HC Deb 09 June 1989 vol 154 cc529-36

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

2.33 pm
Mr. Peter L. Pike (Burnley)

I wish to raise the proposed closure of Bank Hall hospital in Burnley. Let me make it clear at the outset that I shall argue about the reduction in the level of service provided to the people of Burnley rather than about the building itself, which dates back to the 18th century and needs a considerable amount spent on it. It was the former home of General Scarlett, who fought his first parliamentary election in Burnley as a Conservative candidate, fortunately unsuccessfully. He was the victor in the charge of the heavy brigade which took place on the same day as the charge of the light brigade.

The closure highlights yet again the financial restraints that the Government are imposing on the Health Service and the reduction in the provision of services. It will cut still further the facilities available to the people of Burnley, Pendle and Rossendale. This will be the third hospital closure in two years. The Hartley hospital in Pendle and the Victoria hospital in Burnley have both been closed and we have now to consider the closure of Bank Hall hospital.

It is somewhat surprising that at exactly the same time as the announcement of the consultation was made in the local press, a Dr. Gupta of Blackburn and a consortium of eight other people announced the purchase of the former Victoria hospital for £550,000—£350,000 to go to the region and £200,000 to the district health authority—to open a private residential and nursing home for the elderly. Once again, that highlights the way that the Government are shifting their responsibility and the public responsibility to provide care for the elderly. It is time that they put forward clear proposals about the care that should be provided.

I am not opposed to those who have sufficient resources choosing to go into private residential or nursing accommodation, but increasingly to force people to do so is quite wrong. The key element in supporting the private sector, as the Government do, is that a profit element comes into the provision of care. I am not suggesting that some of the nursing and residential homes do not provide a high standard of care, but it is obscene to make profit out of old age. Society and the Government have a responsibility for the care of the elderly.

The consultation exercise has a closing date of 5 July for submissions. That is a reduction of the period laid down from three months to two months, the main objective being to save money—exactly the reason why we are considering the proposed closure. Once again the National Health Service is being tailored to meet financial restraints rather than what should be the priority objective of meeting the needs of those whom it serves. The Lancashire Evening Telegraph of 8 June carried the editorial headline: 'Shoestring' an unwelcome NHS buzz-word. The final paragraph of the editorial stated: Like the British Medical Association's current telling campaign about the present drive for an even more businesslike approach to the running of the health service, we believe it won't do much for patients if the shoestring outlook to funding still stays in place. The problems that we face with the proposed closure of Bank Hall and the general problems of the NHS are caused by the Government's shoestring approach and the necessity for health authorities to cut, cut and cut again to meet budget objectives laid down by the Government. The simple truth is that whenever a health authority makes a cut or a closure to meet the criteria laid down by the financial restraints imposed by the Government, in another 12 months it will have to make yet another cut or closure. If the Bank Hall closure goes ahead, some of the elderly will be moved to Marsden hospital but within two or three years that hospital, too, will be considered for closure. Consultation about closing it a few years ago was deferred, but we know that closure will be proposed again in the foreseeable future.

The interim short-term programme of the health authority for 1989–90 and 1990–91 has been on the basis of achieving savings of £934,000 minimum to £2.5 million. That again highlights the fact that the health authority constantly has to spend its time concentrating on meeting the Government's financial restraints. Those savings mean cuts in what is already an insufficient level of service provision to the people of Burnley. The short-term programme assumed the Bank Hall closure and anticipated that the consultation exercise would receive a favourable response.

I have referred to the Lancashire Evening Telegraph editorial of 8 June, and on the same day there was a news item covering the same issue. In that article, councillor McGeorge said: I cannot see any advantage to patients in this closure and they are what count. Councillor McGeorge is the Labour leader of Burnley council. However, in case the Minister thinks that it is just one party that is protesting, I shall quote the words of a Conservative member of the council who spoke at the same meeting. He said: On this side of the council we don't want to see Bank Hall close either. We don't think anyone can say that private nursing homes can replace the service offered at Bank Hall. I only hope that people who have decided to shut Bank Hall are prepared to accept responsibility of what might happen. At the end of the day, it is the health authority that is making the decision, but it is making it because of the constraints put on it by the Government.

