Leighton Hospital (Hansard, 18 November 1993)

§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)
Two important headlines appeared in the papers today. One was in The Daily Telegraph, which is not a noticeably socialist publication, and it states that the first three years of reforms saw 30,000 new managers and clerks—and 26,000 fewer nurses.
The other headline was in my local paper; it was "Health jobs to go." That, I am afraid, is a reality which is coming ever closer to us in the Crewe and Nantwich area.
It is very important to understand that, when the Government sought to "reorganise" the national health service, what they had in mind was not improving the service, reintegrating the service, or actually providing better cover, but setting down machinery that in due course could mean that the health service will be divided first into trusts and then into individual paying units. Therefore, it is very important for us to look closely at what has happened.
I now feel justified in saying that within the Crewe area we have reached what is in effect a crisis point. I normally hesitate to use the word "crisis" because hon. Members frequently talk about crises in the national health service; but if a very large district general hospital which covers a very important group of constituents and which has numbers that are growing all the time—we have the advantage of being the part of Cheshire which is attracting a population—and is also, unfortunately from the point of view of the health service, taking in more and more elderly people, one begins to understand that what happens to the health service is a matter of grave concern to everyone.
Some years ago, we were told that Leighton hospital, which is now part of the Mid Cheshire group, would find itself able to cope very efficiently under the new system because it would begin to organise, to cut unnecessary administration and to change the ways in which it operated. The reality, of course, was very different. The hospital has been underfunded for a very long time. As the Under-Secretary of State for Health knows, I have raised this subject more than once on the Floor of the House, precisely because Leighton's constant underfunding was not being met either by the region or by any support from the district health authorties.
When it became clear that there would be a general election, however, a certain number of bridging loans mysteriously appeared for Leighton They have now come to an end and we now face a forecast deficit of £3 million. Frankly, anyone who knows what it costs to run a district general hospital will know that to take £3 million out of it is, in effect, to push it close to the point at which it can no longer be viable and to destroy the very basis on which the hospital operates.
It is important to understand that the assessment was riot produced by a finance officer within the hospital. It is the result of independent assessments by outside auditors. Because the DGH was so worried about its finances, they were asked to look at the way in which the hospital was operating and to give their own assessment. They produced not one report but two. I quote from one of the reports: the underfunding over many years (although hidden by non-recurrent factors)
would lead to 107 i. a forecast 'deficit' of £2.1 million for the year to 31 March 1994, ii. a backlog maintenance
—remembering that this is not an old hospital— of £15 million, iii. a worsening 'deficit' rising to £8.4 million in 2005 as the revenue effect of the backlog maintenance expenditure exceeds the growth in revenues.
The auditors went on to outline what they saw as the continuing problems. I quote: In 1992–93 the underlying deficit was hidden by a reduction in the depreciation provisions (arising from a revaluaton of assets)"—
that is something that cannot happen again; certainly it accounted for £1.4 million. In 1993–94 a similar adjustment of £2.6 million is hiding the Coopers and Lybrand forecast deficit of £2.4 million.
In March 1993, the hospital was so concerned that it held talks with both the Mersey regional health authority and the Crewe district health authority in an attempt to achieve a wider understanding of the reports and to look for a means of improving funding. One report stated: No agreement was reached for additional recurrent funding and the Trust was asked to produce further cost savings totalling £700k immediately with a further £1.4 million identified by 30th September … In addition, activity targets"—
the Secretary of State for Health is constantly hymning the ability of the Conservative party to deliver those targets— were set at almost 5 per cent. above the 1992–93 levels. Half of this increase accommodated a backlog in minor procedures, and to maintain activity levels in 1994–95 major and costly procedure will have to be performed.
The report went into considerable detail about the sorts of things that could be done. First and foremost, it suggested that, although the activity targets incorporated the increase over the previous year and worsening waiting lists would result from that difficulty, nevertheless there would be some gains, such as tighter controls and a difference in the accounting policy.
When one looks at the way in which it is hoped to make money, one discovers that one of the items that the report is talking about is more than £1 million for a huge incinerator which will be built to deal with clinical waste. The incinerator will attract great opprobrium because it will not only triple and quadruple the amount of lorries that move on a small road but produce considerable difficulties for the people who live in the area.
