§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]
10.34 pm§ Sir Fergus Montgomery (Altrincham and Sale)It is pleasant to have an Adjournment debate so early in the evening. I had hoped that if I was favoured by such an early call you would be in the Chair, Madam Speaker, but I see that you are leaving.
I welcome my hon. Friend the Under-Secretary of State who will be making his maiden Front-Bench speech. I am sorry if I am not as nice to him as I might have been, but I feel strongly about this subject. I am angry, and my hon. Friend may get the full force of my anger.
I have been angry for a long time about the hospital provision in my constituency, and for many years we have had our hopes raised only to have them dashed. Initially, the hope was that we would get a district hospital in the south of Trafford. To spur matters on, I had an Adjournment debate on 30 June 1980, when my hon. Friend the Member for Ealing, Acton (Sir G. Young), who is also sitting on the Front Bench tonight, was the Minister responsible. On that occasion he said that a decision on the new hospital would be reached with all possible speed.
Because we did not hear anything, in June 1981 I went to see my hon. Friend the Member for Reading, East (Sir G. Vaughan), who was the Minister responsible at that time. He agreed to consider the proposals that he was about to receive for the new hospital. In October 1981, the scheme was accepted by the Department and by the regional health authority. Approval in principle was sent to the Department in July 1982 and a deadline of December 1982 was set for a response.
In November 1982, the Department replied that further work was required on the document and the regional health authority agreed to purchase the site. However, the Department and the Treasury could not agree without any firm scheme being included in the capital programme. In April 1983, at the formal review of capital schemes, the regional health authority could not guarantee a place in the programme and its previous acceptance of a start in 1987–88 was not confirmed.
In October 1983, we appeared to have some rather cheering news. We were told that the hospital had provisionally been put in the programme for the 1988 financial year and that the Treasury had approved the purchase of the site. Many of my constituents thought that their dream of having a district hospital would at last come to fruition—a hospital that had been promised for so long would at last become reality.
Our hopes were dashed when, at the beginning of 1984, the regional health authority suggested that the hospital should be reappraised, and in September 1984 we were told that on the criterion of capital costs a development at Wythenshawe was cheaper than building a new hospital in south Trafford. Our hopes for a district hospital vanished for ever. I hope that my hon. Friend the Under-Secretary can imagine the disappointment and the anger felt by people in my constituency.
Before this debate tonight, I collected the copies of Hansard that contain my speeches on the need for hospital provision in my constituency. I have them all with me. I remind my hon. Friend that, in the musical "My Fair Lady", Eliza Doolittle sings a song that includes the 722 phrase, "Words, words, words—I'm so sick of words", and I heartily endorse that. I, too, am sick of words and I hope that we will now get a little action. We have had no tangible result from the words that have been said over the years.
Unfortunately, the sorry saga is not yet over. Having failed to get a district hospital, we decided that it would be at least advantageous if we could get a community hospital in south Trafford. That idea seemed to meet with approval. It was confirmed by the regional health authority in May 1988. A suitable site was then earmarked.
The community hospital was to comprise 24 beds for the elderly mentally infirm, plus 24 day places, 24 beds for the elderly, plus 30 day places, a 25-place mental illness day unit, 10 day care acute investigation beds, four out-patient suites, two X-ray rooms, plus a diagnostic unit, and a small pathology laboratory. That hospital would have filled a desperate need in my constituency.
To its eternal credit, Trafford health authority was so anxious to have the hospital that it offered to fund 39 per cent. of the capital cost by means of the disposal proceeds, plus a large cash injection. I thought that that would impress the regional health authority and show local commitment.
From the human angle, we are faced with the plight of the elderly not just in Trafford but throughout the country. People are living longer. We have a higher percentage of elderly people. That creates problems. In Trafford, there is an increasing population of over-75s and over-85s, particularly women living alone. It is estimated that in 1992 14,000 women over the age of 75 are living alone. The projection is that by the year 2001 that number will have increased to 15,290. This year there are 2,700 people over the age of 85, and the forecast is that by the year 2001 that number will have increased to 4,000.
