HC Deb 24 November 1986 vol 106 cc113-20

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

10.29 pm
Sir Fergus Montgomery (Altrincham and Sale)

I am grateful for this opportunity to raise what is purely a constituency matter—the future of Altrincham general hospital. I wish to express to my hon. Friend the Parliamentary Under-Secretary of State for Health and Social Security the anxiety that is felt in my constituency about the plans for Altrincham general hospital.

Hospital provision in the south of Trafford is not very good. Indeed, it is abysmal. We hoped that that would be rectified when we were promised a new south Trafford district hospital. In 1983, we were told that it would be on the provisional programme for the financial year 1988. We all thought that it would be the answer to our prayers and that the hospital, which we had been promised for so long, would be built.

At the beginning of 1984, it was suggested that the new hospital should be appraised, and the so-called Wythenshawe option was mooted by the regional health authority. It decided on the Wythenshawe option, which was the extension of Wythenshawe hospital to include 112 acute beds, but they would not be for the exclusive use of patients from south Trafford; they would be part of the total south Manchester provision. To complicate matters further, Trafford health authority made further proposals for what it called an alternative strategy based on Park hospital. The regional health authority has not yet made a final decision.

There, in a nutshell, is the tangled web of hospital provision in south Trafford. I am sick to death of being told how fortunate and privileged we are because south Trafford is such a desirable residential area. Those who live in my area have worked hard and made sacrifices to buy their homes and they are entitled to fair treatment, yet south Trafford has by far and away the worst hospital provision in the entire borough of Trafford. Recent events, including the question mark that hangs over Altrincham general hospital, have only aggravated matters.

I do not know whether my hon. Friend knows Altrincham, but the general hospital is in the middle of the town. It is easily accessible, it is a landmark and, over the years, it has acquired a reputation for excellence. It enjoys a special place in the affections of Altrincham people, and there is enormous anger in my constituency at the prospect of acute beds being removed from the hospital. I speak with some feeling about the hospital, because, in 1978, my gall bladder was removed there. I said at the time that my treatment had been excellent and that, if I needed another operation, I would have no hesitation in returning there. I visit the hospital each Christmas, and in each ward I hear the same story from patient after patient—praise for this small, caring hospital with a hard-working, caring staff. In view of all that, my hon. Friend will not be surprised that the balloon went up with a vengeance when the story went round that Altrincham hospital would become little more than a geriatric unit.

The general hospital currently has five wards with a total of 73 beds and there is an accident and emergency department. The local people seem to believe that those facilities should remain. On 29 October, the community health council organised a public meeting attended by more than 300 people. That gives a clue about the strength of public opinion. I should add that I have been bombarded with letters from anxious constituents. I had hoped to attend the meeting, and I told the chairman of the community health council that my plan was to travel up in the afternoon and to return on the sleeper. As my wife remarked, "What a wonderful way to spend your wedding anniversary." The other two hon. Members who represent Trafford were also invited. In the event, none of us could attend because on that evening Parliament debated the Westland affair and there was a three-line Whip.

However, the hon. Member for Stretford (Mr. Lloyd) wrote to the community health council to say that the problem at Altrincham general hospital was caused by underfunding. At the meeting, that point was repeatedly stressed by others of a similar political colour. Not to be outdone, the prospective alliance candidate for Altrincham and Sale—who also announced himself as the next Member of Parliament for Altrincham and Sale—underlined the point. A representative from the National and Local Government Officers Association claimed that the north-west is the worst place for health care and the poorest provided in funds. It is a great pity that they tried to score political points in an issue that greatly worries local people.

It would be helpful if my hon. Friend the Minister, when she replies, could give the true facts and let me know just how much extra is being spent on the Health Service in the north-west, where that money is going and whether the position in south Trafford is connected in any way with the problems of the Resource Allocation Working Party set up by Lord Ennals when he was Secretary of State in a previous Labour Government. I ask for that information because I believe that the record should be set straight and that the political point scorers should be shown up for what they are—adept at empty and fallacious rhetoric.

