§ 1. Mr. Colin Shepherd
To ask the Secretary of State for Health if he has assessed the extent to which the formula for funding of the regional health authorities adequately reflects the needs of the West Midiands regional health authority.
§ 2. Mrs. Maureen Hicks
To ask the Secretary of State for Health what representations he has received on the allocation of National Health Service resources for the west midlands.
§ The Secretary of State for Health (Mr. Kenneth Clarke)
The new regional allocation formula reflects the relative need for health services of west midlands residents by taking account of the size, age structure, and health of the region's population. I have received several letters about allocations to west midlands region, including a number from hon. Members and one from the chairman of the regional health authority.
§ Mr. Shepherd
I am grateful for my right hon. and learned Friend's reply. Is he aware that there is considerable concern in the west midlands that the resource allocation does not reflect regional needs? Is he aware further that Herefordshire is one of the fastest growing areas in the region in terms both of population size and of age? Because of that, even now, the health authority is finding it difficult to sustain the level of service that the Government expect from it. Can we look forward to future resourcing which will properly and accurately reflect demographic trends and the full implications of patients from Wales going to Herefordshire for treatment?
§ Mr. Clarke
I agree with my hon. Friend. There is concern in the region at the moment. That concern stems largely from a debate that has arisen on the technical planning guidelines that we have given this year. I ask everybody in the west midlands to wait until allocations of funds are made to the west midlands, which will be after the Autumn Statement has been announced. I remind everyone in the west midlands that under this Government the allocation to the west midlands has increased dramatically. It is now up by 37 per cent. in real terms since we took power. That compares with a 30 per cent. increase to health authorities across the country.
Hereford has particular problems because of the age structure of its population and the other factors that my hon. Friend has described. The region will be expected to take them into account when making allocations to the district, just as we shall take all west midlands population; features into account when we make eventual allocations, to the region.
§ Mrs. Hicks
I acknowledge the welcome overall increases for the National Health Service in the forthcoming year, but will my right hon. and learned 817 Friend take on board the obvious anxiety of three west midlands hon. Members who are asking three of the first five questions today and who are naturally genuinely concerned about any talk of reductions? Obviously, from what my right hon. and learned Friend is saying, we do not have cause for concern. May I therefore take that message back to Wolverhampton health authority, which has done a splendid job in managing its resources, and may I tell it that its efforts will be rewarded and not penalised?
§ Mr. Clarke
It seems to me—I only guess—that three Conservative Members from the west midlands have acted promptly after a letter was sent to all west midlands Members by the chairman of the regional health authority. I commend to my hon. Friend a reply that I sent to the chairman of the health authority, pointing out that no cuts of any kind are proposed and also pointing out our excellent record in increasing resources to the west midlands. I am sure that when the regional chairman gets the eventual allocations he will seek to reflect my hon. Friend's concern by allocating further growth money to the Wolverhampton health authority.
§ Mr. Gill
I am grateful for my right hon. and learned Friend's answers. When he considers the allocation of funds, will he use his best offices to ensure that demographic and geographic factors in Shropshire, as opposed to other parts of the west midlands, are truly reflected? Will my right hon. and learned Friend care to consider for one moment that the allocation of funds generally has been more generous to health authorities in Wales, which adjoins my constituency?
§ Mr. Clarke
I certainly give that undertaking to my hon. Friend. Shropshire has certainly done well in recent years. It has a new district general hospital, which now gives the county two extremely good district general hospitals and, in addition, one of the best orthopaedic units in the country, at Oswestry. The district has done very well in the allocation of funds in recent years. The region was able to give an additional £7 million, or a 9.1 per cent, increase, to Shropshire in this year alone. That is a rise of 206 per cent, in cash terms, or 32 per cent, in real terms, since the Government took office. That does not include £0.75 million that the district received in waiting list initiative money. I am sure that when the allocations of cash are made this year when the results of the autumn spending round are announced, the region will make a proper allocation to Shropshire to reflect all the demographic features of that county.
§ Mr. Fisher
Is the Secretary of State aware of the recent university of Leeds survey on health in north Staffordshire, which shows that 50 per cent, of men in Stoke-on-Trent die before they reach pensionable age and that in one part of my constituency the life expectancy for men is less than 62 years? How, therefore, can he justify re-weighting the mortality rates, which has led to the shift in resources of £56 million over the next three years from the west midlands to the rich south-east?
