Hospital and Ambulance Services (Hansard, 13 March 1986)

§ Mr. Peter Pike (Burnley)
I intend to change slightly the content of my speech because of the time of the morning; I wish to give the Minister an opportunity to reply to the debate. Although I had intended to refer in some detail to other parts, I shall restrict my comments to my own constituency and to my own area of the Burnley, Pendle and Rossendale district health authority; concentrating on the problems of hospital closures and reductions in the ambulance service caused by Health Service cuts in that area. This, of course, does not mean that I have failed to recognise that these problems affect the whole country, as all parts have been forced to cut services because of Government restrictions of the finance available for the Health Service.
In my own constituency it was recently announced that two hospitals are to close, Marsden hospital and Bank Hall hospital. It was originally envisaged that the role of both these hospitals would change because of developments taking place at Burnley general hospital. When the 10-year plan for the district health authority was introduced, I welcomed the developments that were taking place at Burnley general hospital and never for one moment imagined that the two hospitals which are due to close would keep their current format.
Having said that, however, until it can be shown that in the area that I represent and in the country as a whole we have eliminated the long lists of people waiting for medical and surgical treatment, and have provided all the necessary geriatric accommodation, I cannot support the closure of a single hospital, and I think that the step that we are taking is a retrograde one. This is especially so in an area like mine, based on the two traditional industries of coalmining, now completely gone, and textiles, both of which give rise to health problems for those working in them, particularly chest problems. Many have underestimated the effect of cotton dust in the air and of the artificially damp atmosphere that was created for the benefit of the cotton rather than that of the people working in the industry. So we have many people with chest problems, and a corresponding need for accommodation and facilities to deal with them. In addition, areas such as north-east Lancashire and Burnley, in particular, have a growing number of elderly people; we certainly need much more geriatric accommodation.
A big campaign is already being mounted by the borough council, the Labour party and the trades council, to fight to save the hospitals and to provide the Health Service facilities that we believe the people of our towns are entitled to. We shall be supporting the prospective candidates in Pendle, Sylvia Renilson, and in Rossendale, Janet Anderson, and the many people who are fighting to preserve the hospitals due for closure, and opposing the cut-backs in the hospital services in their areas. Indeed, the Pendle borough council, which has no overall political control—Labour controls the largest party but does not have overall control—is mounting a massive campaign with all-party support to save the Hartley hospital. When I am arguing for the two hospitals in Burnley—Marsden and Bank Hall—I am not arguing for them at the expense of either Pendle or Rossendale. I would not wish to see Marsden or Bank Hall saved at the cost of losing one in Pendle or Rossendale.
1303 The Minister should look at the medical report of the district medical officer, Dr. Grime, which shows clearly that there is a great demand for more resources for the Health Service, rather than less, in north-east Lancashire in the Burnley, Pendle and Rossendale health authority.
The closures are clearly being made to save money—£1.5 million. But when I returned to my constituency yesterday, I was informed that at the meeting of the district health authority, held only the previous night, cuts of a further £1 million had been requested and further drastic action had to be considered.
It must be said that even moderate people on that committee—Mr. Ashworth, who is a registrar at the county court—were talking of allowing the Government to call in the commissioners to do the dirty work because enough was enough and further cuts could not be countenanced.
Even Muriel Jobling, the chairman of the district health authority, because she has tried to resist some of the proposals—and I do not know her political party—and has not toed the Government line, has had it suggested to her by the chairman of the regional health authority that she might say that she did not want to seek another term as chairman of the district health authority. She did not choose to do that and so she has been told that she is not being reappointed. Yet she has fought to try to preserve the Health Service for the community. The protest of people from all political parties and all parts of the Burnley, Pendle and Rossendale district health auhority has shown the amazed outrage at the decision that she should not be reappointed.
The second aspect of the debate is the restriction of ambulance services and the cutting of that service within Lancashire. That is causing people throughout Lancashire grave concern. Indeed the Burnley Express and News and in particular the Lancashire Evening Telegraph have run a big campaign attacking the new proposals and policy changes that were introduced on 6 January when a quota system was introduced to try to avoid an overspend.