At a time when the Government have increased the resources for the National Health Service above and beyond the 24 per cent. already achieved since 1979, it is essential that the funds should be employed to correct the errors and failures of the past and to translate six years of words into action. In south Trafford we have, for too many years, been waiting to hear about hospital provision. Are we to get a new district hospital? Will we have the Wythenshawe option or the Park option? The people in my area have been very patient. We are entitled to know why there has been such a long delay and who is responsible for it. As long as there is uncertainty, rumours will abound and fears will be created where perhaps no fears should exist. People are confused; they simply do not know what is going to happen. The position at Altrincham hospital has brought matters to a head.

At least the fears of the public have had some effect. If there had been a move to close Altrincham hospital, that seems to have been scotched. The chairman of the regional health authority has said: The immediate future use of the Altrincham General Hospital is that it is to continue as an acute hospital with the Accident and Emergency Department continuing to be open daily from 9 am to 5 pm. The present long-term strategy for the South Sector of the Trafford District envisages, as you know, that Wythenshawe Hospital will become, for the majority of the South Trafford population, the District General Hospital; a small part would be looking to North Trafford and Park for these services. The current proposal is that once Wythenshawe Hospital takes on the acute services from Altrincham General Hospital then the unit will be converted for use as a 55 bedded geriatric unit with 38 day places. This scheme is presently due to commence in 1994/95 with an anticipated opening of 1995/96. Although the Accident and Emergency Department will close (with accident and emergency admissions taken to Wythenshawe or Park hospitals), it is not intended that out-patient and associated diagnostic facilities should be affected; these are to remain in Altrincham, and the Trafford Health Authority intend to increase these services. I must apologise for not writing earlier but Trafford Health Authority have put forward proposals to make greater use of Park instead of Wythenshawe. I had hoped to let you know the results of our examination of these proposals but this is not yet complete. I will let you know when this is done but meanwhile will bear your views in mind in regard to Altrincham General. I have also heard from the chairman of Trafford Health Authority, who states: At its meeting on 16th October 1986, the Trafford Health Authority again considered how to prepare a plan for 1987/88 which will enable it to stay within the estimated allocation whilst continuing to meet service objectives. The Authority decided to put a plan to the Regional Health Authority showing how the necessary savings of approximately £600,000 can be made without making major permanent changes to the patient services at Altrincham General Hospital. The chairman, Mrs. Alexander, continues to list several points. She concludes: In putting forward this plan to the North Western Regional Health Authority the Trafford Health Authority has indicated that it was not prepared to commit itself to extensive and irrevocable changes at Altrincham General Hospital at this time, because of two major points of uncertainty. First, the North Western Regional Health Authority is to undertake a review of its bed and caseload targets for District acute services and it is, therefore, possible that some changes of policy may take place on the overall level of hospital beds to be planned for and, secondly, the Regional Health Authority has still to decide whether to re-open the option appraisal for hospital services in South Trafford. The reference to two major points of uncertainty is of particular importance. Therefore, the ball is very much in the court of the regional health authority.

Perhaps my hon. Friend can discover when the review of bed and case load targets for district acute services is likely to be announced and also what is to happen with the option appraisal. I draw her attention to a letter written by the chairperson of the Trafford area health authority to the previous Minister, dated 30 June 1986. The reply from my hon. Friend the Member for Wycombe (Mr. Whitney), dated 5 August, said that the chairman of the regional health authority would write to her direct. To my knowledge, that reply has not been received.

However, this morning I received a letter from the chairman of the regional health authority saying that tomorrow, 25 November, he would ask his authority if it would like to examine the position again. That is where matters stand. We need a decision so that people know where they are.

I hope that tonight my hon. Friend can shed some light on why we did not get our long-promised south Trafford district hospital. Is it still an option? If we are not to have it, I want to know why not and which of the two options is to be put forward. After all, if a district hospital was promised in 1983, it must have been shown that there was a need for it in south Trafford. If that promise had been kept, I would not have requested this Adjournment debate tonight and my hon. Friend would not have to reply to it. If the promise had been kept, I would have been perfectly happy with the hospital provision in my constituency.

However, for reasons best known to people unknown, the promised new district hospital has not materialised. Therefore, I cannot say tonight that I am happy about hospital provision in my constituency. I assure my hon. Friend that I am expressing the anxieties of many people, of all shades of political opinion, who are genuinely concerned about what is happening. Above all, I want to know the future plans for Altrincham general hospital, because that is a matter of great concern to my constituency.

