Erith Hospital (Hansard, 27 January 1986)

§ Mr. David Evennett (Erith and Crayford)

I am grateful for the opportunity to raise on this Adjournment debate a subject that concerns not only my constituents, but many of the constituents of my hon. Friend the Member for Bexleyheath (Mr. Townsend)—the future of Erith and district hospital. Although I do not wish to indulge, at this late hour, in a history lesson, extolling the good work that the hospital has done and the great service that it has given to the community in the past, at the outset I wish to place on record my determination to see the hospital developed and expanded, and to consider the recent events that have brought it to its present position.

Erith and district hospital has been serving the community in my constituency since the day it was opened in 1924. It was built by public subscription and even today it continues to depend heavily on support from its league of friends who give funds, organise events and take a great interest in the hospital and its patients. It the early days it was known as the Erith cottage hospital, and, though the name has changed, the atmosphere is still that of a cottage hospital providing a much needed service to the local community.

My constituency forms the northern part of the Bexley health district. Like many other outer London areas the public transport routes run from east to west, that is, into the centre of London. Unfortunately for my constituents, the sole district general hospital, Queen Mary's, lies in the south of the borough in Sidcup and is difficult to reach by bus. Queen Mary's is a first-class hospital, but it too is experiencing difficult days because of shortage of finance. Consequently, my constituents rely heavily on the Erith and district hospital and, to a lesser extent, on hospitals that are outside the health district but to the east or the west and therefore within easier reach. One of these is St. Nicholas hospital in Plumstead which my right hon. Friend the Minister for Health advised me recently will shortly be closed.

For a district in the supposedly affluent south-east of the country, Bexley is severely under provisioned and underfunded. We have one district general hospital and one small local hospital where facilities are being constantly reduced, that is, the Erith and district hospital. The underprovision dates back to the break-up of the larger area health authorities, in our case Greenwich and Bexley area health authorities. Regrettably for my constituents, when the area authority was split up, the majority of hospitals and services were on the Greenwich side of the divide. This problem has become even greater now that district self-sufficiency is the order of the day. That is one of the reasons why the facilities of the Erith and district hospital are so important to me and to my constituents.

Erith hospital has two wards open and a third ward, Hawkins ward, permanently closed. As my hon. Friend will agree, it is sad to see any ward closed. At present, minor surgery is provided together with some geriatric care, and altogether around 475 inpatients are cared for each year by the Erith and district hospital. In addition, 14 weekly outpatient clinics are held covering a wide range of specialties and caring for some 12,500 patients a year. There is also an excellent physiotherapy unit and a surgical 771 fitting facility that brings the total number of outpatients dealt with up to nearly 32,000 a year. There is a great deal of work to be done and the potential to do a lot more in this small hospital.

The other facility of particular importance is the accident and emergency department. It can best be described as a walking wounded facility. It cannot and does not attempt to deal with ambulance cases. But it provides an important local service, particularly to local industry. It is, of course, in my constituency that the boroughs industry is concentrated and so its importance to industry will not be missed by my hon. Friend. Last year the accident and emergency department dealt with almost 7,000 cases.

I have not quoted to my hon. Friend the number of patients cared for without a real purpose in mind. What concerns me is that, despite all the efforts of staff within both Erith and Queen Mary's hospitals, the number of patients on the district waiting list has increased in 18 months from 1,077 to 1,399, an increase which should concern us all, particularly in Bexley. This is at a time when the national trend is downward, a my right hon. Friend the Secretary of State and his colleagues have regularly informed the House.

In my constituency we are endeavouring to replace the old and dying industries with new and dynamic ones in order to create jobs that are so vital in the economy today. We have the industrial sites in Thamesmead, Belvedere and Erith itself. We urge industry to locate in our area where there is a skilled work force, plenty of space, and, thanks to the efficiency of Bexley council, low rates. Yet despite all those advantages, and others such as a good location with motorways nearby, we are hampered by a lack of local hospital faciltiies for both industry and the families that boosting local industry brings.

The value of Erith hospital is known to local people and to Bexley health authority alike. The chairman of our district health authority has long championed the cause of Erith hospital and is in the forefront of the campaign to improve services in the area, services which regrettably have been allowed to decline for decades. The decline of Erith and district hospital in the 1960s, 1970s and early 1980s has been allowed to go on for far too long. I want to arrest that decline and begin the long haul back to prosperity and better services in Erith. Erith hospital is important to our quest to renovate and revitalise our local area.

Obviously there is a great need for the kind of facilities that only a large hospital, such as Queen Mary's, can provide and I am the first to acknowledge, having recently been round that hospital, the first-class facilities provided there in Sidcup. But there is also a need for better local health care at Erith hospital. At the moment it provides a good local service but a better service is needed by the local community. That the authority recognised, and it published proposals for the upgrading of Erith hospital to be effected in the mid to late 1980s.

