§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Fallon]
10·31 pm§ Mr. Bernie Grant (Tottenham)Thank you, Mr. Speaker, for choosing the subject of the merger of the Hampstead and Haringey health districts for the Adjournment debate.
The proposal to merge the Hampstead and Haringey health districts has caused widespread alarm in my constituency. This is clearly demonstrated by the number of my constituents who have come to the House at this late hour to hear the debate. I welcome them and hope that the Minister will give my constituents some assurances.
This proposal emerged in March this year and is an initiative from the regional health authority. The proposed merger has come about because of two main factors. According to the regional health authority, these are: first, concern over the viability of the Hampstead health authority and in particular the Royal Free medical school; secondly, concern over the viability of the Haringey health authority, which is experiencing massive cuts and recruitment problems. It is described as an "administrative change" by the regional health authority. The proposal is out for consultation until 30 November. It will be considered by the region at its January 1989 meeting and, if agreed, will be passed to the Secretary of State for formal approval.
The region states that it cannot predict what any new authority may wish to do as regards its services and structures and says:
No proposals can be or should be put forward in this document for changes to service provision. If the merger goes ahead the first task the new authority would face would be the development of a service strategy which would involve extensive research, discussion, debate and public consultation.Basically, we are asked to give a blank cheque to the regional offices and, having agreed to the merger, we may then have a look at the effect on services. That is not satisfactory.The regional health authority document states that the Hampstead and Haringey district health authorities would be disbanded and a new one established to take their place. It states that the health service across the two present districts would be managed by the single authority and a single management structure and that, as a single health authority, it would relate to the Royal Free medical school in all matters concerning medical education, including recruitment, training and research.
It states that there would be a single financial allocation to the new district and that the contracts of all staff, including medical staff, would be held by the new merged authority. The document adds that both the Royal Free for Hampstead and the North Middlesex for Haringey would continue to act as the district general hospital, so that there should not need to be any changes in patient flow or GP referral patterns.
A number of regional policy directions have led to this proposal being pursued. First, there is a desire to get teaching hospitals to spread their expertise and develop links with hospitals outside central London. Secondly, it is said that many specialist services are not viable within 570 small districts. Thirdly, the desperate financial position of the region has led managers to look for even more radical measures.
The Royal Free medical school is the second smallest in London. It has an intake of 100 students a year, and for an intake of that size the regional guidelines say that there should be a catchment population of about 320,000 people. Hampstead has a population of only 108,000; and because of the loss of 112 beds at the Royal Free, it is becoming increasingly difficult to provide sufficient teaching practice for students. Indeed, we understand that the medical school feels it is in danger of being gobbled up by London university.
The Hampstead health district is not considered to be viable because a number of the services currently managed by Hampstead will pass into other hands over the next five years. Friern Barnet is due to close in 1993 and there is a proposal to transfer Coppetts Wood to a new specialist unit at the North Middlesex. That will call into question whether such a district can survive.
Haringey health district is facing extreme financial difficulty as well as recruitment problems. As of 1 August this year, the district has closed, temporarily or permanently, over 200 beds, representing a 40 per cent. cut. The Prince of Wales hospital has closed permanently and the district health authority has decided to end all acute work at St. Ann's hospital, Tottenham. The main hospital in the district is the North Middlesex in Edmonton, and a considerable number of its patients come from Enfield, not Haringey. This sad state of affairs has come about as the result of regional directions, and in our view it will not be corrected by the merger.
The consultation document lists a number of spin-offs that could arise from the merger. First, in terms of the use of the estate, it is argued that the merger would allow the Royal Free room for expansion and an opportunity for more land sales. Secondly, it claims that there would be more scope for income generation. Thirdly, it is said that there would be more scope for greater efficiency and getting better value for money, with the possibility of sharing facilities, such as works computing and physical services.
But why should there be a formal merger? Why cannot some of those benefits be achieved by greater collaboration? The three main reasons are said to be, first, that the district health authority would be able to hold consultants' contracts at district rather than regional level, and that, it is argued, would give the district more control. The second reason, it is said, is that Haringey would receive access to funds such as research money that is available for teaching districts only through the merger. It is argued, thirdly, that only through a formal merger would there be the necessary impetus for increased collaboration, particularly on the teaching front; only with the merger would the medical school be prepared to support academic departments at the North Middlesex.