10.42 pm
The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

I congratulate my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) on winning the ballot, and by so doing bringing his concerns about Altrincham general hospital before the House. I know that he has been an energetic and tireless campaigner in the cause of his constituency and, indeed, is doughty in the cause of the health care of his constituents. I am sure that his efforts are appreciated locally.

I wish first to put my hon. Friend's mind at rest, at least on the immediate concerns. There are no current proposals to change the use of Altrincham general hospital in Trafford health authority. The district health authority has said so, as has the regional health authority. Indeed, both authorities have given assurances on that matter. It was briefly discussed, but was firmly turned down.

Before going into detail, I shall answer some of my hon. Friend's specific questions. He asked about the north-western region, the funding of the Trafford district health authority and about the importance and influence of the RAWP formula in some of the discussions that have taken place. I am glad to put some figures on the record. The north-western region is a growth region, and has been since the Government took office. Spending has risen by 22.8 per cent., compared with an England average of just under 19 per cent., between 1978–79 and 1986–87. Back in 1978–79, the north-western region was 8.9 per cent. below its RAWP target. Last year, we calculated that it was within 1 per cent. of that target, which is a considerable improvement. Indeed, the north-western region has benefited considerably from redistribution from the better-off parts of the country to the north.

The allocation of funds for 1985–86 to the north-western region is the magnificent sum of £904 million—a 6.4 per cent. cash uplift over previous years. The region has the second highest capital allocation in England, the highest being the west midlands. That comes to a total of £71.5 million for the current year. It could not even begin to be said that the north western region has in any way been neglected. We have carried out faithfully the principles of the RAWP reallocation, and the north-western region has benefited considerably.

I am sure my hon. Friend is aware that the Trafford district authority is about 15 per cent. over its RAWP calculation, but he will also be aware that we have been taking a close look at the way in which RAWP is now calculated to ensure that we get the balance right between the different regions. It is for the region itself to decide how the money is allocated between its districts.

It is not just a matter of the input of resources. We are actually seeing something come out for the money that is going in. My hon. Friend will know that we are spending a total of around £30 million on Manchester royal infirmary Phase II and subsequent building. My hon. Friend the Minister of State will lay the foundation stone very shortly for this most important acute and teaching hospital, which will serve the whole of the north-western region, including my hon. Friend's constituents. My hon. Friend will know about the Fairfield hospital in Bury, which was topped out in November by the Chancellor of the Duchy of Lancaster. That is being built at a cost of £6.6 million. He will know about a number of other capital schemes, all of which add up to a considerable sum of money, many of which are replacing worn-out, old facilities throughout the north-west region.

We are treating far more patients. Last year, compared with 1978, in-patients were up by 20 per cent., out-patients were up by 10 per cent., day cases were up by the magnificent figure of 70 per cent. and direct care staff were around 15 per cent. more last year than they were in 1978. So the money is going to real, direct care.

One small item of particular interest, perhaps to myself, is that before 1985–86 there was a computerised call and recall system for cervical cytology in only one of the 19 districts in the whole of the north-west. Within the next 17 months, with assistance from the Government, there will be such a system, which will be of great benefit and will prevent the unnecessary deaths of women in every single one of the 19 districts.

The Trafford district health authority serves three constituencies, including the constituencies of Davyhulme and Stretford. It is a well-populated area and it nestles close to three important teaching districts of Salford, central Manchester and south Manchester. One would naturally expect at least some of my hon. Friend's constituents to enjoy the benefit of being close to those teaching districts for their more difficult problems. The main district general hospital is Park hospital, which is in the north of the district. It is separated from the south by the river Mersey. As a result of that, the residents in the south, I understand, tend to use Wythenshawe hospital in south Manchester for some of their DGH services and the acute beds at the Altrincham hospital as well.

Sir Fergus Montgomery

My hon. Friend is right about the people who use Park hospital and Wythenshaw hospital. Part of the difficulty is commuting from south Trafford to both of those hospitals. It is all very well if one has a car. If one is old or does not have a car, there are tremendous difficulties, because transport services are not good between those two hospitals in my constituency.

Mrs. Currie

I am sure that my hon. Friend will agree that the realities of communications bedevil simple planning done on a piece of paper. I am sure those points are taken into account in the development of the services that we are discussing. The revenue allocation that Trafford is spending is £28.82 million this year—in other words, nearly £29 million. Again, that is a substantial improvement on recent funding. My hon. Friend will know of the developments at Park hospital at a cost of around £3.7 million, which are intended to provide a geriatric unit consisting of 96 beds and 50 day beds and a physiotherapy department. These were opened by my noble Friend the Parliamentary Secretary in September 1986.

