HC Deb 23 February 1993 vol 219 cc858-64

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

10 pm

Mr. Seamus Mallon (Newry and Armagh)

rose—

Rev. Martin Smyth (Belfast, South)

On a point of order, Madam Speaker. In tonight's Belfast Telegraph there is a comment concerning the decision of the electoral court in which there is this statement: If everyone guilty of electoral malpractice were to be disqualified, there might be quite a few vacancies declared". I seek your guidance on whether this should be referred to a committee or whether you can guide us as to what we should do about what I believe is a serious accusation. There are legal procedures, as people are aware, for malpractice, and they ought to follow them through.

Madam Speaker

May I suggest to the hon. Gentleman that he writes to me without delay and lets me have the evidence so that I may see it in full?

Mr. Mallon

I very much welcome the opportunity to raise this matter on the Adjournment. Almost by definition, Adjournment debates are parochial. They are confined to one's own constituency and, as of right, I think, they express concerns within our constituencies. But in this instance, while I want to deal with a localised issue in relation to two hospitals in Armagh that most hon. Members have never seen and never will—although, Madam Speaker, I hope that at some time in your arduous duties you will find the opportunity to visit Northern Ireland and especially my constituency and these two hospitals, where you would be more than welcome—there is a much wider and general point to be made. In relation to these two hospitals, the issue encapsulates one of the core tensions within the entire debate about health care provision.

There are three of those tensions. The first is quite simple, and it is the one that the debate centres on: the survival of the small, local, community hospital as against the large, centralised unit, based on the erroneous assumption that large equals better and more cost-effective. I believe that to be wrong and, in this specific case, I believe it to be very wrong. Not only that, but it is contrary to the Prime Minister's own charter, which we all received with great anticipation; contrary to the Northern Ireland Office charter; and contrary to the board charter that we received through the post only three days ago. That is the first false assumption underlying the type of approach that we anticipate in relation to these hospitals.

The second core tension is that of quality of care as opposed to cost-effectiveness. As we progress through the debate, I hope to show that that is another erroneous assumption. The third crucial element, again relating to the citizens charter, is sensitivity to the needs of the community as opposed to bureaucratic requirements, bureaucratic requirements in this instance being those imposed by the Government and, in a very supine fashion, adopted by the boards. The boards have shown clearly that they evaluate and know the price of everything, but the value of nothing, The difficulty is that, once a decision is made on that basis, it is impossible to reverse.

I believe that we have a valid case about the community hospital in Armagh and Mollinure hospital. Mollinure hospital was opened 18 months ago by Lord Arran, who described it as unique in Northern Ireland", the first of its kind in Northern Ireland and among the best in Europe. Would not it be a remarkable irony if, 18 or 24 months hence, the same Minister were to close the new purpose-built unit that he described in such glowing terms? The danger is that that may happen.

No doubt the Minister will tell me that I am jumping to conclusions and that we are debating only options. No doubt he will have the booklet that has been issued by the board, "Making Choices", which presents six options, four of which contain the presumption of closure of the hospital that Lord Arran rightly praised so generously. Those options must be questioned. The debate will allow the Department of Health and Social Services to focus its attention on those choices.

Mr. David Trimble (Upper Bann)

I am sure that the hon. Gentleman will acknowledge that those four choices threaten not only his two hospitals but the hospitals in the constituency of the hon. Member for South Down (Mr. McGrady), two of the three hospitals in my constituency and perhaps one hospital in the constituency of my hon. Friend the Member for Fermanagh and South Tyrone (Mr. Maginnis). There is a wider dimension.

Mr. Mallon

I thank the hon. Gentleman. That is indeed why I tried to make the broader point that this is not just a parochial constituency matter. It affects Banbridge hospital, Lurgan hospital, Loane house and the whole caring service in the north of Ireland.

"Making Choices" is cleverly written. Four of the options contain an underlying presumption in favour of the closure of the two hospitals that I have mentioned. I am not opposed to the development of three acute units at South Tyrone hospital, Craigavon and Daisy Hill in Newry, but they must not be developed at the expense of the smaller unit that caters for a vast area in our community and that is doing an immensely good job.