That scheme was widely welcomed locally as being positive, progressive and practical. The changes proposed would have cost just over £2 million and would have increased running costs by about £800,000 per annum. But for that sum, which is not a great deal of money, even for a badly underfunded district like Bexley, a whole host of new services would have been provided. Those would include new day surgery facilities; the reopening of Hawkins ward for the provision of general practitioner 772 beds, a facility much in demand in an area such as Erith town ward where the population is stable, aging and close knit; the establishment of a geriatric rehabilitation unit and an elderly, severely mentally impaired day care facility.

Those changes would have provided much-needed facilities in the north of our district and made the district self-sufficient in terms of geriatric care — of great importance to us and, I believe, to the Government. But I regret to have to advise my hon. Friend this evening that in November last year, as a result of the district's cash crisis, those plans were put on ice, to be shelved until 1993. In my mind and in the minds of many local people associated with the hospital, both as staff and as patients, that means for ever.

Regrettably, I also have to advise my hon. Friend the Minister that even abandoning the scheme has not solved the financial problems of the district and it is unlikely that the money will ever be found to carry out the development unless additional funds are forthcoming—from, I hope, the regional health authority.

It seems that the bubble has burst and that my constituents, who live in an area with an increasing population and expanding industry, will not get the facilities that they want and which I believe that they need. It seemed almost beyond belief when the Bexley health authority said that this modest scheme had to be shelved. Yet the worst was still to come. A few weeks ago, Bexley health authority announced that it had overspent by a further £100,000 and that more savings were being sought. One proposal put forward by the authority was that all surgery and inpatient care at the Erith hospital should be terminated.

At a meeting of the authority a few weeks ago, members refused to vote in favour of such a proposal. They believed — correctly, in my view — that ending such facilities at Erith hospital would mean an end to its viability and, therefore, bring about its closure by default. They clearly saw the true effect of the proposal and refused to implement a cut which would have been fatal to the future of Erith hospital. The decision has been referred to the regional health authority to obtain its agreement to an overspend. The decision of the regional authority is awaited.

I wrote to Sir Peter Baldwin, the regional chairman, and was interested in his reply, as it contained an important admission. Sir Peter admitted that Bexley district health authority is underfunded, getting only 89 per cent. of its funding needs at present. We in Erith and Cray ford already knew that—we witness it at first hand—but it was nice to have it confirmed by the experts.

How such a situation can occur in a part of greater London, an area where health care provision is supposedly so much better than elsewhere, is beyond my comprehension, yet I know that health care facilities in my constituency and in Bexley district health authority are poor and that unless drastic action is taken they will get a great deal worse. Despite that evidence of the problems, we are a RAWP-losing area—a fact which is hard to believe, let alone understand.

I ask the Minister what can be done. I believe that the crisis faced by the Erith and district hospital and by Bexley health authority could have been avoided if a more realistic approach to funding the district had been taken by the South-East Thames regional health authority in the recent past. 773 Of course, the historic legacy of the area having been divided into districts has left Greenwich with twice as many hospitals as Bexley and, as surrounding districts have reduced services and, thus, limited out-district care, the demand in Bexley district has increased. Combined with the underfunding and underprovision, there is the reduction caused by RAWP. Urgent action is needed.

The lack of funds and facilities has stretched the district to breaking point and the weakest link in the chain—the one that I fear will break—is Erith hospital. If facilities have to be cut at one of the two hospitals in Bexley, the main general hospital will be protected. That must be right, because it is the principal hospital in the district. However, that means that Erith hospital will have to suffer and that I cannot swallow.

Unless action is taken, the much-needed local facilities at Erith will be lost for ever. Sacrificing services, as my hon. Friend will agree, has nothing to do with good health care. I hope that the chairman of the regional health authority and my hon. Friend will take note of that. A campaign to save an improved Erith hospital is being conducted. It is not partisan. It is a cry from the local community.

I accept that this Government, who have my total support, have done much to aid the National Health Service. We have seen many improvements and much has been done for health care. But in Bexley the evidence seems to be to the contrary. We seem to be at the suffering end, through no fault of our own.

I urge my hon. Friend to visit Bexley to see at first hand the area, its two hospitals and the many problems. A delegation from the community health council will shortly visit the Minister to discuss the problems. Such an opportunity to exchange views is always welcome. Action is required, not words.

This is a cry from the heart from myself and my constituents. It comes particularly from the elderly and those who have elderly relatives in the area. We hear so much about the need for geriatric care. We have evidence to support that need and a scheme to meet it. We have an opportunity in Erith and district hospital to do much more beyond that. We now need support. I urge my hon. Friend to do whatever he can to assist and support us and so ensure a good future for Erith hospital.

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

I am grateful for the opportunity to discuss the problems outlined tonight. I pay tribute to the diligence with which my hon. Friend the Member for Erith and Crayford (Mr. Evennett) pursues this, as he does all issues within his constituency.

First, I shall set the issue in the national context. By doing that I hope to set at rest some of the forebodings about the future of the Erith hospital. It is important to recognise, as my hon. Friend said, the Government's record nationally. It is important that the transfer of resources in real terms is felt throughout the country, not least in my hon. Friend's constituency.