I have said that there is no change planned at Altrincham next year, and I hope my hon. Friend can accept that assurance. As he knows, this hospital of 73 acute beds with one operating theatre and day-time accident and emergency services, which was built around 1870, has been progressively upgraded in the last 10 years and provides an excellent service. It has been the subject of discussion on two different grounds and on two different time scales. The first and the most urgent, which I believe has led, in the immediate instance, to tonight's Adjournment debate, was the overspending of the Trafford district health authority. Its calculation for 1987–88 suggested that it was likely to overspend nearly £600,000 more than would be available. It therefore, responsibly, decided to discuss what might be done about that potential overspending.

Among the schemes that came up was the possibility of reducing the number of acute beds at Altrincham and increasing the number of geriatric beds. This was discussed with the community health council on 11 September, but at the district health authority meeting on 16 October, which was attended by the CHC, the health authority decided against making changes at Altrincham next year to reduce overspending. It decided on a range of other measures which I believe were communicated to my hon. Friend. As I understand it, none affected direct patient care. Some of them simply involved better management of resources, which would keep the authority within its spending limit in a sensible way. However, on 29 October, the CHC organised a public meeting. The district general manager, Mr. Milnes, informed it of the decision of 16 October that no further steps would be taken. I am glad to have the opportunity to say that the DHA decided on 16 October that no action would be taken along the lines it had originally suggested.

As my hon. Friend has said, Altrincham general hospital has been the subject of discussion in the longer term. Trafford will need more hospital beds for the elderly. This reflects the growing number of elderly people in our society. The north-western area expects about 15 per cent. of its population to be aged over 65. In Britain as a whole, there are 3 million people aged between 75 and 84 and about 750,000 people aged over 85. Sensible planning demands that provision be made for services for the elderly. I do not accept my hon. Friend's comment about Altrincham becoming little more than a geriatric unit. Geriatric medicine is an extremely respectable part of medicine, as I am sure my hon. Friend will agree. In so far as we are successful in alleviating people's acute problems through our acute services and, we hope, stopping them from becoming ill due to preventable diseases in middle age, it seems to be axiomatic that, sooner or later, we shall need more services for our elderly people that take into account of the effects of aging. I am sure that we are right to expect that districts which are underprovided in those types of services give sensible thought to them.

The DHA and the RHA are looking at a long-term plan to spend £2 million on Altrincham, probably in 1994–95, which would provide 55 geriatric beds, 38 geriatric day places and an out-patients department with diagnostic facilities for elderly people. For that to happen successfully would mean the transfer of acute beds elsewhere. As my hon. Friend accurately said, that is the subject of considerable discussion. Any change of use from acute to geriatric or to any other use in Altrincham would require the full consultation procedure. If there were any local disagreement, the matter would, of course, come before Ministers. We do not expect to hear of any such discussions for many years, but we are pleased to think that the Trafford health authority and the north-western region health authority are giving some thought to how geriatric facilities are to be provided. I ask my hon. Friend whether, with his local knowledge, he will consider how the services sought for Altrincham might be provided elsewhere. We have to provide the services somewhere. It will be a matter of considerable concern if they are not available.

My hon. Friend rightly referred to a number of letters. I have received copies of them as well. I draw attention to the statement made by Sir John Page in 20 November which said that these matters will be discussed on 25 November. He said that he saw "little or no" advantage in the new Trafford proposals. It will, therefore, be for the region tomorrow and, no doubt, at subsequent meetings, to consider how to achieve the right balance between acute care and geriatric care in Trafford to benefit my hon. Friend's constituents.

I hope that I have answered at least some of the points raised by my hon. Friend, but I shall be happy to meet him on another occasion, if he wishes, to discuss further how to meet the needs of local people. I know that my hon. Friend has made considerable use of local contacts and has been in close touch with the regional and district authorities. I hope that he will continue to represent local people's views and that he will maintain those close links, and perhaps help the planners to get things right for Trafford's old people. We all want the same thing—the best possible services for all the people of Trafford and, indeed, the whole of the north-west.

Question put and agreed to.

Adjourned accordingly at six minutes to Eleven o'clock.