HC Deb 18 June 1992 vol 209 cc1147-52

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Robert G. Hughes.]

11.40 pm
Mr. Tom Cox (Tooting)

This debate centres on the funding of national health service hospitals, especially those under trust status in London and those shortly to gain such status. My hon. Friends the Members for Hornsey and Wood Green (Mrs. Roche) and for Dulwich (Ms. Jowell) will hope to catch your eye, Mr. Deputy Speaker, so that we may have a wide-ranging debate on health matters in London.

In my constituency, St. George's hospital, Tooting, is seeking trust status. There is deep concern among local people about what that will mean for the health of their community.

The evidence shows that many trust hospitals have funding problems, which affect services, staffing and morale. We are aware that changes are made primarily to balance the accounts. To realise that, one need go no further than the comment made to the Select Committee on Health in January by Duncan Nichol, the chief executive of the NHS, who said that the "key duty" of trusts is to break even. That is what causes deep concern in London.

An inquiry on London health care, headed by Sir Bernard Tomlinson, is taking place. He has already been left in no doubt by various organisations in London about the problems that the national health service faces: problems of funding, waiting lists, low staff morale, the need for an improvement in primary health care, and for closer collaboration between hospitals and local authorities, which leaves much to be desired in many parts of London. Those are only some of our many concerns.

Obviously, better management can help but the overriding issue is, and will be, the question of how services are to be improved and that will depend overwhelmingly on funding. We have heard on many occasions that even when trusts sell their services on the open market—which will not be easy—there must be some financial input from the Government. We want the Minister to tell us what that will be. We are aware that earlier this year, in the run-up to the general election, a lot of financial funding seemed to be available —waiting lists were reduced and salaries were increased—but we now realise that things have changed considerably.

Money is more difficult to obtain via Government funding and many hon. Members must have read the report in the Observer business section last week entitled Cabinet row over impact of public spending cuts. It went on to say: A major Cabinet row is developing over Treasury insistence on dramatic cuts in public spending". Based on what we already know, that report could be true.

I saw on the news tonight that the Luton and Dunstable hospital trust, which was established last year, has announced that it is cutting 95 jobs. That is on top of the 16 job losses that it announced last week. So, in a matter of a week, 100 jobs have been lost. Such decisions are causing great concern.

We might be told that such job losses will not hurt hospital services, but we know that that is untrue. I have collected more than a dozen press cuttings that highlight existing problems—for example: NHS trust 'mishandled' injured baby case. Two others, which relate to the Guys and Lewisham trust, state: Heart patients wait as budget runs out one month early. and Four heart patients 'died for lack of money'". We have sought the debate to express our deep concerns to the Minister and to the Government in particular.

I do not expect the Minister to reply to the specific issue that I intend to raise, but I have a duty to alert him to the concerns of my constituents and myself about the appointment of the chairperson to the St. George's hospital trust. Two people, who are well known to the public are in running for that post. However, the front runner is a Member of the Upper House, who is well known in Parliament and outside. I do not intend to mention his name, but many of us are absolutely opposed to his appointment.

That gentleman already holds a number of financial directorships, and one wonders how he can find time to do justice to them all. The local people would view his appointment as chairperson of the trust with contempt. Given his current financial responsibilities, they would consider that he had been appointed to balance the books only, rather than to improve local NHS services as a result of trust status. We are opposed to his appointment.

I accept that the Minister may be unable to address that specific issue, but if that gentleman is appointed, I shall make all relevant correspondence, which I have kept confidential, public. I shall leave the matter at that, because I want my hon. Friends to have an opportunity to take part in the debate.

11.50 pm
Mrs. Barbara Roche (Hornsey and Wood Green)

I am grateful to my hon. Friend the Member for Tooting (Mr. Cox) for giving me time in his debate. All London Members are extremely concerned about the future of the capital's hospitals. Devasting cuts have recently been disclosed at University College hospital and Bart's, and the threat of closure continues to hang over the Elizabeth Garrett Anderson hospital, which is extremely famous, is used by many women and is held in high regard. Much public anxiety exists over the future of that hospital, which offers a unique health care service.

All who care about London and Londoners must be anxious about the state of health provision in the capital, as my hon. Friend ably pointed out. The Government have pressed on relentlessly, encouraging hospitals to opt out, regardless of local feeling and opposition. When ballots of staff have been conducted, and public opinion canvassed, the overwhelming view has generally been to reject opt-out, as in the case of the North Middlesex hospital. But the Government have gone ahead regardless of the views of those who work in the service and the people who use it.

Of the two principal hospitals that served my constituency, one is planning to become a trust hospital and the other became a trust a year ago. The Whittington hospital is planning to opt out and has produced glossy brochures and smart newspaper advertisements telling the people that there will be greater accountability, faster response times, a more efficient service and higher calibre staff. But local residents, staff and patients have all told me that that is unlikely to happen and that they do not want a trust hospital. There is also a large question mark over its financial viability.