§ Mr. Clarke
I am aware of the study, which underlined the great need to improve the health status of the population of the Potteries. I suspect that historically the health status of people living in that industrial area has not been so good as that of the rest of the country. As I said in my first supplementary answer, since we came to power we have given a much bigger increase in funds to the west 818 midlands than to the rest of the country—and certainly greater than we have given to the south-east. Our new arrangements for distributing money are simpler than those that we had before. They reflect the comparative needs of the regions and still contemplate a comparative shift of resources away from London to other parts of the country.
However, whatever formula one comes up with, it is possible to make a case in favour of each and every one of the 190 districts in the country. The formula we are using is the fairest, taking account of all the competing health needs of the different districts.
§ Mr. Corbett
Will the Secretary of State make it clear whether next year under his new formula he expects the west midlands to get more or less money than this year? Is he aware that the North Birmingham health authority, with the Good Hope hospital in Sutton Coldfield, is currently £500,000 overspent and faces having to close wards and beds and to cut services? What is the Secretary of State going to do about that?
§ Mr. Clarke
I expect the West Midlands regional health authority to get more money next year, as it has every year during the lifetime of this Government. The exact amount will become clear when we make the allocations to the regions after the Chancellor has announced the results of the Autumn Statement, which will be shortly. The West Midlands regional health authority has never had so much money at its disposal for the National Health Service as it has at the moment. It is greatly increasing its patient care and I am sure that the hon. Gentleman's district health authority is treating more patients this year than it ever has in the history of the National Health Service. It is a weakness of the management of the Health Service that even when more money is poured into it it has mid-year crises because the management cannot match the expansion of services with the money—[Interruption.] The reason for reforming the service is to improve control over that money so that we can have steady and sustained growth instead of the checks to growth that the hon. Gentleman has just described.
§ Mr. George
If the Secretary of State is still talking to Sir James Ackers—I am not sure that he will be after the right hon. and learned Gentleman's intemperate letter of 24 October—will he guarantee to hon. Members representing Walsall that the final tranche of the £2.4 million to allow the new district general hospital to open on time will actually be made?
§ Mr. Clarke
Sir James Ackers is one of my oldest personal friends—[HON. MEMBERS: "Oh."] He is also one of the very best chairmen of regional health authorities in this country. It is an experience of life that when extremely good and competent people are running things there are sometimes fairly robust exchanges between them. My exchange corrected his letter, but he and I remain on excellent terms. When I next meet him I will take up with him the question that the hon. Gentleman has asked because I realise how important it is that we open this new and important facility at the earliest possible moment.
§ Dame Jill Knight
Could my right hon. and learned Friend shortly inform his great friend the chairman of the west midlands authority that when dealing with the new basket of money he should bear in mind that to both the public and to Conservative Members it is totally 819 unacceptable that women who have reason to suppose that they may have breast cancer should have to wait many months to be sure about it because of the shortage of money, or that a man who has kidney stones, when there is a lithotripter available, cannot have his condition alleviated because of lack of money? That point worries many of us.
§ Mr. Clarke
My hon. Friend has made strong representations recently to Sir James and to myself about proposed changes at the Birmingham women's hospital and she was able to ensure that no reduction of service was planned there. I am sure that Sir James is aware of the shortcomings of the service to which she has referred, and as we put more money into the West Midlands regional health authority, I trust that he and the region will ensure that the district health authorities are put in a position to tackle them.
§ Mr. Robin Cook
Perhaps I can help the Secretary of State in his difficulties with his Back Benchers. Why does he not tell them that their dissatisfaction with funding is evenly spread across the country? Did he see last week's survey by NAHA, the National Association of Health Authorities, which concluded that all health authorities face financial pressure and that nine out of 10 are having to make cash savings in this financial year? Does he recall describing last year's Autumn Statement, which left those health authorities in the red, as a "quite spectacular boost" in health spending? Is he really asking the House to believe that that spectacular boost was all frittered away by bad management? Or is the truth the fact that no health authority got the cash it needed to meet the real rate of inflation?
§ Mr. Clarke
That is quite absurd. The Health Service as a whole is spending more than £2 billion over and above what it was spending a year ago. That is an increase—taking a pessimistic view of inflation—of about 4 per cent. in real terms over and above inflation. The hon. Gentleman should do his homework and stop making wild assertions about the increase being below the level of inflation. The NAHA report is therefore against the background of the health authorities having more money to spend than they have ever had before, a quite spectacular rate of growth in their resources this year and every health authority throughout the country treating more patients this year than it treated last year and expanding its services. Only the hon. Gentleman thinks that there are no shortcomings in management revealed by the fact that they still get themselves into short-term crises towards the end of the year when they have had such a huge influx of funds. It is essential that we tackle those management weaknesses, because then we can get even more out of the enormous increases in funding that the Government are putting into the service.