I referred to the praise that the Minister heaped on Mollinure. It is unique, because it is not just a geriatric hospital: it has a day care unit that allows elderly people to be assessed for perhaps two days a week and to return to their homes in the community to recuperate. That is crucial.

One of the main purposes of the Department is to get people back into the community. Mollinure hospital achieves that. Its assessment unit is unique, because it allows people to be assessed properly, not merely by one doctor but under the multi-disciplinary services it offers. Many people come in whose GPs have decided that they should be in continuous care, but this assessment allows them, after an examination and a period of rest, to go back into the community.

The third crucial point concerns the respite that this allows for carers. How often is lip service paid to carers in our community? Carers are a crucial part of the whole health care service, and a growing part, with the cut that we are experiencing. If elderly people can go into this type of unit while carers enjoy a respite for one or two days, or for a holiday period of a week or two weeks, that caring service will improve substantially. That is what is under threat, and that is what I am concerned about.

Armagh community hospital is a small, effective unit. It covers a vast rural hinterland, as well as the city of Armagh. It stretches to the border areas, upwards of 40 miles. For many people, it is their nearest point of contact, and this hospital serves the area exceptionally well. In the past year, it has served 38,000 patients out of a population in the region of 60,000. Not only that, but of that figure, 14,000 attended the casualty unit.

I have not doubt that we shall be told that the hospital is not cost-effective; it is small, it is good, but we shall be told that its work should be done in one of the acute units, because it is not cost-effective. Lest that be given any credence, I will give two examples.

In 1992, the out-patient cost in Armagh community hospital was £9.22 per attendance. In one of the bigger hospital acute units, in the same unit of management—the South Tyrone hospital—the cost was £17.99. I cast no 4spersions on the South Tyrone hospital, nor would I ever do so. I am simply making the point that, if we are to talk about costs, as I have no doubt the Minister will, we should bear that in mind.

My second point relates to the casualty element, and this applies only to staffing. The cost per attendance of those 14,000 people who attended casualty was £12 per head. I believe that that could not be equalled in any of the acute units, or probably in any of the other units available to us.

My next point is that the hospital serves a huge hinterland. The board has told us in its own little booklet —I view the booklet with more suspicion every time I read it: If service charges reduce accessibility, compelling reasons must be shown. There is almost no such thing as public transport in that area; it is almost totally rural. The only way for people to get to any hospital is by car, if they own one. If they do not own a car, they are dependent on the good will of their neighbours.

We are forgetting the basis of the charter again if changes are made and we bring health care to the people rather than people to the health care. I make that point in a very substantive way, because, when it comes to the health care of people, time means lives. The longer people have to travel, the further the distance, the greater the risk to them.

I make a last general point about the loss of jobs that will be involved. It might be said that one should not do that in this type of debate, in which we are talking about a health service issue, but it is crucial, because the people of whom I speak have given an enormous amount to the sick and elderly in the Armagh area. It is only right that I should refer to their position, because I do not want more jobs to leave Armagh. I do not want to see any more young people with expert ability to care for the disadvantaged having to leave the area to seek work.

In his last contribution to the United States Congress, Senator Hubert Humphrey made a comment that was apt to the situation to which I refer tonight and to many others: The moral test of government is how it treats those who are in the dawn of life—the children; those who are in the twilight of life—the aged; and those who are in the shadows of life—the sick, the needy and the handicapped. We are dealing with all those categories. I urge the Minister to ensure that whatever decision is made meets the moral test laid down by Senator Humphrey.

10.15pm

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

I must at the outset congratulate the hon. Member for Newry and Armagh (Mr. Mallon) on his assiduousness in applying for the debate and his tenacity and perseverance in securing it.

There can be no doubt that the issues that he raises are of concern in his constituency, and he is right to raise them in the House. He will not be surprised when I tell him, in the time available to me, that there is still a considerable time left in which to consider the future of the two hospitals in question, and I am sure that he will take part, as will other hon. Members, in that process.

