HC Deb 12 June 1991 vol 192 cc1016-22

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

11.17 pm
Mr. James Kilfedder (North Down)

I regard myself as fortunate that I was successful in obtaining this special opportunity to raise in Parliament the crucial issue of hospital services in the North Down area.

There is what has been described as a deepening crisis in the provision of health services at the Ulster hospital. Dundonald, the Bangor hospital and the Ards hospital, Newtownards. Tomorrow, the Eastern health board will meet to impose further cuts in the money required for the North Down hospitals. I wish to state clearly in this debate tonight that I regard the board with a considerable degree of contempt because its members act as the minions of the Government. When the Government say jump, they jump, and when the Government say cut, they cut—I am glad to see that I have the approval of some hon. Members in this Chamber tonight.

To prove how dutiful they are, the members of the board cut with a vengeance and without regard for the welfare of the people of North Down. The Eastern health board is totally undemocratic because most of its members are not democratically elected, but are appointed by the Government.

We in Northern Ireland have been stripped of much of our democratic processes. Direct rule is a form of colonial rule, but we still have this Parliament of the United Kingdom. Therefore it is my duty as the elected representative of the people of North Down, young and old and regardless of their politics and religion, to make their protest and my personal protest on the Floor of the House of Commons.

I accuse the Eastern health board of deliberate and wilful discrimination against the people of North Down, and I accuse the Government of undermining the hospitals and health service of that area.

The Government cannot plead ignorance of the gravity of the situation. Time after time I have made representations to the Department of Health and over the years I have drawn attention to the deterioration in the national health service in North Down. Time after time, I have protested at the excessive delays which a number of my constituents have had to experience before obtaining a hospital appointment. Many are still waiting for hospital treatment. In some cases the illness is painful or distressing for other reasons, not least the intolerable wait for surgery which only exacerbates the anxiety and stress.

Those long-suffering people—human beings who have their rights—should be the main consideration of the Government and the Eastern health board. However, since 1989 the board has closed 200 beds at the Ulster hospital at Dundonald, a large, modern hospital. Beds have also been closed at the Ards and Bangor hospitals.

Last year, the board announced the closure of a further 18 surgical beds at the Bangor hospital. I attacked the board for that decision and it responded with the explanation that their closure was temporary. Sadly their closure was permanent and the board meant it to be permanent.

That so-called "temporary" closure did not have the support of the doctors of Bangor. Surely those medical practitioners should know better than the bureaucratic and undemocratic Eastern health board. Sixteen of those doctors took the trouble to write a special letter to the then Minister responsible for health condemning the bed closures at Bangor hospital. They stated that that hospital provides a necessary and worthwhile service for out patients. The doctors took that opportunity to scotch a mischievous suggestion that they did not support that hospital. The opposite is the case, because they asked the Minister for permission to send their patients directly to that hospital. They also asked for an urgent meeting with the then Minister. Six weeks later they received a reply —their request was rebuffed.

I believe that, if the present Minister responsible for health had written that letter, it would have shown more sympathy, because, no matter what others may say, I believe him to be a man of compassion. I hope that, as a result of bringing this case to his attention, he will be shocked into action.

The Ulster hospital at Dundonald has also suffered at the hands of the bureaucrats. Since 1989 almost 100 beds have been closed, including 28 paediatric beds, 20 plastic surgery beds, 20 gynaecology beds and 18 general surgery beds. In fact 20 per cent. of the hospital beds formerly available in the North Down area have been closed in recent years by the board. That represents one fifth of the hospital beds that were available for the treatment of patients. Sadly, all that has been done to the detriment of the people of North Down.

One might assume that the population of North Down was small and reducing, but that is not the case. There is an enormous population in the North Down area. There has been a population explosion there. About 260,000 people live in the area covered by the North Down and Ards unit of management, a considerable percentage of whom are elderly people who need easy and ready access to hospital care. At least 40 per cent. of the resident population in the Eastern health board area, which includes Belfast, live within the sphere of the North Down and Ards unit of management.

Despite the fact that 40 per cent. of the resident population live there, it has, unbelievably, only 18 per cent. of the board's total number of hospital beds. Anyone can see that that is totally unfair. I hope that the Minister, in the comment that he is now making to his ministerial colleague, is agreeing with what I say. That miserable and alarming figure—I am not referring to the Minister now —which clearly demonstrates the grave injustice that is being done to the people of North Down will be even further reduced as a result of the board's proposed cuts. And more cuts will be made the following year.

