NHS Trust (Bradford) (Hansard, 24 April 1991)

§ Mr. Max Madden (Bradford, West)
I am extremely pleased to introduce this short debate, for which I have applied for the past six weeks.
The recently published Bradford health plan outlines a number of overall health priorities: mothers and the newborn; infants; toddlers and children; adolescents; people requiring acute services; people with chronic diseases; people requiring rehabilitation and stroke services; and, elderly people.
About 80 women in every 1,000 of child-bearing age have a baby each year, which provides Bradford with one of the highest birth rates anywhere in the country. Projections show that there will be some 5,300 to 5,600 births each year, yet there has been a relative decline in expenditure in maternity care services, which has fallen from 10.5 to 10.1 per cent. of total expenditure, during the past five years.
Bradford has the highest proportion of children under 16 years old anywhere in the country—23 per cent. of our total population—and by the year 2001, the five-to-14 age group will have increased by 10 per cent.
The health plan says: The health of children in Bradford is poor and presents a greater challenge than for most other health districts. Children between the ages of 0–14 years have a 42% increased risk of dying in Bradford than elsewhere in the country … Deaths in children under one year old are particularly high … The different levels and patterns of death amongst different ethnic groups is relevant to Bradford's multi-racial population. Death rates for babies of mothers of Pakistani origin for example, are 16.9 per 1,000 total births, compared with a rate of 9.4 for babies born to mothers of British origin … Serious congenital malformations are more common in Bradford than elsewhere in the UK. Yet expenditure has again fallen from 5.5 per cent. to 4 per cent. in the past five years.
There are about 45,000 disabled adults in Bradford. Of those, 18,500 have severe disability and 9,000 very severe disabilities. Of all day hospital attendances, stroke is the most common condition. Deaths from stroke are about 20 per cent. higher in Bradford than should be expected. Heart disease is a major killer.
The plan goes on to say: Generally the population of Bradford is younger than the population of England and Wales. It is predicted that in Bradford the number of people aged 65 and over will reduce from 46,000 in 1985 to 44,600 by the end of the century. However, within this figure the number of people aged 85 and over will increase by 27% from 4,000 in 1985 to 5,100 by 2001. The Bradford hospitals trust became fully operational on 1 April, although it has clearly been in the driving seat for several months, having been formally established in mid-December. Its official aim is to provide high quality health care, promptly and equitably for the people of Bradford. Sadly, public confidence in the Bradford trust achieving its aim has been seriously undermined. In January, constituents who wanted operations at Woodlands hospital were told that operations had been cancelled on the Government's instructions because of the Gulf war. It 1185 has since become clear that patients awaiting operations at the Bradford royal infirmary and at St. Luke's hospital were also refused admission on identical grounds.
The trust cancelled all operations for which patients required a long stay for five days at the start of the Gulf war. In doing so, it acted without authority or instructions from the Government. I understand that Bradford health authority ordered the trust to reopen the list, yet it took a further six to nine days before operating lists were working normally again. Even by the middle of February, operations requiring long stays in surgical beds—especially for hip replacement operations—were still being refused.
One constituent, outraged at being refused his double hip replacement operation in Bradford, thought that he had obtained his operation by going to Scotland. However, his consultant in Scotland wrote saying that he could not be admitted, as neither Bradford nor Tayside health authority was willing to pay for it. So much for patient choice and for the Government's claims that, under the new reforms, money will follow patients. Now, four months later, my constituent is in Bradford and I wish him a full and speedy recovery following the operation that he should and could have received in January. If he had not had the confidence to protest, I wonder whether he would now be having the operation that he badly needs.
Over Easter, ward 16 of Bradford royal infirmary, which treats young people for ear, nose and throat illness, was closed for a fortnight. It is believed that the primary reason was that the four consultants responsible for the specialty chose to take their holidays simultaneously. Nurses were redeployed as a result of the closure, but those who could not be found alternative duties were forced to take unpaid leave. It is also clear that paediatric staff at St. Luke's hospital are now working under extraordinary pressure.
In February, an internal memo was leaked. It is strongly believed to have been written by Dr. Mark Baker, chief executive of the trust and former district general manager for Bradford health authority. The memo, which is dated 25 January, stated that overspending on the budget was running at 2.5 per cent. to 3 per cent. and that there should be an immediate reduction of 6 per cent. in current expenditure and a reduction of 3.5 per cent. against budget. Strategy should be based on reduced staffing, reduced plant and overheads and marginal cost limitation.
