HC Deb 14 April 1988 vol 131 cc448-56

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

10.8 pm

Mr. Max Madden (Bradford, West)

I am pleased to have this opportunity to introduce a brief debate on the National Health Service in Bradford. Last December., I was also most grateful to have the opportunity of introducing a debate on poverty in Bradford which showed clearly the direct links between poverty, especially unemployment, large-cale dependence on benefits, poor and over-crowded homes and ill health.

I am sad to say that Bradford has become known as a low pay city by reputation to a large number of people by virtue of the extensive low-pay of people in full-time employment. I am sad to say that Bradford is also a poor-health city. More babies die in Bradford than in most other cities. There is a high incidence of heart disease and illness associated with poverty, particularly tuberculosis and dysentery which, sadly, are commonplace.

There are 25,000 unemployed men and women, and one third of the population depend on benefit. There are so-called poverty zones in Bradford where men, women and children are caught in a vicious spiral of deprivation and decline, producing a sub-culture of alienated and apathetic people who have very little hope for themselves, their families, for others in the community or for the community itself. Above all, those people need worthwhile, well-paid work, job security and confidence to plan for a better future for themselves and their families.

Too many people are trapped in the despair of years of unemployment, desperate hardship and increasingly extensive debt. In many cases their confidence of ever getting a decent job and keeping a decent job with decent pay is shot through. Too many people are fed up with temporary job programmes and training programmes and go back on the dole or to part-time and low-paid work.

If private investment is to come to Bradford, it must be encouraged by public investment being pumped into that city by Government. Sadly I have to report to the House that if all the money available under the latest initiative—the so-called city action programme—were spent in Bradford, it would represent less than £1 per head for every person in the district. The best way to prevent illness in Bradford is to remove or substantially lessen the burden of poverty which grips our city. More work is the key, with more and better homes, better community services and a better community environment.

Earlier this year, Bradford suffered a major blow when Bradford health authority announced NHS cuts of more than £2 million. Last month, that package of cuts was revised downwards to £1.4 million after extensive protests throughout the district. Inevitably, it will affect the standard of patient care and patient services. We are confronted with the closure of a maternity ward at St. Luke's hospital, and the transfer of some family planning services from excellent NHS clinics to general practitioners. We are also confronted with cuts in cancer screening and community nursing and the cancellation of a rheumatology consultant appointment for young disabled people. Fewer people living outside Bradford will be able to receive treatment which traditionally has been available in the city.

All that is to bring the authority into balance next year. The bulk of the cuts are being introduced only for financial reasons, because DHSS Ministers say that the authority is not allowed to go into deficit.

Health authorities are subject to central control and the chairs of regional health authorities are widely perceived as reliable, safe political agents of the Government. Just how that has come about can be seen by the cavalier and the discourteous way in which Mr. Royston Moore, a senior Conservative politician, has been treated. He was the chair of the Bradford health authority for some time and I understand that he was telephoned only days before the March meeting of the health authority and told that he would not be reappointed. He was not even informed who his successor was to be. That is a disgraceful way for such a senior public servant to be treated by the DHSS. Sadly, it has become fashionable for the DHSS and the Government to treat senior public figures in that way.

The Prime Minister, a mother, tells us and the public that the National Health Service is safe in her hands. In that case, how can she stand back and allow a maternity ward in Bradford to close? How can she allow excellent family planning advice to be denied to large numbers of women of all ethnic origins who want that advice to be given by women and who are extremely reluctant to attend male doctors? How can the Prime Minister stand back and allow £1.4 million to be taken away from the NHS in Bradford this year with the possibility of more being taken the year after?

"Grapevine", the official newsletter of the Bradford health authority, had a new year message in January this year under the banner headline: A happy new year to all our Readers. The message from the district general manager, Mr. Mark Baker, said: It has been a long hard autumn. Since September we have been trying to wriggle out of our most serious financial crisis ever. In addition to the much publicised ward closures, we have had to stop building programmes, equipment purchase, restrict the use of agencies, save energy, freeze management posts and many other things in order to save money. So far, although we have closed beds, clinical services have largely been spared. It is not clear yet how badly off financially we will be next year. Indications are that we will start the year with a deficit of at least £1 million despite all our efforts this year, and maybe as high as £2 million. Managers alone cannot solve the problem, nor is the Government going to change its policies on Health Service funding overnight. If we are to continue developing services, and avoid painful closures, everyone must help. Use up old stocks rather than ordering new; save paper in case notes and in communications, save energy by turning off lights and heaters. Above all, think about the cost of what you do. The simplest of tasks involving machines or other equipment has a cost to it. If everybody helps, jobs and services will be more secure.

