§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Archie Hamilton.]12.48 am
§ Mr. Peter Thurnham (Bolton, North-East)
I am grateful for this opportunity to put the case for Bolton's new hospital facilities. With permission, I shall give 77 different reasons why they are so desperately needed.
I have been applying for an Adjournment debate since the end of April, when the people of Bolton were dismayed to learn that there was to be an 18-month delay to the start of work on Bolton's already long overdue additional hospital facilities. I must express in the strongest possible terms my dissatisfaction over both the delay itself and the stated reason. It is said to be the result of overscheduling by the North-Western regional health authority in its 10-year plan, announced last year. Apparently, the North Western regional health authority has planned an over-commitment in the earlier part of its plan. Everything is said to be certain in the 10th year of the plan, but over-commitments have been planned in the fourth year, such thatDistricts must appreciate that delays must occur … by up to 2½ years".The latest programme is now said to be realistic.
Therefore, I now call on the Government to carry out an urgent inquiry into the scheduling arrangements for capital spending in the regional health authority, and if necessary to review the provision of funds to enable construction of Bolton's new facilities to commence without delay.
I have been pressing the need for those new facilities since I was elected. The then Minister for Health, the present Paymaster General, stated during his visit in the general election of 1983 thatBolton's case is burnt into my mind".We were pleased when in June of the following year, my hon. Friend the Parliamentary Under-Secretary's predecessor, the present Minister for Housing, Urban Affairs and Construction, visited Bolton to see for himself the existing facilities, which are split between the two sites of the general hospital and the royal infirmary. As a result of that visit, when I gave him a four-page list of reasons why Bolton needed the new facilities, an urgent review of the timetable for the long-promised improvements was put in hand. It was with great relief that the people of Bolton heard in April last year that Bolton's case had been accepted by the regional health authority, with a programmed start date of January 1988 for the £16.5 million phase 1, and 1994–95 for the £17 million phase 2.
The importance of the project lies not only in its significance to the health of the people but in its impact on the town's general morale and economic well-being. Employment in Bolton's National Health Service has risen from some 3,500 in 1979 to 4,500 currently. Even after efficiency savings of £400,000 due to competitive tendering, the projected new facilities contribute to a forecast further increase of 600 NHS jobs in Bolton, including 400 nurses. In a town with such high unemployment, the importance of such a project cannot be overestimated.
Historically, Bolton, along with other towns on the north-west of the Greater Manchester conurbation, has been deprived of health services while resources have been 156 concentrated on the teaching hospitals in the centre of Manchester under the influence of powerful medical and teaching lobbies. As a result Bolton, along with Wigan, Bury and Oldham, has poor facilities and capital stock. However, while capital developments are in progress at Bury and Oldham. Bolton has fallen far short of its requirements. Both my hon. Friend the Member for Bolton, West (Mr. Sackville) and I invite the Minister to visit Bolton to see for himself the pressing need for work to start now, without delay. As I shall describe, the evidence is overwhelming.
Managing for years on a make do and mend basis, Bolton is now over 12 per cent. short of its resources allocation working party allocation, and 18th out of 19 in the RAWP league table in the north-west region. By 1993, if activity targets are achieved, the district will be at only 80 per cent. of financial target allocation, representing a shortfall of £9.5 million a year.
Bolton health authority, serving an area of some 54 square miles, has 1,315 beds, but they are split between two main sites— the general hospital has 872 beds and the royal infirmary 233 beds. Those two sites are approximately one and a half miles apart, and together provide for the acute and emergency admissions.
The split between the two sites causes difficulties and confusion. For instance, the casualty reception is at the royal infirmary, but the coronary care unit is at the general hospital. In consequence, ambulance drivers may make mistakes, and skilled anaesthetists, together with paediatricians and surgeons, have to spend time travelling from one hospital to another. The accident and emergency unit at the royal infirmary is one of the two busiest in the north-west region, with 72,000 attendances in 1984.
Despite being so busy and having to serve the needs of a population of a quarter of a million, Bolton is the only district in the north-west without proper intensive care facilities and without specially trained staff. On present projections, it will be 1994 before Bolton gets its target of 13 intensive care units. Meanwhile, there are but three high dependency beds at the infirmary. The one at the general hospital is only partially equipped by voluntary donations from the Women's Royal Voluntary Service.
How many such districts are there in the south-east of England which do not have intensive care facilities? What would the people in my hon. Friend the Minister's constituency of Wycombe say if their hospital had no intensive care facilities?
Both the region and the Department know that childrens' lives are at risk without centralised children's services. There is an acknowledged need for 10 operating theatres, but we have only seven. On a visit last Saturday, I found that two out of the three operating theatres at the general hospital are so seriously substandard that a temporary facility is having to be provided until a full upgrading scheme can be afforded. The air conditioning system is no longer properly operative, and there is therefore a potential risk of infection.
