Royal Hallamshire Hospital, Sheffield

HC Deb 21 June 1988 vol 135 cc1099-106

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

12.1 am

Mr. Irvine Patnick (Sheffield, Hallam)

During the course of this Adjourment debate I hope to outline to those hon. Members who are still in the Chamber a dilemma facing my constituents, patients, consultants, the Sheffield health authority, the hospital staff, the readers of The Star—the local newspaper which has informed everyone of the situation—and not least myself. The dilemma is that the Royal Hallamshire hospital, Sheffield has closed 109 of its beds, made reductions in the service of the ophthalmic department and cut back the funding of research work carried out by Dr. Kanis which has resulted in his obtaining a personal overdraft and seeking subscriptions from his colleagues and others to continue his work. Everyone must admit that that is no way to run a hospital

Having first-hand knowledge of the Royal Hallamshire hospital as a patient and visitor and having served as a one-time county and city councillor and a member of the community health council, no one is better placed than I to appreciate the gravity of the situation

The Hallamshire is in my constituency, as are the Trent district health authority headquarters, the Sheffield health authority headquarters, the family practitioner headquarters, the university and the polytechnic. Many of the staff and students live in Hallam and the faculty of medicine and dentistry is also in the area. As a lifelong citizen of Sheffield who has passed the hospital at least twice a day, I can claim more than a passing knowledge of it—and I do not intend any pun there

The exemplary efforts are on record to show that every effort has been made by the hospital and its staff to reduce unnecessary costs and for that I pay tribute to the staff, the administrators, and Sheffield health authority who all deserve tribute for their work. Supplying a first-class service while making economies remain the priorities of the Hallamshire

Designed in 1965 and opened in 1978, the Royal Hallamshire hospital cost only £32 million. If only such figures were possible now. It was built to replace the Sheffield royal infirmary and the Royal hospital, Sheffield. The Hallamshire has 730 beds and a staff of 3,200, or 2,500 whole-time equivalents. It inherited the traditional funding and staffing from the two small units that it replaced. From that point it was destined to be a financial loser as the appropriate funding never ensued. Everyone acknowledges—and it is statistically proven—that the Hallamshire has higher general overheads than the average provincial hospital. For example, the Hallamshire's energy bills and what it pays to Sheffield city council in lieu of rates will further my point

Correction of the unfortunate original design, which caused excessive costs, has led to a 15 per cent. reduction in energy costs during the past three years. For this year alone, the electricity bill is £920,000 and the gas bill is £985,000. Its huge monolithic structure, with large amounts of glass, means that on hot days the sun heats the buildings. The situation is reversed on cold days. While on hot days energy is used for cooling, on cold days it is used for heating. That is far from ideal, if not daft. Is it any wonder that the comparability indicators for the use of energy for all regional health authorities show the Hallamshire as one of the highest users, if not the highest?

The hospital's rate payments to the city of Sheffield are also a cause for concern. In 1987–88, it paid some £1.5 million, and in 1988–89 some £1.6 million, in lieu of rates. According to my calculations, that equates to 3p in the pound of Sheffield city council's total rate income per year. When Sheffield city council was rate capped, the Hallamshire and the Sheffield health authority had an unexpected windfall and could use the cash saved for patient care, which was their original intention

All those matters lie beyond the control of the hospital and the health authority—thanks to Sheffield's high rates policy. It is more obvious when compared with the national average. On 10 May, my hon. Friend the Member for Langbaurgh (Mr. Holt) asked the Secretary of State for the Environment if he would list the available information for the 10 authorities with the highest combined rates. Sheffield came second with a poundage rate of £347.50. Therefore, hospital funding provided for health care goes, instead, to a spendthrift authority

Let us compare the Hallamshire's rates expenditure with the Sheffield Northern general hospital, whose payment in lieu of rates is only £920,000. While the Hallamshire is a high-rise building on a small site, the Northern general is on a large site with open fields and many buildings. If the building scheme scheduled for the northern general hospital is commenced, I am sure that in the long term it will relieve some of the pressure on Sheffield's Hallamshire hospital

