HC Deb 04 February 1986 vol 91 cc260-6

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

11.42 pm
Mr. Tony Baldry (Banbury)

I am grateful for the opportunity to raise this important subject and I thank the Minister for the care that he has taken so far in dealing with the representations that I have made about the Horton hospital.

As both my parents have spent their working lives in the National Health Service—my father is a doctor and my mother a nurse—I have, naturally, always had an interest in the NHS, and since becoming the Member for Banbury I have taken a particular interest in the Horton general hospital. It is a first-class general hospital with well-qualified and highly motivated staff serving the medical needs of a wide catchment area stretching into Northamptonshire and Warwickshire.

Any debate on the NHS is liable to become either a statement of statistics or an exercise in special pleading. I hope to do neither. Horton is a well run hospital. The local community has every reason to have confidence in the hospital's unit administrator, Dennis Baston, and his team. Whereas the average national daily cost per inpatient is £79, at Horton hospital it is only £66, and whereas the national average in-patient case cost is £577, at Horton it is £528.

Some people seek to give the impression that the NHS is in a state of constant decline, is starved of resources and has ever-shrinking staff numbers. In fact, the figures show that local health services have never had so many resources devoted to them. Revenue spending on health services in Oxfordshire has increased by 101.7 per cent. in cash terms since 1979, representing an increase in real terms of 13.2 per cent. That means that the Health Service in Oxfordshire has a budget 13.2 per cent. bigger than it was in 1979. Revenue spending on Horton general hospital has increased by 103.8 per cent. in cash terms since 1979, which represents an increase in real terms of 14.4 per cent.

During the past six years, about £2.25 million has been spent on new building works at the hospital, and during the next five years about £6,640,000 is planned to be spent on new building works. Since 1979, about £670,000 has been spent on new medical equipment at the hospital. There is no doubt that Horton general hospital is a more secure, better district hospital now than it was in 1979.

Against that background of consistent achievement in the NHS and consistent extra resources for the hospital, I raise my specific anxieties, because, despite the consistent improvement, many beds at the hospital are empty for want of nurses and some financial resources. The first legitimate anxiety relates to RAWP which, as my hon. Friend will know, is the formula by which resources are allocated from central Government to regional health authorities. There are good grounds for suggesting that Oxfordshire regional health authority is underfunded. As my hon. Friend will know, it is one of the fastest growing areas of population in Britain, yet although in 1977–78 the region was 7 per cent. above its RAWP target, it is now 3 per cent. below target. It would appear to have had a more negative movement than any other region. I do not understand why Oxfordshire regional health authority should be in that position. The region's budget may be underfunded, so, however hard it tries, it will have difficulties in meeting all its commitments. At the end of the day, that means that in a good district general hospital beds are not being used as they should be.

In a letter to me last October, my hon. Friend the Minister acknowledged that Oxfordshire is not receiving its fair share of resources. He said: It is true to say that Oxford RHA receives 3 per cent. less than its fair share of the available resources, whereas in 1977–78 it received 7 per cent. more than its share. What happened was that, just at the point when the region was on target to receive exactly its fair share, its relative need for health care increased because of rapid population growth. The target shifted. This had the effect of converting Oxfordshire health authority from an over-target region to an under-target region. In simple terms, that means that the regional health authority has insufficient funds for its means and is not receiving a fair share of the funds available.

I appreciate that, this year, Oxfordshire is receiving about £1.4 million of growth money from the Government to pay for better services. However, that entire sum may be swallowed by unexpected bills: £344,000 to cover Oxfordshire massive rates increase; £700,000 to pay for higher than expected wage awards; and £250,000 to pay for a new national agreement on ambulance men's pay. I simply ask: when will Oxfordshire again receive its fair share of central Government money?

Our second anxiety relates to the nurses that the district health authority can provide at the Horton. That is partly a consequence of the resources that the regional health authority can apply to the district and the district health authority can apply to the hospital. Recently, Oxfordshire health authority undertook a comprehensive review of nursing. That review is not yet completed, but its results so far demonstrate such low numbers of nurses at present on the wards as to give rise to great anxiety. It is neither fair, sensible nor acceptable to allow the numbers of nurses on wards and in the community to reach such levels that the staff who remain become demoralised It is unfair to the nurses and to the patients. I fully appreciate that some of the problems relate to difficulties in recruiting nurses. Horton, like every other hospital in Oxfordshire, is suffering and is finding it difficult to recruit either state registered or state enrolled nurses. Nursing services are extremely stretched. At Horton beds are closed because of a combination of recruitment problems and revenue difficulties.

In a recent letter to the county's Members of Parliament, the district group manager, Dr Paine, observed: The options will have to be those which will bring up the level of nursing staff on individual wards to such a level that they can feel that they carry out their duties effectively and without exhaustion and disillusion, as is too commonly the present case. It looks as though some reductions of service will be inescapable if this is to be achieved within even the optimistic predictions for the district's funding in 1986. That letter was written prior to certain of the unexpected expenditure which the district will incur, such as the rates increase to which I drew the attention of the House earlier.

