§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]
§ 12.9 am
§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)
I am grateful for this opportunity of presenting to the House the serious financial position of the Pontefract district health authority. I must inform the Minister and the House that my hon. Friends the Members for Normanton (Mr. O'Brien), for Hemsworth (Mr. Buckley) and for Wakefield (Mr. Hinchliffe) associate themselves with my remarks, and that my hon. Friend the Member for Wakefield hopes to draw the House's attention to the problem in his area as soon as it is possible and convenient.
The serious financial constraints facing the Pontefract area health authority arise from a package of cuts totalling £1,652,000 that has already been required this year. Those cuts are likely to remain for the duration of the short-term programme. In addition, there is considerable doubt about the unit's ability to maintain this level of cuts next year.
Two near miracles were achieved in Pontefract in the early summer. On Monday 10 August the emergency and casualty department of Pontefract general infirmary was closed for 12 hours between 9 pm and 9 am each day. That serious decision was taken for a hospital whose catchment area includes major industries—mining and chemicals—and two major motorways. The surprise was that within two or three days the hospital was able to announce its reopening, because it had been able to find some doctors to staff the unit—doctors that it had been unable to find for months before.
The second miracle was the admission by the Minister that the Pontefract general infirmary was seriously underfunded and consequently run down. No one suggested that it was an inefficient hospital. No one could; there were figures to prove that it was efficient. In England, we now spend £724 per case, and in Yorkshire the figure is £662, but in Pontefract we spend only £580, which is well below the national average. We have not an inefficient authority but a seriously underfunded one.
Let us examine the figures. For 1987–88, £25,198,000 was the revenue allocated in the budget. That represented much less than the authority's projections. Its budget was for £26 million. So, from the first day of the financial year, there was a shortfall of £802,000. Recognising that it had a major problem, the health authority started closing wards, delaying appointments and generally cutting back on staff.
We are not discussing a hospital situated among leafy suburbs; it is in an area of high unemployment, where people suffer from chronic chest complaints and major industrial diseases, and where it is difficult to recruit young doctors. Unfortunately, the measures taken did not achieve the economies required to bridge the gap between the health authority's projections and the revenue offered. Yet the hospital was not inefficient, and it was spending a fifth less per case than the national average.
In case the Minister thinks that this is special party political pleading, I shall make two points. My mailbag is crammed with letters not only from patients and their families complaining about hospital waiting lists, but from local industrialists. I have them here and they are available for perusal by any hon. Member, and certainly by the Minister. They all recognise that the cuts have gone too 427 far. I have letters that I hope to present to the Minister from 47 patients and members of staff of the Castleford and Normanton hospital. The operating theatre there is about to close. The local newspaper, the Pontefract and Castleford Express regularly highlights the problem in front-page headlines. In letters to the press, a local general practitioner asks if we are to expect improvements only after we have the poor sleeping on mattresses in corridors in the manner of Third-world countries.
I recently had a letter from a Methodist minister, and it is worthy of quotation. It is from the Rev. John B. McCarthy, the superintendent minister of the Castleford Methodist circuit. The letter says:As Hospital Chaplain at the Castleford & Normanton Hospital in the Pontefract Health Authority I write to express my deepest concern at the proposals which will result in a grave deterioration in the health and welfare of the people in this area. I have ministered in Castleford, Pontefract and district for twenty four years, during which time I have visited the local hospitals regularly, and for the past two years have been a hospital chaplain. The standard of nursing in our hospitals is of the highest quality, and during the past two years in particular I have been deeply moved by the ready testimony of patients at Castleford to the excellent care and encouragement they have received from the hospital staff.I can only make a plea that such a high quality of nursing should be continued by maintaining the wards at the Castleford & Normanton hospital. In the present climate of fear and anxiety which affects everyone, but particularly the older members of the community, I believe it is essential that we should have confidence in our hospital service, and I plead with you to exercise your influence to build up this confidence.For the sake of those who need helping most please do all you can to encourage Her Majesty's Government to direct more money to support the Health Service in this community.I have many such letters from people who are not at all involved in politics.