That is the reality of the new year message to the staff of Bradford health authority.

I urge the hon. Member for Derbyshire, South (Mrs. Currie) to consider a number of positive suggestions that I should like to put to her. They are ways in which the Government could make a direct contribution to relieving the financial pressures of Bradford health authority and which would remove entirely the need for the cuts package this year and the threatened cuts package next year.

First, I understand that the pay award report is with the Prime Minister. I urge the Prime Minister and the Minister to understand that if the pay award is fully funded it will give Bradford an extra £660,000 this year. I hope that the pay recommendations will be accepted in full. A total of 500 staff have been made redundant from Bradford health authority in recent years. In fact, staff morale is so low that a working party has been looking into the reasons for that low morale for some time. In 1987 a report from that working party said: The Authority's Working Party on Staff Morale has at several meetings discussed a concern that low pay is contributing to the low morale of certain groups of employees in the Health Service. That is no surprise because the working party also discussed the pay levels of ASC groups 1 and 2, Clerical Officers and Nursing Auxiliaries. It said: For each of these groups average gross earnings were below the EEC low pay figure' of £116 per week. The conclusion of that working party in its report was the following: The Authority records its concern about continuing levels of low pay for various pay groups in the NHS, which are felt to contribute to problems of staff morale within the Service, and to difficulties in recruiting and retaining staff.

I say to the Prime Minister and to the hon. Lady who will reply tonight that, if it is seen to be necessary for the Government to give substantial pay increases to judges, the police, the military and others whom they wish to recruit, retain and motivate, it is similarly vital that all those who work in the Health Service should be treated in the same considerate and generous fashion.

The hon. Member for Derbyshire, South is very free with her advice. Most of it is met with derision by my constituents. If she really wants to stop people, especially young people, smoking and drinking alcohol, why does she not ban tobacco firms and brewers from advertising their products in sponsoring sporting events? If she really wants to stop taxpayers' money being wasted in the National Health Service, why does she not bring the drugs industry into public ownership?

If the hon. Lady wants to give the Bradford health authority extra money, why does she not exempt the authority from rates, which would give it an extra £1 million this year? I understand that private nursing homes are exempt from rates. Why then is the National Health Service liable to rates? I also suggest, since we shall be debating the poll tax next week, that the NHS should be exempt from the poll tax.

Why are not the Bradford and other NHS authorities throughout the country exempt from water and sewerage charges, which also represent a substantial burden on those authorities at the present time?

Why can the Government not provide extra funding for maternity, family planning, cytology, and community nursing services and a new, urgently needed consultant rheumatologist to deal with the young disabled?

This week's social security cuts add enormously to the poverty in Bradford and will intensify ill-health. Only this week, I was told about a young widow with five children who, as she is in receipt of widowed mother's allowance, is not eligible for free school meals. She will now have to pay an extra £15 a week for the school meals which her five children take each day. There are 9,500 children in Bradford who will lose the right to free school meals as of this week.

Credit must go to the Labour-controlled Bradford council, which has sought to relieve some of the hardship that the cuts in social security will bring many men, women and children in our city by supplying school milk, which the Government stop them supplying free, at 1p a day, so that it can continue to be given to children under the age of nine at school. The council has also cut the price of school meals to help those who are losing out under the social security cuts.

There is no way that the charities of Bradford or of the rest of the country can replace the DHSS payments that used to be made for all sorts of urgent necessities to very poor people. It is indeed sad that we are this week taking a step back in history into poor relief, with deserving and undeserving poor.

Pensioners resent being told by the hon. Member for Derbyshire, South that they should sell their homes so that they can go private. She has conveniently overlooked the fact that, if they sold their houses and acquired more than £6,000 in the process, they would, as a result of her Government's social security changes of this week, lose all rights to benefit.

Many of my constituents do not have one holiday a year, let alone two, and certainly could not provide themselves with sufficient funds to go into private health care by giving up a second holiday. If they have a front room to decorate, certainly forgoing the decoration of that room would not provide them with the funds necessary to go into private health care. The Government need to understand that the people of Bradford depend on the National Health Service. They want more to be spent on improving and expanding the service and on preventive medicine. Bradford's NHS needs extra money which could easily be provided if the Government had the political will, understanding and compassion to do it.

I hope that this short debate will add to the pressures which are being put on the Government by every community for a change of political will and policy. We know that the money is available and that there is no need for cuts in the NHS in Bradford or anywhere else. I look forward, as do the vast majority of my constituents, to a change of policy, more understanding and more compassion from the Government for the real needs of people in Bradford and throughout the country.