The reality is that a district general hospital—the only one within a considerable distance—will be expected to find a cost saving of an immensity that no business would be able to sustain in the period that has been set down without going bankrupt, yet the Government pretend that they are the Government of business men. There is absolutely no conceivable way that any major hospital could find £3 million out of its budget, with the return on assets involved, within the time scale and in the manner in which it has been asked to do so and continue to provide a wide range of services.
We must understand that the report is talking about activity increases which will impact on costs at a greater rate than revenues and the deficit therefore worsens.
I quote: this is likely to be significantly understated in view of the capital investment required in the immediate future to make inroads into the backlog maintenance book and the associated revenue effects
108 Mid Cheshire hospitals trust has a recurrent shortfall—not one, but a recurrent shortfall—against target return of at least £3 million against a background of ever-increasing demand for services and its large maintenance bill.
We then come to the practical means which are being suggested for dealing with some of the problems. We discover that my constituents, who have already seen a number of ward closures at that hospital, will be told that more wards will be shut, that there will be consolidation —which is a Conservative word for ensuring that not as many people are cared for as were before—and that there will be such cuts in clinical services that in my view the orthopaedic services will be rendered virtually non-existent.
I could give the House a list; it does not mean anything to hon. Members, but it will mean a great deal to my patients and constituents. In order to meet the strategic directional changes, we shall integrate in-patient facilities for ENT and ophthalmology, merge wards 18 and 19, close down wards 9 and 10 and form them into a single unit, close ward 19A altogether and develop day care services —of course, but at what cost? Can one always provide the same level of care through day care services that one can with in-patient care? Of course not. We are going to merge wards 13 and 15 into a unit with a vascular interest, which is a nice way of putting it. Ward 14 will be closed, and the proposal says: NB six beds are also used for Gynaecology.
We will notice, because that is a result of a previous alteration.
I am sure that the Minister will give us his normal calm recitation of facts that have been supplied to him by those who are now adept at covering up the truth of what is really happening in the national health service. He will probably say that the hon. Lady is exaggerating; she does not understand it; she does not know anything about it. Let me, therefore, give him some more facts.
The implications of the changes are a net reduction of 39 beds and very high occupancy levels in remaining wards. Availability of beds is currently not a constraint, the document says, but there is no doubt in my mind that there will be considerable constraints if we lose that number of beds. It is said that there will be serious consequences for handling emergency medical overflow. It is said that no additional developments in hospital services can be generated by cost savings, and although it is thought that the establishment will be held at average in-post levels, any future initiatives to increase patient activity could not be at marginal cost.
There is no suggestion that what is being imposed on the hospital is being done in order to improve its efficiency. Not even the regional health authority—which will itself be cut so that it will not be capable of understanding statistics that are given to it about the need for proper patient care and for services—argues that what is being imposed is in the interests of the patient. Something very different is being imposed. It is the kind of brutal attack on funding for the national health service that is the reality of Conservative health care—not all the simple, rather beautifully phrased, careful terms that somehow hide the reality. That is what will happen in my constituency.
Already the atmosphere in the hospital is worrying. I feel that it is important that I should come here and say these things tonight because one of the things which the Government have done, and for which the Minister has never taken credit, is to frighten health service workers so 109 that they do not dare to speak openly about what is happening to their jobs and their hospital. They are worried. Many of them know that they have already been earmarked for redundancy. All right, they are told now that those will be non-medical jobs, but tomorrow they will be medical jobs. Today they are told of voluntary reductions; tomorrow the reductions will be compulsory.
The Government also tell us that the unit is highly efficient. Not only do Ministers praise the administration of Leighton hospital, but they give it awards. They say how well run it is by everyone concerned and that it is part of the Government's quality initiative. The hospital even had a visit in the past three weeks—naturally, one of which I was not notified —by a Minister who told the hospital how brilliantly it was operating.
Some measures will have a direct impact. It is stated that the service in accident and emergency departments will be improved through nurse practitioners. Nurse practitioners, we are told, are experienced nurses who have taken a course on the diagnosis and management of common injuries
and who are able to practise in their own right".
Fine. Let me tell the Minister after a lifetime of living in hospitals that trained doctors, even at consultant level, know that the real problem with accident and emergency work is that a number of people present their injuries in such a way that those injuries can be missed even by people with considerable training. Any major hospital can provide the Minister with cases of people who left the accident and emergency department, sat on the steps and were afterwards readmitted, if they were lucky, or suffered because their condition was missed.
