§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]
1.25 pm§ Mr. David Evennett (Erith and Crayford)I am most grateful for the opportunity to raise on the Adjournment the important subject of the funding of the Bexley health authority. I do so because it affects the health care that is being provided to my constituents, those of my hon. Friend the Member for Bexleyheath (Mr. Townsend) and those of my right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath), and because, to date, there has been a noticeable lack of response to the crisis in Bexley, especially from the Government and the South East Thames regional health authority. This lack of response, in spite of the efforts of my right hon. and hon. Friends and myself, has been bitterly disappointing to the people of Bexley, who feel disinclined to accept the Government's exhortations that the Health Service is in good hands when they see both a lack of facilities in their area and the curtailment of the limited existing facilities in an effort to balance the underfunded budget in Bexley. Regardless of whatever happens elsewhere in the country, my constituents are experiencing a reduction in the all-important area of health care.
For my part, I accept that the Government have achieved a great deal in their management of the National Health Service. I know that there has been a major investment in the NHS and that nationally there are more doctors and more nurses than before; that more patients are being treated, and that more surgery is being performed than ever before. All this costs a great deal of money, so no one can argue that the funds are not being made available to the NHS, yet somehow in Bexley we are not reaping the benefits of this spending. In Bexley, we are not experiencing these advances. We are not even in a position where the standards of care are being maintained from year to year. We are experiencing a reduction in service caused by the closure of wards, the closure of operating theatres and clinics and the curtailment or reduction of other services.
Locally, the service has declined to the point where the district health authority's aim is to try to provide a service at the level that prevailed in 1984–85. Therefore, we are definitely not seeing any advance. Instead, we are seeing rather a regression. Despite the appointment of a new and enthusiastic health authority chairman, why are we experiencing such difficulties in Bexley? That is a question that I ask myself regularly, as I am sure my colleagues ask themselves. It is one that my constituents regularly raise, and to date I have received no satisfactory answer. I can point to a number of factors that contribute to the underprovision which exists, but I cannot explain, either to my own satisfaction or to that of my increasingly sceptical constituents, why action has not been taken to remedy the situation.
I accept that one reason is geographical location. Bexley is on the edge of Greater London, and the fact that it is near to the centre of London and the main teaching hospitals clearly is of significance. There is a tendency for people to say,"If facilities locally are not that good, we can always travel into town." What they forget is that for most people in my constituency central London is at least an hour away. It is a journey which can be trying at the best 592 of times. To make that journey is the last thing that ill people would wish to do, especially as follow-up treatment at outpatient clinics would probanly mean making the journey during the rush hour. That attitude also takes no account of families or of the difficulties that hospitalisation brings, including the problems of travelling long distances by the elderly relatives of patients.
Bexley is not an inner-city area and is not that near to central London. It is not an area of declining population. On the contrary, it is a area of population growth, and a significant part of that growth is formed by an increase in the number of elderly people. In my constituency, there is a great deal of housebuilding, not only in Thamesmead and Crayford, but in Belvedere, where I have a home. That growth, and the fact that people quite rightly expect to receive local health care when they are sick or injured—unless they require some highly specialised treatment that can obviously be provided only at a limited number of locations—demand that the district's health care provision should increase, not decrease.
Regrettably, the reality is different, and the poor state of the district's budget has meant that many essential services have had to be cut to make ends meet. That must be wrong. Bexley's proximity to central London, and the fact that it is within the South-East Thames region, mean that it is within the resource allocationworking party formula a "losing" part of the country. The effect of RAWP, as we know, is regularly raised in the House by many right hon. and hon. Members, along with its effect on health care provision in their constituencies. In respect of RAWP and of the Bexley health authority, my colleagues in Bexley and I have raised this matter in the House and with the previous Minister several times. However, so far, we have received little response. It is true that we have been given tea and sympathy and a lot of shoulder-shrugging, but that is why RAWP is an acronym that I have come to dread.
