§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Goodlad.]
11.42 pm§ Mr. Tim Janman (Thurrock)I am grateful for this opportunity to bring to the attention of the House some strong concerns in my constituency about proposals being put forward for the reorganisation of the delivery of acute services by my local health authority. You will be aware, Madam Deputy Speaker, that my hon. Friend the Member for Billericay (Mrs. Gorman) would also like to make a few comments before my hon. Friend the Under-Secretary of State for Health responds to the debate.
The proposals essentially involve the delivery of acute services from the two general hospitals in our health authority area, Orsett and Basildon. The proposals are to centralise accident and emergency care, intensive care, coronary care and general medicine at Basildon, and to centralise all day care surgery and planned surgery at Orsett. The proposals give rise to four particular concerns.
The first is that Orsett, which is currently a general hospital that is held in the highest esteem and affection by my constituents, will become a cold surgery hospital rather than a full general hospital because under the health authority's proposals all warm surgery and general medicine will be centralised in Basildon.
Secondly, the centralisation of all accident and emergency services at Basildon will mean that the 88 per cent. of non-emergency attenders at Orsett from my constituency—many thousands of people every year—will have an extra seven or eight miles of hassle and inconvenience travelling to Basildon, often accompanied by either a young or elderly relative with a fairly serious injury. The irony is that the worst rates of social deprivation in the health authority area are, on the whole, in my constituency—yet those are the people who will have an extra seven or eight miles to travel, often facing severe traffic jams on the A13 at the main roundabout just below Basildon. That is causing a great deal of concern.
It is worth noting that only nine district health authorities in England with a similar or greater population than that of Basildon and Thurrock attempt to provide all their accident and emergency services on one site. Of those nine, only four have a population greater than that which will be attained by the borough of Thurrock and the district of Basildon combined by the end of the current decade.
From the A and E statistics, one can make a case for saying that the borough of Thurrock—that is, my constituency and part of that of my hon. Friend the Member for Billericay—should be its own district health authority. According to a written answer of 24 May, if one takes a ratio of the number of A and E units and the populations of each of the English district health authorities, one discovers that 119 English district health authorities have a population to A and E unit ratio of less than 129:1, which represents the ratio of the population of the borough of Thurrock set against having one A and E unit still maintained at Orsett.
The third major concern about the proposals is the lack of a full intensive therapy unit at Orsett, given that major planned surgeries will be carried out there under the DHA's proposals. When the proposals were first advanced, many consultants in the district health 974 authority were concerned about that point. It is fair to say that they have been mollified to some degree by some amendments that the DHA has now made to its own proposals, but there will only be a 24-hour intensive therapy unit at Orsett under those proposals. That, again, is a matter for concern.
The fourth major concern is the centralisation of general medical and coronary care at Basildon despite the fact that the five wards with the highest premature death rate for circulatory system diseases are all in my constituency, as are the three highest rates of schaemic heart disease in the district. The three highest rates on a ward by ward basis in the health authority area for this type of heart disease are also in my constituency. Therefore, under the local health authority's proposals the part of the district with the highest percentage of people likely to be needing that care will have to use a hospital that is further away.
The key question is why Basildon and Thurrock district health authority has put forward these proposals. Apparently, it is to save money. Yet Sue Jennings, the acute unit manager for the DHA, has said that if the DHA were to get the extra £1 million tomorrow, which is the amount by which it will be over budget in this financial year, and in all future years henceforth in real terms, she would not want to withdraw the health authority's proposals, but would want to do more planned surgery, such as hip replacements, and to expand other services.
My hon. Friend the Member for Billericay and I have submitted a response to the health authority, which will have arrived there earlier this week, ready for the meeting this Thursday, suggesting that if the proposals of the Basildon and Thurrock health authority are motivated mainly by the desire to get into budget, we feel that a combination of pruning excessive management posts allowing the private sector to utilise spare facilities—hence providing more revenue—and the implementation of the community health council's organisational recommendations, to which I shall turn later, represent a superior methodology for achieving that objective than that proposed by the DHA. Of course, substantial reductions in the number of administrative and clerical staff could also be achieved to that end.
If, on the other hand, the primary objective is to improve service provision, we recommend that the district health authority should agree with the community health council a joint proposal that will find a new consensus among the population and will carry public support, provided that it has the consensus of opinion behind it.
