§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Arbuthnot.]
11.26 pm§ Mr. Michael Carttiss (Great Yarmouth)I am grateful for the opportunity to protest on behalf of my constituents in Great Yarmouth against the Government's decision to accept East Anglian regional health authority's recommendation to split Great Yarmouth and Waveney health district.
I am honoured to see here with me the Chief Whip, some of whose constituents belong to the James Paget hospital catchment area, my right hon. Friend the Leader of the House and my hon. Friend the Member for Norwich, North (Mr. Thompson), together with other colleagues and my hon. Friend the Under-Secretary of State.
Since the inception of the national health service 45 years ago, Waveney and Great Yarmouth have been treated as one health community. The old Great Yarmouth general hospital and Lowestoft general hospital, serving what we now call the Waveney district, were in the same hospital group for hospital management services when the NHS was set up—that also included the Norwich hospitals. Waveney and Great Yarmouth was treated as one district in the old Norfolk area health authority from 1973–74, which is when I became a member of that health authority. I well remember the difficulties we had in Great Yarmouth and Waveney in getting Norwich people to give us any attention.
Great Yarmouth and Waveney health authority was established when the districts were created about 13 years ago. For all that time, Waveney and Great Yarmouth have been treated as one health district. The James Paget hospital was built at the southern end of my constituency to serve Great Yarmouth and the Waveney district, replacing the two general hospitals to which I have referred.
Unlike my hon. Friend the Under-Secretary of State, whose great uncle was a Prime Minister, my great uncle and grandfather worked on the land in Filby where I live now. I am sure that the Prime Minister to whom I refer, who held office in the early part of the century, would have shared my grandfather's view—although he was not a Liberal—that if it works, do not mend it.
We have a situation which works in Great Yarmouth and Waveney, but the East Anglian health authority proposes to split it up. It proposes to merge Yarmouth with Norwich to create an East Norfolk health authority, and to put Waveney with the Suffolk authority. Decisions which affect people in Yarmouth and in Waveney which have been taken for the past 20 years within our district will now be decided in Ipswich for the Suffolk end and in Norwich for the Norfolk end.
My local newspaper, the Great Yarmouth Mercury, reported:
Opposition is stacked up against the changes planned for the local health service. The medical staff is solidly against the shake-up, and it has even united the Labour and Tory sides at Great Yarmouth Town Hall.When East Anglian regional health authority launched its consultation exercise in the summer, it presented four options about which it talked widely with various people who submitted their views. The general view was that local 290 people were in favour of Yarmouth and Waveney district remaining as the purchasing body under the new arrangements. The hospitals are self-governing trusts and it makes sense to reorganise—I am not against that.
The Minister did not accept that merging Yarmouth with Waveney and Norwich would have been a reasonable proposition. I accept that there must be some merger. I am not asking that we do not merge with Norwich, because I recognise that we must have a reorganisation of the health service. The problem is that the splitting of Yarmouth and Waveney will create a small bit on the east coast of Norfolk. The huge conglomeration of Norwich, with about 500,000 people in that health district, should be compared with the 70,000 or 80,000 in my health district. When Waveney, which is much bigger, is added the total will be around 250,000 people.
In the time which I spent on the Norfolk area health authority, we were able to balance the interests of our area with those of Norwich. Under the new arrangements, Waveney will be at one end of the Suffolk regime, while Yarmouth will be a small bit on the end of Norfolk.
The chairman of the Association of Voluntary Organisations in Great Yarmouth wrote to the chairman of the East Anglian regional health authority, saying:
I am writing to say that, at a general meeting of our Association at which some 25 local organisations were represented, we found that your authority's decision to ignore the strength of local feeling quite abhorrent … This Association has rarely been more united about anything, nor has it been more vocal; democracy of local people is being totally ignored and public confidence in the whole process of consultation has been swept away.That is the perception in Great Yarmouth and in the constituency of my hon. Friend the Member for Waveney (Mr. Porter) who, with permission, will intervene later.In publishing its four options for change, the health authority was confronted by recognition in most quarters that there had to be some change. However, the change which would have gained public support would have been one which ensured that the integrity of Yarmouth and Waveney together would continue.
In putting the reasons for rejecting the Great Yarmouth and Waveney merger with Norwich—the proposal of which the Great Yarmouth and Waveney district health authority approved—there was much talk about coterminosity. I will not take the time of the House to read all the details. However, the fundamental argument against Yarmouth and Waveney staying together was the need, according to the regional health authority and endorsed by the Department of Health and my hon. Friend the Minister, to relate the boundaries of the new health district and the purchasing bodies of hospitals and other local services to the providers of social services, education, probation etc.
In that sense, the Minister felt that East Anglian regional health authority was right to remove Waveney, which is in Suffolk, and to put Yarmouth, which is in Norfolk, with the Norfolk health authority. Next year, however, the review body which is to look at the structure of local government will be in Norfolk. It is likely to recommend abolishing Norfolk and Suffolk county councils, with the result that social services providers will not be based on the present boundaries.