The matter does not end there. Last Thursday the doctors in the area took an unprecedented step. As far as I am aware, it was unprecedented, although such steps may have been taken elsewhere. They published in the local newspaper an article which has no political bias, but which expresses great concern. It says:People of the five hospitals (Served by the Pontefract District Health Authority). Divisions of geriatrics. Are you aware of the proposed cuts planned for your hospital service? The Health Authority's … budget is overspent by £805,000—but we are efficient. Pontefract spend: £580 per case; Yorkshire spend: £662 per case; England spend: £724 per case. No more money is available. Drastic cuts are inevitable. Emergencies will be treated but the waiting time for Routine General Surgery, Orthopaedics and Urology will escalate.Effects of cuts after 1 year:The advertisement was referring not to me; it was referring to the Minister and the Government that she represents. The advertisement goes on to say:
The hospital service is at the mercy of the politicians.
- (1) General Surgical waiting lists will double to more than 2,000.
- (2) Orthopaedics—present waiting time 8 months—after cuts will rise to 22 months.Are you prepared to accept this inadequate service? We look to you the community to take action.It says that people should tell their councillors and Members of Parliament, and concludes:This advertisement has been inserted and paid for by the Consultants at Pontefract General Infirmary.Those consultants are apolitical. Authorities and hospitals are inefficient, but the inefficiencies in Pontefract 428 hospitals are the result of the sloppy, inefficient thinking of the Government and the greed of some of the consultants. The Government stand for free enterprise, and as part of that stance they encourage the opening of local private hospitals. A new hospital called Methley Park was opened on the edge of my constituency three years ago. The secretary of that hospital, Mr. J. Whitfield, was a Member of Parliament for Dewsbury. When the hospital was just an idea, doctors and consultants in the area were invited to become shareholders. Many did, and that compromised their integrity. Their desire for money compromised their medical ethics.
The directors' report of 31 December 1985 revealed that in the first two-year period the hospital lost £547,674. The chairman of the hospital suggested that all concerned should market it. They tried very hard and, as the Minister will be aware, before the last election the Government made money available to shorten hospital waiting lists. The Pontefract area received about £90,000 to £100,000. The health authority produced a plan whereby the Pontefract general infirmary would take 660 patients off the hospital waiting list. Unfortunately, that was not acceptable to the consultants. Therefore, the health authority produced another plan whereby the private hospital would perform only 302 operations for the same money. The consultants who refused to perform operations at Pontefract were the same consultants who performed those operations at the private hospital. That is a serious situation.
The health authority was put in the position of being blackmailed. It had no option but to agree. I hope that serious consideration of these matters will be brought to bear in future.
Services are beginning to crumble in Pontefract. The result of recent decisions is that the waiting list will increase by 1,300. In other words, it will nearly double. It must be remembered that earlier in the year 300 were taken off the list when 600 should have been removed from it. I shall attempt now to bring my remarks to a conclusion because I know that my hon. Friend the Member for Normanton (Mr. O'Brien) would like to intervene in the debate for a few minutes.
We shall lose 64 beds at the Southmoor hospital. The geriatric unit at the Pontefract general infirmary is to close. I could continue on that theme, but instead I shall put some questions to the Minister. Does she stand by her statement in her letter of 26 August 1987 that the Pontefract area health authority is underfunded? Does she accept that health care in my constituency has reached a dangerous level? Does she accept that consultants should not be encouraged to become shareholders in hospitals near the catchment area of their prime employer, the National Health Service? Will she consider establishing a judicial inquiry into the procedures that were implemented at the meeting of the Pontefract district health authority on 12 October 1987? Great concern has been expressed in local circles about the validity of the vote.
I ask the Minister to investigate why the procedures of consultation with the community health council and other interested bodies, including local authorities, were not implemented before a decision was taken. Most importantly, will the Minister give serious consideration to provide extra funding to enable the authority to withdraw its decision to introduce savage cuts in patient care?
I should like to know whether Methley park hospital received any funding from the business expansion scheme. 429 Finally, will the Minister please consider my request to visit Pontefract and investigate the serious issues to which I have referred?
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
I congratulate the hon. Member for Pontefract and Castleford (Mr. Lofthouse) on winning the ballot and gaining the opportunity again to raise on the Adjournment the important matters that involve the Pontefract district health authority. I met the hon. Gentleman and the right hon. Member for Wakefield (Mr. Harrison) in Sheffield on 14 September to discuss Pontefract and Wakefield's respective financial positions. I know that Bryan Askew, the chairman of the Yorkshire regional health authority, has done likewise on several occasions, and most recently on 16 October 1987. With those meetings and this evening's debate, I hope that the hon. Member for Pontefract and Castleford feels that he is being given every opportunity to represent his constituents, with whom I feel rather familiar.