The need for improved health services in Bolton is undeniable. The mortality figures show that the expectation of life in Bolton is significantly below average. People born elsewhere in England can expect to live one or one and a half years longer than people in Bolton. Why should that be so? There are a number of contributory factors. Bolton's climate, which benefited its cotton industry, is not so good for its inhabitants. The atmospheric pollution in Bolton has only recently been 157 reduced. Historically, Bolton had the highest sulphur dioxide concentration in the north-west but now peak levels only occasionally exceed the recommended level of 60 microgrammes per cubic metre. Unfortunately, Bolton's rivers, the Tonge and the Irwell, are still among the worst polluted rivers in the north-west, whose rivers are among the worst in the country.
Two reports have highlighted the deficiencies in Bolton's health. In 1980 the Black report found that Bolton was among the 10 worst areas in the country as measured by standardised mortality rate. The second, the Holland report of 1983, placed Bolton 97th out of 98 for areas of the country which suffered above average "avoidable" deaths from preventable diseases for the period 1974–78. In the next four-year period, 1979–83 the town was still placed in the bottom third of the country.
These reports show the effects of socio-economic factors, which are further revealed by estimates that 1 per cent. of hospital bed clays are accounted for by elderly patients without suitable homes to return to. The district medical adviser has said that it would take decades for Bolton's health to overcome these difficulties and for Bolton to be rid of its image as a sick town.
The people of Bolton are not suffering from a failure to see the doctor. The number of prescriptions shows that Bolton's population takes nearly 9 per cent. more medicines per head than the country as a whole, at a cost 4 per cent. higher than the England-Wales average.
The evidence that Bolton needs improved health services is overwhelming. Indeed, on this evidence, Bolton requires above average facilities. The DHSS approval for phase 1 established an essential need for 17 different facilities—accident and emergency, dispensary, fracture clinic, out-patients department, X-ray, rehabilitation, ear, nose and throat, and dental out-patients, theatres, inpatient acute beds, coronary care and intensive therapy beds, day care unit, staff changing, administration departments, medical records, kitchen, staff dining room and doctors on-call accommodation.
The waiting time for a consultation with a rheumatologist is 39 weeks, and ophthalmic waiting times are substantially above the national average at 15 months. As for staffing levels, there is a shortage of staff for mental illness patients. For consultant radiologists, the district is within the worst 5 per cent. in the country, based on work load in 1984–85. For in-patient hospital treatment rates, Bolton again comes near the bottom of the North-Western regional health authority league tables—16th out of 19 for district specialties.
Excluding mental handicap, there is a shortfall of 241 hospital beds, of which 42 are general medical, and 27 are orthopaedic. So the principle of equal access to health care is possible only if Bolton's patients are referred to other districts.
At 12 per cent. below the target set by RAWP, Bolton is short of £3 million on general revenue, and a further £3 million on revenue related to capital. On capital account, Bolton's deficiency is £21 million, the second worst in the region, which is again acknowledged in the commitment to phase I of the planned expansion to the general hospital for which some £16.5 million is budgeted. The region's outline strategy report calls for cash to be allocated on an efficiency basis. Bolton already shows a lower than average cost per patient, perhaps, as I found on Saturday, because some beds are occupied by three or four different patients each day. We are pleased with the recently 158 completed geriatric facilities, and the Princess Anne maternity unit has long been held up as a paragon to other districts. The unit had a throughput of 3,000 per annum when it opened in 1977, increasing to more than 4,500 by 1985.
Besides making efficient use of National Health Service facilities the people of Bolton have also provided voluntarily. In the past two years £130,000 was successfully raised in an appeal for new medical equipment, and for many years the WRVS has provided many hundreds of volunteers for hospital services. Bolton's initiatives for care in the community were accepted by the previous Minister for Health as some of the best in the country.
In conclusion, I trust that the Government will accept that resources must be found to fund the much-needed new facilities without further delay. Bolton with its split sites is in an impossible position to plan if resources are not made available to go ahead with phase 1 as soon as possible. Surplus capacity in the new oversized boilerhouse and duplication of units in the present old buildings require extra staff and expenditure without patient benefit. The general hospital is the right site for development as the infirmary lacks rooms and the general is the only site large enough for construction of the required services.
The history of promises for the building of the phase 1 extension of the general hospital started in the 1978 when it was promised that the extension would begin in 1984. By 1980 the date had slipped to 1985 and in 1981 it slipped a further year to April 1986. In 1983 it was scheduled to begin in October 1986, to be completed in 1989. Last year it was scheduled to start in January 1988, but we are now told that it is to be further delayed, with a start date scheduled for September 1989 and completion three years from that date.
An early start must be made on the X-ray and pathology units which, with the most recent delay to phase 1, means extra costs of some £830,000. There will be ultimate economies from the provision of day care and centralised facilities, but I am sure that my hon. Friend the Minister would wish to support both the very necessary and long overdue capital investment and the allocation of revenue to run it. By calling for a review of capital programming in the North-West regional health authority and by restoring the original schedule the Government could save not only many hundreds of thousands of pounds of extra costs incurred as a result of the delays but, most importantly, the health of the people of Bolton.
I call upon the Government to ensure that construction work starts without further delay.
§ 1.2 am
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
I am happy to have the opportunity to respond to my hon. Friend the Member for Bolton, North-East (Mr. Thurnham). I am sorry that he has had to wait since April for this debate, but he made excellent use of the opportunity once it arose.
