hospitals. In many parts of the country tremendous efforts are being made not only to keep cottage hospitals but to build more community hospitals. Elsewhere in Trent region that is happening. The Ilkeston community hospital will open in 1987. Some money has had to be reallocated to it from districts such as southern Derbyshire to make sure that that happens. It is partly in response to the sorts of needs that my hon. Friend mentioned.
The problem facing smaller units is that they have to work harder to do more intensive and highly skilled work. Increasingly, there are certain areas of work that we would not expect them to do. Paediatrics—the care of sick 1176 babies—would probably be one of those areas. It may also include some maternity work, as my hon. Friend mentioned. The trouble with maternity cases is that one does not know that one is high risk until it happens. As a general policy—as a patient I have been dubious about this, but I can see the force of the argument—over a number of years we have brought more and more maternity patients into hospital and more and more into the high tech side of maternity care. Our first consideration must be the baby, and then we should consider the mother. No one speaks for the baby. It is important to bear that in mind.
§ Sir John FarrI apologise to my hon. Friend for interrupting her. She has had a trying evening. Does she think that in maternity and geriatric cases the same principle applies, which is that the person much prefers to be fairly near his home town and is probably a much better patient? In that way the patient can have ready access to visitors and his visitors will not have to rely on difficult or non-existent transport.
§ It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]
§ Mrs. CurrieI take on board entirely what my hon. Friend said. However, I must put it to him—this is a matter with which I have wrestled, having been involved in obstetrics as a member of a major teaching authority—that if we wish to continue our progress in bringing down the death rate of sickly babies, we cannot always do it in the kinds of services and hospitals in which our mothers bore us.
We have been tremendously successful. The perinatal mortality rate per 1,000 live births in the past six years has dropped from 15 per 1,000 to nine. That is a remarkable achievement. With the best will in the world, I am convinced that that could not have been done without the high tech work. Indeed, some of the best perinatal mortality rates in the country are in some of the poorest areas which, nevertheless, have concentrated much of their maternity care on some of the finest hospitals in the world. We must accept that we must consider the results. I hope that I have convinced my hon. Friend that we are alert to the problem of whether bigger or smaller is better. There is no easy answer and the debate will undoubtedly continue for many years.
Both my hon. Friends have clearly pointed to the perennial dilemma of the Health Service—the Oliver Twist syndrome. We have finite resources. The Health Service always has finite resources. But expectations are infinite and increasingly one comes to the conclusion that the possibilities also look infinite. There are operations that we are doing now, such as the heart transplant on a young woman like Debbie Leonard, whom I met in Mr. Speaker's rooms on Monday. She is now fit and well with someone else's heart beating inside her. Kidney patients now achieve a survival rate of 86 per cent. after five years. That is remarkable. The failures in kidney donation are now the rarities and the number of failures is falling all the time. I mentioned the perinatal mortality rate. There are hundreds of life-saving interventions done now that simply were not possible or successful until recently. No doubt as they become standard practice, so we shall find that something else comes up that we all want to do.
1177 My hon. Friends asked about the resource allocation working party. They will know that it has been in operation now for 10 years. It was introduced by a Labour Government and espoused by this Government. We looked at it again and we calculated the figures several times, which in some cases has hurt local authorities. Yesterday, for example, I was in south-west Surrey which before 1981 was substantially below its target and now within a space of 12 months is well above it, not because it had much more money, but because the calculations have been done differently. That creates serious management problems which we recognise.
I have said to my hon. Friends that within the region the allocation is a matter for that region. They will accept that I cannot comment further on that, except to say that if one is looking for the bread that is floating on the waters, having a word with the regional health authority is sometimes useful.
My hon. Friend will know that we are now looking hard at the RAWP formula. The purpose of that is that the substantial progress made under RAWP has resulted in all but the two North Thames regions being within 4 per cent. of their target share of resources, so it becomes increasingly important that the target should be accurate and should reflect relative need as far as possible. Therefore, the aim of the review is to look at the scope for refining the RAWP formula—perhaps bringing it up to date a little—and improving its measurement of need.
The variants that are being covered take account of previous criticisms of the formula — for example, morbidity, social deprivation and the special problems of the inner cities, some of which my hon. and learned Friend the Member for Leicester, South mentioned. We must pay attention to those difficulties, yet they are difficult to grasp. The measurement of the population need is at the heart of the problem. RAWP currently uses standard mortality rates, which are effectively the death rates. That may not tell us very much about what people suffer from, and that might be different from what kills them. If someone dies quickly from a disease, that may cause less drain on the Health Service than if they suffer for a long time from a disease which does not kill them. We are examining that point very carefully.