The revenue budget for Sheffield district for 1988–89 stands at £175 million, up from £162 million in 1987, which is a significant increase on the 1979 figure of just over £72 million. A further positive result is that Sheffield now has a thorough increase in funding, together with more nurses, midwives, doctors and dentists, than in 1979

Some £120 million is allocated for new buildings and major facilities in Sheffield in the 1984–94 planning period. Despite that—and despite even an analysis of recent patterns of Government funding for the Sheffield health authority commissioned by the health care strategy group, a non-elected Sheffield city council panel—a report prepared for the city council by Colin Thunhurst of the Nuffield Institute for Health Service Studies at Leeds university grudgingly acknowledges that the Government have provided Sheffield health authority with more money for health care. We are all extremely grateful for that

The Hallamshire's share of the health authority's cake was a budget of £33 million in 1987–88 and £34.5 million for this financial year. The northern general hospital has a revenue budget of £35 million for 1988–89. I am not suggesting that robbing Peter to pay Paul is the way forward

The Hallamshire is short of cash and the actions outlined in my introduction are now in operation. That has resulted in ophthalmic care patients contacting me regarding treatment delay. A consultant, who is also a constituent, said in a letter to me: We have had 12 beds closed since the end of October last year—almost a third of our beds. He then said something quite interesting: Only if patients do not arrive for operation"— I hope that the Minister will take this on board— or are found to be unfit are any other patients being sent for and these at short notice. He states that anyone listed for cataract operations on his routine list may have to wait seven years. Before the bed closures, that waiting time was down to five months

The case of Dr. Kanis has received extensive media coverage and representations from grateful patients have been impressive. Jeremy Watson, medical correspondent of The Star, has hightlighted the plight of Dr. Kanis, who, after his five-bed metabolic unit was closed as part of the savings at the Hallamshire, decided to raise the funds to service the unit—£100,000 for the year

An abstract from the health authority review of the 1988–89 financial plan shows what amounts to a temporary closure of 14 orthopaedic beds, 15 ear, nose and throat beds and up to 72 beds and associated operating theatre sessions in other specialties. I cannot understand why that has happened. The Hallamshire has a 94 per cent. bed occupancy rate and its cost efficiency is all right. Is it that the hospital's financial problems really arise because of the volume and complexity of the work being carried out there? Can it really be that that, together, the rapidly rising cost of high technology and medicine—which are more heavily concentrated in the Hallamshire—are substantially outstripping the budget and the ability of the health authority to fund them? Or do the special costs of acute services in teaching hospitals in large cities, such as the Hallamshire, pose additional funding problems?

The teaching hospitals rightly make the case for additional funding to support centres of excellance and the added responsibilities that they carry. It has been estimated that 1 per cent. of the £175 million is the cost of that work at the Hallamshire. I understand that the Trent region accepts the principle that additional funding is needed, but has failed to provide a commitment for those funds. The Hallamshire is faced with an annual overspend of £500,000, arising from the additional costs for blood products, primarily for haemophilia patients treated under the region's specialised arrangements. Again, extra funding to meet that inevitable expenditure has not been provided by the region

The Hallamshire's total deficit amounts to £1.1 million, plus a consequent £1 million shortfall. Both of those sums are less than the annual payment that it makes to Sheffield city council's coffers in lieu of rates. If the £500,000 for haemophilia patients could be funded, that would be very welcome. Some £300,000 needs to be spent urgently to redesign the air handling plant and about £500,000 is also needed for essential alterations to the windows. The resulting long-term energy savings will create further economies. The sum of £60,000 is all that is needed from, say, the waiting list money to restore the ophthalmic unit

Many hon. Members may justifiably make similar pleas for special funding, but not for such important reasons as those that I have outlined. I am extremely grateful for all the funding that the Royal Hallamshire hospital has received. It is rather ironic that the shadow Leader of the House made reference to Oliver Twist in the previous debate. However, like Oliver Twist, on behalf of everyone who uses or may use the Hallamshire hospital I ask my hon. Friend the Minister, please may we have a little more?

When my hon. Friend replies, will she explain to my constituents in particular and to the area in general what is seen as the way out of the dilemma that they face? I submit that, through no fault of its own, the Royal Hallamshire hospital appears to have been penalised for its own excellence and its obvious success. Can the Minister assist, please?