There is genuine concern that, because Oxfordshire health authority has not been able fully to fund the increases in nurses' pay, the number of nurses at Horton has had to be cut. That has meant that beds have had to come out of service and it has hit, in particular, cold surgery so that the waiting times for operations have lengthened and on a number of occasions the hospital has not been able to use the operating theatres in the most cost effective way.

I have read with interest the auditor general's recent study into nursing and I fully appreciate the argument that substantial savings can be made nationwide on redeploying nurses. However, having made several visits to Horton hospital, and having discussed the matter at considerable length with those involved, I am more than satisfied that in Horton the nursing staff are already being used as cost effectively and efficiently as possible, given the size of the hospital, the present 37½ hour working week which makes it difficult to provide 24-hour-a-day, seven-day-a-week cover, and other contraints imposed by the Royal College of Nursing. I should be very surprised if anyone going into Horton could find a more cost effective way of using the money available for the nursing staff. The situation with nurses will be even more critical next year as each 1 per cent. increase in nurses' pay, which is not funded centrally, costs Oxfordshire health authority £8 million. When will we have a system of pay reviews that ensures that health authorities have available locally the resources necessary to honour pay awards agreed nationally.

The last matter to which I wish to draw the attention of the House and which impinges upon the efficiency and effectiveness of Horton hospital is the effect of the recent introduction of the regulations on the maximum amount of money available to keep people in private nursing homes. I support fully the need to control such demand spending and understand why it was necessary to introduce the regulations. However, it is estimated that at any time there are up to 20 people in Horton hospital who are not really ill. They are old and would be far better off in nursing homes, but they cannot be admitted to private nursing homes because the Department of Health and Social Security cannot fund them. In consequence, they are costing the community far more by being in hospital and they are also taking up valuable beds which could be used by patients in need of acute medical beds.

The chairman of Oxfordshire health authority and the chairman of Oxfordshire community health council have as a matter of urgency been carrying out an evaluation of all the private nursing provision in Oxfordshire. If it should be shown that the present DHSS levels have been set too low to enable private nursing homes to provide proper accommodation for those who are entirely dependent upon the DHSS for support, I trust that my hon. Friend will again consider the limits. It must be in everybody's interest that no acute bed in a general hospital is unnecessarily occupied.

I hope that by the tenor of my comments I have made it clear to my hon. Friend the Under-Secretary of State and to the House that I do not approach this matter by way of special pleading. I hope that I approach it by way of balanced and objective analysis, wishing to try to discover how it is that at a time when more money than ever before is being devoted to the Horton hospital and to the National Health Service as a whole we find ourselves in the curious position that, notwithstanding, there are empty beds at a good, efficient hospital like Horton. The Horton hospital is a first class general hospital. We intend to ensure that it remains a first class general hospital that is able effectively and efficiently to serve the medical needs of local people.

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

I am very grateful for the opportunity to respond to this Adjournment debate. It is well known to the House that my hon. Friend the Member for Banbury (Mr. Baldry) takes a very close interest in all the affairs of his constituency but particularly in the medical cover that is provided for his constituents—appropriate indeed for the son of a medical family.

I am grateful to my hon. Friend for placing his entirely fair points in the context of the increasing and expanding medical care that is being provided by this Government. I do not wish to enter into a statistical knock-about, but it cannot be said too often that significantly and steadily, in real terms, this Government have increased the proportion of resources that are devoted to the National Health Service both nationally and regionally, including the Oxfordshire district and the Horton general hospital.

The real terms increase in expenditure since 1979 will be over 20 per cent. this year. My right hon. Friend the Secretary of State for Social Services has announced that during the next three years we shall continue to give the same degree of priority to the NHS. Expenditure in Great Britain on the NHS is set to rise by nearly £2.8 billion to well over £20 billion in 1988–89. That represents a real terms increase in each year.

I shall now refer briefly to the Oxford region. I represent an Oxfordshire constituency and therefore take a particular interest in the region. It reinforces my ministerial responsibilities. My hon. Friend referred to the resource allocation working party. Pressures continue upon the Oxford region. They spring largely from its rapid growth in population. The pressures on the Oxford region have been taken into account in the allocations. For example, the allocation to the region in 1986–87 represents an increase of 7.3 per cent. over 1985–86. That compares with increases in other regions that range from 5.7 per cent. to 8 per cent.

This is a slightly lower allocation, in cash terms, than that which the region had hoped for or expected, but an increase of 7.3 per cent. is significant when there are heavy pressures upon expenditure generally. That allocation will put the region back on the course from which it was deflected. It will move towards its target of receiving a fair share of resources and it will correct the drift away from that target which has been a feature of recent years. The region, we estimate, is now within 2 per cent. of its target. The planning guidelines which we are now issuing to the regions, predict growth for Oxford of 1.7 per cent. in 1987–88 and 1.8 per cent. in 1988–89, and are designed to continue this process. I therefore submit that Oxford is feeling the benefit of the change in the RAWP formula in 1985–86 from past population figures to population projections for the year of allocation, a change specifically aimed to reflect more fully the needs of regions with rapidly growing populations. Coming from the region, as I have said, I well recognise that factor.

