Islington Health Authority (Hansard, 6 July 1990)

§ Mr. Jeremy Corbyn (Islington, North)
I should like to refer to the problems of Islington health authority, which obviously covers my constituency as well as the constituency of my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) and part of the borough of Haringey, which is covered by the Hornsey and Wood Green constituency.
I am sponsored as a Member by the National Union of Public Employees. I receive no personal income from that organisation, but I have a considerable interest in the health service through that sponsorship and because I represent an inner-city area. My hon. Friend the Member for Islington, South and Finsbury cannot be here, because he is away in Brussels on Front-Bench duties. He wishes to be associated with the general thrust of my remarks because he is worried about these matters.
The Islington health authority covers a predominantly impoverished inner-city area. In many senses, the health problems in the area are related either to the poverty of elderly people—there is an aging population—or to housing and social stress, such as alcoholism and various forms of psychiatric illness which largely emanate from social conditions.
It is to the credit of many people and organisations in Islington—the health authority, the council, the community health council, Islington Health Watch and many more—that Healthy Islington 2000 has been launched. It is trying to put into practice what the World Health Organisation has been preaching for a long time. I refer to a paper which was included in the report by Dr. Leila Lessof, the borough's public health officer. Monika Schwartz produced a paper on behalf of Healthy Islington 2000, in which she said:
We can recognise that not only do we need to promote healthier life-styles, we also need to create a healthier environment for people who work and live in Islington. The main points were as follows: to develop relevant health targets and indicators; to address directly inequalities in health, taking account of the health needs of the black and ethnic communities who live in Islington; to co-ordinate health promotion activities between the borough, the district health authority and other agencies; and to encourage an interdisciplinary approach to improving health and collaborative projects.
The Government's funding policies in respect of the needs of Islington health authority do not make many of those achievements possible.
The borough has been poll tax-capped, as have neighbouring boroughs, so there are problems involved in trying to implement the community care policies that have been put forward. There are also problems associated with the lack of ring fencing of community care expenditure, an issue which was extensively debated in the House recently. In addition, there is a great thirst for a better health service in Islington. The social history of the borough reveals—for example, the establishment of the Manor Gardens centre in 1912—the desire of working-class people living in the poor area of Upper Holloway to achieve a degree of communally provided and funded community health care.
1313 There are several health funding issues affecting Islington that I particularly draw to the attention of the House. One is the closure of Friern hospital, a large Victorian institution in the borough of Barnet which is jointly funded by Islington and several other areas. It is due for closure in 1993 and has been the subject of much controversy, particularly since there is no ring fencing of the community care provision of money that will be passed to borough councils.
I do not doubt the intentions of the London borough of Islington to carry out a decent community care policy. It is simply that the pressures on the borough's budget are intolerable. In addition, the borough has been poll tax-capped, as has the neighbouring borough of Haringey. An example of the difficulties facing mentally ill patients came in this story in The Haringey Independent of 28 June: Forty-nine-year-old Miss Patricia Burbidge of Wood Green was taken to North Middlesex Hospital where she died of multiple injuries. She was a mentally ill woman who was killed when she was in collision with a train at Bounds Green station.
Police are not treating Miss Burbidge's death as suspicious and an inquest will be held later this month. They believe Miss Burbidge was an in-patient at Friern Barnet, a mental hospital being run down as part of the Government's care in the community programme. The Voluntary Co-ordinator of the Enfield and Haringey Branch of the Schizophrenia Fellowship, Pamela Maher, criticised the pace of the rundown of long stay psychiatric hospitals in the wake of the tragedy. She said: With the rundown of Friern Barnet Hospital, it's increasingly difficult for staff to cope.' That emphasises many of the problems affecting the morale of the staff and the safety of patients, due to the rundown and accompanying loss of staff.
That newspaper carried a further story about the closure of Friern hospital and reported that Dr. Doris Hollander, consultative community psychiatrist at Friern hospital, was deeply worried about the shift of patients from the hospital. They would end up homeless, in prison or committing suicide, she said.
It is important for us to air loudly problems such as that. There are 590 patients at Friern, 200 of whom come from Islington. I am sorry to say that patients from many mental health institutions do not get adequate community care. Instead, they slip through the net, and a tour of people in London who nightly have to sleep near the central heating grilles of offices, alongside the Savoy hotel or in parks in north London reveals the tragic situation of many former in-patients of long-stay institutions. I am in favour of community care, but if it is not properly funded, we shall continue to have the disastrous situation that now exists.