Hampstead has a population of 108,000, although there is a large influx of patients from Barnet, and it is accepted that the district has the primary responsibility for patients from south Barnet. It has 710 acute beds, mainly at the Royal Free, but includes 70 beds for infectious diseases at Coppetts Wood, 130 care-of-the-elderly beds, and 810 mental beds, most of them at Friern. The number of acute beds has been cut by 112 since 1986, when beds were redesignated to receive the elderly people from New End 571 hospital, which has now closed. Coppetts Wood is to move to a district general hospital site and Friern is to close by 1993. The district has a budget of £63.7 million.
Haringey, on the other hand, has a population of 196,000. The North Middlesex hospital is the main acute hospital, in Edmonton. Residents of Hornsey and parts of Wood Green use the Whittington hospital for acute services. The other hospital in Haringey proper is the St. Ann's hospital. There is a proposal in the region to end all acute work there. It will become mainly long-stay. It has a budget of £50 million and had cut £3 million from its budget this year to stay legal. That has resulted in a freeze on the use of all agency staff for six months, and four wards are temporarily closed.
But there are other options for possible mergers and the consultation document looks at some of them. The three main ones are: Hampstead and Bloomsbury, Hampstead, Haringey and Enfield, and Hampstead and Barnet. They have all been rejected for various reasons.
Let me briefly examine the Hampstead and Barnet option. A number of things have happened. Barnet has refused any advances and wants to stay independent and conterminous with its borough. A merger would create one district in two separate regions—the North West and North East Thames regions. North West Thames does not want another teaching district or merged authority at present.
I wonder whether there have been other reasons why the merger has not gone ahead. These are neighbouring health districts, and they should merge. Is it true, for example, that the Prime Minister has had a word to say about this, as it lies in her constituency? Could it be that she wants her district health authority to stay small and beautiful at the expense of other health authorities such as Haringey? I look forward to the Minister's reply.
We are opposed to the merger for a number of reasons. Why does the North East Thames regional health authority need four medical schools in its region? Why does it not merge the Hampstead district with Barnet and, in so doing, transfer one of its four medical schools to the North West Thames regional health authority? Is it true that the only reason for keeping the Hampstead district is so that the region may retain £9 million of SIFT money that it would otherwise lose?
Why the haste? We understand that the Prime Minister's review of the National Health Service may do away with regional health authorities altogether—or at least alter their boundaries. Should not the merger wait until we are clear what the Prime Minister has in store for us?
As patient flows will not change, 40 per cent. of the patients will come from Barnet, not from Haringey—another reason why the neighbouring districts should merge. As a new district, a substantial proportion of these resources will go out of the district and into Barnet.
We want to know where the district general hospital will be. I do not accept the idea of two district general hospitals, or one in two parts. We want to know whether the district general hospital will be the Royal Free or the North Middlesex.
We are concerned about the movement of staff, of which we have had some experience. We understand that, under the merger, consultants will move between the 572 Royal Free hospital and the North Middlesex hospital at will, but we do not believe that. We could not get consultants to travel one mile between the North Middlesex hospital and the Prince of Wales hospital or between the North Middlesex hospital and St. Ann's hospital. Can we seriously expect them to travel many miles between the Royal Free and the North Middlesex hospitals? Will the Minister give us some assurances on that tonight?
The waiting lists are much worse in Hampstead than in Haringey. Is the merger just to make the figures look better so that the average figure will lower the Hampstead health authority's figures? Will Haringey people have to wait longer as a result of the merger?
A report which appeared in the Haringey Post of 13 October this year under the headline "Hospital queue crisis" said:
Health watchdogs are warning that women and the elderly are casualties of soaring hospital waiting lists. The picture is bleak across the North East of London. At the Royal Free, Hampstead, queues grew last year by 45 per cent. Nearly 1,000 patients have been waiting two years for surgery. A spokesman for North East Thames Health Authority, which covers Haringey, said GPs are referring more patients to crowded hospitals. 'Lists have grown, but we are getting through more patients.'The waiting lists are grim.One of the innovations in the Haringey health district has been the upgrading of the haematology department which has done excellent work for sufferers of sickle anaemia, sickle cell disease and thalassaemia. That is because our district has large numbers of people from black and minority ethnic communities. West Indians, Africans and so on suffer from sickle cell and Cypriots suffer from thalassaemia. The North Middlesex hospital made special arrangements for those two diseases because the people are there on the doorstep. However, we understand that under the merger the haematology department is scheduled to go to the Royal Free hospital. Thus the department looking after those with sickle cell and thalassaemia will be miles away from the sufferers. That is a disgrace.
Recruitment is another reason offered for the merger, but in Hampstead vacancies stand at 8 per cent. and in Haringey at 10 per cent.—not enough of a reason for the merger.
We also note that community services in Haringey are good. They have been built up over a period of years. We have not drained our key services as other regions have done in order to build up our community services. We fear that the community services that have been fought for in Haringey will be put at risk under the merger.