What if the health authority is motivated mainly by the desire to get into budget? My hon. Friend the Member for Billericay and I have examined some aspects of the health authority in some detail. We have examined its management organisation charts. From our experience in business and industry, we believe that 10 posts are superfluous to requirement in the management structure. That is particularly the case in the community care unit. The analysis has been backed up by comments that have been made to us by nurses who work in the unit and by the community health council. We believe that a saving of £300,000 could be made if the 10 posts were axed.
We agree with the community health council that the promotion of 18 staff to neighbourhood managers within the community services unit should be indefinitely postponed. It is our guestimate that that would save a further £75,000.
975 Between April 1984 and March 1989, the administrative and salary costs for my district health authority rose by 34.8 per cent. Over the same five-year period, the accumulated increase in the retail prices index was only 26.7 per cent. If we compare the numbers of admin staff in the authority with various measurements of patient throughput, we obtain some interesting facts. Using figures that my hon. Friend the Minister gave in a written answer to my hon. Friend the Member for Billericay only last week, in 1985 the number of deaths and discharges in the health authority was 33,300. That rose to 33,710 by 1988—an increase of 1.2 per cent. Over the same period, the number of administrative and clerical staff rose by 6.1 per cent., from 490 to 520. In the period 1988–90, by the health authority's own measurement of throughput, the number of in-patients and day cases at Orsett and Basildon hospitals increased from 38,170 to 39,222—an increase of 2.76 per cent. Yet the number of admin and clerical staff—admittedly, across the whole health authority and not just in the two main hospitals—increased from 520 to 560.72, an increase of 7.8 per cent.
I have used 1985 as the base year—a year well beyond the major boundary changes in district health authorities in the early 1980s. If the number of admin and clerical staff had increased by the same percentage as the throughput in patients from 1985 to 1990, which would give a zero productivity increase, instead of increasing from 490 to 560.72, the number would have increased to only 510.
I am willing to accept that our figures are based on a certain degree of guestimate—neither of us is expert in the matter—but we hazard a guess that 50 posts in the admin and clerical staff could be lost. If those heads went, that would save £400,000. Even with the possibility of some double counting of the management posts to which I referred earlier, it is clear that there are opportunities for considerable savings in the health authority. Certainly, the authority could save more than the £260,000 which the authority said that it would save in the first year under its own proposals. My hon. Friend the Member for Billericay intends to talk about that in a little more detail.
If the motivation behind the proposals is not to get into budget, and if that is being used as a smokescreen simply to reorganise as the authority wants to but which it knows will be unpopular with my constituents, it should make new proposals after holding discussions with the community health council and the family practitioner committee. With those two bodies it should formulate a consensus approach that will carry the population with it. I hope that my hon. Friend the Minister will take note—I am sure that I shall visit him with my CHC on the matter—that my CHC has put forward alternative proposals that include keeping a non-emergency casualty unit at Orsett and centralising general medicine and coronary care at Orsett, not Basildon, but keeping a high dependency unit at Basildon to support the centralisation of emergency admissions at Basildon.
My hon. Friend the Member for Billericay and I support the alternative proposals of the community health council because they are realistic and will maintain, if not improve, the service to the entire area, but especially our respective constituents. That improvement will not be achieved through the DHA proposals. As my hon. Friend the Member for Billericay rightly wishes to speak, I do not have time to say any more about the CHC's counter-proposals, except to emphasise that I support them.
976 I must strongly reiterate to my hon. Friend the Minister that there is considerable local opposition to the DHA proposals. I respect, of course, its desire to get into budget. In the past five years there has been a consistent real terms increase in the amount of funding that it has received. I find it difficult to believe that that total amount of funding is the problem. Whatever the motivation behind the specific DHA proposals, there is considerable local opposition to them. Nearly 20,000 people have now signed the petition that one of my local newspapers, the Thurrock Gazette, has organised. My hon. Friend should use his powers to put pressure on the DHA to withdraw its proposals and to assess properly its efficiency and its efforts to get administration under control. It should not reduce service provision to my constituents. It should make cuts in the other areas that I have mentioned rather than in the core services.
It would be much better if my hon. Friend could use his influence to bring pressure to bear on Basildon and Thurrock district health authority to withdraw its proposals. It should work with the CHC and the family practitioner committee to decide upon an acceptable way forward that is within budget.
Some of the controversial DHA proposals are supported by medical opinion—for example, the centralising of emergency services provision at Orsett. The CHC has accepted that medical opinion is right in that respect and as a politician I do not think that it is right that I should argue against that opinion.