This debate is not the occasion to discuss the wider merits of the NHS's resource allocation policies. But the concept behind RAWP was basically acceptable and I have supported it in the past. It is only right that we should ensure that there is a parity of service in all parts of the country. However, I do not support the reality of the manner in which that concept is put into operation or the effect that the allocation of resources under RAWP has had on health districts such as Bexley.
In Bexley, the effect of RAWP is that perfectly good wards and operating theatres in an up-to-date hospital are out of commission because of a lack of money with which to run them. There can be absolutely no sense in a policy that allows vast sums to be spent on capital projects, such as hospital building, if the revenue is not provided to run these services.
If we are looking for national parity—what RAWP is supposedly all about—it must be achieved by levelling up and by improving the service provided across the board. There should not be a reduction in, or levelling down of services, and parity should never involve the closure or mothballing of modern hospital facilities. We should be looking to match health care facilities nationwide, and not the lack of them. Some of Bexley health district's problems are also historical. Before the recent Health Service reorganisation, Bexley health district was part of the larger Greenwich and Bexley health authority. That area authority had two modern authorities at either end of the area: one in Greenwich and one in 593 Sidcup, together with the Brook hospital, Woolwich, and a number of other smaller hospitals scattered within the area boundaries.
When the area was split into two districts, with boundaries conterminous with the London boroughs of Greenwich and Bexley, the facilities in each district were uneven. The bulk of the area's hospitals was sited in Greenwich, with the result that Bexley has only three hospitals, two of which are within its geographic area. I refer to Queen Mary's,Sidcup, Erith and District hospital, and Bexley hospital, which is a psychiatric hospital. Thus the facilities in Bexley are limited. Queen Mary's hospital, which is in the constituency of my right hon. Friend the Member for Old Bexley and Sidcup, is the district general hospital and the other mainstream hospital is Erith and District hospital, which is in my constituency, and which is a very small hospital with limited facilities. Erith hospital has been an important part of the local community for many years. It is much loved and much needed by my constituents and I have raised the precarious future of that hospital in a previous debate in the House.
Queen Mary's hospital is a modern hospital about 10 years old with 556 beds. It houses many specialist departments, including the district's maternity unit and an excellent accident and emergency department. By contrast, Erith and District hospital, a small unit, was originally built, as a cottage hospital, from public subscriptions. It has 31 beds, provides many out-patient clinics and what is best termed as a walking wounded accident unit.
Proposals for the upgrading of Erith hospital have existed for some time now, but so far no work has been carried out because of the district's financial predicament. Indeed, the local people have now come to doubt not only that Erith hospital is to be upgraded but that it will survive at all. In fact, its closure has been mooted in the recent past as another way of saving money. I have fundamentally disagreed with and opposed such proposals for closure and I shall continue to do so. For many of my constituents the temporary shelving of the upgrading proposals appears to be indefinite and they rightly cannot see any difference between indefinite and permanent.
As I have said, those hospitals are the only mainstream hospitals within Bexley and they both play a vital role. Obviously Queen Mary's hospital, as the district general hospital, meets the bulk of the demand for health care within the district. However, Erith also has a vital role to play, especially since Queen Mary's is in the south of the district while Erith is in the north and the roads, railways and bus routes tend to run from east to west to and from central London.
Although the two hospitals are just about sufficient to provide adequate care to meet the needs of the local people when full use can be made of all their facilities, reductions in services such as we are experiencing at present strain resources to the limit and mean that some people are undoubtedly not receiving the treatment they should be, that we want them to receive, and that I am sure my hon. Friend the Minister would agree that we should be providing. We must never forget that we are dealing with the health, welfare and well-being of individuals, not bald statistics.
The financial predicament of Bexley health authority is such that in May of this year the authority had drastically to cut services in an effort to save money. The list of cuts is extensive and includes the closure of an operating 594 theatre and a ward at Queen Mary's, a limitation on outpatient prescribing, a reduction in out-patient bookings, dental clinic services, assessment clinics and family planning clinics, including family planning surgery. It also included the closure of an operating theatre and consultant beds at Erith hospital, a reduction in the number of general practitioner beds at Erith hospital, a reduction in the casualty services and a number of other reductions.