But even if we were generous enough to give the Whittington the benefit of the doubt and question what local people have told us, we must consider what has happened at the neighbouring hospital that serves my constituency, the North Middlesex, which has opted out. The picture there is extremely grim. It became a trust just over a year ago. Is it locally accountable? While meetings of public bodies are usually open to the public, meetings of the trust board are held in private, so local people and representatives of the community health council and the press cannot attend.

Last week the hospital announced cuts of £1.7 million, and I gather that from last April the general manager of the trust was having almost daily meetings with the Department of Health in an effort to deal with problems that were arising. To enable the latest cuts to be met, the hospital has announced that, instead of two meals a day, patients recovering—and therefore needing nourishing meals—will get one meal and a snack. After 6.30 there will be no evening drinks. Is that how we should run our more caring and more efficient health service? It may he an efficient way to save money, but it is hardly the way to help patients recuperate. It is another example of trusts putting financial savings before patient care.

It has been announced that about 50 jobs will go. My excellent local campaigning newspaper, The Hornsey Journal, confirms that redundancies will occur among auxiliary nurses and nurses in medical wards and casualty departments. I recently questioned the Secretary of State for Health about casualty facilities in my constituency and she asserted that excellent services were being provided. It is also reported that a surgical ward with 26 beds and half of another ward will be closed at the North Middlesex hospital. That is not the way to attract higher calibre staff, but it undermines the confidence and skill of those professionals whom we admire so much.

My constituents are understandably anxious about health care in the community. In April this year, the North-East Thames region had the worst record in England for waiting lists of more than two years. The promises that we were given about trust hospitals have been broken and there are financial crises at both Whittington and North Middlesex hospitals.

I urge the Government to act urgently to ensure that patients' lives are not put at risk for the sake of unrelenting commercialism.

11.56 pm
Ms. Tessa Jowell (Dulwich)

I, too, welcome this debate and thank my hon. Friend for Tooting (Mr. Cox) for allowing me to share his time.

We desperately need urgent action to deal with the looming crisis facing London hospitals. The optimistic propaganda from Ministers about the future of London hospitals simply does not square with the experience of constituents who visit my weekly surgery and the many who write to me.

The problem is London's dual role in meeting Londoners' health needs and also securing as a regional and national resource in providing specialist treatment for people from many parts of the country. The issue is how those two roles can be properly reconciled.

I wish to describe how those two responsibilities impact on the local hospitals used by my constituents—King's College and Dulwich hospitals. My hon. Friend the Member for Peckham (Mrs. Harman), who for many years—since before I arrived in the House—has sought to find solutions to the problem, will share my concerns.

King's College hospital is classed as one of London's major teaching hospitals. It is unusual compared with other London teaching hospitals because seven out of every 10 people treated at the hospital live in the Camberwell health authority area, which my hon. Friend the Member for Peckham and I represent. Three out of every 10 people travel from other parts of the country or from Europe to benefit from the highly specialised forms of treatment that are provided. It is a world centre for liver transplants and for specialities like the treatment of diabetic gangrene of the foot. King's College hospital is also unusual in that, because it is old and desperately in need of refurbishment, its unit costs are lower than those of other teaching hospitals.

I remind hon. Members that the area served by the hospital is described by health care statisticians as one of high morbidity. That means that, for instance, three times as many babies die before they are a year old in Camberwell as in the Prime Minister's constituency of Huntingdon.

This year, King's will have to save yet another £7.8 million as it prepares to become an opted-out trust with effect from 1 April next year. As part of the cuts programme, 120 beds have been closed in the past 18 months.

The brunt of those cuts has been borne, not by the national and regional specialties, but by the services for local people—my constituents and those of my hon. Friend the Member for Peckham, particularly by the elderly.

The problems arising from the shortage of beds is evidenced almost every day by the queues of patients who have been through the casualty department and are waiting on trollies for a bed to become available. Too often, elderly people have to be admitted, not because they need hospital care, but because they cannot be looked after at home, as the community services have been cut. That shows the perversity of the sorry saga. The casualty department that was built to treat 30,000 patients a year, now regularly treats in excess of 80,000 a year.

We all celebrate King's status as a world-class hospital, but the health care of my constituents will be vulnerable if the Government allow market forces, not the health care needs of local people, to plan London's health services. It is particularly perverse that the hospital that can give the chance of life to someone, from wherever in the world, who needs a liver transplant, cannot admit an elderly lady who lives down the road and has broken her arm, without subjecting her to a long wait in one of its corridors before a bed becomes free.

I hope that the Minister shares my serious worry about these matters and that he will give answers that I can convey to my constituents.