There are some aspects of the proposals that the CHC and I can accept, but the complete withdrawal of accident and emergency facilities in the borough of Thurrock, particularly in my end of the borough, is unacceptable. The package of proposals is not acceptable and I hope that my hon. Friend will bring pressure to bear to get them withdrawn.
§ Mrs. Teresa Gorman (Billericay)I thank my hon. Friend the Member for Thurrock (Mr. Janman) for allowing me time to speak in his Adjournment debate. I also welcome the presence of my hon. Friend the Member for Basildon (Mr. Amess).
My constituency straddles the two main hospitals of Thurrock and Basildon. Those large district hospitals are relatively close together, so that, on paper, one might reasonably ask why we need two main hospitals to service the area. The Thurrock half of my constituency, however, points to the river and is distinct from the other side of my constituency which is on the other side of Basildon, the town in the middle of it. The people in that part of the constituency relate to the Basildon hospital and think quite differently about themselves. Although the two hospitals are geographically close, there is a major motorway between them that must be crossed. At busy times of the day—increasingly that means all day—the motorway is heavily congested. The people of Thurrock view with great concern the prospect of going to Basildon hospital for accident and emergency treatment.
Many people living in the area of Thurrock district have modest incomes and do not have motor cars. Public transport between that part of Thurrock and Basildon hospital is not good, and it is worrying those people that they will have to go to Basildon for accident and emergency treatment.
977 There has been a great upsurge of concern in the area and I sometimes think that we neglect the fact that the institutions about which we are speaking exist for the people of the area, not for the administrators who wish to make things neat and tidy on paper.
I praise my hon. Friend the Member for Thurrock for the work he has done in looking into the problem, including the detailed financial analysis that he has made. Although it was said that the initial savings would be about £1 million—the figure of £800,000 was mentioned—it would seem in the final analysis that the actual savings as a result of this major change of policy would be little more than £250,000. I am sure that that sum would be dissipated when the changes came into effect, through the provision of new beds and the extra facilities that would have to be provided at Basildon hospital. Those expenses would soon gobble up any money that was saved.
I have talked to the nurses on both sides. They assure me that there are far too many chiefs and not enough Indians—that, as my hon. Friend said, there are too many administrators. Thurrock has one of the fastest growing populations in the country, with a 10 per cent. increase a year, which is five times the national average.
In the Thurrock part of the constituency we have Tilbury docks, one of the major docks, where the chances of accidents happening are relatively high. The accident and emergency unit should be retained in Thurrock. We have Shellhaven and Mobil, the two largest oil terminals in the country, for which accident and emergency services are vital. We also have the development of the Thurrock-Dartford bridge to supplement the tunnel, the development of an enormous shopping centre and a new town of almost 8,000 dwellings, the Chafford Hundreds.
For all those reasons, the facilities for accident and emergency treatment should be retained in the Thurrock part of the constituency. We have in the past agreed to amalgamate gynaecological services. We have discussed the prospect of the people of Basildon having to go to Thurrock for what is known as cold surgery, which is a curious term for long-term surgery. We have the prospect of people needing emergency surgery having to go all the way from Thurrock to Basildon. That is not the way to treat people, remembering that this is their health service.
We want to keep the people of Thurrock safe with their own accident and emergency service. I hope that the Minister will respond positively to that request.
§ 12.2 am
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)I wish at the outset to congratulate my hon. Friends the Members for Thurrock (Mr. Janman) and for Billericay (Mrs. Gorman)—but particularly my hon. Friend the Member for Thurrock—on raising this issue and on expressing clearly the concerns of their constituents about the proposals that have been put forward by the health authority.
My hon. Friend the Member for Thurrock has a reputation—it was drawn to my attention soon after taking up my present duties—as an assiduous advocate of his constituents' interests. There could be no better illustration of that than the detailed presentation—my hon. Friend the Member for Billericay will not mind my saying that, for while both my hon. Friends signed the 978 presentation, it reflects the detailed work that has been done by my hon. Friend the Member for Thurrock—that he has made as background to the representations that he has been making on behalf of his constituents as a result of the concern that they have expressed about the proposals.
My hon. Friend has taken up these matters in private, as well as in the House tonight, and because I regret to say that I doubt whether what I shall say tonight will conclude the matter, I confidently expect my hon. Friend to continue to pursue his campaign in the coming weeks.