Councillor Kevin Kirkham of the SLD also spoke. He said that he agreed wholeheartedly with what councillor McGeorge, the leader of the Labour group, had said. An article in The Burnley Citizen, which also came out on 8 June stated: Councillor Butterworth, who is chairman of the League of Voluntary Workers for Burnley's remaining hospitals added: 'Bank Hall should be kept open and all hospital closures should be opposed'. The Burnley Express and News, which came out today, described the proposed closure as Criminal and horrifying for the elderly and long-stay patients accommodated there. Councillor McGeorge is quoted as saying that the gloves have now come off. We are going to fight this all the way. He went on to call on the community health council to join the fight and not, as in the past, cop out and agree with the proposals being made by the health authority. I shall be fully involved in that fight, and I shall fight every inch of the way to ensure that we do not see a further reduction in service level provision for the people of my area.

Mr. Wolstenholme, of the Burnley, Pendle and Rossendale health authority, sent a document to the unions saying that, in addition to the problems for the patients involved, there would be reductions in staff. In a letter sent to the National Union of Public Employees, he said: Whilst some staff will be needed to transfer to Marsden Hospital with the patients such an arrangement will not be extended to cover all the staff presently at Bank Hall Hospital. That, too, shows further job reductions.

The health authority's policy and resources committee, in its integrated planning statement for 1989—it has not yet been approved by the full district health authority—indicated other problems as well as that of finance. I have already briefly referred to the growth of private residential and nursing homes. That document says: The rapidly expanding number of private residential and nursing homes has also had an effect upon the service demands for this client group. Over the past five years, the number of private nursing home places has increased by approximately 23 per cent. and the number of residential home places by 25 per cent. It goes on: Work had been due to proceed on the new Geriatric Unit at Rossendale General Hospital in 1989–90, but this scheme has now been omitted from the Regional Capital Programme. The District is now seriously concerned over the standard of care that can be provided to the elderly at Rossendale when the service is severely limited by grossly inadequate accommodation which was condemned over 10 years ago. That shows not only the Bank Hall closure threatening the service level provision, but provision that would have been made at Rossendale general hospital being dropped from the programme. Of course, many of the people who cannot go into Rossendale would have been accommodated in Bank Hall hospital in Burnley.

The consultation document says: Major changes in the pattern of care of elderly people have occurred in recent years which to a large extent is due to the development of the private sector nursing home and rest home provision, and in part of technological changes in medicine. In 1983–84 the District Strategic Plan recorded that there were 385 places available in private homes for the elderly and 87 places in private nursing homes. By the beginning of 1989 this figure had risen to 1,500 places and 400 places respectively and is set to rise even further by 1990–91. There is a public responsibility to care for the elderly, whether through the health authority or the social services. The House still awaits the Government's response and a debate on the Griffiths report, community care and the many other issues linked with problems such as the closure of Bank Hall hospital.

There will be a reduction in beds for the elderly from 43 to 26, and, because of the way the beds will be relocated, the provision of beds for children will be reduced from 65 to 54—yet another cut in services. A considerable amount of money is being spent to move the children's ward from Marsden hospital and to move the elderly from Bank Hall hospital to Marsden hospital. About £90,000 will be spent on adapting accommodation at Marsden hospital and £200,000 will be spent on transferring the children's ward from Marsden to Burnley General hospital.

Our main argument is that there will be a reduction in service provision. Areas such as Burnley, Rossendale and Darwen, and Pendle have particular problems because many people have worked in industries which cause chest problems and so on in old age. Also, many young people are leaving the towns because the Government's policies have reduced the amount of work available. We therefore need a higher than normal level of Health Service provision, particularly for the elderly.

I know that the Minister will refer to the developments at the Wilsonhey unit and Pendle community hospital. I welcome the developments and I do not say that we cannot change the use of a building, but I and the people whom I represent believe that there is insufficient provision now. Cuts will not be accepted by the people of Burnley, Rossendale and Darwen or Pendle. If the Government do not recognise that and make the necessary resources available, they will lose two seats at the next general election.

Care of the elderly is a public responsibility. The Government should wake up to that responsibility and make resources available to health authorities and county council social services so as to meet the needs of the community that those bodies serve.