Bryan Askew and I have said that a major cause of the tight financial position of some districts in Yorkshire and elsewhere has been their success in treating ever increasing numbers of patients. This increased productivity is excellent but local management has continually to balance it against the expected growth in income. Yorkshire districts on the whole are doing just that and are to be applauded for all their efforts in this direction. I wish particularly to put on record my admiration for the steady and sensible efforts of Roy Widdowson, the chairman of Pontefract, and George Barnes, the district general manager, who try to keep local Members well briefed.
It is the responsibility of all health authorities, as with other organisations, to work within their budgets. There was a statutory obligation not to overspend, and I accept that in Pontefract this may have required some difficult decisions to be taken and priorities to be reassessed, but to the authority's credit it has sought to do this in a sensible and rational way. I am advised that the measures taken for this year, 1987–88, should not significantly affect the volume of patient care. The proposals for 1988–89 will need to be worked out in detail and where appropriate they will be subject to consultation. I take note of the hon. Gentleman's questions and I look forward particularly to responding to his invitation to visit Pontefract. I have no doubt that I shall be treated with the greatest courtesy that is typical of Yorkshire people, especially if he promises to come with me on the day.
The track record of the Health Service is one of continuing success, and sadly that is all too often overlooked by the critics. Some 6.5 million in-patients and more than 37.5 million out-patients were treated in England last year and that is an all-time record. I am sure that we would all like to pay tribute to the hard work and dedication of the doctors, nurses and the staff of the Health Service which those figures demonstrate.
We are now involved in the biggest hospital building programme ever seen in the Health Service, worth more than £3 billion. We are employing over 11,300 more doctors and dentists and more than 51,000 nurses and midwives than in 1979. We have new and better services, such as the computerised call and re-call schemes to ensure 430 that women at risk will be screened for cervical and breast cancer, and we are the only country outside Scandinavia to make national progress in that way. Yorkshire's first breast cancer screening centre will be at Huddersfield, with several more centres opening to provide a countrywide service by 1990. We have been making the reduction 0.r waiting times for hospital treatment a major priority. We are providing £50 million over two years, which should lead to an additional 100,000 people on the waiting lists being treated this year and a similar number next year.
§ Mrs. Currie
I may answer the hon. Gentleman's point in my next sentence.
Pontefract district health authority is receiving over £82,000 from the waiting list fund this year to carry out 725 extra operations on people on its waiting lists during 1987–88. The specialties involved are urology, gynaecology and orthopaedics. The waiting list in the Pontefract DHA. fell by 350 cases in the six months to March 1987. The number of urgent cases waiting more than a month has also fallen quite dramatically. The number of non-urgent cases waiting more than a year rose by 70, but that represents a relatively small proportion of the total waiting list. The figures do not reflect the additional operations to be carried out with money from the waiting list fund. It is also worth putting on record the important fact that the Yorkshire regional health authority intends to carry out work on increasing health promotion. It hopes to increase its budget on that from under £300,000 to nearly £3 million over the 10-year planning period.
§ Mr. O'Brien
The procedure on closing hospitals means that there should be consultation with CHCs and other community interests. What procedures have been carried out in the case of the closure of the Wardle Aldam hospital in the Pontefract district area, where the decision was taken to close the hospital without consultation? Will the Minister ensure that DHSS guidelines are carried out in our area?
§ Mrs. Currie
I am satisfied that the guidelines have been followed. Any permanent change, if the CHC disapproves, must come to Ministers and go through the appropriate consultation procedures. However, temporary changes are entirely within the purview of the district health authority, and that is a matter of fact.
If we consider what has been happening in Yorkshire and Pontefract in a little more detail we find that the gross revenue spending for Yorkshire has risen from £313 million in 1978–79 to an initial revenue cash allocation this year of £786 million. We expect, therefore, that it will have an increase of some 27 per cent. in real terms over the earlier figure. That is quite dramatic. Capital spending in Yorkshire has also increased dramatically to more than £70 million. The total released by land sales is also commendable and the figure since 1978–79 is £8 million.