Anyone who doubts that that catalogue of reductions can have only disastrous consequences, need merely consider one item on the list to see what damage is being done. The closure of an operating theatre at Queen Mary's hospital has reduced the amount of surgery that can be performed in the district by up to 20 per cent. As the annual total for surgical procedures performed in the district is about 9,000, it means that the closure of that one theatre will cause up to 1,800 operations to be cancelled or delayed. That means that 1,800 people will have to wait even longer for surgery possibly in pain, probably in discomfort. Those 1,800 people will be added to a waiting list that is already too long in Bexley and which the Government are committed to reducing. In other parts of the country we have seen waiting lists successfully reduced.
That is the result of only one item on the list of closures and reductions. The combined effect of the cuts in services is too awful to contemplate but it can mean only one thing, we in Bexley have a poorer standard of health care than we had or we want.
The obvious question is what more can the district do to save money or provide more treatment by increasing efficiency. It is a question I have put to the present chairman and the previous chairman of the district health authority.
However, the finger cannot be pointed at Bexley in respect of a failure to improve efficiency. Far from it. The authority has very low costs per patient and manages to maintain a high number of patients treated per bed. Bexley health district is probably one of the most efficient and cost-effective authorities that there is, and the authority has rigorously applied every effort to achieve all the efficiency savings that it can, but the one obstacle that its efforts cannot and will not overcome is a basic lack of funds from the South East Thames Regional health authority.
The district is under funded. I received a letter about a year ago from Sir Peter Baldwin, the chairman of South East Thames regional health authority. He said, in admitting that Bexley is underfunded, that
My Authority is, as you know, constrained by the overall level of revenue resources allocated by the Secretary of State. In comparison with many other Regions the South East Thames Region is deemed to be better provided and therefore has received, and will continue to receive, revenue reductions year on year until national parity is reached. Similarly within this Region there is an unequal distribution of revenue resources and I am committed to making this distribution more equitable. Bexley District should have more revenue. It is presently receiving only some 89 per cent. of the revenue which we believe it should have; by 1993–94 this will have risen to 95 per cent.The regional chairman's commitment to seeing Bexley receive the funding that it should is commendable, but regional finances seem to be such that all that the regional health authority can do is promise to try to improve the level to 95 per cent. by 1993–94. What the state of the Health Service in Bexley will be then I do not know. I feel that such comments are unacceptable, as do my constituents.
595 The Health Service cannot be run on promises of jam tomorrow. Tomorrow may never come.
Against that background, the authority had little option but to agree the package of service reductions that I mentioned which were implemented earlier this year. The authority was faced with an overall deficit of around £750,000 for 1986–87. Unless the authority had cut services to patients the district would be facing a deficit of £1.5 million by 1989–90. Balancing the books by reducing services has meant that the authority will be lucky to provide the same services as in 1984–85, so instead of services being improved, they are being reduced.
Bexley health authority's annual expenditure is about £35 million. That is a great deal of money, but in real terms spending in the district is lower than it was in 1982. The exciting and imaginative scheme put forward for the redevelopment of Erith hospital, a scheme that would revitalise that hospital as a centre for health care in the north of the district, would have cost about £3 million. It takes little arithmetical ability to work out that the 11 per cent. deficit in regional funding would be sufficient to pay for that scheme if only the money were forthcoming. What Bexley health authority needs is sufficient funds to operate Queen Mary's hospital fully and to begin the redevelopment of Erith hospital.
Earlier this week I asked my hon. Friend the Minister for Health in a written question whether he would come to Bexley to see the situation for himself and, in particular, visit Erith and district and Queen Mary's hospital. I am delighted that my hon. Friend has agreed to visit us early in the new year. I thank him for that most sincerely.
I know that my hon. Friend is concerned about the Health Service and its patients and is determined to see that those in real need obtain the best facilities and services from the NHS. I beg him to look long and hard at the funding of Bexley health authority, to observe the consequences of the situation that I have outlined and to take action to remedy what is at present a depressing state of affairs.