12.13 pm

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

I congratulate my hon. Friend the Member for Sheffield, Hallam (Mr. Patnick on winning the ballot. I am sure that he has noticed, as I have, that he is the only Sheffield Member here tonight. I think that that is a pity and a reflection on some of those who have been elected to represent Sheffield

My hon. Friend has shown a keen interest in health matters on behalf of his constituents. When he and I get on the Master Cutler on a Monday morning we often discuss these issues, and again even later when I sometimes give him a lift to the House, so I am well versed in some of the issues that he has raised

I do not know whether he realises that he has written some 70 letters to my Department since the election last year, tabled seven questions and has now initiated this debate. I commend him to his constituents as being one of the most assiduous Members of the House, and certainly of the new intake. He has put his case very well indeed

Before discussing some of the detailed points that my hon. Friend has made, I should like to put the issues into a general context. As I am sure he knows, spending on the Health Service in the United Kingdom has increased from £7.7 billion in 1978–79—the year in which the Royal Hallamshire hospital was opened—to £22.7 billion this year. In cash terms, every family now contributes more than £1,600 a year to the National Health Service, whereas it contributed only £500 a year under Labour

That increased investment has resulted directly in treating more patients more effectively in more modern hospitals than ever before. The national figures show that about 1.25 million more in-patient cases were treated last year than 10 years ago, plus 500,000 extra day cases, and 4.5 million extra out-patient visits were paid each year

That is reflected in the increased number of staff that we have taken on. The national figures are represented in what are known as whole-time equivalents, or whole-time funded posts. We have more than 6,000 more doctors and dentists in NHS hospitals, more than 8,000 more doctors and dentists in general practice and almost 65,000 more nurses and midwives. Of course they are all better paid than ever before. The Government are meeting the £749 million bill for the nurses' pay award which was announced recently, and the most fundamental review ever carried out of nurses' future training needs is under way in Project 2000, which has also been announced

My hon. Friend mentioned the building of the Royal Hallamshire and the developments in his constituency and asked about other developments in Sheffield. When we came to power in 1979, we were faced with virtually a complete shutdown of the hospital building programme. The Royal Hallamshire—my hon. Friend has described its physical problems so aptly and eloquently—was built and completed during that time. We were trying to deliver 20th century health care in 19th century hospitals, so we started the most intensive and extensive hospital building programme ever. Since 1979, 286 schemes costing more than £1 billion have been started and completed in the NHS. More than 500 schemes, with a total value of £3.8 billion, are at various stages of planning, design and construction

The Sheffield area is covered by Trent regional health authority, which also covers the Southern Derbyshire health authority, which, as my hon. Friend knows, encompasses my constituency. Spending in Trent has risen from £369 million in 1978–79 to £989 million in 1987–88, an increase of about 31 per cent. in real terms. For this year, 1988–89, Trent's initial cash allocation is increased by another 6.3 per cent.—well above inflation—to more than £1,050 million. That increase is above the national average increase of cash to the National Health Service. That means that Trent has been growing faster than the national average and is getting closer to its RAWP target

That also reflects the general recognition of Trent's poor funding compared with others in the past. Whatever Opposition Members might say if they were here, during the 1970s areas such as my hon. Friend's constituency and mine were in a very bad way and had long been neglected in the Health Service. Only in the past decade or so, and particularly in the past few years, has funding been able to catch up to the level demanded by the needs of the local population. I see my hon. Friend nodding in agreement with that

Trent's record on patient care is impressive. Between 1978 and 1987 the number of in-patient cases treated rose from 461,000 to 624,000, a huge increase of 35 per cent. Those are not just statistics. They represent hundreds of thousands more people every year being treated in the Trent hospitals. Last year, 1987–88, the number of people on waiting lists fell steadily. The number of people waiting for more than 12 months has fallen dramatically by more than 3,000—a drop of more than 20 per cent. There have been 27 major capital developments since 1979 in the region, with 14 others under construction and 23 approved to start