2.47 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

I congratulate the hon. Member for Burnley (Mr. Pike) on his success in the ballot. I should like to give the House the background to the proposed closure of geriatric facilities at the Bank Hall hospital. As the hon. Member for Burnley pointed out fairly, the proposal is only at the consultation stage and has not yet been considered by the North Western regional health authority. If there is an objection by the community health council, it will be considered carefully by the health authority. If there is a sustained objection, it will come to Ministers for further consideration. The hon. Gentleman knows that and pointed it out.

I hope that the House will permit me to comment briefly on the provision of patient services generally in the Burnley, Pendle and Rossendale districts. The Burnley, Pendle and Rossendale district health authority provides a full range of health care services for a local population of about 227,000.

The hon. Member for Burnley referred to cutbacks. For the period from 1982 to 1987–88, the latest full year for which we have figures, in-patient treatments were up by 15 per cent. to 32,000 patients per annum and out-patient treatments were up by 7 per cent. to 165,000 patients per annum. I fail to see how the hon. Gentleman can sustain his argument that there have been health cutbacks. The level of resource funding, to which I shall turn in a minute, is a different issue. The record shows that the hon. Gentleman cannot sustain his argument, because patient care measured in terms of in and out-patient treatment, has risen. The number of people treated by community nurses in the district has also risen by 29 per cent. to 35,000 per annum.

Those figures do not show the increase in the quality of care that has also taken place and which reflects the staffs dedication and commitment. I know that the hon. Gentleman will join me in thanking and congratulating the health authority staff. As politicians, we do not thank Health Service staff enough. We take them for granted, and, as a Health Minister, I join the hon. Gentleman in congratulating the staff who work in his constituency.

The right hon. Gentleman asked me about the Griffiths report and I can only repeat the commitment given to me by my right hon. and learned Friend the Secretary of State for Health and the Prime Minister that we shall shortly bring to the House our conclusions on the second Griffiths report on care in the community. They were extremely important, and were deliberately omitted from the White Paper "Working for Patients" because our thoughts and deliberations had not been concluded. However, they will shortly be complete and we shall bring them to the House.

A more tangible sign to the local community of the Government's commitment to improve services is the local building programme, in particular, the completion of the Burnley general hospital phase 3 development, the Wilson Hey unit. That has provided 49 paediatric and surgical specialty beds, with a playroom and outside play area for the children, 105 surgical beds, four high-dependancy beds, three operating theatres and one minor operating theatre, at a total cost of about £6.1 million. A further £5.9 million project to expand Pendle community hospital is also well under way to providing an additional 72 geriatric beds by May 1991. Those new buildings and the facilities which they contain will ensure that the improvements in patient care achieved in recent years will continue well into the future.

I take further issue with the hon. Gentleman. I do not think that he would dispute the figures that I have given because they are facts. It is not sensible to equate hospital closures with cuts. They are sometimes necessary because buildings are worn out and beds, wards and hospitals need new buildings.

The hon. Gentleman implied that any closure was wrong, although, to be fair, he qualified that. He referred to Hartley and Victoria hospitals. Closures are merely signs of the re-provision of health care services. As I have already said, the Health Service is spending £12 million on new capital projects in the health authority area. That is an example of our commitment constantly to improve the care and provide it in a more modern and acceptable way, which is in the patients' interests.

Mr. Pike

Will the Minister accept the important point that, within this consultation paper, a reduction of beds, both for the elderly and children is clearly shown?

Mr. Freeman

That is not right. I am informed that the elderly use 80 per cent. of the 43 beds currently available at the hospital, which gives a figure of 34. I am informed that the replacement Deerplay ward at Marsden hospital will provide 26 beds and that a further 10 beds will he available at the district general hospital for family respite. They will not be beds for members of the family to use as patients, but so that they can enjoy some respite. That makes a total of 36 beds. Therefore, I do not agree with the hon. Gentleman that, in the short term, facilities will be reduced.

I also take issue with the hon. Gentleman's argument that private nursing health care and residential homes are wrong in principle. He implied that they were immoral because a profit is made from them. I disagree. Private nursing homes and residential homes, when properly organised and providing a good quality of care, are perfectly acceptable. As the hon. Gentleman well knows, patients are supported, when appropriate, by the Department of Social Security through income support.

Mr. Pike

The Minister will realise that, given the limitations on the money provided, families have to supplement the cost, sometimes with great difficulty.