§ Sir Geoffrey Finsberg (Hampstead and Highgate)I am grateful to my hon. Friend the Member for Erith and Crayford (Mr. Evennett) and the Minister for allowing me to intervene in the debate.
My hon. Friend the Member for Erith and Crayford rightly points to the problems that are affecting the health authority in his constituency and says that they derive basically from the policy of the resource allocation working party. He is right. He is also right to say that it affects the four Thames regions. What he has said is that what was introduced by the Labour Government, one of whose Ministers is now a leading Social Democrat, is now under attack. Some of us have attacked it from the beginning. What saddens me is the hypocritical way in which the Labour party now decides that it does not like the system about which it made no comment when it was introduced.
My hon. Friend the Minister knows how grievously this RAWP issue is affecting my constituency. I might have applied for an Adjournment debate and had a long one, matching what my hon. Friend the Member for Erith and Crayford has said, but I did not want to do that for two reasons. First, I know from my experience how grossly 596 overworked Ministers in this Department are, unlike many of my colleagues in other Departments, and I do not want to impose the burden of yet another Adjournment debate. Secondly, I ask my hon. Friend, in considering what he will say about Bexley, to try to accept that there is an enormous gulf in perceptions of the NHS. He and I know that we are spending an enormous amount more in real terms on the National Health Service, nearly 30 per cent., but the public's perception is different. In Bexley, as in Camden, closed wards in new hospitals make it virtually impossible to make any real breakthrough in public perception.
I shall not ask my hon. Friend the Minister to visit me, because he knows the problem, but I hope that he can assure the House that the review that has been undertaken on RAWP will soon be completed and that it will recognise that the time has come to stop RAWP. I hope that he will accept that if one is improving services within the Health Service, one can no longer reduce the good ones to improve the poorer ones, nor decide that the standards of excellence in the London teaching hospitals can be carved away.
§ The Minister for Health (Mr. Tony Newton)I begin by expressing, perhaps with some wryness, my gratitude to my hon. Friend the Member for Hampstead and Highgate (Sir G. Finsberg) for not threatening me with yet another Adjournment debate. That move may reflect his long experience as a Minister in the Department, and one who probably stood at the Dispatch Box replying to such debates more often than anybody else, except possibly his immediate predecessor as a Health Minister. I have noted what my hon. Friend said.
My hon. Friends the Members for Hampstead and Highgate and for Erith and Crayford (Mr. Evennett) will know that I am the Member of Parliament for part of one of the Thames regions, so I am more than familiar with some of the comments about the problems perceived to exist in the Thames regions. Beyond that, I would not wish to be drawn at this stage into a wide-ranging discussion on the RAWP formula, not least because it is clearly one of the issues of what is known, in this dreadful jargonised world, as sub-regional RAWP, which is in some respects a distinct issue from national RAWP.
I would probably carry both my hon. Friends with me in acknowledging that while it is not a particularly pleasant acronym, RAWP, when translated into commonsense English, simply represents a policy of trying to ensure equity of access to health services throughout the country. As a general proposition nobody would wish to depart from that, although there is a great deal of argument about how that general proposition is carried through into practical reality, and in particular about the financial allocations that go with it.
I begin conventionally, although perhaps more than that, by congratulating my hon. Friend the Member for Erith and Crayford on having secured this Adjournment debate and the opportunity to put, as he has done with great force and clarity, the concerns of his constituents. I hope and expect that his constituents fully realise how much effort he has put in over the months to make sure that their interests are so strongly and clearly represented in the House. In that, of course, his hard work is shared by his colleagues, to whom he referred—my right hon. 597 Friend the Member for Old Bexley and Sidcup (Mr. Heath) and my hon. Friend the Member for Bexleyheath (Mr. Townsend).
My right hon. Friend the Member for Old Bexley and Sidcup, in the debate on 16 June, eloquently described the difficulties and challenges of funding Bexley health authority. That attracted considerable attention, not least among Ministers—my predecessors in the Department. Earlier this year my hon. Friend the Member for Bexleyheath led a deputation to Ministers from the Bexley community health council, at which many of these issues were addressed. I ought perhaps to mention the fact that I know that some of the issues are of concern to my hon. Friend the Member for Chislehurst (Mr. Sims), who, although his constituency is across the border from Bexley health authority, is concerned about his constituents who receive treatment within that authority. My hon. Friend has gone out of his way to speak to me about those matters during the past week or two.