With the possible advance of the closure of Friern hospital, a degree of panic is setting in. Insufficient alternative accommodation will be available if the closure is brought forward two years, the latest proposal to come from the regional health authority. May we be assured that such a speedy closure of Friern will not go ahead without the provision of adequate, full-time, permanent accommodation for those who will be discharged when the hospital finally closes? My second substantive point is the problem of the funding of Islington health authority. The annual report of Islington community health council stated:
In October last year the health authority agreed cuts in services of 65 beds, and 16 per cent. reductions in operating theatre out-patient sessions. 1314 In November, the health authority announced delays in funding a number of big capital schemes, including Whittington's diagnostic block. The report continued: Waiting times for admissions and out-patients' appointments grew. Many patients had appointments postponed, and sometimes postponed again, as a result of those decisions. The quality of care received by patients has deteriorated and there are worries that patients are being pushed out of hospitals far too quickly.
As part of the proposals to save money, the authority's search for solutions includes centralising services on the Whittington site, removing all remaining acute beds from the royal northern hospital, a historic hospital just down the road, the accident and emergency department of which was closed some time ago despite the hospital being the borough's war memorial. The more efficient use of out-patient departments has meant that pressure on the hospital has become worse. Last October the number of beds was reduced by a further 60 on top of the considerable cuts that had already taken place.
Doreen Scott, a fine woman who suffers from severe disability and is wheelchair bound, is the chair of Islington community health council. She has done enormous work throughout the borough for many years and, as a patient of the Whittington hospital, she conducted a survey on the effect of those cuts. It stated: the food was poor—often not hot enough and often not what I ordered…maintenance of the ward was poor—light bulbs were not replaced and the payphone not emptied. When she was in hospital she witnessed the problems of transferring patients between wards because of the lack of staff. One patient had to go for a test in the diagnostic block across Highgate hill wearing his pyjamas because there was no ambulance available to fetch him. She witnessed a number of elderly patients being discharged who appeared to be still in need of hospital care. She is experienced in such matters.
The long-term problems are that over the decade the health authority has been told to make cuts of about 15 per cent. in real terms and 11 per cent. real terms expenditure has been cut from the Islington health authority since 1983. Dr. John Yudkin, a respected doctor dealing with diabetes at the Whittington hospital, who is well known to many people, presented a fact sheet, which was never denied, to members of the authority and the public last November. It stated that, despite the money granted to Friern hospital and the underfunding of the pay awards, during the past six years there has been a continuous cut in funding. Efficiency savings meant that the increase in expenditure had to be met by a reduction of expenditure in the district. On top of that, the district has had to contribute to the pool expenditure of the Lawson cuts and the regional growth pool. He also explained the problems that he and many others suffer as a result of the severe cuts in the expenditure of Islington health authority. There has been a 34 per cent. bed loss in the past six years. The Whittington hospital is now down to a mere 600 beds. At its height it was a large hospital of 1,500 beds.
At its meeting in October, the district health authority received a list showing the closure of one ward at the royal northern hospital, the closure of further wards at the Whittington hospital, restriction to five-day usage, agency and recruitment costs and the reduction in operating theatre lists. That last item saved £160,000, and the total list added up to savings of £1 million. That saving has resulted in a considerable deterioration of the health care 1315 available to the people of my constituency and that of my hon. Friend the Member for Islington, South and Finsbury.
The health authority's more recent meeting on 6 March 1990 listed proposals for service reductions totalling £980,000 and analysed how the problems had come about. It stated:
The major problem for Health Authorities with this allocation is that the provision for inflation has only been included at 5 per cent. This is unlikely to be sufficient to meet either pay or price inflation. Pay awards for public sector employees are likely to be settled with a 7.5 per cent. increase being the minimum expectation with price inflation are also running at 7 per cent. Ludicrous demands are placed on area and regional health authorities, which mean that they cannot meet the targets and needs of patients within the community that they are there to serve.
By contrast, Hornsey central hospital, which is also in the district, demanded £1 million for refurbishment for one part, which was at first refused, and has now been phased over two years with £250,000 being paid in the current year, and £750,000 next year. In the same year that refurbishment of Hornsey central hospital was refused by the regional health authority, about £1 million was spent on the refurbishment of the regional health authority offices: these are serious matters indeed.
A merger has been proposed for Bloomsbury health authority, with part to go to Parkside, but the majority to Islington. There has been strong opposition to the merger for a number of reasons. First, it prevents Camden from having a coterminus health authority and makes coterminosity with Islington much worse—it is already not coterminus and will become even less so. In addition, Bloomsbury health authority is notoriously underfunded. A public consultation document on the merger received 60 responses, which is a large number for such a process. It is arcane to ask somebody to comment on the boundary changes of a health authority; nevertheless there were 60 responses, and only three supported the idea. Two responses were qualified and 55 had serious reservations.