In the 75-plus age group there is increasing dependency. Nearly 20 per cent. of those in the 85-plus age group are bedfast, 50 per cent. are unable fully to help themselves, and 20 per cent. of those over the age of 80 suffer from severe confusion. I hope that my hon. Friend will therefore appreciate the importance of a new community hospital that would provide much-needed facilities for my constituents.
The detailed feasibility study was completed in September 1990 so that a bid could be made for the 1993–94 capital programme. The total cost, inclusive of land, at that time was £11.7 million. At the April 1991 regional health authority meeting it was noted that the proposal was in line with the accepted regional health authority strategy but could not be funded to start in 1993–94. We were told that the scheme should be considered in the next rolling forward of the capital programme. Consequently, the scheme was resubmitted on 30 November 1991 in the hope that work could start in 1994–95.
During the winter of 1991–92 a great deal of discussion took place between the Trafford health authority and officers of the regional health authority. Consequently—and this gave us great hope—the plans were expanded to include an extra ward for the elderly, in line with the recommendations of the health advisory service. That increased the cost to £14.8 million.
South Trafford community hospital was included on a short list of six schemes for consideration by the regional health authority. A presentation of that scheme was given 723 to the members of the regional health authority in mid-February. At the end of April we were given the bad news that our community hospital was not in the regional capital programme. That is not good enough. I should be failing in my duty if I were to let this go by without a protest. I give my hon. Friend fair warning that I shall badger the Department of Health and the regional health authority until I get fair treatment for the people who live in my constituency.
I have some statistics from the North Western regional health authority about the capital spending from 1980 to the present time. One column shows the capital investment per resident since 1980. In Preston district, capital investment per resident has amounted to £490, in north Manchester to £451, in central Manchester to £948, in Stockport to £86 and in Trafford to £98. Stockport at least has a major scheme in the current capital programme.
Consideration of the regional health authority capital scheme shows that since 1980 three districts have fared worst—Rochdale, Stockport and Trafford. Again, the Rochdale scheme has been given the go-ahead, but Trafford has the lowest overall investment in the north-west region. I think that Trafford has been shabbily treated and that south Trafford has been treated worse. If Trafford district health authority has not been given a fair deal, south Trafford is the Cinderella of the health service in our area.
The community hospital was intended to improve the quality of locally based community services. It would have provided excellent modern facilities for the elderly and for the elderly mentally infirm. It would have been a boon to carers in my constituency. Many people devote their lives to looking after their elderly relatives. The community hospital would have offered a place where elderly relatives could have been looked after while carers had a well-earned break. Carers could have been sure that their elderly relatives would be extremely well looked after while they were having their well-earned break.
As my hon. Friend the Under-Secretary will have deduced, it is a sorry tale that I have had to tell. For at least 15 years we have had a history of proposals and counter-proposals for rationalising hospital services in south Trafford. The imperative of providing an acceptable hospital environment for south Trafford's residents has been delayed far too long and I do not think that it can be delayed any longer. I therefore hope that my hon. Friend will at least give me some decent news—perhaps some cheering news. I hope that he will knock a few heads together in the Department of Health and the regional health authority. I warn him that we have been patient for long enough—perhaps we have been too patient and have not fought as hard as we should have—and we want no more words or promises. We want some action to ensure that south Trafford has fair hospital provision.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo)I am grateful to my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) for his kind welcome. He referred to the fact that this is my maiden Adjournment debate at the Department of Health, 724 although I had the pleasure of answering 16 Adjournment debates during a brief sojourn at the Department of the Environment.
I am glad to have the opportunity or responding to my hon. Friend and I should like to begin by congratulating him on using this opportunity to express his heart-felt concern about Trafford health authority's proposal for a new hospital in south Trafford. I very much regret that his first Adjournment debate on the subject was as long ago as 1980. I appreciate from the sequence of events which he outlined how frustrating those 12 years have been for him and many of his constituents. It is good that he is back in the House to continue championing their interests, and I was particularly glad that last week saw some remarkable gains in the local council elections in his constituency.