Mr. Freeman

I am aware of that. For nursing homes, the state provides about £200 per patient per week. I know that fees often run in the range of £230 to £240 a week, implying some contribution from the savings of the elderly persons or their families. That is a significant degree of support. Private health care can march in step with the NHS in terms of the quality of care delivered.

The hon. Member for Burnley asked me about staff protection. I am informed that the Burnley, Pendle and Rossendale health authority, after consulting the district joint negotiating consultative committee, has already adopted a policy for staff protection in the event of any change or use of premises, and that policy will be fully implemented.

Turning to the Bank Hall hospital, the opening of new and better NHS facilities must rightly be accompanied by a rigorous examination of the continuing use of older existing beds. The Burnley health authority has considered how the hospitals in the district are being used, the services they provide and the level of patient activity involved. It has also considered the capacity of the private sector to meet the needs of elderly patients for nursing care.

Major changes in the pattern of care of the elderly have occurred in recent years and are due to a large extent to the development of private sector nursing homes and, in part, to technological changes in medicine. We all welcome the fact that people are living longer. Although there are many more elderly patients and many more are being treated, it is a fact that the pattern of treatment has changed. The average stay in hospital for geriatric patients is much shorter, and because the number of beds has been maintained in the health authority concerned, and the average use of beds is decreasing, even after the demographic pressures, the occupancy of beds is falling.

In Bank Hall, the decrease has been from 90 per cent. to 82 per cent. occupancy, as the average length of stay has fallen from 227 to 108 days. This is partly the result of the greater availability of residential places in the private sector. Elderly patients can readily find a place which provides nursing care, following a period in hospital for active medical treatment. In the past, many such patients would have been kept in hospital for want of suitable alternative accommodation. I am sure the hon. Gentleman joins me in welcoming this move, whether it takes place within the Health Service or without it. Patients who are medically cured should not be in wards in hospital. They prevent others from being treated there and it is not good for their morale or general wellbeing.

Taking account of these developments, the district health authority has concluded that there is a need to rationalise hospital services in the district. That is the reason for the proposal to close Bank Hall hospital. As a result, financial, medical and nursing resources can be used to greater effect within the NHS.

The option favoured by the district health authority and set out in its consultation document is for the closure and disposal of Bank Hall while expanding services for elderly people at Deerplay ward at Marsden hospital in Burnley. The proposals are set out for consultation under arrangements that apply to all proposals for a significant change in patient services. This is covered in departmental guidance issued in October 1975.

The hon. Gentleman mentioned the time scale for consultations. The normal provisions will apply in this case—a three-month period for consultation at district health authority level, taking us to the end of July. I hope that all the parties involved will play their full part, as, I am sure, will the hon. Gentleman. I hope that the community health council and all involved will make constructive comments on the proposed closure and on alternative ways in which patients should be cared for.

Finally, I turn to the main theme of the hon. Gentleman's speech, the level of funding. He said, fairly, that he is specifically concerned not about this particular site or about its future but about the level of funding. The White Paper proposes that the basis of funding should be changed—first, through the regions and, secondly, through the regions to the districts. We wish to fund district health authorities on the basis of weighted capitation—on the number of residents in a particular district health authority area, weighted by their relative age and morbidity, which in turn will reflect various social and industrial health factors—and the relative cost of providing health care. A more automatic system of allocating taxpayers' resources will, we believe, be fairer and more certain and will enable Health Service managers to plan with greater confidence for the future.

I do not know about the particular demographic and population pressures in the hon. Gentleman's health authority area. However, when the new system is in place the successor to the old resource allocation working party targets for regions, and, through them, for districts, and the targets that Ministers, of whatever Government, chose to aim for in terms of resource allocation, a system that served us well for many years—it will reflect fairly population movements, population growth and the other factors that I have mentioned. There will then be less criticism of whether one area has been more or less fairly treated than another.

When the new system of allocating funds is in place, I hope that the hon. Gentleman will agree that it will be for the health authority to decide local priorities. I hope that greater attention will be paid to using finite resources effectively in any year. The resources of any Government, of whatever political complexion, are finite. After a health authority has received finite resources in any particular year, it must use them effectively and efficiently. Both the hon. Gentleman and I agree that we want to improve both the quality and the quantity of health care.

Question put and agreed to.

Adjourned accordingly at two minutes past Three o'clock.