The hospitals in question, Mullinure geriatric hospital and Armagh community hospital, are two of the eight general and acute hospitals currently under review by the Southern health and social services board. In March of last year, following the publication of the Department of Health and Social Services regional strategy and its own area strategy, the Southern health and social services board decided that the time was opportune to review the provision of acute and general hospital services in its area.

A hospital planning liaison group was set up and immediately commissioned each unit of management providing those hospital services to undertake a review of current provision. From the reports received from the units concerned, the planning liaison group prepared a consultative paper, to which the hon. Gentleman referred, entitled "Making Choices". That was issued to a wide range of groups and individuals early in December 1992 inviting responses by 28 February 1993. I understand that, following complaints about the length of time allowed for consultation, the board agreed to extend the period to 31 March.

It is important that the status and purpose of "Making Choices" is fully understood. It reaches no conclusions about the overall pattern of hospital provisions, about the future role of any hospital in the area or about the size of any hospitals or specialties they might offer. The paper is intended to provide the background to a consultation process which will assist the health board, in the first instance, to reach a broad view about the future pattern of hospital care; that process should be completed by about June this year. Thereafter, it will be necessary to undertake much more detailed planning to test and quantify any proposed changes before they can be implemented.

The objective of the present exercise is to reach that broad view on future services. It should be borne in mind that in the detailed planning of any changes, there will be a further opportunity for people in the community or hon. Members to examine the available data more critically. Where the closure of any facility is contemplated, there will be a further public consultation exercise.

As the hon. Gentleman said, "Making Cioices" presents us with six options describing possible patterns of future hospital services. The board has made it clear that they are not recommendations but subjects for discussion to stimulate debate on the future pattern of hospital care. It is easy to say that if an item is suggested as a subject for discussion we are somehow steering the public towards a particular course. That is not so—we hope that the people will take the six choices as an opportunity for general and genuine debate.

As I said, "Making Choices" is not intended to come to a conclusion on the future of Mullinure or any other hospital. I shall concentrate on Mullinure because the hon. Gentleman made a particular point of saying that it has been opened recently. Although it was recently opened officially, it was planned some years ago, based on the best information available and in response to a pressing need to find suitable alternative accommodation for people who were housed in what I think the hon. Gentleman would agree were wholly unacceptable conditions at Tower Hill. The full impact of the community care policy had not become evident and was not anticipated at that stage. The extent of the growth in the private and voluntary sectors could not have been envisaged.

The capital cost of Mullinure was approximately £2.3 million. It is accepted that that is a considerable sum, but it is small in terms of the overall capital expenditure to bring hospital services into the next century, let alone the next millenium. More significant is the revenue cost, which was £1.85 million for Mullinure in 1991–92.

The board will of course seek an alternative use for any buildings which might become redundant. The pattern of service provision has to change in the light of new developments, new treatment techniques and advances in medical science. Paragraph 7.33 of "Making choices" states that there might be other options for the development of geriatric hospital services. Although it is beneficial to have assessment and rehabilitation services on an acute hospital site, it does not apply to continuing care beds. A strong case can be made for their being as local as possible for the sake of convenience and to maintain links with the community. However, as I said, nothing has been decided.

We must consider the fact that we now have a different system of health care. We have come into the modern world. There is an increased emphasis on promoting health and preventing disease, in addition to providing care and treatment for those who need it. There is a continued development of acute hospital services to allow them to develop the role of providing specialised care. There are further shifts from institutional care to care at home or in the community, paralleled by a strengthening of the role of primary care. There is also improved targeting of health and social need to ensure that the most disadvantaged people in the community receive an adequate share of services. Changes in acute hospital services must be viewed in the context of improving the community's health and wellbeing alongside changes in other services, with the overall objective of making better use of existing resources.