I did not send in an objection or a view on the document because I associated myself with the response put forward by Islington Health Watch, as I chaired the meetings that drew up the response.
In the objections it was claimed that:
The consultation period is unreasonably short …while it is claimed that the plans will improve liaison between Westminster Council and the Health Authority, the same argument has been totally ignored for Islington and Camden…Creation of a Camden Health Authority (by merging Bloomsbury and Hampstead Authorities) needs looking into …The merger of Islington and Bloomsbury Health Authorities will probably be followed by merging Hampstead Health Authority with them. Thus causing a second upheaval on top of goodness knows how many upheavals in health service reorganisation in the past 15 to 20 years.
I hope that those objections will be taken seriously by the Minister.
My union—the National Union of Public Employees—and the Confederation of Health Service Employees and other unions have shown their objection to the proposal. They are concerned about the problems that will result in the development of community services, mental health 1316 services, education and management arrangements. It is interesting that the City of Westminster also sent in an objection which says:
The issue of coterminostity between health and social services authorities remains important, particularly in view of the legislative proposals in the NHS and Community Care Bill currently before Parliament, for this was the primary justification for the proposed transfer of north-east Westminster to Parkside. I have had discussions with many people associated with health work in Islington and Camden in preparation for this short debate. They are all concerned about funding, about the closure of Friern, and about the need to develop facilities which will meet the needs of the people of our borough. They are in a difficult position. The Bloomsbury merger has been mooted for some time and there has been some consultation on it. A large number of objections have been sent in.
Will the Minister tell us that the Bloomsbury merger is not going ahead? He and his colleagues have had letters from my hon. Friend the Member for Islington, South and Finsbury, with which I wish to be associated, asking that it should not.
Will the Minister instead announce that it is his intention to retain the objective of coterminosity between health authorities and local authorities. It will be difficult to achieve a good standard of co-operation, as has developed between Islington health authority and the London borough of Islington, if one has to deal with two or even three boroughs, which is what will happen.
Also, the Government and Ministers should study the allocation of resources regionally within the health authority. Islington comes within the area of North-East Thames regional health authority, and that area extends from very poor areas of inner London, which need the resource allocation working party formula because they have continuously lost resources over the past decade, all the way to Southend. They are diferent areas with different problems. The authority provides an expensive service. If there is to be health service reorganisation, it would be better to set up a London health planning agency which could direct resources as they are required to health authorities within London. At least that authority would be based on London boundaries rather than on the curious boundaries of the four Thames regional health authorities.
I had discussions this morning with the chairman of Islington health authority, Mr. Moonman, who emphasised the good relationship that had developed with Islington health authority and the need for the Minister to say clearly that the merger will not go ahead and that a new authority will be appointed. I am worried about the lack of democracy in running the health service. There should be rapidly appointed a health authority which reflects the needs and aspirations of Islington's people. We do not need one whose members are drawn solely from the business community, and that seems to be the formula that is developing. We need an authority that represents the borough council, local community and trade union interests and local business people who have a contribution to make. That would genuinely reflect the needs of the borough as a whole. Anything other than that is a receipe for long-term disaster.
Islington requires a recognition of its health needs and support for the good health initiatives that have been taken. Above all, it needs resources. We cannot go on year after year with one ward closure and one bed closure after another in order to meet some ridiculous target set by the 1317 Minister for the regional health authority. We need the resources to meet the health needs of the people that I represent.

§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
The hon. Member for Islington, North (Mr. Corbyn) has raised a wide range of issues and I have little time in which to respond. I do not think that I can reply to all the questions that he posed, but I shall cover as many as possible.
The hon. Gentleman quoted a call by public health officials for fixing, among other things, targets for the provision of health facilities for ethnic minorities and asked for an improved inter-disciplinary approach to health management. He mentioned a number of other desirable objectives, and I do not disagree with any of them. In terms of those objectives, the hon. Gentleman should be rather more open-minded than some of his hon. Friends to our reforms in the management of the health service. The fixing of health targets, especially for ethnic minorities, is one of the positive results that I expect to flow from the introduction of the purchaser-provider split which is at the core of those reforms. The hon. Gentleman does not have to accept my word for that positive result of the National Health Service and Community Care Act 1990. He can consult Mr. Chris Ham, who writes for a magazine which I suspect the hon. Gentleman reads more frequently than I do, Marxism Today.

§ Mr. Corbyn
I do not read it at all.

§ Mr. Dorrell
Perhaps the hon. Gentleman should read it; he could learn how the management of the health service could be improved using the principles contained in our Act. Mr. Ham, who is certainly not a Government supporter, argues that for people who share the hon. Gentleman's political point of view the ideas in the Act present an opportunity—precisely the opportunity that they are intended to present—for health service managers to think specifically about the health needs of people resident in their areas, and then to set out to ensure that those health needs are met.