The Sheffield district health authority, which I know very well, having been there on a number of occasions, covers a population of about 530,000. As my hon. Friend said, it is a major centre for teaching and health care and it is Trent region's oldest teaching authority—the Trent region has three, including Nottingham and Leicester

Sheffield's current and expected temporary difficulties need to be seen in the context of substantial recent and future growth in Trent region and Sheffield. Allocation of funds to the district health authority is Trent's responsibility. Between 1982–83 and 1987–88, Sheffield's revenue spending increased from £122 million to £166 million, an increase of 36 per cent. in cash terms—one of the largest increases in the country. The initial allocation for 1988–89 is £175 million, including nearly £500,000 development funds. That is an enormous sum. Taking on board what my hon. Friend the Member for Hallam said about £30 million being a substantial sum 10 years ago, £175 million now makes Sheffield one of the biggest health authorities. It has had an enormous funding increase in recent years

Patient care has also increased significantly. Between 1982–83 and 1987–88, the number of in-patient cases increased by 41 per cent. That means that the Sheffield hospitals are coping with more than 2,000 in-patients every week and 12,500 out-patient visits every week, or rather more than 2,000 per working day. We are content that the money is well spent. The number of front-line staff in Sheffield has increased in terms of whole-time equivalents from under 8,000 in 1982 to nearly 8,500 in 1986, the last year for which I have full details. Most of the increase of nearly 500 posts was due to extra nurses being taken on

There is also a major building programme in the Sheffield district. The most recent examples are a new out-patient and ward block at Northern general hospital which was formally opened in September by their Royal Highnesses the Duke and Duchess of York. That block cost £10 million. I visited the new £6 million acute geriatric unit at the same hospital which will open this year. Currently under construction is a £9 million extension to the children's hospital. With such programmes we can look forward in Sheffield to being able at last to offer health care in modern facilities that accurately reflect the staffs skills

Sheffield is a major centre for high technology medicine with some of the leading clinicians in their field. For example, the stereotactic surgery unit, which is funded by the Department and is in its second year, is the only one in the country and one of only three in the world. If my hon. Friend the Member for Hallam has not had a chance to meet some of the people involved, I recommend that he does. The district is also the regional centre for all the regional specialties, including plastic and burns surgery, neurology and spinal injuries. Much specialist work has gone into child health care, particularly child leukaemia and the reduction of infant mortality

Sheffield is also doing excellent work in health promotion. Its "Health City 2,000" was launched a year ago and is geared to making Sheffield one of the healthiest cities in Britain. I am sure that my hon. Friend would join me in agreeing that there is room for a lot of progress, as coronary heart disease and lung cancer—among others —are among the worst in Britain. I ask my hon. Friend to check whether Sheffield city council, which has taken this matter seriously, has sorted out the issue of smoking on its buses. Last time I was there, I was impressed by signs on the side of the buses saying, "Smoking kills" but not impressed to see people on the top decks puffing away merrily. My hon. Friend may like to pursue that matter

I attended a seminar on nutrition and healthy eating at the Royal Hallamshire in November last year. It was a thoroughly stimulating and encouraging afternoon and the seminar was typical of the work in the district. There is a great deal that is first class in Sheffield and it is right that attention should be drawn to it. The NHS is giving excellent service to local people, and that is to the credit of all concerned, especially the staff

As my hon. Friend has described it, the Royal Hallamshire is a modern tower block hospital of 728 beds which was opened in 1978. I hope that we have learnt a lot from the Socialist building patterns of those days which have landed us with so many problems these days. The current financing problems need to be considered in relation to the rest of the district as well as to the particular circumstances of the hospital. Sheffield has 10 management units, including the Royal Hallamshire and the Northern general, which is another teaching hospital of a further 1,000 beds and has a budget of about £35 million. Some health authorities have budgets of that order for their entire district, but these are budgets for single hospitals

Last year, the Royal Hallamshire had an underlying deficit of £1.7 million—by far the largest deficit of any unit, including the Northern general hospital. Nearly all the other units kept more or less to their budgets I feel bound to mention that the performance indicators for Sheffield and its hospitals are not too brilliant, although its hospitals are much cheaper than the equivalent teaching hospitals in London. As my hon. Friend said, average occupancy has reached 94 per cent., but that is not necessarily a good thing. It is too high a percentage and leaves no room for flexibility—for emergencies, for example. As a consequence, I understand that some patients were moved seven times during a stay of seven days, which is clearly unsatisfactory. I am not being critical. I recognise that there is pressure for more and more health care and that doctors, nurses and managers try to respond to it