It is also worth putting the growth in Pontefract on record. I want to make comparisons with the year 1982, when the new district health authorities were formed. Last year Pontefract health authority treated 22,765 in-patient cases which is a 14 per cent. increase over the 1982 figure. It dealt with more than 117,000 out-patient attendances, a 13 per cent. increase over the 1982 figure and it dealt with over 20,000 day-patient attendances, a 78 per cent. increase over the 1982 figure. That is hardly a 431grave deterioration in the health and welfare of Pontefract people.as stated by the Methodist minister referred to by the hon. Member for Pontefract and Castleford.
More staff are employed—especially more front-line staff—and there is more money. In 1982–83, the figure for Pontefract was just about £20 million. This year the initial cash allocation is £28.25 million and I am sure that the hon. Member for Pontefract and Castleford will realise that that is a substantial increase.
Capital spending in Pontefract has also shown an improvement, and there are more improvements to come. Pontefract has already benefited from increased capital spending with the completion of the new geriatric and psychiatric unit at Pontefract general infirmary in 1981 which cost £2 million. A long list of projects that are under way or shortly to start also includes the day surgery unit of £1.7 million, which has already been started, the intensive treatment unit and coronary care unit costing £0.7 million, which will be started this financial year, new accident and emergency department and out-patient facilities, replacement wards for Pontefract general infirmary, which are to start shortly, and a long-stay unit for the mentally ill which is planned to start in 1990–91.
§ Mr. Lofthouse
The hon. Lady will recollect that there was some difference between us about Sheffield's total allocation. The regional health authority confirms that the allocation was £25,188,000 for this financial year. Is the Minister saying that that is wrong and that it is £28 million? If that is the case, the local authority does not know about it.
§ Mrs. Currie
My advice is that the initial cash allocation for this year was £28 million, as I have just said. The hon. Gentleman should be aware that a health authority spends money from several different pockets, which may include proceeds from land sales or the special initiatives that I have mentioned. That is the figure that is being spent.
In all, some six major schemes costing over £9 million are due to start this year or next, with further development later. That is where the point about what might be meant by underspending arises.
The regional strategic plan provides for Pontefract to receive an extra £6.9 million of revenue after allowing for inflation by 1993–94 to enable the authority to develop its own services for its own people. The extra money therefore recognises that work currently undertaken in other districts on behalf of Pontefract will be taken over by Pontefract. That cannot be done overnight. It depends on how the new more efficient facilities are brought on stream and how they function and on the achievement of the region's target for cost-improvement programmes, which I know that the hon. Gentleman will actively support.
432 The Government and the regional health authority recognise that, in order to look after its own people locally, the health authority will require additional resources in future. It does not mean that people are being prevented from seeking treatment now, but it does mean that they are having to travel too far and are receiving that treatment in old facilities which require replacement. That might also explain the sharp difference in the cost per case. If the complicated cases cannot be dealt with in Pontefract, they must go somewhere else and that will affect the cost per case in Pontefract. The figures are not comparable.
However, I have looked again at the performance indicators that I showed the hon. Gentleman when I met him in Sheffield, and it is worth putting them on the record briefly. They are only a guide to areas that need to be investigated, but they at least demonstrate that there may be patterns of work that could be tackled.
The gap between patients in general medicine beds in Pontefract is 2.9 days which is among the worst turnover intervals in Britain. It means that beds may be lying idle for long intervals between cases. The annual number of patients per obstetric bed is among the lowest 10 per cent. in the country. That is not because of the length of stay is unduly long. Other explanations suggest themselves.
If we look at the occupancy of beds, we find that for nearly all the main specialties, with the exception of gynaecology, Pontefract is well below the England averages and sometimes very much below. In general medicine fewer than 70 per cent. of beds are occupied. That is less than it used to be. In general surgery only 66 per cent. of the beds are occupied and that is much the same as it has been for many years. In ear, nose and throat, only 39 per cent. of the beds allocated to that specialty are occupied and that is a drop on previous years. Those are the figures for 1986.
Those figures are not the whole truth. I am sure that local investigation is required to discover the underlying reasons, but there is clearly scope for tackling the questions. Nor is it a matter of doing loads of day cases instead at the moment because most specialties do not do very many, while the larger numbers in general medicine and general surgery have not changed much in recent years. We expect that that will improve as the new day surgery facility comes on stream.
I hope that I have managed to convince the hon. Gentleman and his hon. Friends that Pontefract is benefiting considerably from national initiatives and local efforts. It is to be congratulated on its progress and—
§ The motion having been made after Ten o'clock on Wednesday evening and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-one minutes to One o'clock.