HC Deb 08 May 1987 vol 115 cc1030-8

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

2.34 pm
Mr. Ron Leighton (Newham, North-East)

An acute crisis of medical and nursing staff afflicts the National Health Service in the London borough of Newham. It is getting worse. That is why I sought this emergency debate in Parliament to lay bare the facts and to seek a response from the Government. Newham, as I have often explained to the House, has more than its share of difficulties. In health matters, the borough is caught in a pincer. As recent authoritative reports have shown, much sickness is caused by deprivation and the debilitating effects of an unhealthy environment. Good health greatly depends on adequate incomes, diets and good warm housing.

Since 1979, Government policy has doubled the number of people in Newham living in poverty on supplementary benefit, and actually trebled the number of unemployed. Cuts in housing expenditure have led to a waiting list of 12,000 people, and the worst housing in London. That damages health, especially for the most disadvantaged. Yet, when my constituents seek health care they suffer again, for they are confronted by a service in crisis, which is breaking down under the strain of trying to cope, and is under-staffed and under-resourced. A frightening burden is being placed on devoted but overworked staff, while local people endure longer waiting lists and delays in treatment. Sometimes for patients, the hours of waiting can negate the benefits of treatment and cause unnecessary pain and distress. Acute staff shortages make it difficult to maintain standards of care.

I have raised these matters before and have given Ministers the details in correspondence, but there has been no satisfactory or adequate response. It is because the situation in Newham is worsening that I deal with the matter again today.

Services for and health care of Newham patients are suffering because of shortages of staff right across the board. I spent a large part of last Tuesday discussing the matter with the Newham community health council, Lady Sherman and her colleagues at the Newham health authority, and Mr. Richard George, the manager of Newham general hospital. At present, there is a shortfall of staff of 420 in the Newham health authority. They range from medical staff locums, nursing staff, medical records staff, medical secretaries, occupational therapists, audio technicians, pharmacy staff, chiropodists, and many others. The shortfall of nurses is particularly grave. Shortages are acute among operating theatre nurses, operating department assistants, intensive therapy nurses, paediatric nurses and midwives.

The health authority is being forced to use untrained people and to have extensive recourse to agency staff, which, of course, is more expensive. But that does not help to make up the shortfall. One clear reason for the shortages is the abysmally low rates of pay in the NHS, the competition that it faces from local authorities and other employers who offer higher salaries, and also the additional London weighting that is offered by neighbouring areas. The Government recently agreed to pay this year's pay review body's recommendations on nurses' and midwives' pay. I welcome that, but the unanimous view of all those to whom I spoke was that it was too little, too late. It still leaves salaries unacceptably low—well below those of comparable white-collar jobs —and will not solve the problem.

There was also agreement that the level of London weighting was hopelessly inadequate and in no way compensated for the high cost of housing and living in London. Contrasts were made with central banks and building societies that offered London allowances of up to £2,000 on top of already higher salaries. I was assured that, unless some flexibility and improvement is given in the face of the aggressive action of the institutions that I mentioned, the position will get worse.

Newham health authority's problems in attracting nursing staff are compounded by the inducements being offered and the vigorous recruitment drives being mounted by countries such as Australia, the United States and Saudi Arabia. Another worry is the difficulty in recruiting and retaining administrative and clerical staff, particularly for medical records departments. It is vital to have records available for all out-patient clinics and for in-patients on the wards, and it is important for patients' continuing care that their GPs are aware of what treatment is being given to them or is proposed. Yet a medical secretary on personal secretary grade gets £4,912 to £5,855. For HCO grade the salary is from £5,418 to £6,556. How many hon. Members could get a secretary for such miserly sums? When agency staff have to be employed, they are paid double. The City of London, with its big bang salaries, is only 20 minutes away on the tube, so why should secretaries work for the NHS? Yet doctors need their records.

Incidentally, I do not understand why, as Mr. Jim Franklin, a carpenter at Newham general hospital told me, fully skilled building craftsmen are being offered £29 a week less than maintenance craftsmen. Perhaps I could have an explanation.

The shortage of midwives is extremely grave. The birth rate in Newham is booming. It increased 20 per cent. last year, yet the local school of midwifery is closed because of an inability to recruit midwives. Newham is 20 per cent. short of midwives, and Newham general hospital is 15 short. That places a huge burden of stress on those who remain. It is the mothers and babies who suffer. Out of some 250,000 qualified midwives nationwide, only 30,000 are willing to practise in the NHS. This begs the question of their rewards. Even after their increase, a staff midwife receives only £7,730 per annum minimum, to £8,600 maximum. Can anyone say that that is enough?