12.1 am

The Minister for Health (Dr. Brian Mawhinney)

I congratulate the hon. Member for Tooting (Mr. Cox) on his good fortune in securing this Adjournment debate and on the way in which he introduced it. I also thank the hon. Members for Hornsey and Wood Green (Mrs. Roche) and for Dulwich (Ms. Jowell) for their contribution, and acknowledge the presence on the Opposition Front Bench of the hon. Member for Peckham (Ms. Harman). All three of them will realise that they have taken a substantial amount of the time available for the debate, so my ability to respond to it has been curtailed. Therefore, I hope that they will not attribute the lack of specificity of my reply to any discourtesy.

The hon. Member for Tooting started by drawing attention to what he believed were the funding problems of trust hospitals and the issue of resources. Without much ado, I shall now address that worry, which was also reflected in the speeches of the other two hon. Members. It is important to understand that, taking the number of acute beds per thousand of the population as an index, in inner London the average is 4.1 and in England it is 2.5. Therefore, in terms of the provision of beds, inner London's quota is well in excess of the national average.

The figure for health revenue expenditure per thousand of the population in inner London is £445, and the average in England is £233. Those are pre-reform figures, but the position has not changed much in the past couple of years. Therefore, contrary to the impression given by the hon. Member for Tooting, the amount of resources spent in inner London is substantially greater than that available in the rest of the country.

I have another piece of information, the relevance of which I believe the hon. Gentleman will understand. The average cost per episode—Department of Health jargon for case—in inner London is £790. The figure for all acute cases in England is £546. The hon. Gentleman will see, therefore, that considerable extra resources are being put into London and that the cost of health care in London is higher than it is in the rest of the country.

The hon. Member for Tooting said that London finds money hard to come by. I remind him that we are in the same financial year as when the general election took place. He will know that the health budget this year rose by 5 per cent. in real terms.

I have noted the hon. Gentleman's point about the possible appointment of a chairman to the potential trust in which he takes a particular interest. If hon. Members have views about the names submitted for such an appointment, I shall be happy to receive them and to take them into account in the consultation process before deciding who should be chairman of a trust. I hope that they find that helpful.

NHS trusts are a central part of the reform programme set out in the National Health Service and Community Care Act 1990. The whole purpose behind the creation of NHS trusts is to improve the quality of health care and to produce benefits to patients. Since the Act came into force in 1990, 156 hospitals and units have become NHS trusts. Now, in the third year, there have been 151 applications so far.

The hon. Member for Hornsey and Wood Green suggested that this process is driven by the Government. No so. It reflects the fact that the professional and managerial staff in the NHS are increasingly supporting the Government's reforms.

After the third wave, most NHS health care will be provided to patients through NHS trusts, with up to two thirds of eligible units established as trusts.

We have heard stories this evening of the kind that we often hear. The stories which I can contribute are based not on newspaper accounts but on the facts. NHS trusts in London increased their acute and general activity by more than 11 per cent. in 1991–92 compared with the previous year. The Royal London and associated hospitals NHS trust and the Royal National throat, nose and ear hospital NHS trust each increased its activity by more than 20 per cent.

The Royal National orthopaedic hospital has been able to reopen more than 40 beds which the district had previously had to close. It would have been slightly more convincing if the hon. Member for Hornsey and Wood Green had balanced what she had to say about trusts with the record of non-trust hospitals, which experienced difficulties, financial problems and bed closures long before trusts were ever thought of.

As an example of the improvements that trusts have been able to make, the North Middlesex hospital will open a fourth theatre next month and is planning a major redevelopment of the A and E department. Mount Vernon hospital is purchasing several new pieces of equipment worth £4 million; these include a linear accelerator and two new magnetic resonance imaging scanners. The Central Middlesex hospital is now installing a magnetic resonance imaging scanner in a joint venture with a private company. The Royal Free Hampstead NHS trust has decreased the number of people waiting over a year for general surgery from 560 to just 18. At Guy's and Lewisham NHS trust, the number of patients waiting more than a year for treatment has come down from 2,200 in March 1991 to 680.

I do not suggest that trusts do not have continuing problems to deal with and to overcome, but it does them, and consequently the health care of the people of London, no service to suggest that trusts are inherently evil, non-productive and bad, and that the old system was great, good and marvellous. That was not the story that we heard in the days when trusts did not exist.

I deeply regret that I cannot deal with health care provision in London, but I have no more time. However, I have no doubt that, as we move through the year and when we receive the Tomlinson report, the matter will come before the House on a number of occasions and I look forward to future debates on it, not least because it is important that we should address the problems of London in a way that will protect the health care of its citizens while at the same time freeing resources to be spent in the other Thames regions and around the country.

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

Adjourned at ten minutes past Twelve o'clock.