My hon. Friend referred to the impact of RAWP formula. The regional health authority has put a paper on RAWP to Ministers, and it will have an opportunity to put to Ministers its arguments on this issue in a regional review which will be chaired by my right hon. Friend the Minister for Health. We have also asked the National Health Service management board to undertake a review of the RAWP formula, keeping the guidelines which aim at a general equalisation of health provision throughout the country. While the terms of reference of the review have not yet been finalised, the objective is to ensure that the RAWP formula is applied with common sense and sensitivity. This will provide an opportunity for the region to put to the department its particular concerns about the application of the RAWP formula to the Oxford region.

I therefore hope that my hon. Friend recognises in the application of these figures that substantial funds are available. I hope that they have been applied flexibly, recognising the changing pressures in the regions, and specifically in the Oxford region and district.

I deal now with other points which my hon. Friend made about the general pressures on the health authority to meet the pay awards. That is recognised, and it must inevitably be part of any arrangements of the funding of the Health Service. We have provided increases which are above the rate of inflation. It is important to understand that the cost improvement programmes are making available additional funds to authorities which go back into the kitty to cover not only the pay awards but improvement in the services. Resources released in this way through increased efficiency and cost improvements added something like 1.5 per cent. nationally to the money available for services and pay awards. Authorities are expected to improve on that next year. Oxfordshire has a cost improvement programme in 1986–87 of 1.8 per cent. In fact, in 1985 authorities have been able both to fund the 1985 pay awards and to develop services.

Health authorities cannot expect, any more than employers in other industries and services, to be insulated from uncertainties about the level of pay settlements. It would be wholly unrealistic to expect the taxpayer to pick up whatever costs arise. We have no plans to increase health authorities' cash limits to fund pay awards. As we have made clear, there is an inevitable trade-off between expenditure on pay and on services, and the precise balance will vary from year to year. I hope that my hon. Friend will accept that that is the way that we must conduct our services.

Mr. Baldry

The difficulty is that district health authorities and others fix their budgets at the beginning of the year in anticipation of a pay award and halfway through the year they find themselves with percentage increases that they did not and could not have anticipated, because of review body decisions.

Mr. Whitney

No one pretends that it is an easy problem. The pay awards must be contained within the steadily increasing percentage of the national wealth that is devoted to health. I hope that with cost improvements authorities will accept that and find sufficient flexibility. The awards are phased and that helps health authorities solve the problem which, I accept, is difficult.

It may not be possible for me to cover all the points mentioned by my hon. Friend. Nationally, there has been an increase of about 50,000 nurses and midwives. My hon. Friend said that the shortening of their working week is a factor in that. We have significantly—perhaps not as much as we should have wished—increased the rates of nurses' pay in real terms. That produces pressures.

I understand that there are problems at the Horton hospital in Banbury and with the Oxfordshire health authority. The authority has set a review committee to work. I am not sure whether it has reported, but when it does we shall consider how the health authority can cope. It is a problem that must be solved locally, because the national picture shows a steady increase in the number of people employed in nursing since we took office.

My hon. Friend mentioned those elderly people who would be better off in a nursing home. He referred to the level of supplementary benefit. From November, the allowance for an elderly person in a private nursing home was increased to £170 per week. That is subject to examination and review. Management consultants are studying the level and its feasibility. We have set in train studies on the assessment of old people to ensure that the service is being provided for those who genuinely need it. At £170 per week, the provision is not ungenerous.

As a Minister with responsibility for social security I had the privilege of going around the country looking at nursing and residential care homes. It struck me as entirely possible to provide a good level of care in nursing homes with such funding. I hope that will continue to be the case.

It is regrettable if facilities are not used. Because of the way in which we run our Health Service, many decisions at local level must be taken by the district health authority. My hon. Friend was kind enough to accept that the resources made available to the Oxfordshire health authority and the Horton hospital were not ungenerous. The Oxfordshire health authority has gained substantially and expenditure on Oxford district between 1978–79 and 1984–85 has more than doubled, representing an increase of 13 per cent. above inflation.

During the past six years £2.1 million has been spent on capital developments at the Horton hospital, and in 1983 four new operating theatres were completed. Next year a new phase will begin which will provide 100 beds for elderly people and a new day hospital at a cost of £5.2 million. There are plans to replace the accident and emergency unit. The upgrading scheme will be assisted by local fund-raising, which, as my hon. Friend says, demonstrates the support for the hospital.

This is a good story. I understand the problems, but with the support that the health authority is receiving at national level, I hope that it can cope with them.

Question put and agreed to.

Adjourned accordingly at eleven minutes past Twelve o' clock.