We also recognise that centres of excellence such as the Royal Hallamshire face additional pressures simply because of the nature of their work and the need to support medical teaching. I understand that Trent regional health authority is committed to giving its teaching authorities additional support in the longer term to help them to cope with that

There have been some temporary closures, and I stress the word "temporary". Some of the decisions were made in consultation and agreement with the clinicians concerned who have established a peer group at the Royal Hallamshire to review medical practices and ensure that they are economical. That is a very sensible approach, and one that we should applaud, particularly in the light of the Government's increasing interest in medical audit. Whatever money we spend, we need our clinicians to check on the outcome: do we get a better outcome from one procedure than from another; can we get a more effective outcome; do we get better health?

My hon. Friend asked about the building scheme at Northern general hospital. I am delighted to announce approval in principle of a £24 million development at the Northern general hospital. The scheme will provide six new adult wards, two children's wards and four new operating theatres. It will also provide new out-patient facilities, including a colposcopy and laser clinic. The scheme is part of the modernisation of the Northern general hospital

I am delighted to convey to the House this stop-press information, which highlights my previous comments about a continued improvement in health services, now and for the future, for the people of Sheffield. Building work is expected to start in about May 1989 and is to be completed in 1992

The theme of my speech is that, although there may be a temporary problem at the Royal Hallamshire, it would be wrong to get it out of proportion or consider it out of context. Many routine aspects of health in Trent and Sheffield should be emphasised; they greatly outweigh the negative aspects

My hon. Friend raised one or two specific points to which I should like to respond. I share his concern about rates in Sheffield. He may not be aware that the total amount paid in rates, or in lieu of rates, by the Trent regional health authority in 1986–87 was just under £21 million. That is the largest bill by a long way of any regional health authority in England. Sheffield's rates have increased substantially in the recent past. However, in two of the past four years, Sheffield has been rate-capped under the Government's legislation and hence has faced lower bills, which is more than can be said of neighbouring Derbyshire. The politicians of Sheffield should know that an estimated £4,250,000 of NHS money is to go into rates payments this year in Sheffield, and of that sum £1–3 million is for the Royal Hallamshire hospital alone

We have discussed energy problems pretty thoroughly, and I hope that the designs of our new buildings will take into account the problems outlined by my hon. Friend —problems that are all too common in buildings that were erected in the rather less tightly controlled 1970s. Money has been lent to Sheffield by Trent regional health authority for energy saving schemes, and I know that the DHA is doing its best to minimise payments. If we simply allocated extra money, there would be a lack of incentive to get normal energy costs under control, and that is an important matter. In the end, it is for the district health authority to manage its financial affairs on rates and energy as it sees fit

Let me finish with a comment about Dr. Kanis. We recognise the importance of his work, particularly in osteoporosis. He will be one of the speakers at the conference on women's health that I shall be chairing tomorrow. I understand that the health authority has not accepted his offer personally to fund his unit

However, the NHS is continuing to provide Dr. Kanis with in-patient facilities so that he may continue to treat his patients. His work with day and out-patients, where the majority of people are seen, will also continue to be substantially unaffected

Dr. Kanis is discussing with the district and regional health authorities how best to secure the long-term funding of his own in-patient unit as part of his research work for which, as my hon. Friend knows, he already receives a substantial grant of £700,000 from the Medical Research Council, a figure that ought to be set alongside some of the other funding values that we have been discussing. There is also no reason why other agencies and bodies should not bear at least a proportion of the cost over the short or long term, and I understand that Dr. Kanis is exploring this possibility. I look forward to meeting him again tomorrow

I hope that what I have said reveals our awareness and concern and our support for health care in Sheffield. I commend my hon. Friend's efforts on behalf of his constituents. They are very fortunate to have him as their representative

Question put and agreed to

Adjourned accordingly at half-past Twelve o'clock