The memo stated that emergency action should include total immediate recruitment freeze until further notice …except for junior medical staff …an absolute ban on use of nurse agencies and a ban on all purchases unless essential for emergency medical purposes. It went on to say that there should be planned restriction on the volume and range of activity, for example pathology, X-ray and surgery, help for sick staff to retire and honesty about redundancy. It states that that could result in a rise in the waiting list.
The memo also said that there should be an absolute freeze on development until further notice" and no upgradings except for new jobs or as part of total reprofiling. It also stated that no promises should be made, and that 1186 staff whose employment is to be terminated should be identified early and released at the beginning of the financial year. Situation is partly the result of HQ profligacy, partly due to creepage but also significantly due to loss of management control. Some directorates have taken positive action to reduce cost but we are now in a different scale of crisis altogether. For all directorates, getting a grip on spending now is the only relevant measure of performance. In addition to taking the action I have outlined, I want formal feedback by next Wednesday on what can be achieved and what the service implications are. I gave a copy of that memo to the Minister when I met him, together with colleagues, in March of this year.
Dr. Baker, at the time of writing that memo, had been district general manager less than 12 months previously. He was also the senior manager and the architect of the budgets that he is now busily cutting. Paragraph 6 of that memo says: If action leads to ward closures, manage them right—we will help. Use the crisis to achieve goals. On 30 January, staff on ward 6 at Bierley Hall hospital were told that their ward would close. I shall not pursue that matter, as I am glad that my hon. Friend the Member for Bradford, South (Mr. Cryer), in whose constituency Bierley Hall is located, will deal with it later.
It is clear that expenditure cuts will have several knock-on effects. Not least will be the blocking of acute beds, thereby defeating throughput, without which the trust cannot succeed. Dr. Baker admits that longer waiting lists will result. The Bradford health plan says that waiting lists are high on the political agenda.
Then, in a delphic paragraph, the memo says that waiting lists are as much about the way doctors work as they are about unmet need. It is clear that both the purchaser and the provider will need to discuss the management of waiting lists and targets set for different conditions, dependent on the availability of resources. The purchaser may well have to decide to limit activity. This will in practice either change the way services are provided or clarify the need for additional NHS funds. In late February, there were rumours that the special care baby unit at St. Luke's hospital in my constituency was to close. My opposition to the closure was dubbed "scaremongering" by leading local Conservatives. I wrote to Dr. Baker on 15 March. He replied: The proposal to close the SCBU at St. Luke's hospital is still under consideration. The proposition was made by the consultants who run the unit, not by management. Should it be pursued, an operational policy would be developed which ensured that both outcomes would benefit not deteriorate. A small number of items of equipment, which were funded by public donation, would naturally be retained and used at the Bradford Royal Infirmary. By 10 April, the Bradford Telegraph and Argus was reporting: A special care baby unit at Bradford's oldest hospital will definitely close it was revealed today. Health chiefs at the city's new Hospital Trust said a ten-cot ward at St. Luke's Hospital—which looks after premature and sick babies—will shut within four months. I pay tribute to a campaigning group called Baby Unit Regional Parents Society, which has done an excellent job in campaigning to keep this unit open. It fears that sick babies could be at risk if they have to be transferred across the city from St. Luke's to the special care baby unit at BRI. The intention, as the Minister will undoubtedly tell us later, is to centralise maternity services at BRI. I appeal to him not to allow the closure of the special care baby unit at St. Luke's until that centralisation has taken place. I understand that it could be two or even three years ahead.
1187 It would be wrong to put the life of any child at risk by transferring it when it was extremely sick across several miles of what is often a congested inner-city centre. It would be much better to keep the unit until centralization can take place, with proper and adequate accommodation at Bradford royal infirmary.
Also in February came news of a £5 five-year trust hospital catering contract awarded to a company called Taylorplan Services of Chiswick in London. Catering staff at BRI and St. Luke's will be made redundant as a consequence of this contract. I sponsored three early-day motions—Nos. 544, 545 and 546—on the subject.
The first of these reveals that, according to Taylorplan's latest accounts, the firm is technically insolvent. It has very large pre-tax losses, and its assets exceed its liabilities by a considerable amount. The other two motions refer to the company's extremely poor past performance, especially in cleaning contracts, not least at Airedale hospital, a neighbour of Bradford, where, in the first four months of the cleaning contract, there were 450 complaints; and to the company's low rates of pay and poor conditions of employment.