I wish briefly to put some of the issues into context. Obviously, because of the time factor, I shall not be able to speak at length about the national background. However, in 1987–88 the allocation to the hospital community health service is no less than £10,963 million—in other words, very nearly £11 billion. That is an increase of more than £600 million over the total funds available in the current year and includes—and this point is of considerable importance to any discussion on this matter—two special funds.
One fund is worth £50 million over two years, and is to tackle waiting lists. This problem was referred to by my hon. Friend the Member for Erith and Crayford, and is clearly related to the general concerns expressed by my hon. Friend the Member for Hampstead and Highgate. The other fund is for £30 million over two years to provide transitional help for regions receiving less than the national average growth rate, which we are calling—in the Department's shorthand—the RAWP bridging fund. That is directed at alleviating some of the anxieties that have been expressed here today.
That latter new fund will be directed principally at the four Thames regions, although not exclusively, because there are similar problems in one or two other places. It will help those regions bridge transitional costs and undertake schemes to unlock resources for the future. That does not undermine the principles of RAWP. It is directed towards some of the problems that have been raised. I must emphasise that the extra money, whether the general extra money, waiting list money or the RAWP bridging fund money, will be given to regional health authorities, which, in turn, will fund their various districts.
It is my judgment—and I hope that my hon. Friend the Member for Hampstead and Highgate will endorse this—that it would be hopeless for Ministers to second-guess everything throughout the Health Service in trying to decide the exact pattern of services locally. It is a matter for regional health authorities to determine allocations to districts. Our objective is to ensure that regional health authorities have adequate funding to run an expanding Health Service and make it possible for them to allocate funds between their districts in a way that is then reflected at every level.
The other point that I wish briefly to make was curiously reflected in some of the comments made by my hon. Friend the Member for Erith and Crayford. In terms of access to hospital treatment for Bexley residents as 598 acute in-patients and day-patients, the district's record is actually good when compared with the national average. I understand that it is among the best 20 per cent. in the country. Throughput for major acute specialties is also in the top 20 per cent. and maternity provision is well above the national average.
I mention those points not to sound complacent in any way—as my hon. Friend knows, that is the last thing that I would wish to do—and I am conscious of the fact that when any Minister uses statistics in that way the ghost of Disraeli hovers at his elbow muttering about
lies, damned lies and statistics.Nevertheless, we must measure the situation in some way, and according to some measures the position of Bexley is not unreasonable. I say that, not to dismiss the concern that has been expressed, but to show the difficulty of forming a balanced view as to the precise cause of the problems and what can best be done about them.As I have said, the authority's problems have been ably and eloquently brought to the attention of Ministers and of the House. I therefore hope that, whatever else he may think, my hon. Friend will accept that those concerns have not been lost on Ministers or, indeed, on the South East Thames regional health authority and its chairman, to whom specific reference has been made. Indeed, I spoke to the chairman this week after undertaking to visit the authority. I should point out that the regional director of finance and his staff have been and are giving an amount of time and attention to Bexley's problems which, might be described as disproportionate by comparisons with other authorities in the region, but which neither I nor they regard as such. The amount of time being devoted to these matters reflects the recognition of the anxieties that have been expressed.
Another oddity in all this was reflected in my hon. Friend's remarks. Compared with many authorities in the South East Thames region and throughout the country, on the face of it Bexley lends itself to being a fairly smoothly run and effective district. It is compact, it does not have a legacy of old, badly sited hospitals, and it has a modern district general hospital at Queen Mary's. I acknowledge the problem of the mental illness hospital, which is over the border in Dartford and Gravesham but managed by Bexley, and that may have played some part in the situation that my hon. Friend described.