10.25 pm
Mr. Pat Wall (Bradford, North)

I am pleased to support my hon. Friend the Member for Bradford, West (Mr. Madden). Bradford's district health authority covers an area of 54 square miles and is compact and densely populated. The majority of its 350,000 population live within three miles of the city centre. The population is expected to grow by 38,000 by the end of the century. The authority says in its strategic plan for 1987–94 that there is a close correlation between the incidence of illness and social and economic circumstances. It is that fact above all which makes the £2 million cuts outlined by my hon. Friend a central issue.

Of the 17 health districts in the Yorkshire region, Bradford has the second highest incidence of poor housing and the highest incidence of overcrowding. In the social index, Bradford is the worst of the 17 district health authorities. For every 100 middle-aged men who die of heart disease in the rest of the country, 140 die in Bradford. A new-born Bradford girl can expect a life two and half years shorter than her average sister in England and Wales. In inner Bradford, infant mortality is 17 per thousand, compared with a national average of below 10 per thousand. In the Bradford city area, there are over three cases of tuberculosis per thousand; in some areas of the city, there are nearly 10 cases per thousand.

My hon. Friend has listed some of the cuts which must take place to meet the £2 million deficit which the health authority faces. I should like to mention one sphere which he did not take up but which should be close to the heart of the hon. Member for Derbyshire, South (Mrs. Currie)—smear testing for cervical cancer. We believe, as I am sure the hon. Lady does, that all women aged 20 to 65 should be tested regularly. A scheme was introduced in Bradford in July 1986, but only for women aged 35 to 64. It will take a further five years to complete the first call-up. The interval between testing and results is seven weeks, and the interval between smears is five years. The cuts mean that the health authority has to make a choice between extending the age range or lowering the interval between tests to three years. Neither funding nor laboratory capacity will allow the health authority to carry out both.

The city of Bradford is proud of its pioneering work in the treatment of cancer by chemotherapy. I have family reasons to be grateful for the developments which have been made in the city. One effect of the cuts is that outsiders will be refused that treatment. In our turn, we will be refused treatment by other health authorities. I have had letters from Manchester university about orthopaedic surgery and from Leeds about the treatment of inflammatory bowel disease.

To conclude, I support the point made by my hon. Friend about the urgent need for the Government to meet the pay needs of nurse and health workers, rather than increase the burden on Bradford health authority. A Government who can afford to give £2 billion in one stroke to the richest 3 per cent. of our population can well afford to meet the needs of health care in the Bradford districts.

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

I congratulate the hon. Member for Bradford, West (Mr. Madden) on raising this debate. I am sorry that what he said was such a standard rant, and that he did not find it possible to approve of anything that we are trying to do, unlike his hon. Friend the Member for Bradford, North (Mr. Wall) who at least recognised our efforts in relation to cervical cancer.

Indeed, when it comes to prevention, despite the rather unkind remarks from the hon. Member for Bradford, West, it might help if he and his hon. Friend were able to encourage his constituents to take some notice of some of the things that we have been saying. We have strong evidence to show that if people changed their lifestyles some of the problems that have been mentioned, particularly in relation to heart disease, could be reduced.

The hon. Member for Bradford, West put some important points to me. I am shortly to carry out the ministerial review for Yorkshire region, and I will ensure that all of those matters are discussed with those responsible. Not least, I want to raise with Yorkshire regional health authority, and perhaps I can give notice of that to it tonight, the very poor neonatal and infant mortality figures that hon. Members have mentioned. share the hon. Gentleman's concern. They were the worst in England in 1986.

I do not think that it is a problem simply associated with the hospitals. The solutions probably lie outside with the family practitioner committees and with the community services; but I intend to get something done about it, for the sake of the women of Bradford and their babies. I will also take up with Yorkshire region the points that have been made about the cervical cancer programme.

There have been significant overall increases in national health funding in this country. We have the second largest programme of expenditure of total Government money after social security. I am sure hon. Gentlemen will note the figures. So far this year, we have about £22 billion to spend. Perhaps after my right hon. Friend the Prime Minister has finished her deliberations there will be more than that; we shall have to see.

We allocate our money for hospital and community health services to the regional health authorities. The gross revenue spending of the Yorkshire regional health authority, which is responsible for Bradford, was £583 million in 1982–83. This year it is £851 million. That is a 46 per cent. increase in cash terms and a more than 4 per cent. increase in real terms, which is slightly higher than the national average.