Again I wrote to Dr. Baker on that matter. In a letter of 19 March, he replied as follows: The catering service was tendered for in the usual way and Taylorplan Services Limited are on the approved list of contractors. They currently hold a large number of public sector contracts, including one in our Trust, and we have no concern over their work quality nor their corporate security. As you know, the pay rates for NHS ancillary staff are generally low and I understand that Taylorplan's basic wage rates are competitive. The new contract will save the NHS some money and most staff can expect to be reemployed by Taylorplan as well as receiving redundancy payments. Last month came news that mothers and toddlers using the child development centre at St. Luke's were to lose their own transport because the Spastics Society funding had ended and there was no money to secure independent transport. I am very grateful for the efforts of the current district general manager, who has been desperately trying to find the necessary funds to allow independent transport to continue.
A friend of the centre described the importance of transport in the following way: We need transport which has proved fundamental for getting children into the centre. They are heavy and it is difficult for mums to use local transport. Many of our mothers, especially the Asian community, have other children under school age. Bus stops are not always near home and adverse weather conditions can affect the health of the handicapped child. It is difficult to collapse a buggy when a handicapped toddler cannot stand or even sit on a pavement. We have come to the end of our money raised for transport and are now without any means of bringing children in. Incidentally, those people also need money for equipment and toys. Under the trust, no money was available, and they faced the prospect of losing their transport.
It is now very clear that, given the financial crisis in Bradford, the establishment of the trust this year was a tragic blunder. 'The Government were advised by Bradford community health centre and others to defer the trust for at least a year to enable the financial situation to be clarified and experience of trusts in other parts of the country to be obtained. However, as the Government, for reasons of political dogma, were determined to see a trust established in Bradford this April, they owe it to my constituents and the constituents of other Bradford 1188 Members of Parliament to inject extra funds now to restore the services that have been cut already and to avoid other cuts that are threatened.
Bradford needs about £5 million if those cuts are to be avoided. It was not given Government money that was available to cover deficits at 31 March last year. It has a deficit of about £1 million as at 31 March this year. In the past six years there has been no pattern of underlying deficit in Bradford, so why has Bradford been denied the Government funding which could and should have been provided? I hope that the Minister will say that that money will be forthcoming.
My constituents should not be penalised by enduring diminished standards of health care. It does not matter how the present situation came about— whether it was by resources being switched wrongly from community health to acute services, by management losing control or by profligate spending. That is irrelevant to Bradford. It is essential that money is made available now to ensure that those cuts are not made and that the standards of health care in Bradford are maintained.
A senior nurse wrote to me in early February: The Health Service in Bradford is being dismantled and no one has the power to call a halt. I receive many reports showing that staff within the trust and throughout the national health service in Bradford are extremely demoralised. They do not believe that anyone cares or that any action is being taken to remedy the faults that they see around them. They are fearful for the future and they are afraid that they will be sacked if they stick their heads above the parapet. Even now, with the trust formally established on 1 April, there is no trade union recognition, or even a handbook on the terms and conditions of employment.
The Government have the power to do something about the situation. If the present Government refuse properly to fund the new trust in Bradford, the people of Bradford have the power to vote in the next general election to return a new Labour Government who will end the Bradford trust and others, stopping the spread of a two-tier health service in Bradford and throughout the country, and the drift towards the privatisation of the national health service. By restoring proper funding, we shall create a new national health service dedicated to offering care free at the point of delivery. That is what the people of Bradford want and deserve. I very much hope that the Minister will give us some assurance that the money we pressed him for in March and which we shall continue to press him for will be made available.

§ Mr. Bob Cryer (Bradford, South)
I thank my hon. Friend the Member for Bradford, West (Mr. Madden) and congratulate him on obtaining tonight's Adjournment debate. I should say as briefly as possible that the people of Bradford regard the Bradford national health service trust as the enemy within the national health service.
My constituents are concerned that Bierley Hall hospital, which is being taken over by the trust, has faced two ward closures. One of those wards was refurbished at a cost of £100,000 to the national health service. Surely that is a waste of resources, as is the sacking of newly qualified nurses, trained by the national health service. Surely it is wrong that those skilled and caring staff are facing the dole queue.
1189 The Minister will have received a letter from me about Westwood hospital, which is not part of the trust but is proposed as a section for another trust. I ask the Minister carefully to consider the letter that I sent him and to ensure that Westwood hospital is not sold off for building development but that instead a village complex is built there for mentally handicapped people. The patients at that hospital, their relatives and the staff want such a concept to be applied to Westwood.