Since 1979 we have increased spending on the NHS more than any other Government. We are talking about 20 per cent. in real terms. The announcements for next year —1986–87—will represent an increase of 6.7 per cent. 774 or over 2 per cent. more than the currently forecast inflation. Within that will be the effects of the cost improvement programme which is planned to total £150 million during the year. Capital spending is also being increased each year. So the general national picture is good and belies the impression which is given in the House, by the media and by interests whose objectives are to paint unnecessarily black and bleak pictures of what is happening in the National Health Service.

We are sadly familiar with the acronym RAWP—the policy of redistributing resources between different parts of the country. That policy has been followed for about 10 years. We are set to continue this policy. The aim is that regions that have historically received less than their fair share of resources or have rapidly growing populations will receive the largest increases.

The decision on the 1986–87 allocation reaffirms our commitment to redistribute resources more fairly. Substantial progress has been made since the arrangements recommended by RAWP and, as regions move closer to their targets, it becomes increasingly important that the targets are a reasonably accurate measure of need. That is why, in December, my right hon. Friend the Secretary of State asked the NHS management board to review the operation of the RAWP formula, particularly the ways in which relative needs in different parts of the country are measured, taking account of such factors as the patterns of illness across the country and the special problems of the inner cities. We are certainly not insensitive to the impact of the RAWP formula on the London regions.

The south-east Thames region is a RAWP loser, but that is not the case with the Bexley health district. The south-east Thames region was 13 per cent. above target when RAWP was introduced in 1977–78. In 1985–86, it is 5.6 per cent. above target. Long-term revenue plans have assumed annual reductions of just 0.3 per cent., which is equal to a reduction of 2.86 per cent. by 1993–94. Following last December's statement, the position of the four Thames regions and the special health authorities is marginally better than originally assumed. South-east Thames region will receive an increase of 5.8 per cent. compared with forecast inflation of 4.5 per cent.

In addition, the Thames regions, with their higher unit costs, have been achieving higher levels of cost improvements than other regions. They are expected to continue to do so. I hope that my hon. Friend will recognise that we have understood the region's problems and that, within the natural constraints of general financial policy, which my hon. Friend supports, we are moving towards meeting them.

I well understand the points that my hon. Friend made about the origins of the Bexley health authority and the issues it has created for Bexley. Bexley is a RAWP gainer. My hon. Friend referred to Sir Peter Baldwin, the chairman of the regional health authority, who suggested that Bexley's revenue funding is 89.6 per cent. of its RAWP target. It is planned to increase that to 95 per cent. by 1993–94. This means that there will be a small but steady gain in the district's revenue allocation until 1993–94.

It is true that Bexley faces a somewhat difficult financial position caused by the overspending which has been gradually building up over the past three years without being tackled. This financial year it is projected to total £400,000 out of a total budget of £28 million. This is creating a challenge for the district—there can be no 775 doubt about that. The new district general manager, who was appointed in July 1985, has accepted a priority task to develop a financial strategy over the next three years with the aim of ensuring that any early measures to restrict spending do not further restrict the district's long-term RAWP manoeuvre. I hope that its achievements will solve the problem.

We are looking for cost improvements. The region has proved to be one where significant cost improvements have been recorded. The district's cost improvement performance has been disappointing. In 1984–85 cost improvements amounted to 1.1 per cent. which is well below the regional performance of 1.88 per cent. The proposed district target for 1985–86 was less than 1 per cent. and the district has been asked by the region to consider raising that figure to the 1.5 per cent. average which is set for all the districts in the region.

That is the financial background against which the current matter is proceeding. I recognise the history, which my hon. Friend explained, of the plans that were in hand for the Erith hospital. The decision rests with the district and then the regional health authority. It is not yet with the DHSS.

At the authority's meeting on 15 January, the district general manager put forward a suggested package of measures for effecting savings, a major part of which was the closure of in-patient facilities at Erith. Those 776 suggestions were rejected by the authority and a decision was taken to continue to try to provide the present level of services at Queen Mary's and Erith hospitals.

On 6 February, there is to be a further meeting. The district general manager and the treasurer will meet their regional counterparts to discuss the financial position in Bexley and explore ways in which regional bridging finance might be made available to meet revenue commitments to enable present services to continue.

No further proposals for Erith hospital will be made or formulated until after that meeting, but the district general manager has been asked to present other revenue savings options at the next authority meeting.

I hope that my hon. Friend recognises that there is some sensitivity about the future of Erith hospital. I take careful note of the support that he has shown and that Erith hospital clearly enjoys in the local community. I am certain that what my hon. Friend has said, and the support the hospital enjoys, will be noted by the district and regional health authorities. I assure him that, before any further decisions are taken, that point will be taken into account. Should any decisions come to the Department —we are a long way from that stage—we should also take careful note of what my hon. Friend has said.