The authorities decide how to allocate the money to the district health authorities. There is not a set formula for doing so. They try to take into account many factors, such as those mentioned by the hon. Gentleman. As a result, Bradford's funding has also increased at this time, with the result that its initial recurrent allocation for this year is nearly £71 million, which includes a development fund of about £500,000. The authority is also to receive substantial additional sums for improving services for specific service developments, £60,000 for AIDS funding, a joint finance allocation of £940,000 and pump-priming funds of £1.5 million spread over three years. To assist the district to develop its community-based mental handicap and mental illness services, there will be about £700,000 in 1988–89. I hope that hon. Gentlemen will agree that those are also important areas, alongside the acute services.

Bradford will also receive £280,000 from the central waiting list initiative, which is a significant amount. It has a substantial cost improvement programme of £2.7 million, or 3.8 per cent. of the revenue budget. It is the highest in the Yorkshire region. £500,000 of that will come from competitive tendering savings, which I am sure hon. Gentlemen will not like, but it is true, and about £1.4 million will come from a recently agreed package of measures, about which hon. Gentlemen have spoken, and which I shall refer to shortly.

Bradford has also appointed a commercial manager with the aim of generating net income of £50,000 in the first year, rising to £120,000 next year. We regard that as a very exciting development. As clause 4 of the Health and Medicines Bill passed without a vote late last night, we hope that we shall make progress on that initiative before very long.

Last year, as has been said, Bradford health authority found itself having to make adjustments for in-year pressures, which amounted to about £400,000. It was helped by the additional funds announced by my right hon. Friend the Minister for Health in December, and Bradford's share was £460,000. That health authority, like all others, has a statutory obligation not to overspend. It is not a question of the Government being unkind to it. We all have a statutory obligation not to overspend, me included.

Clearly, it is prudent against that background at the start of the financial year for the health authority to review budgets in the development programme to ensure that it does not start programmes which it cannot finish or face last-minute adjustments which could be damaging to patient care. Most of all, as it has an ambitious development programme, it is essential to ensure that all developments are affordable.

I understand that various measures taken will not affect patient care, for example, maternity services. Since 1980 two small post-natal wards have been closed at St. Luke's hospital without undue pressure on remaining beds. The birth rate has fallen now, despite the remarks made about the family planning service, and early discharge after delivery is now established good practice. Bradford tells me that it feels able to close a further ward, B3, without in any way compromising patient care. In the event of unexpected demand, additional beds could be reopened at the Royal infirmary maternity unit. The saving on this is £120,000 which is achieved without any loss of quality of care and throughput.

Mr. Madden

Will the Minister confirm that the maternity ward, B3, at St. Luke's was closed in 1987 and had to reopen within 48 hours because of increased need? Will she acknowledge that it is unsatisfactory to centralise maternity services at Bradford Royal infirmary because there are inadequate support services and it is a long distance for many of my female constituents to attend the BRI rather than St. Luke's?

Mrs. Currie

I hope that the hon. Gentlemen will allow me to ensure that those points are considered. When I do the regional reviews I ensure that we have maternity services and care for women firmly on the agenda. I shall ensure that those points are drawn to the attention of the health authority.

The transfer of mental handicap patients from Green Lane hall hospital to Westwood, which was begun in March, is also of some interest. These patients have already moved to substantially upgraded accommodation at Westwood and I think that their quality of life has improved. Again, the change will release £120,000. There are several other similar examples.

There have been substantial improvements in the services, despite what hon. Gentlemen have said. Between 1982 and 1986 the acute in-patient cases treated increased by 13 per cent. to much higher than the England average and day cases increased by 48 per cent.—a growth rate on a par with the rest of the country.

I have mentioned service developments planned for this year. These include the pump-priming projects related to the provision of mental handicap and mental illness services in the community, the opening of two new geriatric wards, staffing for three new mental health centres, medical and surgical equipment, and a range of other developments.

Best of all is the redevelopment of Bradford Royal infirmary and St. Luke's hospital phase 1. Work is planned to start soon at St. Luke's. The total cost will be £33 million. The worst of the existing ward accommodation at St. Luke's will be replaced. The result will be a modernised hospital service in Bradford, caring for its population well into the next century. I hope that hon. Gentlemen will support that scheme and recognise that it is a major replacement of old facilities, many of which have given cause for considerable concern. We are interested to see how that progresses.

On that basis, I hope that hon. Gentlemen will realise that I am interested in what they have said and will ensure that these points are given due attention.

The motion being made after Ten o'clock, and the debate having continued for half an hour, MR. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-two minutes to Eleven o'clock.