As my hon. Friend said, the reason for this debate is that the health authority issued a consultation document this April and is currently out to consultation on the proposals contained in it. I shall not weary the House with a recital of the document's contents, but I should observe at the outset of my speech that if the objections that have so far been maintained by the community health council are maintained throughout the system, the proposal will land on Ministers' desks. Therefore, I hope that both my hon. Friends will appreciate that I am constrained in what I can say about the merits of particular proposals because they seem to be set fair to land on Ministers' desks and I must not prejudge the outcome of that decision-making process. If it comes to that, I am sure that both my hon. Friends will wish to put their views again, and I shall ensure that there is ample opportunity for them to do so.
I must emphasise that the drift of health service management in recent years—this is not unique to the health service—has consistently been to try to delegate decisions further down the line. When, in the health service or anywhere else, one tries to delegate decisions, those at the top of the service must recognise that occasionally the managers to whom decisions are delegated will make decisions with which those at the top may disagree.
In those circumstances, the burden of proof placed on anyone wishing to encourage a Minister to overturn the decisions taken by a delegated manager is, rightly, heavy. My hon. Friends must show not only that if I were in that manager's position I should do as my hon. Friends advocate, but that their arguments are so weighted that they should overturn my natural preference for a delegated system of management and support their propositions.
My hon. Friends have been elegant in expressing the concern about the proposal within their constituencies. But there is no proposal to close Orsett hospital. On the contrary, there is a proposal to change its role in a way that my hon. Friends and their constituents find unsatisfactory, and their reasons for doing so were expressed by my hon. Friends. It is important for everyone to understand that there is common ground between the health authority and my hon. Friends, and their constituents, about the importance of maintaining hospital facilities, both at Basildon and at Orsett, which is not in dispute.
There is an obvious worry that the residents of the Thurrock district will have to travel to the Basildon end of the health authority district. As both my hon. Friends stressed, when considering whether that is an appropriate arrangement, the health authority and, ultimately, perhaps Ministers will have to bear in mind that there is a concentration of disadvantaged areas in the Thurrock end of the district. As my hon. Friend the Member for Billericay stressed, there is also a concentration of industrial plants that might give rise to industrial 979 accidents. Those factors undoubtedly have to be taken into account, principally by the health authority and, if necessary, by Ministers, when reaching decisions.
Without prejudicing what we as Ministers might conclude if the proposal reached our desks, I shall say a few words about the basic arguments that my hon. Friends advanced against the health authority's proposal. First, there are financial arguments. I am glad that it is common ground between both my hon. Friends and me that the health authority has a clear obligation, which it must discharge, to ensure that its financial affairs are properly managed and its budgets are properly balanced. That is the only basis on which we can achieve a proper distribution of resources throughout the health service, and it is an entirely proper discipline for health service managers at all levels to insist upon.
It is also worth remembering that Basildon and Thurrock health authority has closed the gap between its spending level and the national target defined by RAWP; the gap was 11 per cent. seven years ago, but today the authority is on its RAWP target. That shows that there has been effective management of resources.
My hon. Friend the Member for Thurrock emphasised what he felt to be the scope for savings on administrative and clerical staff, suggesting that 50 heads could be saved at a total saving of £400,000. I do not dismiss that argument. If the issue came to Ministers' desks, we would carefully consider it.
My hon. Friends should also recognise that when the health service recruits additional managers, it does so in the belief that the extra management effort contributed by administrative and clerical staff will release resources for better use elsewhere in the service. That can arise in two ways: by clerical staff taking over administrative functions previously carried out by clinicians, with the result that a 980 higher proportion of clinicians' time is available for patient contact; and by ensuring that other resources are more effectively managed and that any management posts created should achieve a considerable improvement in the effective use of resources in the service. It has been one of our purposes since 1979 to ensure that health service resources are more effectively used. One manifestation of that is the extra investment that we have made in management.
The second leg of my hon. Friend's argument was that, whatever the arguments about budgetary balance, the health authority may believe that these changes are necessary anyway. He stressed the advantages of looking for a consensus with the CHC. It undoubtedly has a role to play in this; I welcome the fact that it is involved in constructive dialogue on the way forward for the health authority.
Ultimately I am sure that my hon. Friends will recognise that it is for the managers of the authority to decide how best to provide patient care and proper financial discipline in the health authority's area.
It seems that the case may well come to Ministers. I can assure my hon. Friends that we shall carefully weigh the arguments that they have advanced tonight. We shall provide ample opportunity for them to develop them in private, and I am sure that they will take up that offer. Our objective will be to ensure that the health authority maintains proper financial standards and disciplines; and, much more importantly, that the resources used by the health authority are used to clinical effect in its area.
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twelve minutes past Twelve o'clock.