Another acute shortage is of occupational therapists. At St. Andrew's hospital there are none at all at the moment. At Goodmayes hospital, which caters for many Newham people with mental illnesses, there is only one. She, with untrained helpers, has to provide a service for between 100 and 180 clients daily. The other vacancies have not been filled for a long time.

One of the most worrying shortages is of nurses. The monthly reports of the director of resources show a steadily worsening position, with extra costs due to the shortage of agency nurses yet still a shortage of 21 per cent. The high use of agency staff of up to 10 per cent. has serious implications for continuity of care and accountability. On Tuesday in Newham general hospital I was shocked to learn that, although there should be 10 operating theatre nurses, there are only two.

This has had a disastrous effect. The four-theatre operating suite, allowing for routine maintenance, should provide 34 sessions a week. However, this was reduced to 30 on 6 April because of nurse shortages, and on Monday of last week this had to be reduced further to only 20, a cut of 40 per cent. The surgeons cannot work for lack of nurses and the waiting list for patients grows longer. There will be 20 sessions a week for a fortnight, and no one knows what will happen after that. The hospital also has a one-third shortage of operating department assistants. There is a shortage of intensive care nurses at the hospital. These nurses give care on a one-to-one basis to patients in beds with much expensive hi-tech equipment. There are four such beds in Newham general hospital, but at least one is usually shut down.

There should be eight paediatric nurses at the hospital working with children, but there are only two. There is only a quarter of what there should be. At St. Andrew's hospital there are 90 nursing vacancies. There were once three accident and emergency departments in Newham and there is now only one, which is at Newham general. It was designed to take 32,000 to 33,000 cases per annum but it is now having to cope with 70,000. The congestion can be imagined. The waiting time for patients is usually around four hours, but is often longer. This causes great frustration and sometimes violence. The stress and strain on nurses can be imagined. Is it surprising that morale suffers? And let us recall the meagre rewards that we offer nurses. Even with the increases, a student nurse will now receive from £4,540 to £5,170. An enrolled nurse will be paid from £6,250 to £7,750. A staff nurse will receive from £7,300 to £8,600.

The service at Newham's accident and emergency department is not just on the brink of collapse; on several occasions it has collapsed arid has had to be closed because of a shortage of nurses. On 5 January it closed at 5.40 pm until 10 am on 7 January. In other words, it was closed for 40 hours. On 20 March, it closed at 5 pm until 10 am on 23 March. In other words, it was closed for 65 hours. Ambulances were diverted to as far away as Romford, yet my constituents should be able to rely on the casualty service.

The position was explained in an article in the Newham Recorder on 15 April, which referred to hospital neglect of a dying woman. The article reads: Damning allegations about lack of nursing care for a dying 71-year old woman were admitted last week by Newham General Hospital. Hospital chiefs upheld her son's claim that she was left unattended for four hours after falling and badly cutting her face. The Hospital Manager … said: 'We apologise unreservedly. We accept that the state she was found in was unacceptable.' He said the ward she was in was understaffed, and had many nurses who were only temporary, when the incident happened over Christmas last year. 'We have been trying to improve the care on that ward ever since', he said. The article continues: When her son David visited on Christmas Eve he found her slumped in a chair, unattended, with blood on her face. He stayed with her for four hours but could get no treatment for her. Mr. Cookson, who lives in America, told Newham General he was 'disgusted' with their treatment of his mother. I can well understand that Mr. Cookson was appalled at the treatment received by his mother—so would all of us be. But Cabinet Ministers do not suffer such treatment. They do not use the service The Prime Minister claimed that the NHS was safe in her hands, but she does not consider herself safe in its hands. When she requires treatment she goes private. We are getting double standards, a good standard for the wealthy who can buy privilege and a second-class one for the rest. It is a two-tier system with profit-led care for the haves and an inferior cash-starved service for the have-nots.

The Government's encouragement of private practice is of no use to the people of Newham. My constituents see only a faltering commitment to the NHS, with a lack of resources damaging the standard and quality of health care, undermining the basic principles on which the NHS was built.

The NHS was built by a previous Labour Government on the noble socialist principle that in sickness wealth should be no advantage and poverty no disadvantage, that the best treatment should be available to all free at the point of use and paid for from general taxation. In this way the healthy support the sick. Now we have a Government who cut taxation while starving the NHS, thereby vandalising a service of which this country was once so proud.