In the west of Norfolk, the constituency represented by my hon. Friend the Member for Norfolk, North-West (Mr. Bellingham), the health district set up under this new system of purchasing bodies-replacing the old administrative ones—and known as the North-West Anglia 291 authority, cuts across the county boundaries of Norfolk and Cambridgeshire. So the coterminosity argument has not applied in the King's Lynn and Wisbech area, and what is good enough for King's Lynn and Wisbech is certainly good enough for us in Yarmouth and Waveney.
The other argument is that there will be more competition if we have an area health authority based in Norwich and one in Ipswich buying services from the James Paget. That is the market economy theory. I am not against the reorganisation of the health service or against bringing some private enterprise market forces to bear on it, but the ultimate conclusion that one is forced to draw from the idea of having the two authorities is that if the Suffolk authority can purchase care more cheaply from Ipswich, which is 50 miles from Waveney, that is where it will purchase it. That will result in fewer services being created and expanded in the James Paget hospital, which serves 250,000 people on the coast.
I conclude by saying that every organisation in Great Yarmouth was wholly opposed to this move. It would not cost the Government any more to agree to what I am saying. We know that in London 5,000 fewer nurses have been replaced by a threefold increase in the number of administrators. I fear that something similar might emerge from the reorganisation that the Minister has accepted.
§ Mr. David Porter (Waveney)I am grateful to my hon. Friend the Member for Great Yarmouth (Mr. Carttiss) and to the Minister for allowing me to intervene in the debate.
My hon. Friend the Member for Great Yarmouth will know that I agree with every word he said—not because he is almost invariably right but because he lives, works and has his being in his constituency, just as I have mine in Waveney. He and I are here first and foremost to represent our constituents.
In Waveney I have not been made aware of a single person in favour of the dismembering of the district health authority. The Minister has sadly misjudged the mood of the people. He takes professional advice: some good, some bad, some with hidden agendas and some with personal axes to grind. He should have listened to the advice that we both gave him. We should be his advisers for matters to do with the coast.
We told my hon. Friend, other Ministers and the Whips that we objected to the plans from day one. I even came to London in the summer recess to tell him that. We brought a health deputation to see him, with petitions containing over 30,000 signatures. He ignored them all. The consultation exercise proved a sham from start to finish. The RHA is a sham, distant and remote. Now it is to go. Its guarantees on health care are seen as worthless.
It is not so much the RHA that people care about; it is the future of the James Paget hospital. It has been a great success story and is dear to the hearts of the people of Great Yarmouth and Waveney. The Minister has given guarantees that the James Paget shall be presumed to be the local hospital for the people of north Suffolk, not Ipswich hospital, which is more than 40 miles away.
The Minister's guarantees are being dismissed locally as another sham exercise—a fobbing off by London planners of the tiresome people of East Anglia who know what we want left alone. How can guarantees be given in 292 an internal market? This decision has undermined confidence, the winning of hearts and minds to the NHS reforms that was going on slowly but steadily.
If the new Suffolk-only purchasers cut any funds out of the James Paget hospital, it will begin to wither. With the Norfolk and Norwich hospital in such a mess, Norfolk will follow suit and the James Paget will die. Health care on the coast will return to pre-James Paget conditions, worse than those of the third world. Thus the Government are also undermining the enormous transformation in health care east of Norwich which they have so successfully brought about in the past 14 years.
If only at this late hour my hon. Friend would have the courage to scrap the plan, or at least go for an alternative. I urge him either to delay for a year or two, until the other reforms have settled down, even if we are the last bureaucratic oddity in Britain; or to put Waveney in with a Norfolk configuration. Waveney has always looked to Norwich, not Ipswich, as our regional centre.
I, too, am in favour of economy of scale, better value for spending and skills development of staff. However, the reforms must carry people with them, not fly in their face. My hon. Friend the Minister has ignored history and culture as well as the NHS criteria. Those criteria are, first, that change must demonstrate patient care gain—the alleged £250,000 savings are figures out of the air—and, secondly, that change must be by popular consent. The plans fail on both counts. I plead with my hon. Friend the Minister to remember that he is a politician first and has become a bureaucrat only because he is a politician.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)I thank my hon. Friend the Member for Great Yarmouth (Mr. Carttiss) for his courteous approach to this subject, which I know exercises considerable feelings in his area. He was good enough to say that he accepted the basic premise of the argument for larger health authorities and that he understood well why they should be larger, should have more clout, should be better able to withstand the pressures and distortions within a particular area and should be able to find savings by reducing bureaucracy. He said that he understood all those arguments. I am glad that he realises that the retention of very small health authorities runs counter to the spirit of the reforms that we have introduced.