A letter from the Lancashire family practitioner committee dated 4 February to the regional general manager of the North-Western regional health authority said that it had considered a report at its committee meeting on 29 January on the current situation in the Lancashire ambulance service. The letter went on to express the concern of general practitioners at the effects of the introduction on 6 January, without prior notice, of a quota system for outpatients as a result of an anticipated overspend of £250,000 in the current financial year by the Preston health authority, the managing body for ambulances for the seven Lancashire districts. Preston health authority has, on a number of occasions, sought additional resources from the regional health authority to offset the continued effects of repeated efficiency savings and cost improvement programmes. The Lancashire family practitioner committee registered its gravest concern at the present situation and rejected completely the interim solutions which had been introduced. It called on the regional health authority to provide further resources to cover the projected overspending until the results of the review of Lancashire ambulance services, which has been commissioned by the regional health authority, are available. Similar views have been expressed by Burnley, Pendle and Rossendale community health council. It wrote to Preston district health authority on 11 February and sent a copy to the hon. Members 1304 representing the three constituencies within its area. It expressed concern at the authority's failure to consult the community health council regarding what it viewed as a "substantial variation in service" and concern at the distress caused to patients by this action. The letter said: my members are amazed to have read a statement in the press from yourself and officers that as a consequence of reducing the workload in regard to transporting out-patients to hospital by some 35 per cent., some inconvenience will be caused to patients. That view was being expressed to the chairman of the Preston district health authority.
The letter attaches a schedule of cases where seriously ill patients have failed to keep their out-patient appointments. It is a long list and it is being added to all the time. It gives an example of a 43-year-old lady who was thought by her general practitioner to have suffered a stroke. She was refusd an ambulance by control staff because the daily quota had been reached, despite the fact that she needed to attend the hospital x-ray department for a brain scan. It was eventually discovered that the lady had a brain tumour. I can give many examples, but time is short. It is a nonsense to run an ambulance service on a quota system which says that if the quota is used up during the first three days of the week no ambulances will be available on the next two days. As I have said, I have a long list and if the Minister wishes to look at it I will provide him with a copy.
The change has also resulted in wasting the time of professional Health Service personnel, particularly physiotherapists. It has increased the work load for hospital administrators, who are now continually having to change patients' appointments because the quota system means that patients cannot attend on the date or time for which the appointment was originally made. Disruption has been caused to the work of outpatient clinics. Ambulance men allege that the time and capacity of ambulances has been wasted because they do not always carry a full load and additional spaces have been available. There was a manpower shortage in 1984 and at that time transport was hired and hospital car volunteer drivers were used, mainly for day care cases, at a cost of £300,000.
Finally, because I want to allow time for the Minister to reply, I want to deal with the important aspect of people who have had their training blocked and are not being allowed to do emergency work or anything else, or complete their training in the ambulance service. That is a matter of great concern. As I understand it, the reason for that is to save money. Once people are fully trained they will have to be paid slightly more. I know that the National Union of Public Employees is taking legal advice on that and is fighting on behalf of its members and is trying to ensure that they are able to provide the services necessary for running outpatient and emergeny services.
It has to be said that emergency services have now been so cut to the bone that in times of major emergency, or two incidents happening at the same time during certain stages of the night, ambulances would not be able to provide the much-needed service to the people of North-east Lancashire. These issues, at this early hour of the morning, are crucial to the people of north-east Lancashire, Burnley and Lancashire as a whole. I believe that the cases I have illustrated are examples of what is going on, not only in my part of the country but throughout the length and breadth of this country because of the cuts being imposed by the Government.

§ Dr. John Marek (Wrexham)
I congratulate the hon. Member for Burnley (Mr. Pike) on bringing to the attention of the House this important and serious aspect of deficiencies in the National Health Service faced by his constituents.
I hope that we do not hear the usual Government claptrap from the Under-Secretary of State about expenditure on the NHS increasing by 18, 20 or 22 per cent. The Government use a convenient starting date—1979, rather than a little later, which gives a different figure. They are selective about the way they use figures. They conveniently forget about demographic change. The population is aging.

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

§ Dr. Marek
The Government forgot about that. It is a lot of claptrap. We are getting more older people. The Under-Secretary of State may laugh, but that is a serious reason why there should be real growth in the NHS. The Government compare growth in the NHS with the retail price index, but they do not compare it with a medical index. We all know that the costs of medical equipment have increased much more than the retail price index has increased.
The Government do not take into account medical advances which mean that much more complicated pieces of apparatus are available to cure diseases and treat ailments than were available just five years ago. Now that is run of the mill equipment. The Government simply say, "The NHS is looked after. There has been growth." If they took account of those factors, they could not make such statements.
We all know about the massive increase in unemployment. Unemployment affects health, and the nation is not as healthy as it was. This places increased demands on the Health Service. The Government do not take that factor into account. If all those points had been taken into account, the Government's statement about real growth in the NHS would be seen by everyone to be nothing but claptrap.