The hon. Member for Newry and Armagh and the hon. Member for Upper Bann (Mr. Trimble) referred to the six options which have been tested against the board's core values for service provision. The core values are as follows: appropriateness, as services should meet the needs of individuals and the population as a whole; equity, as there should be no administrative, social or geographical barrier to services and there should be a fair share of the services available to the whole population in accordance with need; accessibility, because as far as possible services should be available locally, as the hon. Gentleman stressed; acceptability, as services should satisfy the reasonable expectations of the population; efficiency, as services should use resources to their best effect; and lastly, effectiveness, as services should achieve the intended benefit.

The board's options reflect the Department's strategy for the provision of acute hospital services, which has two main elements: the concentration of specialised services on a smaller number of sites, using markedly fewer beds overall, accompanied where necessary by supporting services locally; and a substantial shift from in-patient to day and out-patient investigation and treatment. The strategy's aims reflect the public demand for increasingly sophisticated and technically advanced services which lead to more effective treatment, shorter stays in hospital and, more importantly, better results for patients.

I have often said in the Chamber, and repeated during the 16 months that I was Minister responsible for health in Northern Ireland, that the health service in Northern Ireland should be to treat patients and that the social services in Northern Ireland should treat the clients as well as possible. We are not a furniture warehouse, or a job protection scheme, but we must consider the available facilities to make sure that there are sufficient beds for the necessary operations and sufficient people to provide that care.

Mr. Trimble

In his latter comments the Minister set out the criteria that the board has set for itself. He seemed to be concentrating more in its application concerning acute services. Does he appreciate that one has to give more weight to certain considerations when dealing with different aspects of medicine, and that in providing continuing care for the elderly particular emphasis should be placed on accessibility? The carers arc usually also elderly and not particularly mobile; consequently, there is a greater need for local provision. That adds weight to the argument of the hon. Member for Newry and Armagh about Mullinure and other hospitals which are providing continuing care for the elderly.

Mr. Hanley

The hon. Gentleman makes an important point. However, Northern Ireland is better suited than almost anywhere else in the United Kingdom to providing the right care, as we have health and social services boards which combine two aspects of provision within one area of responsibility. The boards are therefore able to plan both the acute services and the social services for the area: instead of what has happened in the past in other parts of the United Kingdom where the service has not always been matched, in Northern Ireland we can plan for the right balance.

Turning to the strategies for elderly people, the options to which the hon. Gentleman referred also reflect the Department's strategy for services for elderly people, which aim to increase the proportion of people aged 75 and over who are cared for in their own homes to 88 per cent. by 1997. It is a well established fact that the vast majority of elderly people prefer to be cared for in their own homes. Of course, people should not be cared for in their own homes if they are not suited to or do not want to be cared for in their own homes, but the basic principle that the vast majority want that, and that it is the best treatment for them, underpins the Government's community care policy.

The three major principles of that within the document "People First" were, first, to help elderly and other vulnerable people to lead as far as possible full and independent lives; secondly, to respond flexibly and sensibly to the needs and wishes of invidual people and the relatives and friends who care for them; thirdly, to concentrate professional skills and public resources on those who need them most.

I repeat what I said at the beginning of my speech. We are in a consultation exercise: absolutely nothing has been decided yet. General direction has been given because of the needs of people in Northern Ireland and the best use of resources. The hon. Gentleman said in an aside, "If it's not broke, don't fix it," but life does not stand still, and that also applies to medical treatment. If there are new ways of treating people better, if people can stay in hospital a shorter time, and if elderly people can be treated in their own homes in the way that they want, we should aim for that. We should be treating people as flexibly, professionally and in as modern a way as possible, making the best use of resources.

I stress again, as I often have, that any money saved by the process, if there are savings to be made, will go straight back into patient care; it is not a cost-cutting exercise. Hon. Members may treat that comment cynically, but it is an honest pledge that we shall put any money saved by these exercises into improved patient care in the areas where the money is saved.

I am grateful that the hon. Gentleman has raised the subject today. I hope that I have helped to stimulate more responses to the document than might have been forthcoming otherwise, and I hope that the hon. Gentleman will continue to make contributions to this particular procedure, and that ultimately we shall be able to serve the people of Northern Ireland better than in the past.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.