May I give another example of the injustice done to the people of North Down? The budget of the North Down area of management is approximately £38 million. That figure—for last year—is the most recently available one. The budget of the City hospital for the same period—only one of the many hospitals in Belfast—was approximately £62 million. That proves to me, as I have long argued, that Belfast should be hived off from the Eastern health board area. The City hospital's tower block cost about £70 million. In fact, it cost more, due to the extras that were added on over the years. That vital money was drained away from the funding of the Ulster and Bangor hospital and the Ards hospital, Newtownards.

In the face of public fury, the eastern health board has retreated from its original intention to impose cash savings of £1 million. The board states that it will provide non-recurring assistance, up to £350,000, for this year. I emphasise the words "for this year." That money will not be provided next year. Consequently, in 1992 there will be further cuts in the realistic funding required for the hospitals in the North Down area. It may mean in due course the end of the remaining acute facilities in Bangor hospital. That would be a scandal. It would arouse great and militant anger. That is one reason why I shall fight with all my might the undermining of the hospital services in the North Down area.

Let me make it perfectly clear that the North Down hospitals are most efficiently managed and truly cost effective. The Government talk of waste in many United Kingdom hospitals which must, they say, be eradicated. There is no fat in the Ulster, Bangor or Ards hospitals. They are being penalised for having shed all the waste of past years. The budgetary restraints now being imposed will imperil the level of hospital services for the people of North Down. Moreover, apart from clinical services being affected, more nurses and ancillary staff will lose their jobs.

When cuts of £1 million were imposed in previous years, the Eastern health board shut approximately 100 beds. So the proposed cuts—I use the term cuts, as I am speaking about a reduction in the money that is required for the hospitals—will mean about 65 more beds closed. The fact that beds have been closed—and that more will be closed in good and efficient accommodation at the Ulster hospital—is blatant nonsense. The cost of maintaining a patient at the Royal Victoria hospital in Belfast is 40 per cent. more than keeping a patient at the Ulster or the Bangor hospital. It is 30 per cent. more expensive to keep a patient in the Belfast City tower block than in the Ulster hospital, the Bangor hospital or the Ards hospital.

It is sheer stupidity for the Eastern health board to force people into the Belfast hospitals when they would prefer to be in either the Bangor or the Ulster hospital. The Ulster hospital is modern and efficient and the doctors, nurses and staff are excellent. Indeed, I was tremendously impressed by a surgeon whom I happened to meet—a Mr. McNeilly—who personified all that is good about the Ulster hospital. I would compare the Ulster and Bangor hospitals with the eight wards in the main corridor in the Royal Victoria hospital, Belfast.

Let me provide not my own opinion but an independent professional opinion. The Department of Health in London set out what is termed an estate code, putting hospitals into different categories—A, B, C and D—according to their physical conditions. The categories are as follows. Category A represents property which is in … new condition and will perform adequately for a full normal life. Category B represents property which is sound and operationally safe with only minor deterioration. Category C represents property which is operational but major repairs will be needed soon (in three years for buildings). Category D is the lowest of them all: The property is at serious risk of an imminent crisis. The Ulster hospital is rated in category A. But where are the eight wards in that main corridor of the Royal Victoria hospital? They are way down at the bottom, in category D. According to the Department of Health, the property is at serious risk of an imminent crisis. I should emphasise that the A classification for the Ulster hospital and the D classification for the wards and main corridor of the Royal hospital were given by Mr. Ceri Davies, who submitted a report to the Government a few years ago.

Let me explain what the board now proposes and what is happening. The board says that people in the North Down area, instead of going to the modern Ulster hospital or to the Bangor hospital, must go into Belfast, perhaps ending up in the main corridor of the Royal, which has received a D classification. It is also a hospital where the beds are 40 per cent. more expensive than the beds in the Ulster hospital.

I point out to the Minister—if he does not already know this—that people in North Down do not like travelling to the Royal Victoria hospital in Belfast. There is a real danger of terrorist activity. Cars are frequently stolen from the Royal. Moreover, many relatives have great difficulty travelling by public transport—often with many changes—from their homes in North Down to the Royal Victoria hospital, Belfast.