I make no criticism of the medical staff. They are devoted to their tasks but overworked and underpaid. They are bearing the brunt, unfairly, for the under-resourcing of the NHS. The system is kept afloat only by working dedicated staff into the ground. The Government often boast about the increased throughput of more patients despite fewer beds, but higher throughput means patients are more dependent, and therefore more demanding when in hospital. But a price has to be paid, and it is being paid by the nurses. They endure stress, depression, fatigue and often poor job satisfaction through lack of time to do work properly, in deteriorating conditions. Is it surprising that morale plunges?

We must obtain practical and effective solutions to the real and pressing problems in Newham today. The Government must show that they care. I hope that I do not hear from the Minister the tired, stale old excuses or the jargon-riddled evasions that I have received in official letters before, when I have raised these matters on behalf of the people whom I represent. Action needs to be taken now, and I hope we shall see some new thinking and positive steps taken quickly to alleviate the pain and distress that exists.

First, let me deal with pay. I welcome the agreement to implement nationally the proposals of the pay review body. However, in the Newham context, we must go further. Our borough, for some inexplicable and bizarre official reason, is not considered inner London, although it is impossible to imagine a borough more "inner city" than Newham, whatever criteria one takes. Not only that, but Government statistics reveal that we are the most deprived local authority area, bar one, in the whole of England and Wales. So why this absurd and unjust discrimination? Newham should immediately be classified "inner London". That would straight away give higher salaries to many of the staff, and bring them up to those paid to our neighbours. Unless and until that is done, the attraction will always be to the adjacent boroughs, thus denuding Newham because of its low salaries—despite its high living and housing costs, the threat of crime and the other drawbacks of deprived areas.

I wrote to the Department about the matter twice last year, and received replies from the Under-Secretary on 20 May and 19 August. In his last letter, he talked of the boundaries of the London weighting. Of course a line has to be drawn somewhere, but surely it must be plain that it is ludicrously drawn at the moment, with St. Andrew's hospital on one side and Newham general on the other, and leaving the borough of Newham on the wrong side. Remedying that nonsense is something that can be beneficially done now. In addition, the Government should consider other ways of providing premium pay for areas with shortages of staff. I should have thought that that fitted in with their own ideas of "market mechanisms". In his letter to me, the Under-Secretary said: In the longer term, we have identified as a top priority for the NHS Management Board, and Len Peach as Director of Personnel, achievement of an adequate supply of well-trained and motivated staff and securing action on significant shortages of manpower. Work is in hand to find ways to reflect local economic factors in pay arrangements whilst preserving the essential, national framework of the service. " So "work is in hand". That was many months ago. What has happened to that work? Why the delay? Why not get on with it? Will the Minister announce something advantageous to us today, as she has the opportunity?

Then we must look at housing. Why should staff journey to work in Newham from other, possibly leafier, suburbs? It is impossible, with prices soaring far out of their reach, for staff to buy houses in the borough. On the contrary, many nurses have been driven out, and are leaving for other parts of the country with cheaper houses and lower living costs. We shall never solve our staff shortages until we tackle the accommodation problem.

What do the Government propose? I ask the Minister to reply specifically on that point. The Government have slashed the money to local government for housing by well over half, and have cut Newham's housing investment programme allocation by over £150 million since 1979. That has resulted in an exacerbated housing crisis in Newham, with over 12,000 people on the waiting list and hundreds of homeless families in bed-and-breakfast accommodation.

The borough council can do little. The Government have a responsibility: what are they going to do? I want to hear the answer today.

Finally, I make a proposal of my own. The Government never tire of telling us that the London Docklands Development Corporation is regenerating east London. What has it done to regenerate the National Health Service? A considerable population is growing in Beckton, all of whom will need health care; they will make demands on the National Health Service. There are, of course, plenty of flats for sale in docklands, if one has the spare £350,000 to pay. But the nurses do not. Will the Government take action to see that the development in Docklands not only makes demands on the NHS but also contributes to it? This is one of the few places locally with land available. Will the Government speak to the LDDC now, with a view to building nurses' accommodation in Docklands at low cost? That would attack the problem. It would be a practical idea, and this afternoon we want to hear from the Government some practical ideas. We want to hear not what they cannot do but what they can do.

I look for an assurance that the Minister and her officials will give their full attention to the staffing of the NHS in the borough and that they will take all the action that is necessary to remedy the scandal of the gross and dangerous shortages that exist, and to ensure that the people of Newham have a good, adequately funded, resourced and staffed health care system, on which they know that they can rely.

I look forward to the Minister's reply. She must know that, unless urgent action is taken now, the NHS in my area will slide further into a spiral of decline from which it will be difficult to recover.