The Government not only embrace the objective set by the hon. Gentleman but have provided the management framework to turn that objective into reality. Part of the purpose of the health service reforms is that the new health authorities, as prudent purchasers on behalf of their resident populations, should be thinking in a way that has not been necessary in the context of traditonal health service structures. They should think in an ordered manner about the precise health needs of their resident populations and use the budget provided by the national health service to ensure that those priorities are met. The health authority is charged with producing a properly prioritised budget to purchase health care that meets the specific needs of its resident population.
I embrace most of the first part of the hon. Gentleman's speech. The Government seek to do exactly what he urged. That is why we are reforming the structure of health service management to ensure that objectives are more accurately met than was possible in the past.
The hon. Gentleman went on to mention three specific matters that have arisen in his constituency. I shall deal with each of them briefly. The first is Friern hospital. He said that it was part of the Government's programme to 1318 run down large mental hospitals as part of their community care programme. As the hon. Gentleman may know, I am the Minister with responsibility for mental illness issues. It is not our policy to run down large mental hospitals. Our policy is to provide mental care that is more accurately targeted to meet the clinical needs of each patient.
Most people in the mental illness world, although not all, recognise that in the past too many patients were put in unsuitable, large-scale hospitals where their clinical needs were not met. It is not our policy to close all mental hospitals. It is our policy to ensure that patients who can most benefit from treatment in the community should have the opportunity to receive it and that those who need more structured support should have that support. The facilities should be available to ensure that the clinical needs of each patient are met.
The context of Friern hospital is interesting. The hon. Gentleman expressed anxiety about patients being discharged without proper support and without a proper treatment programme. That anxiety is precisely the reason why my Department is helping to fund the TAPS—team for the assessment of psychiatric services—programme of research into what happens to patients who are discharged from Friern. We want to be sure that our widely accepted objective of providing more accurately targeted clinical care to individual mental patients is met.
We have set up a research organisation that will act as an informal policeman to ensure that precisely the fears expressed by the hon. Gentleman about patients being discharged from Friern hospital will be examined. We shall find out whether the hon. Gentleman's fears are soundly based. I hope that they are not. We shall do what we can to ensure that they are not. I can give him some comfort by pointing out that the personal social services research unit conducted a research programme into those fears in 28 local schemes. It found that no patient in any of the 28 schemes ended up as the hon. Gentleman described, either on the streets or in prison.
The Government's policy is to ensure that mental patients are treated properly according to their clinical needs. That policy will continue and it will not be changed.
The hon. Gentleman spoke next about what he described as the underfunding of Islington health authority. He alleged that there had been substantial real terms cuts in Islington's health spending. I am glad to assure the House that that is not the case. Between 1982 and 1988–89 real-term spending by Islington health authority rose by 9.5 per cent. The initial cash allocation for this year is up by 9 per cent. on last year.
I prefer to judge the effectiveness of health care in a district by the effect on patients rather than the amount of money spent. The hon. Gentleman may be interested to know that the number of in-patients treated in Islington health authority has risen at an average rate of 1.5 per cent. a year since 1982 and the average number of day cases has risen at an average rate of 6 per cent.
I do not accept that there have been real cuts in the level of health care provided by Islington health authority. I accept, however, that there have been changes in the way in which that health care has been provided. I do not apologise for that, because it is important for any manager in the health service not to insist on managing a service 1319 that is set in aspic. All services should be responsive to the latest opportunities to improve the effectiveness with which health care is delivered.
Thirdly, the hon. Gentleman talked about the proposals on which we have gone out to consultation to change health authority boundaries in the area of London which he represents in part. No decision has yet been taken. We are still considering carefully the 60 responses to the consultative document. My officials have had the advantage, which perhaps the hon. Gentleman has not, of reading all the responses. I am glad to assure him that his presentation of the balance between support, neutrality and opposition is not that which is perceived by my officials who have read the representations.
The hon. Gentleman laid some stress on the coterminosity argument. I understand the concept of 1320 bureaucratic neatness, which has some appeal, but those who consider management structure issues within the health service have to approach them more seriously than merely examining lines drawn on a map and then saying "Wouldn't it be nice and neat if all the lines could be drawn down the same streets or the same rivers." There are important issues to be considered and I do not regard coterminosity as an especially important one in terms of the planning of health care in any locality, including that which the hon. Gentleman represents.
The hon. Gentleman laid some stress also on the principle that there should be local representation on district health authorities. That misunderstands the nature of a DHA and its purpose. I would—