The scheme is a high priority for the district. As my hon. Friend said, it involves the building of a community hospital on a green-field site to serve the needs of south Trafford. From what he said, it is clear that he has been attending to this issue for a long time and has been pursuing the interests of his constituents in this sphere. His concern is well recognised in the House.
The proposals for future hospital provision in south Trafford are the outcome of many years of debate and of much detailed analysis and hard work, some of which my hon. Friend mentioned. During that time, there has been a gradual change of emphasis, although it is true that the residents of Trafford have enjoyed considerable increases in the number and quality of health treatments. From 1982 to 1992, that has meant that the number of in-patient cases increased by nearly 11 per cent. overall. In the same period, day cases increased by 115 per cent. Waiting times for treatment in Trafford are as good as those experienced anywhere in the North Western region. Not only are there no people waiting more than two years, but there is no one waiting more than 12 months for treatment. There is an equally impressive achievement with regard to the cancellation of operations—in 1989–90, the latest year for which figures are available, only 1.1 per cent. of operations were cancelled, which is one of the lowest cancellation rates in England.
§ Sir Fergus MontgomeryThe point that I have tried to make over the years is that people in my constituency have either to go to what is now called Trafford general hospital, which is in the north of Trafford, or to Wythenshawe, which is in Manchester. We are asking for some facilities in the south of the borough as they are desperately needed because our hospitals are small and tend to be very old and antiquated.
§ Mr. YeoI appreciate that point and I shall deal specifically with the proposal which has thus far been turned down by the regional health authority. Although I understand the thrust of my hon. Friend's intervention, I wanted to quote the figures because they are an eloquent testimony to the success of the Government's reforms of the health service and to the quality of the work of many health service employees in that district.
As my hon. Friend knows, in his part of the world there is a new £2 million maternity unit, a £2 million mental illness unit and a £4 million geriatric and physiotherapy unit, all of which are solid, practical achievements.
There are many other interesting community-based developments taking place in the district. For instance, the district health and family health services authorities have 725 jointly produced locality profiles for key areas in Trafford in need of improved health services. Those have been produced with the full involvement of the local authority, voluntary sector and community groups. Specific plans are being drawn up to make services more appropriate to the needs of people in these areas.
On the patients charter, I know that Trafford's patient charter action group is steadily improving its standards. For instance, it is committed to bringing the waiting time for treatment down to nine months. Communicating with patients is a high priority and a local consultant has developed a range of letters which explain the commonest 40 operations in layman's terms, offering advice and so on. I have an example which deals with the operation to repair a rectal prolapse. The example is comprehensive and easily understood. That is a demonstrable record of real achievement.
As my hon. Friend said, the focus of attention was originally the plan to have a new district general hospital in Altrincham. However, that focus began to change because far higher efficiency in providing modern medical treatment enabled existing hospitals to provide a more than adequate service. It was soon recognised that additional new acute beds could not be justified against a background of short stays in hospital and the more intensive use of medical staff and equipment, especially in view of the overprovision of acute beds in Manchester generally.
There is now no debate about extra acute beds because in 1988 an option appraisal by the district highlighted the need for a community hospital which would act as a referral centre for specialty services provided elsewhere. The community hospital plan was agreed by North Western regional health authority in May 1988. What we have is a full-blown proposal for a community hospital in Altrincham offering out-patient services, day care surgery and facilities for the elderly and the mentally ill. My hon. Friend described the facilities in detail. Clearly, it is desirable to replace existing facilities of outdated design with an integrated service. There is a clear objective that future hospital development in south Trafford should concentrate on improved provision for the elderly and mentally infirm.
So far, so good. There is agreement between us that the present proposal will be good for the residents of south Trafford. It is entirely understandable that the district wishes to provide the most modern facilities at the earliest opportunity. However, I am afraid that translating its proposals into reality has proved a complex process, and that has given rise to the concern expressed by my hon. Friend.