One concept behind the national health service reforms as set out in the White Paper "Working for Patients" was that the money should follow the patient—in order to meet the needs and wishes of the patient. That is not happening in this case. The Eastern health board is turning that round. The patients must follow the money into Belfast. That is something that I will not accept, and that is why I demand a full independent public inquiry into the running of the Eastern health board—in particular into the way in which it manages the North Down area hospital. Nothing less will satisfy the people of North Down—unless, of course, the Government decide to abolish the whole system and replace it by a body of people who are directly elected by the people of Northern Ireland.

Pending a full inquiry, I demand a full and searching examination by the Select Committee on Health. The Eastern board should take no action on budgetary matters until the Select Committee has had an opportunity to cross-examine the officials and others in the Eastern board. There is much more that I would like to say, but in order to leave the Minister a reasonable time in which to reply to the debate, I shall finish by quoting from "better service, better care" which was sent to me and, I think, to almost everyone in Northern Ireland by the Minister. It states: Your Health and Social Services Board's new role. They will act on your behalf".— that certainly does not apply to the Eastern board, which is acting against the interests and wishes of the people of North Down— to make sure the health and social services are working for you. That is a sick joke. The document also states: Boards will be funded according to the size of their resident population". There are 260,000 people in the North Down management area, and they are not getting the money and the beds which such a number of people requires.

The document emphasises allowances for age and health. There are many elderly people in the area. The story that I have to relate about the Eastern board is a sorry one. The people of North Down have no way to appeal for justice other than through me on the Floor of the House. I strongly urge the Minister to respond to the needs and wishes of the people whom I represent.

11.36 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Jeremy Hanley)

I am grateful to the hon. Member for North Down (Mr. Kilfedder) for clearly setting out the concerns of his constituents about hospital services in their area. The hon. Gentleman has given many years of dedicated service to the people of North Down and Northern Ireland and, indeed, to the United Kingdom as a whole. He is a stout defender of his constituents' access not only to health and personal social services, but to the whole range of public services. Through his activities, such as obtaining this useful Adjournment debate and his parliamentary question which I look forward to answering tomorrow, his reputation as a watchdog of local interests will be further enhanced, if not in the national press, certainly in the columns of the County Down Spectator and the Newtownards Chronicle.

I should like to reply not only to the points made by the hon. Gentleman in his excellent speech, but to some of the concerns in the area that have arisen over the past few weeks. One of the arguments is that perhaps Bangor hospital should become a new acute hospital. It is worth dwelling on what a modern acute hospital is expected to provide. It must be able to offer high-quality care 24 hours a day, seven days a week, 52 weeks a year and, as a minimum, it should provide a general medical and surgical specialty, obstetrics and gynaecology, a consultant-led accident and emergency department with adequate supporting staff and facilities; an intensive care unit, a full anaesthetic service and a range of investigative facilities, including pathology and radiology.

Sufficient manpower levels are essential for the maintenance of high-quality services. For consultant medical staff, for example, it is necessary to maintain, when possible, at least three consultants in each specialty, and that means ensuring that their case load is sufficient to justify this investment in highly skilled and experienced staff, together with the facilities and equipment that they require.

To justify a new acute hospital, a minimum population of 100,000 and preferably up to 200,000 is required. Those are the sort of services that are provided by the Ulster hospital. Of course, that does not mean that a great deal more cannot be done to improve the Ulster hospital. I accept what the hon. Gentleman said—that the Ulster needs to be improved—but it makes a tremendous contribution to patient care. Naturally, it could be made more attractive further to enhance the quality of its excellent services. I know that the Eastern health and social services board is finalising its plans for further major investment in the hospital. Obviously we cannot abandon the Ulster hospital and start again. That would be an appalling waste of public money. The ideal solution, from the perspective of the people of North Down and the hon. Gentleman, would be to put it on a set of wheels and trundle it down the road towards Bangor.

However, we have to ask whether the people of Bangor and Ards are denied reasonable access to hospital services. In terms of national and international comparisons, travel times are extremely good, not just to the range of acute hospital services at the Ulster and Ards hospitals, which are respectively some 10 miles and five miles from Bangor, but to the full range of regional services provided by the major Belfast hospitals, some 15 miles away. Although I accept some of the hon. Gentleman's comments about Belfast, thousands, if not hundreds of thousands, of people receive excellent treatment there and are happy to go there to receive it. Many parts of Great Britain would envy the range and quality of the health and social services enjoyed by the population served so ably by the hon. Member for North Down.