My hon. Friend is extremely concerned about the plans to rebuild Bolton general hospital. Before going into detail about that, I should like to say a word or two about the very large scale of investment in the Health Service in the north-west region under the present Government. As my hon. Friend knows, he and we can be justly proud of our record on this. The region is better funded and better managed and is treating more patients than ever before.
159 Since 1978–79, Health Service spending in the region has increased from £380 million to £807 million in 1984–85 — a growth in real terms of 19.8 per cent. Taken together with the region's allocations for 1985–86 and 1986–87, expenditure in real terms in the region is forecast to rise by 23 per cent. compared with an average of 19 per cent. for health authorities in England as a whole. Those figures include the recent £50 million increase to take account of particular pressures from the National Health Service review body pay awards. This growth comes from real growth in Health Service resources and from redistribution from historically well-off regions in the south to the north.
If we look at how the north-west region has moved towards its resource allocation working party target, we see that in 1977–78 it was 11 per cent. below and that it has advanced to 0.8 per cent. below this year. That comes from making better use of existing resources. The region estimates that its cost improvements for 1985–86 will be 2.3 per cent. That includes cash releases, through efficiency, of £10.721 million. I understand that Bolton is making its contribution to this picture. For example, on domestic services £600,000 will be released this year alone through competitive tendering for additional health services in the area. Two contracts have been awarded: one in-house, covering the Bolton general hospital, and one to Crothalls, an outside company.
In addition, the region has had and continues to have the second highest capital allocation in England. This year it amounts to £71.517 million. On a per capita basis the region's basic capital allocation works out at £14.89 for every man, woman and child in the region, and compares with the average for England as a whole of £12.70.
The Government's investment is enabling us to tackle the legacy of health services problems in Bolton and elsewhere in the region. Let us be clear what the problems are. They are not with the services provided. All who work in Bolton's health services—my hon. Friend gave a figure of about 4,000 — give good service to Bolton's people. The problem relates to the amount of service that they can provide. Health services are indeed unequally spread across the region. Bolton people find it harder to gain access to health services than do people in the best served north-western districts, notably south Manchester and Trafford. That is not new. The problem was among the backlog of unattended needs left behind by the Labour Government, and we must face it now. The Government care about Bolton, which is why we have proposed that there should be development of Bolton general hospital.
We have already given approval in principle of phase one, and the regional health authority plans a second phase. The total redevelopment costs will he more than £38 million. It is an ambitious hospital building and rationalisation programme. Work on phase one will begin in 1989. Other preparatory work must be done before then — for example, drains must be laid. The phase one development will include 148 acute beds, eight intensive therapy beds, four X-ray rooms, an accident and emergency department, three theatres and seven coronary care beds at a total cost of £16.541 million.
160 My hon. Friend referred to problems about timing, but before the work can be carried out much has to be done. Resources are having to be released from over-provided districts, and the region has had to produce a manageable capital programme. That has certainly given the impression of slippage, to which my hon. Friend referred. As he said, the region's capital programme was overcommitted in the early years because the regional health authority was advised that, for planning reasons, overcommitment can act as an incentive to progress and assist in responding to slippage, so that maximum use is made of capital allocations.
Whatever the reasons for the approach, the result was an over-ambitious capital programme. To have rebuilt Bolton's general hospital at the date previously suggested would have depended on other planned and equally necessary schemes suffering delays unforeseen when the programme was drawn up. So a capital programme on that basis was over optimistic and always at risk of disappointing someone. Morever, recent experience of the construction industry, at least in the north-west region, is that delays are not occurring to the same degree. The regional health authority decided that overcommitment was no longer the right way to cope with slippage. That has been the subject of discussion between the region and Ministers. The region has produced a programme which is affordable in successive years, not overcommitted and realistic. There is no need for further conjecture, and I assure my hon. Friend's constituents that they have a date for the hospital rebuilding which is as firm as possible. We can all look forward to it with confidence.
I understand the pressures to which my hon. Friend referred, but I ask him to note that, in addition to the general hospital rebuilding, there has been much capital spending in Bolton in recent years. Indeed, it totals £16 million since 1982. For example, a mental illness unit is being built at a cost of £1.9 million. Next year, £320,000 will be spent upgrading the X-ray department, and £773,000 on expanding a pathology laboratory. They are demonstrations of our commitment. I recognise that my hon. Friend would have wished progress to be much faster. I hope that he accepts that the earlier forecasts were made with the best of intentions. I understand the disappointment that they caused, but I hope that he accepts that the movement of the revenue funding and the commitment to the steadily increasing capital funding—an increase on an already significant amount of capital expenditure—will bring Bolton up to the standards that he and I want for his constituents.
I hope that my hon. Friend accepts that we are moving in the right direction and that significant increases in resources are being devoted to improving health care in Bolton, to which he referred so effectively. I ask him to carry back to his constituents my commitment that the timetable that has now been established has every prospect of being adhered to.
Question put and agreed to.
Adjourned accordingly at twelve minutes past One o'clock.