Although the Government place ever-increasing resources at the disposal of the national health service, those resources are finite, and priority has to be established between competing claims. For example, the demands for capital grossly exceed supply, notwithstanding the fact that this year total capital spending is expected to reach £2 billion for the first time.
Capital expenditure on hospital and community health services in North Western region rose by 49 per cent. in real terms over the period 1986–87 to 1990–91. During the same period, capital spending in Trafford rose by 265 per cent. The equivalent increase in capital spending in England over the same period was 21.5 per cent. Capital 726 investment in North Western region will be about £124.5 million this year, compared with last year's allocation of £104 million.
North Western regional health authority, in common with other regions, has a difficult task—that of distilling local plans for rationalisation into some form of priority order. Given the development of health service provision in this country over many years, it will come as no great surprise to learn that most districts see the need to rationalise and re-cast the provision of services. That process is fundamental to a well-managed system and the achievement of increased efficiency. But some changes, however beneficial they may be, cannot be achieved overnight.
North Western region has made great strides in developing what is generally regarded as a fair and objective system to decide competing priorities. The planning guidance stresses the need to address service considerations, which have been summarised as: the need to achieve value for money; the need to keep services of proven value going; the need to "plug" service gaps; the need to ensure equal access to services and a "fair sharing" of resources; and the need to improve service quality.
I do not want to go into great detail on the allocation of capital in the north-west, because my hon. Friend will be well aware that since 1989 the authority has operated a three-year capital programme—one year being added by way of an annual roll-on. At its meeting on 28 April, the authority considered for approval major building projects for a start on site during 1994–95.
In the category covering more or less self-contained developments of existing district facilities, the total cost of eligible bids amounted to about £185 million at today's prices. Those bids were sifted by a group made up of representatives from medical, nursing, planning, finance, personnel and estates divisions. The exercise pruned the number of schemes for consideration down to six, costing about £109 million to complete.
South Trafford's community hospital was one of the six and had an estimated cost of £14.8 million. The authority could approve the allocation only of some £25 million, to be spent on three schemes, the highest cost being just over £10.5 million, for a first phase at Rochdale. My hon. Friend has seen the papers placed before the meeting, and I am sure that he agrees that all the schemes are eminently worth while. All were forcefully argued by their respective proponents.
As we all know, the authority decided not to include Trafford's proposals for start on site in 1994–95. The straightforward and unambiguous reason for that decision was that other submissions had a higher priority.
My hon. Friend has condemned previous ministerial responses as merely words, and I shall be especially careful about what I say now, so that I do not raise false hopes. It is inherent in such rolling programmes that schemes not included have only one year to wait before being eligible to be considered again. However, I understand my hon. Friend's disappointment and that of Trafford because this was their second successive disappointment. As my hon. Friend said, Trafford's bid for inclusion in 1993–94 was turned down in 1991.
In view of the train of events, I can well understand my hon. Friend's wish to seek an assurance that the region remains committed to the Trafford proposal. I can state categorically that its failure to secure funding in 1993–94 or 1994–95 does not imply that the RHA has withdrawn its 727 support for the scheme. The region is firmly committed and I understand that the district will resubmit the proposal later this year.
I hope that my hon. Friend will understand why Ministers cannot intervene. The Government have aimed to set a framework of objectives and priorities within which local management must be allowed to manage. In terms of access to district services, I think that the responsibility lies fairly and squarely on the regional and district health authorities.
728 I appreciate that my hon. Friend may not be satisfied by what I have had to say. Indeed, I would be surprised if he were so satisfied. I welcome his intention to continue to make forceful representations in the House to Ministers and to the RHA. I am sure that that is the right strategy for him to pursue on behalf of his constituents. I must conclude, however, by referring again to the RHA's well-developed strategy to tackle capital developments within the region. It is difficult for it to establish priorities and difficult issues arise, but the region is best placed to tackle those issues and I hope that it will continue to do so with the interests of everyone within the area at heart.
Question put and agreed to.
Adjourned accordingly at one minute past Eleven o'clock.