We are also worried about the community health council. We have an excellent council in Haringey. What will happen after such a merger? Will there be two officers, one at the Royal Free hospital in Hampstead and one in Tottenham? On the basis of our experience, we are sure that that will not happen.
One of our major problems is the cost of travel. People from my constituency have to take three buses to reach the Royal Free which takes two hours, and the return journey takes four hours. If they go by tube they have to go to the City and then come back into London. It is even more ludicrous that people from Tottenham have to leapfrog the Islington health district to get to Hampstead. My 573 constituents will have to go past the Whittington hospital in order to reach the Royal Free. Time prevents me from developing that argument further.
We are very worried about the merger. Teaching hospitals may be prestigious, but they drain resources, particularly when the Government are cutting money available for universities, asking them to go to private industry. This is a retrograde step. It is a bad, ill-conceived proposal that should be withdrawn now.
§ The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie)I congratulate the hon. Member for Tottenham (Mr. Grant) on his success in proposing this subject for debate and presenting his concerns and those of his constituents about the possible merger of Haringey and Hampstead health authorities. It is a pity that other Opposition Members have been unable to support him. Perhaps the hon. Member for Holborn and St. Pancras (Mr. Dobson), whose constituency is affected by the proposed merger, has been unavoidably detained elsewhere.
For the debate, I have looked at a number of cuttings from local newspapers serving the hon. Gentleman's constituency and seen how the possibility of change has aroused genuine concern about the future of local health services. I remind the hon. Gentleman—he mentioned this matter in his speech—that general practitioners refer wherever they think is appropriate for the patient whom they are treating, and they will continue to refer to the North Middlesex, whether or not there is a merger. No one will be forced to refer patients to the Royal Free hospital. As I understand the proposal, both hospitals will continue to serve as major hospitals in their areas. In that sense, therefore, the travel worries are probably somewhat exaggerated.
I was also rather sad to hear the hon. Gentleman's comments about the disadvantages of being in a teaching district. As he probably knows, I used to be chairman of a teaching district. Teaching authorities and medical schools are now trying very much to avoid hunting around the country for small numbers of esoteric, difficult cases which might provide teaching material. They are trying to respond to the health needs of the local population. Some fine work of that kind goes on in the teaching hospitals in London, and, therefore, I should have thought that that would be regarded as an advantage of the merger
I offer the hon. Gentleman some reassurance about the proposed merger. I wish to clarify how the proposal may be carried forward. I am keen for him to understand the legal situation, which should be put on the record tonight. If I have time, I may describe some of the recent developments in the neighbourhood.
The hon. Gentleman will have read the consultation document from the North-East Thames regional health authority, which sets out exactly what it wishes to do. I wish to quote what the authority says on this matter. The document states:
The amalgamation would enable the new authority and its managers to organise and deliver health services to people in Haringey and north Camden more effectively and to higher standards than are possible at present. It would provide wider opportunities for medical undergraduate education and better career opportunities for trained staff.However, the main improvements, in the view of the regional health authority, would be to acute hospital services. The document states: 574health care services in the community, although less obviously affected by the changes"—those services are very good in Haringey—
would also benefit from the increased influence of the medical school and opportunities to attract financial investment and manpower.Paragraph 1.2.3 of the consultation document states:Both the Royal Free Hospital"—that is, Hampstead health authority—and the North Middlesex Hospital"—that is, Haringey health authority—would continue to provide the main acute services for their localities. The range and scope of specialist acute services would he increased.Paragraph 1.2.4 states:There is no intention to try to alter existing patterns of patient flows.That needs to be understood. Those are the proposals as they stand. I hope that the hon. Gentleman will convey to his constituents the fact that they should not feel agitated about things that have not been proposed.The discussion document has been produced by the regional health authority and, since August, copies have been issued widely for informal consultation to various interested parties, including the hon. Gentleman, his hon. Friends and my hon. Friends whose constituents may be affected. Comments have been invited by the end of November and will be considered by the regional health authority at its meeting in January next year. This debate and the hon. Gentleman's remarks will no doubt be considered, along with other representations on that date. It will then be for the regional health authority to decide whether it wishes to continue with the proposal.
The responsibility for making the decision whether there should be a merger rests firmly with my right hon. and learned Friend the Secretary of State. If the regional health authority wants to pursue that course, it will need to put a submission to him making the case for a merger.