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

As is the usual courtesy, I congratulate the hon. Member for Newham, North-East (Mr. Leighton) on his success in the ballot and on choosing this subject for today's debate. He has made a number of my points for me, such as pay and Len Peach's suggestions about pay flexibility, but I am afraid that shortage of time means that I shall be unable to answer all his questions. Perhaps he would write to my right hon. Friend the Secretary of State for the Environment, who I am sure would be interested to hear from him about housing in London.

Mr. Nigel Spearing (Newham, South)

What about the boundary point?

Mrs. Currie

If Opposition Members want an answer to some of the questions for which I have responsibility, I hope that they will provide me with an opportunity to give them.

The Newham health authority is one of the best in London. Under the leadership of Sally, Lady Sherman, and all her staff, it is doing an excellent job in caring for the people of east London. It is a caring, thorough and responsible authority. Recently I visited Plaistow hospital for the rededication of the chapel, which was led by Princess Alice. I was most impressed. I understand that substantial improvements in health care have taken place since the Newham district general hospital was opened in 1983.

I am glad to have the opportunity to discuss briefly today the staffing of such an authority. The hon. Gentleman is quite right when he says that there are problems. I have obtained a list of the directly employed staff of Newham health authority at 30 April 1987. If he wishes to have it, I shall arrange for the hon. Gentleman to have a copy of this information. It shows that in certain specialties, not just nursing, there are serious problems. Nursing is the most spectacular simply because large numbers of nurses are employed. The number of budgeted establishment places for trained nurses is 946, but only 752 are in post. The authority is all right for untrained nurses in post. It has 180 out of the budgeted number of 183. The budgeted learners establishment is 250, but only 188 are in post. I suspect that that has much to do with the drop in the enrolled nurse training intake that has taken place recently all over the country.

The authority should have 28 pharmacy staff but it has only 21. It should have 18 operating department assistants but it has only 13. It should have 32 radiographers, but there are only 27. It should have four audiologists, but it has only one. It should have 41 physiotherapists, but it has only 34. The authority has 19 speech therapists, and that is its budgeted number. The authority is very short of occupational therapists. There should be 17 occupational therapists in post but there are only seven.

The authority should have 285 administrative and clerical workers, but there are only 256 in post. I confirm that the hon. Gentleman is right to draw attention to how difficult it is to attract medical secretaries. That problem exists not just in Newham or in London but in a number of other parts of the country where alternative employment is readily available.

The hospital is all right for library staff; it has one post and one person in post. Severity-seven of the 90 catering posts are occupied, but there are only 127 domestic and cleaning staff out of an establishment of 151. Portering, linen and transport are all satisfactory. The engineering services are slightly down, but not substantially so, although, of the 18 posts in building services, only 12 are filled. The hospital is up to establishment in garden maintenance and health education services. The problem therefore seems to be specific to certain activities. l note with great interest that some of the unskilled posts seem to be filled and that the problem seems to be in recruiting to fill the skilled posts. If I have time, I shall come back to that.

The authority tells me it has experienced some difficulties in recruiting permanent nursing staff up to the complement, although most of the vacancies are filled with agency nurses, which does not cost more, because the authority is obliged to pay the nurse only at the midpoint of the scale relevant to her qualification. A number of measures have been taken to boost the recruitment of nursing staff. The authority is seeking to remedy the shortage of theatre nurses by pursuing an in-house training programme and, in the long term, by developing links with the English national board's theatre course at the London hospital. The authority has involved itself in a little reverse brain drain by recruiting in Ireland, where it interviewed 500 possible recruits. Eighty-four training places were on offer and 30 applications from trained nurses are now being processed along with a further 280 letters of inquiry. We welcome that development.

The health authority is planning to spend an extra £66,500 in 1987–88 to promote recruitment. In addition to that normal advertising, health authority officers run a weekly job shop at Plaistow jobcentre and plan to extend the scheme to other jobcentres. Resources have been set aside for London Transport and local bus advertising, and efforts have been made to recruit staff in areas of high unemployment such as Liverpool and Yorkshire. There has been a good response to the authority's clerical and secretarial register, which will act as an employment bank.

Therefore, it is not a question of money, and the problem is certainly not to do with the funding that goes to the health authority. In 1982–83, the gross revenue expenditure of the health authority was £30,613,000. This year, the initial cash allocation is over £44 million, which represents a substantial increase and an increase in real terms. The authority's funding this year shows a 4 per cent. change from the previous year.