Against that background, I understand that Bexley has a recurring budget shortfall of £942,000 for the next three years. With the non-recurring potential overspend for 1986–87, the overrun for this financial year was estimated at around £1.7 million out of a total budget of £36,731,000, although I shall qualify that point in a moment.
Discussions at senior levels in both the district and regional health authorities have taken place over a long period to try to resolve the problem. One result has been that an inquiry team headed by the region's director of finance is going to Bexley—it may already be there—to examine the district's finances in detail and to suggest positive courses of action to put it on a firmer financial footing. I emphasise that the aim of all this is entirely positive. The intention is to offer a high level of practical and professional help to the district, although clearly I cannot prejudge the results of that inquiry.
In the light of what my hon. Friend has said, I should give a couple of examples of what the regional authority has already sought to do to try to help Bexley. As was confirmed at the district review meeting on 26 June, the 599 region has offered Bexley £480,000 bridging finance, chiefly to facilitate the launching of its competitive tendering programme, which in turn will generate benefits for the district in years to come. That finance depended on Bexley's presenting to the region a realistic and affordable short-term programme. I understand that a preview of that programme has been received and is being assessed by the region.
The region has tried to help also by providing £450,000 in grant for the development of mental handicap support services. I understand that the district authority has developed an ambitious "ordinary life" programme of resettling mentally handicapped people in three and four-bedroom surburban houses near shops and facilities. Such a policy is expensive. Indeed, Bexley has the highest unit cost for resettling mentally handicapped people in the region. To be eligible for the help offered by the region, Bexley must provide it with essential details of the programme's dependency and assessment costs.
I am not suggesting that those contributions are overwhelming, but they are clear examples of how the region has tried to help.
Since the offers were made, there has been a major development. I am told that, rather than have a projected overspend of £1.7 million, Bexley will break even. That change in its fortunes, if that is the right word, is attributed chiefly to some planned savings and difficulty with nurse recruitment, which is proving to be a problem for several health authorities. The region's director of finance will want to consider those factors also.
As a result of the change from a projected large overspend to a projected rough break even, Bexley has asked the region for only £192,000 of the £480,000 bridging finance which was offered, and I understand that the money has been transferred to the district's account.
As for the £450,000 grant to help develop mentally handicapped support services, I gather that details of the dependency and assistant costs are still awaited by the region.
My hon. Friend said with some vigour that the district had brought forward a package of measures which, in the words of the district general manager—I am afraid that 600 DGMs have as much awful jargon as Ministers—will "reprofile" services in a way that will produce the greatest benefit to patients from available resources.
The measures are designed primarily not to reduce expenditure but to focus it on what are thought to be priority services in the acute sector and to improve services for the elderly, the mentally ill and the mentally handicapped, who have previously been neglected.
I understand that the local community health council has expressed opposition to most of the proposed measures. Consultation on the measures was completed on 8 September and the Bexley community health council reported back to the authority on 13 November, having considered all the comments that had been received. I believe that a special meeting of the health authority is to be held early in December to agree a course of action.
My hon. Friend will know what I am about to say next. In view of the community health council's opposition to the proposals, there must be a good chance that they will land on Ministers' desks for decision, so I am pre-empted from offering views on them as I shall have to consider them with care later. I can only assure my hon. Friend, as I have assured others before him, that Ministers do not regard their role as rubber stamping whatever is presented by health authorities—I certainly do not. If proposals come to us, they will be examined with great care, and the views of local interests, my hon. Friend and others will be weighed.
I hope that I have been able to assure my hon. Friend, and through him, his constituents, that we are not ignoring the health authority's problems. They are being addressed at senior level by the regional health authority with active indications of ministerial interest. I thank my hon. Friend for reinforcing that interest and making me even better informed today.
My hon. Friend asked me earlier this week to visit some hospitals in the Bexley area. I hope that I have demonstrated my interest in the matter by saying that I hope to do that early in the new year. I have no doubt that I shall have further contact with my hon. Friend then, if not before, and I look forward to that. Meanwhile, I hope that the work now continuing will help to overcome the problems to which my hon. Friend referred, and I assure him that I and other Ministers will not lose sight of what he said.