I apologise to the House, and to the hon. Gentleman especially, but I cannot respond in detail to some of the arguments that he has advanced or offer opinions on them. The issue may come to my right hon. and learned Friend the Secretary of State, and to effect the merger my right hon. and learned Friend would need to lay orders before Parliament to define the new district and establish the authority. Before doing so, he would be required to consult interested bodies. That would allow those concerned to put their views direct to us. I am not trying to fudge the issue and I am not trying to avoid it. I have listened with the greatest care to the hon. Gentleman, but it is the legal position that precludes me from commenting directly on what he has said. I can guarantee, however, that there is no possibility that such a proposal could be achieved without close scrutiny and full consultation with all those who might be affected by it.
I know that Haringey has various difficulties, and, because of the measured and careful way in which the hon. Gentleman has made his case, I shall merely say that he and I know that the Haringey social services department has serious problems. That does not help in resettling and helping those who are being discharged from hospital. I ask the hon. Gentleman to use his good offices to ensure that the people of Haringey get a good service from the authorities, be they health authorities, which are part of my responsibility, or the social services and local authorities. Given the hon. Gentleman's experience before 575 he came to this place, I know that he has considerable influence with the social services and local authorities. I ask him to use his good offices as well as he possibly can.
The hon. Gentleman drew attention to waiting lists and said that the lists in Haringey are rather better than in Hampstead. That is partly because Hampstead, being a teaching hospital, attracts patients from a wider area. Some of the cases are the trickier ones, and it is sometimes probably more appropriate that they should be referred there to await the careful attention of the distinguished people they will see.
The hon. Gentleman asked me a question about waiting lists in Haringey, to which I replied on 15 April. I stated that on 31 March 1979 the number of those on the in-patient waiting list—the hon. Gentleman asked for an annual comparison—was 2,063. The number had fallen to 1,004 by 1987. In other words, the length of the list had been cut by half. The only times when the lists in Haringey have been high are 1979 and 1982—years when people had decided to take industrial action. That merely proves that industrial action hurts only patients. It does not hurt the Government or many of those whom it is thought will suffer by the making of a point. We should do all that we can to ensure that the flow of activity of patient care is not interrupted in an inappropriate way.
The hon. Gentleman may be aware of the marvellous plans for St. Ann's hospital and for some of the other developments that are taking place. I understand that the St. Ann's development is to be financed by the sale of the Prince of Wales site. That has been agreed, and a substantial sum has been made available by the Housing Corporation to enable some extremely useful and valuable housing associations to take over the site and provide housing. It seems that it will be a thoroughly beneficial proposal.
I was attracted by an article in a local newspaper, entitled The Journal, that appeared on 20 October. It set out in detail exactly what is proposed for St. Ann's hospital. I am not the first always to commend what is to be read in newspapers, but there are many occasions when they contain much good sense. The St. Ann's unit would in future be called the St. Ann's centre for health care. I understand that much of the emphasis would be on promoting the positive theme of healthier living and the 576 prevention of illness wherever possible. I am sure that the hon. Gentleman will join me in commending that approach.
The article reads:
The main emphasis of care would be on the elderly and the mentally ill.Research in the neighbourhood shows that that key group is not getting quite the attention that it should. In addition, St. Ann's will have an expanded children's centre. This will include, in addition to existing facilities, speech therapy, audiology, a community health clinic and a team of children's nurses who will work in the community.The hon. Gentleman talked about services for those with the condition that is known as haemoglobinopathies, sickle cell anaemia, thalassaemia and the like. St. Ann's would include the first centre in the area completely dedicated to these blood disorders. That, I think, is the answer to the problem that the hon. Gentleman has posed.
The hon. Gentleman will know that my officials have written to all health authorities throughout the country to ask what services they are providing for haemoglobinopathies, because I for one am not satisfied that many parts of the country are getting a service. I must tell the hon. Gentleman that my constituents are not getting a service of that quality, and I commend those, as the hon. Gentleman has rightly done, who have worked so hard to improve the chances of people with those conditions or with the traits that might lead to them.
Similarly, I would like the hon. Gentleman to approach some of these topics with rather more optimism. Change is sometimes necessary. The districts that were drawn up in London some years ago have not always fulfilled expectations. Nearly all have falling populations, which makes it much harder for teaching hospitals that are an invaluable part of the medical services in London to draw on an adequate population. It also makes it much harder, as we now seem to have more boundaries than we need, to ensure that we have good links between the hospital services and the community services.
On that basis, I ask the hon. Gentleman to join me in a note of optimism for the future of the care provided by Haringey health authority. I repeat that the proposal for a merger with Hampstead will be the subject of full public consultation before the Secretary of State makes a decision.
§ Question put and agreed.
§ Adjourned accordingly at Eleven o'clock.