I hope that, before a trust is established, the Minister will take positive action towards a village development at Westwood. Those representing the Labour party and the Conservative party in Bradford and elsewhere will very much welcome such a development.

§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
In response to the debate, I had hoped to enlarge upon the answers that I gave to the hon. Members for Bradford, West (Mr. Madden) and for Bradford, South (Mr. Cryer) in a recent Question Time. In the time left, however, I may have to précis those answers rather than enlarge upon them.
When the hon. Member for Bradford, South came to see me, I undertook to consider what he had to say about Westwood. The proposal for a village development on the site of a mental handicap hospital is not unique to Westwood, but we are prepared to consider it for that hospital.
The hon. Member for Bradford, West presented us with a strange amalgam of a speech. When he started, I thought that, at last, the Government were winning. The hon. Gentleman couched the argument that he wanted the House to consider in terms of the public health outputs achieved by the NHS in Bradford. I should be more than happy to enter into a debate on that, as I believe that that is the way in which health debates should be run.
The hon. Gentleman is right to draw attention to the fact that there is an unusually high birth rate in Bradford and to the fact that health managers should address the problem of perinatal mortality and that associated with the incidence of congenital malformations. That is precisely why we have changed the way in which the health service is managed. That will ensure that Bradford health authority, the purchaser authority, is charged with the use of public money to achieve the public health objectives of the city. It is to that authority that the principal responsibility for commissioning and designing health care provision in the city falls.
Although the management of hospitals is an important part of the responsibility of the health service managers, it is essentially a secondary function. Their primary responsibility is to use the resources available to the NHS to meet the kind of public health objectives that the hon. Member for Bradford, West defined. However, having started so well, it was sad that the hon. Gentleman then veered off into oldspeak and engaged in a prolonged discussion of the range of inputs into the health service. He then went on to give a party political broadcast about how all the problems would be solved with the election of a different Government. History does not bear out the claim that a change of Government from one party to another, either way, provides such a solution.
1190 The hon. Gentleman made an unfair attack on the management of the new trust for decisions that they were alleged to have taken in response to the outbreak of the Gulf war. It should not have escaped the hon. Gentleman's notice that that trust started to operate on 1 April. That fact will not allow the hon. Gentleman to sustain an argument about decisions taken in January and February. The trust was established on 1 April 1991. The decisions taken were reached on the basis of the old health service structures, not on the basis of the trust and the distinct purchaser authority.
I shall use the specific changes that are being made in Bradford to rebut absolutely the charge that there is a lack of interest in health care or that there is any reason for a decline in morale in the health service, if such a feeling exists.
It is important to consider the changes in the revenue budget of the Bradford trust. I will repeat the explanation that I gave to the hon. Gentleman for Bradford, West when he came to see me, as it is important. By setting up the acute sector as an independent management unit of the trust, in Bradford, we have obliged managers in the trust to address the overspend that has gone for some time in that sector. The managers are committed to reducing that overspend by tackling overspending in the support service and administration costs. The trust intends to maintain the existing range of services and activity levels by focusing on improved efficiency and cost-effectiveness within the acute sector. It has no intention of cutting services.
The greatest criticism of the traditional system of managing health care in Bradford is the fact that, for several years now, the acute sector has been allowed to raid the budget that was originally allocated to the community services, as the barons of the acute sector have been living over budget and the community services in the city have not had the level of spend that the health authority originally planned for them.
If the new arrangements for health care in Bradford do no more than ensure that the acute sector effectively lives within the prioritised budget of the health authority and the resources that the authority plans to use for community services are in fact used for community services, that outcome alone in my book would justify the changes that we have introduced.
However, that is not the only justification. Once again, the hon. Gentleman neglected to draw to the attention of the House the fact that the Bradford trust has allocated to it the largest capital budget of any trust in this financial year. I listed the figures in the answer that I gave him on 16 April, in column 147 of Hansard. There is an investment budget in prospect for Bradford's hospitals in this decade of £110 million. That is not the outcome that one would have expected if the health service managers were not committed to the future of Bradford's health service.
The new arrangements and the people in charge of them in Bradford intend in their plans to provide a new model of health care in Bradford which will be better attuned to the health needs which the hon. Gentleman rightly itemised at the beginning of his speech. I look forward to seeing the results of that flow through to the people of Bradford.