The problem is not affecting patients. The number of in-patient cases has risen from 21,000 in 1982 to over 22,000 while the number of clay cases has increased from 1,600 to 35,000. Added together, those figures show that the number of patients who are treated per year has risen by about a seventh. Out-patient attendances are affected by changes in the arrangements for ear, nose and throat and general surgery and other changes that have been made since the new hospital was opened. However, the waiting list in Newham is very much better. The improvement is among the best in the country. The number of people waiting for urgent treatment dropped from 2,000 on 31 March 1983 to 1,188 on 30 September 1986, the last date for which figures are available, and very few have to wait for longer than the required one month.

Similarly, the number of non-urgent cases has dropped from 1,819 to 1,115. The improvement applies to general surgery, and trauma and orthopaedics, for which the number of non-urgent cases on the waiting list dropped during that period from 532 to 393, and only 64 cases now have to wait more than a year. I accept that that figure is too high, but there has been a spectacular improvement.

Mr. Spearing

Will the hon. Lady give way?

Mrs. Currie

I am sorry, but there is no time.

Mr. Spearing

There are four minutes left.

Mrs. Currie

With the gaps in staffing that we have seen, but with a substantial increase in funding, a leap in patient treatment and a clearing of waiting lists — an improvement of some 40 per cent.—there are a number of points that are clear and worth putting on the record. [Interruption.] The National Health Service staff are clearly all working like Trojans. Since those people are the constituents of the hon. Member for Newham, South (Mr. Spearing) I hope that he will join me in recognising the extraordinary spectacular efforts that are clearly being put into Newham by all National Health Service staff. Any company—indeed, any establishment—would be proud of the way in which staff are working in that health authority. It is remarkable. I was particularly pleased when I was there to see how good morale was and the cheerful and pleasant atmosphere all those staff had created for patients.

One of two things is happening. Newham may be managing perfectly well without its full "paper" establishment of staff. The authoriy tells me that it is using overtime and agency staff and, as a result, is within 2 or 3 per cent. of establishment. That may be a sensible way to respond to fluctuating need, but management would be wise if it looked at its funded establishment to see whether it has the pattern and teams — the mix — that it still wants, or whether changes are needed. I am sure that the hon. Member for Newham, North-East agrees that it serves no purpose to put numbers on a piece of paper. But this also raises the question how staff in scarce specialties can be well and effectively used. As a result of today's debate, I shall send the figures to the regional health authority and Lady Sherman and ask if they can give some thought to the sort of questions that I am raising. I hope that the hon. Gentleman will support me.

Either Newham is managing perfectly well by managing its staff in a way that does not show on paper, in which case it should be more explicit about it, or it is not managing perfectly well and staff should be recruited.

Mr. Spearing

Boundaries.

Mrs. Currie

My guess is that it is not a matter of boundaries. We find these difficulties in a number of parts of London. Therefore, poaching from other neighbour-hoods would not solve the problem.

I was interested recently to meet nurse trainers from the West Lambeth health authority who are making a considerable effort to recruit and train young men and women from the Brixton area—people who do not have the paper qualifications to come into the traditional forms of training but who, they feel, have a great deal to offer the Health Service. They find that they are meeting an enormous enthusiastic response. I have spoken to the chairman of that district health authority about the efforts of those nurse trainers and asked him to support them.

It is significant that Newham is able to recruit people for the unskilled posts but has the most difficulty in recruiting for the highly skilled posts; yet there are supposed to be 300,000 unemployed people in London. Perhaps, as a result of today's discussion, which I welcome, we can draw the attention of all concerned to the question whether our patterns of recruitment and training, particularly in London where these problems seem most acute — and not just in nursing because, as we have demonstrated, the problem seems to be reflected in a number of other jobs—are appropriate to the labour force which is available and which wishes to work for us.

It may well be that nothing much will come out of this, that we shall continue in the same way and that health authorities such as Newham will continue to use overtime and agencies as they have done so far. If they continue to look after more patients and to bring down their waiting lists, I have to say that we should work on results as much as on input.

Perhaps, as a result of today's discussion, a spark has been struck which may help the constituents of not only the hon. Member for Newham, North-East but other London Members and people throughout the Health Service. I am more than willing 'to have an open mind on these matters and I shall endeavour to take the action which I have described.

3.3 pm

Mr. Nigel Spearing (Newham, South)

The Minister has not answered the central points put by my hon. Friend the Member for Newham, North-East (Mr. Leighton) about the recruitment of nurses for an accident and emergency service, about the whole question of boundaries and about adequate incentives for skilled secretaries——

The Question having been proposed after half-past Two o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at four minutes past Three o'clock.