The front page of today's Labour Weekly states: MPs' hospital to close. A central London hospital is to close down for a month in order to meet government health cuts. The hospital—St. Thomas's—is directly opposite the House of Commons and is frequently used by MPs. The West Lambeth District Health Authority, in order to cope with health cuts, faced a difficult choice. A paper from the administration suggested giving over more beds to private health". That is another sad aspect of what has been happening under the Government. They have been putting in their own people, trying to privatise the NHS. The article continues: the authority rejected the proposal. The chair then resigned"—[Interruption.] I wish that the Under-Secretary of State and the Whip would stop twittering from a sedentary position. I shall take one more minute, and then the Under-Secretary of State can have seven. The article states: no treatment in August, except of emergency cases. That means that about 1,000 people will not be given treatment, waiting lists will lengthen and hospital workers and doctors will try to find hospital beds in other parts of London.
1306 What does that have to do with the efficiency about which the Government talk so often and for so long? What efficiency? What a way to run the National Health Service.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
With permission, I shall intervene for the third time in tonight's debate. The hon. Member for Wrexham (Dr. Marek) implied that he was averse to claptrap, yet he gave us several minutes of claptrap, reinforcing the claptrap from the hon. Member for Burnley (Mr. Pike) about the alleged cuts in the Health Service. It is therefore necessary to repeat that, in real terms, there has been a 21 per cent. increase in spending. There has been an increase in capital spending from £365 million in 1978–79 to £900 million next year. More details on that fact, and not claptrap, will be given by my right hon. Friend the Secretary of State in tomorrow morning's debate—I suppose that technically it will be tomorrow—on the impact of the Griffiths' report.
I commend the hon. Member for Wrexham for staying in the Chamber and listening to me, and so improve his knowledge of the Health Service. He clearly needs to learn more about that.
The region represented by the hon. Member for Burnley is a significant RAWP gainer and has gained 11.7 per cent. in real terms since the Government came to office. There is an important story to tell about capital spending. The hon. Gentleman talked about hospitals. The north-west region has the largest capital programme in England, involving about 10 per cent. of total capital spending. There are new hospital developments throughout the region in a massive programme, in Preston, Salford, Bury, Wigan, Central Manchester, Blackpool, Wyre and Fylde; and in Blackburn, Hyndburn and the Ribble Valley. That is a picture of which we should all be proud—including the hon. Member for Burnley when he stops trying to make party political points.
I was glad to note that the hon. Member for Burnley welcomed the commissioning of the new Burnley general hospital, an impressive project which will benefit his constituents. The authority and the Health Service are proud of that hospital. It has, however, had implications for the other local hospitals to which the hon. Gentleman referred and in particular for the Hartley hospital. However, the local health authority has to make proper use of its resources, taking account of the demands on it. Should it come to a decision at the end of the day for a permanent closure—and I can make no comment on that—the decision would be subject to the usual processes of consultation, of which I am sure the hon. Gentleman is aware. If it is opposed by the community health council, for example, it would come to Ministers for a final decision. Only at that point would it be appropriate for my right hon. and hon. Friends to take a decision on the matter.
I must emphasise that redeployment of resources stems from the fact that the hon. Member for Burnley's constituents are to enjoy the services of the new development at Burnley general hospital. Instead of proposing that as a cut, he should take account of the development of services to which I have referred.
The ambulance service in Burnley, which is run on behalf of the Burnley health authority by the Preston health 1307 authority, has been overspending its cash limits. The ambulance service is a growing demand service in that it faces growing demands and receives growing resources. That service must be run under some financial discipline.
The quota system to which the hon. Member for Burnley referred is for non-emergency services. I understand that arrangements are made that, whenever there is a case of urgent medical need, it has been met. There is no question that the routine arrangments of the non emergency services are set aside in cases of particular emergencies. Obviously, I cannot comment in more detail on the detailed cases to which the hon. Gentleman referred. I take note of his points and I have no doubt that the chairman of the district health authority will consult and take note and if necessary either I or the district health authority chairman will write to the hon. Gentleman.
The point I must emphasise and of which I expect the hon. Gentleman to take account is that these growing resources are available to the region and to the hon. Gentleman's health authority. It is pointless for the hon. Member for Wrexham to continue to use his favourite word "claptrap". The fact is that the resources are growing.
Taxpayer's resources spent on the constituents of the hon. Member for Burnley are growing in real terms. Many of those resources are devoted to the provision of appropriate sevices, which must be run under reasonable financial disciplines and limits. That has been put into action.
The emergency medical cover is not affected. If individual cases go wrong, we shall be prepared to take them up, and, as the hon. Gentleman knows, he has the right to take individual cases up directly with the health authority.