We must consider whether there are direct links between deprivation and ill-health that we can counter with Health Service resources. We must examine the case of the patient with no family support and inadequate housing who may well be the kind of geriatric patient to which my hon. Friend the Member for Harborough referred, who may need longer in hospital. In certain parts of the country, longer stays may be necessary, not for traditional reasons, but simply to ensure the health needs of that patient and the Health Service may have to do more there than somewhere else.
We have been considering teaching hospital costs which particularly affect the Trent region and we have also considered the teaching hospitals, at Leicester, Nottingham and Sheffield. The costs associated with the teaching of medical students are separately identified and they are protected from redistribution under RAWP. We are considering whether the arrangements could be improved.
We are also concerned about patient flows across regional boundaries and I have already mentioned patient 1178 flow across district boundaries. Regions' RAWP targets include an adjustment to allow for patient flows across boundaries. We need to know whether that reflects the costs involved as fairly as possible or whether improvements can be made. Much of that information will become available as the Körner information systems are installed in our regional health authorities and district health authorities.
When I was the chairman of a health authority, I was bedevilled by this problem. Half the time I would ask questions and then be told that the information was simply not available or when it was available, it was available so late as to be less than valuable in terms of planning. It is a major task to improve that supply of information but it is under way. As we improve that, RAWP and its formulae can become more accurate and reflective of genuine need.
The timetable is as follows—the report is to include recommendations on the timing of any proposed changes and the new data that become available through Körner will be introduced in health authorities from 1987–88 onwards. The timing of some changes may be linked to the timetable for the implementation of Körner. That will depend on the best method of implementation from region to region.
I would now like to consider the Trent and Leicester health authorities. Whatever else we are doing, we are sending more money to Trent. The authority is using the money very well to care for more patients. It is worth putting the figures on the record. In 1978–79 Trent received a revenue allocation of £366 million. This year, the figure is £907 million. In cash terms, its allocation has risen nearly three times in the space of a mere six or seven years. That is quite remarkable.
Capita money has increased from £42 million in 1978–79 to £65 million today. A large chunk of that is being spent in Leicester. As a result, we are treating nearly 600,000 in-patients a year in Trent. The exact figure is 579,000 and that is an increase upon the figure of 461,000 in 1978. Out-patient attendances have risen in the same period from 2.8 million a year to 3.35 million a year. If anyone had challenged us to care for 3.35 million out-patients in Trent six years ago, we would not have thought it possible, yet that is what has happened. Day cases have risen, and the numbers of direct care staff — doctors, dentists and midwives — have all increased. That is certainly something of which we can all be very proud. I am especially proud to see the way in which money is being translated into patient care.
Leicestershire district health authority is the largest in the country, caring for a population of more than 800,000, so the size of the figures to some extent reflects the population change. We have to start from 1982, when the boundary changes were made, as figures for earlier years are not strictly comparable. In 1982–83, the authority spent £118 million. This year, the figure is just under £154 million. That is a staggering increase. In real terms, there has been a steady rise which no doubt turns some of our colleagues, including my hon. Friend the Member for Uxbridge (Mr. Shersby), green with envy. RAWP is working, and the money is being allocated to districts in the greatest need.
My hon. and learned Friend the Member for Leicester, South identified the most spectacular change. In recent years, the district has been spending capital allocations of more than £10 million per year. As my hon. Friend will know from the previous debate, Hillingdon has spent only 1179 £6.5 million over several years, but Leicestershire, has spent some £45 million since 1982. That, again, is a staggering sum and I was delighted to hear of the ways in which it was being spent. We shall no doubt have other opportunities to hear of further developments being achieved.
A quick calculation on the back of an envelope shows that, size for size, per head of population, on capital alone Leicestershire is spending almost twice what Hillingdon is able to spend. That is what RAWP is all about. It poses problems for colleagues in some parts of the country, of which we must take cognisance, but it means that opportunities are being developed to provide better health care for local people in other parts of the country.
1180 On that basis, I am glad to have had this opportunity to air some of these issues. I am deeply grateful to my hon. Friend the Member for Harborough for the courteous way in which he put his points and to my hon. and learned Friend the Member for Leicester, South for the detail that he offered. We look forward to being nudged even further on these issues. I hope that the bread will taste good when it comes in. It is certainly being put to good use in Trent region and in my hon. Friends' constituencies.
§ Question put and agreed to.
§ Adjourned accordingly at twelve minutes past Ten o'clock.