As my hon. Friend said, one of the factors that we have to take into account in assessing how the new, larger purchasing authorities should be configured is "coter-minosity", meaning common boundaries with other authorities such as family health services authorities and social services departments. If we went for the option that my hon. Friend favours as his second preference—putting Waveney and Great Yarmouth into the new East Norfolk health authority—there would be one boundary for the Suffolk FHSA, another for the social services department and another set of boundaries for the health authority. It would be a pity to leave that anomaly unless there were good reasons for it.
I am aware of the concerns of local people because my hon. Friend has spelt them out on more than one occasion and again tonight. Particularly in the Waveney area people feel that they will find themselves denied access to the James Paget hospital. There is no reason for that. Now that health authorities are separated from hospital management 293 they have only one function. It is to purchase, buy, commission or whatever one likes to call it, health care for everyone in the area.
There is no reason why health authorities should decide to distort the access of my hon. Friends' constituents to an excellent local hospital, change the patterns that have been built up and alter local health care which is satisfactory relative to what it was some time before the James Paget hospital existed. Not only would there be no reason to do that, but there are specific guarantees. My hon. Friend the Member for Waveney (Mr. Porter) says that the guarantees mean nothing because they are from the region. However, they are backed up by the health authorities, and have been confirmed in a letter from me. We regard them as sensible and achievable guarantees. My hon. Friend's constitutents have guarantees that they will continue to be referred to what they rightly regard as their local hospital—the James Paget hospital. There is no question of them suddenly being referred to Ipswich or anywhere else. I reiterate that.
I am also aware that people feel that the hospital is put at some risk by the new arrangements. There is no reason for that. My hon. Friend knows that I have visited the hospital twice since I took on this job. It is an excellent hospital, and it is very much loved and respected by everyone in the locality. There is no reason why it should suffer—indeed, there is every reason why it might well find that it has extra patients and demand from people outside the old Great Yarmouth and Waveney area as a result of joining the new areas to the two larger health authorities. It may mean that there is greater demand for the services of the James Paget hospital.
Reiterating the guarantees given by the region, we have also said that the funds that are now spent within the Great Yarmouth and Waveney area should be ring-fenced, which is an additional safeguard for the hospital. We have also said that the additional funds which will be forthcoming as a result o0f having fewer health authorities and therefore fewer overheads—fewer bureaucrats, if one likes—will be spent in that area. All those guarantees have been given.
When my hon. Friend brought the deputation of clinicians and others on 2 November, we had quite a long meeting, as he knows, and I listened very carefully to their fears about the future of the James Paget hospital. The only really substantive worry that I could identify was that at some time in the fairly distant future certain specialties might be "rationalised", as we tend to say in the health service, away from the James Paget to either Ipswich or Norwich, or both, in pursuit of cost savings. Of course, that is always a possibility in a changing health service, but if choices had to be made about a service or specialty continuing at James Paget or being provided on a larger scale in Norwich or Ipswich, a small health authority, such as one formed by keeping Great Yarmouth and Waveney 294 together, would find itself even more tempted to take that low-cost option because it would be less able to withstand the problems of adopting or maintaining a higher cost service.
The James Paget is an excellent hospital and has a sound future. I have no doubt about that and nothing that I have seen or heard with my own eyes or ears, or from officials or anyone else, puts its future in any doubt.
Looking to the future, we have heard various guarantees and statements, designed to calm the fears of local people, clinicians and my two hon. Friends. It is up to them, the community health council, the clinical directors at the hospital and anyone else concerned to monitor that that happens and to ensure that people continue to be referred where they believe that they should be, that services remain at the James Paget hospital and that all the things that have been said about its future are upheld.
I am aware that both my hon. Friends are very disappointed at the decision. I should like to have been able to find some reason to contradict the decision of the regional health authority. I accept that there are fears, but in reality I have not found any good reasons why we should adopt what is, in effect, an anomalous option and I have therefore been unable in conscience to contradict the regional health authority, and I had to advise the Secretary of State of that.
As I have discovered in the short time that I have been in this job, the health service is littered with anomalies, ranging from large hospitals that were built but probably should not have been, to some very strange arrangements throughout the country, which may or may not have been the result of acceding to political pressures. That may be perfectly defensible, but it is not my job to suggest anomalies where there are no good health or patient care reasons for allowing them.
Both my hon. Friends have suggested that some sort of "Yes Minister" syndrome is operating here—that I have become the tool of bureaucrats and officials and that I am acting merely in the interests of bureaucratic tidiness and the usual mediocrity that is found in organisations. That is not true. The conclusions that I have reached and have conveyed to my right hon. Friend the Secretary of State are designed precisely to implement the policies set down by Ministers. The aim is, if possible, to establish large health authorities that will be coterminous with other agencies.
I am personally convinced that neither the constituents of my hon. Friend the Member for Great Yarmouth nor those of my hon. Friend the Member for Waveney have anything to fear from these arrangements. I think that the James Paget hospital has a very bright future.
§ Question put and agreed to.
§ Adjourned accordingly at ten minutes to Twelve midnight.