I shall now deal with the Ulster, North Down and Ards hospitals unit and its financial position. As the title is rather long, I shall refer to it—I hope without causing offence—as the Ulster hospital unit. I do not want that to be regarded as a Freudian slip either. I take this opportunity to clear up the misunderstandings that appear to have arisen over whether financial cuts are being imposed on the unit. The Government are spending £1,166 million on health and personal social services in Northern Ireland this year. This represents an increase of £115 million over 1990–91, so there are no cuts there.

Of this total, the Eastern board is getting £430 million, compared with £390 million last year. That is an increase of £40 million, so there are no cuts there, either. The share of the Ulster unit is almost £37 million, compared with just over £33 million last year. That is not a cut, either. To talk of cuts is destructive and damaging, causes needless fears, and is plainly wrong.

As to beds, I have a sneaking suspicion that most people will agree that we are treating patients, not beds. To take the example of the Ulster hospital, in 1985–86, it treated 15,261 patients, and in 1990–91, 17,033. In other words, if one can treat more patients with fewer beds, that is the best use of the resources, and one that produces the best service.

As happens every year in the Ulster unit, as in every other, the Government expect each board to find cash-releasing cost improvements, which the board retains as a contribution towards the costs of planned developments of services. The costs of pay awards above the Government's cash limits have to be taken into account, as do the costs of inflation above forecasts and various other pressures. These savings do not leave the board. They are not cuts—they are reinvested in the business.

Therefore, that figure, which was set at 1.3 per cent. overall this year, was varied by the Eastern board. I think it right that the five hospital boards should be expected to find slightly more—about 1.6 per cent. of the allocation —and that its four community units should be expected to find slightly less—0.9 per cent. That reflects the fact that the Government expect to see a gradual shift of resources from acute hospitals to community care. In Bangor and Newtonards, I have seen some marvellous examples of community care in the past few months. I have been honoured to visit a great number of such projects.

In the case of the Ulster hospital unit, a cash-releasing cost improvement target of 1.6 per cent. produces £590,000 out of a total budget of nearly £37 million. The unit has had a unit general manager since 1 April 1990, as has every unit in Northern Ireland. These managers are expected to manage. Speaking with the experience of my professional background, I can say that I would expect any manager worth his salt to be able to find 1.6 per cent. savings through greater efficiency while protecting the quality and volume of services that his unit delivers. It is possible to achieve that without affecting any services. For example, better purchasing policies or the better use of resources could avoid any reduction in services. The figure relates to reallocation for factors that will have to be met in any event.

In addition to the figure that I have mentioned, the unit has argued that it needs to find £300,000 to meet an overspend from last year that was caused by a combination of factors. While not accepting the figure in its entirety, the board allowed the unit to retain £328,000 non-recurrently in 1990–91 from the closure of Crawfordsburn hospital to provide time for the unit to take appropriate management action. The unit ended the financial year in a more or less break-even position. On its calculations it still has to find about £300,000 for the current financial year.

The board has again agreed this year to provide between £250,000 and £350,000 on a non-recurrent basis. The exact figure will be determined following discussions between the board and the unit. As I have said, the unit has to find a sum, which it will use within the unit, for extra expenses for this year.

I am sorry that the hon. Gentleman was unable to attend the meeting which the board held last Wednesday with representatives of the district councils of North Down, Ards and Castlereagh. I have read the minutes and I am disturbed by some of the views which were expressed by those in the local community. I read also the report of the meeting in the Newtownards Chronicle.

The chairman of the board made it clear at the meeting that there are no proposals to close the Bangor or Ards hospitals. I hope that my explanation of the funding position will further reassure the people of North Down that there are no funding crises at the Ulster hospital unit as have been described in the Ulster press. The Eastern board plans to develop and improve even further the services that are presently provided at the Ulster hospital.

In the longer term, of course, once the further investment has been made at the Ulster, someone might question whether it was necessary or desirable to sustain acute services at both the Ards and Ulster hospitals, which are less than five miles apart. Such factors will have to be considered one day, but any changes will need to be carefully planned. It is entirely right that the issues should be dealt with in consultation with the board, the local people and their representatives.

I cannot comment on the future of the Ulster and Ards hospitals without referring to Bangor hospital. I perceive that there is a considerable gap between the services which people appear to believe are provided and the services that are actually provided. It is not an acute hospital, but it provides many extremely useful services. There is no reduction planned of which I am aware and—

The motion having been made after Ten o'clock, and the debate having continued fir half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at thirteen minutes to Twelve o'clock.