If the Minister is simply about to tell us that the hospital is run efficiently, is treating more people, has a faster input—that the peas are running faster through the pea factory—and that that is the only way that he will estimate how good health care is, he might as well save his breath to cool his porridge. We know that that is nonsense.
We know that many more people are going to that district general hospital than previously and that the staff are doing a good job in enormously difficult circumstances. However, we also know that the staff are demoralised and frightened for their future. We know that the administrators expect to close basic services in a number of wards. We know that it is inconceivable that £3 million can be found in the time available.
The effect will be to deprive my constituents of what was an efficient, if underfunded, desperately important hospital. There is no way that the Government will get away with this constant fairy tale about not worrying because the hospital is bound to be able to cope. We have reached the point where consultants and nurses are directly affected by the regrading of sisters, by shoving various specialties together in some wards to close others, by closing wards at weekends and by the refusal to refill vacancies, all of which is having and will continue to have a direct effect on patient care. The situation is dangerous.
Unless the Government are prepared to be if not realistic, then at least to listen to those who know what they are talking about, my constituents will have a valid argument for saying to the Government, who are keen on treating health care as a business, "You would not ask any business in the world to find a £3 million cut in the time available. You are prepared to wreck the NHS and to exclaim how efficient you are by getting rid of top level 110 administrators." What the Government have done is indefensible and what they are about to do is appalling. In no circumstances whatever will the Minister escape blame if this goes ahead.

§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
After the statesmanlike intervention of the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) in an earlier debate on the problems of eastern Europe, I am disappointed by what she has just said. She descended from a sensible beginning to an unforgivable piece of depressing rhetoric about the health service, which will do no good at all. What sort of impression does the hon. Lady think that phrases like "bankruptcy", "crisis" and " a dangerous situation" will have on the patients, staff and the people trying to manage the difficult situation in her local hospital?
The hon. Lady need not hold up headlines from the press. The health service is not about headlines but about—and I choose my words carefully—one of the great benevolent and beneficent organisations in the world. It does an extraordinary job and it does not need politics and rhetoric flying around.
I would not be so starry eyed as to say that I am relaxed about the situation at the hospital, as the hon. Lady accused me of being. I am not. There has clearly been a continued overspend. We are relying on managements at hospitals around the country to set budgets and to keep to them. That has not happened in this case, and there are financial problems which have to be addressed. That is an unsatisfactory situation, but we agree that we have to face it.

§ Mrs. Dunwoody
If there have been continual problems of overspend that need to be dealt with, why has the previous executive not moved outside the national health service but gone elsewhere within it? If his financial management was so lacking, why has he been appointed to another NHS unit?

§ Mr. Sackville
If another trust or unit wishes to hire that person, it is its affair; he is no longer at the Leighton hospital. I think that the hon. Lady will agree that the management there is first-rate, realistic and will try to tackle this problem.
Let me put the matter in context. The hon. Lady knows that there have been a number of favourable developments at her local hospital, and I hope that she will give credit for that. She mentioned that my noble colleague Lady Cumberlege was at the hospital recently to open a new unit. The hon. Lady will know that a new day surgery case unit was opened in April of this year. She will know that on 5 November—on the visit to which I referred—Lady Cumberlege opened a new endoscopy unit. The hon. Lady will also know that the funding required to renew the roof, about which we spoke in an earlier debate this year, has now been approved. She will know that work is in progress on a £2 million rehabilitation unit for elderly people which will provide accommodation of a high quality, improve discharge times and be of great service. She will know that £800,000 has just been spent on a CAT scanner and its associated equipment. She will also know that the necessary action has been taken to reduce junior doctors' hours six months ahead of the national target. 111 Those are all things of which the people who work at the hospital can be proud. It is good news, which should be put on the record after the hon. Lady's litany of doom and gloom.
There is a deficit that has to be tackled. I agree that actions taken in the past were quite clearly not realistic about the future funding. When it was clear that actions needed to be taken further to improve efficiency at the Leighton hospital, such actions were not taken, and those things must be faced up to.
The hospital continues effectively and viably. Activity, as the hon. Lady knows, has continued upwards. The description of the hospital being in crisis does not begin to paint a proper picture of what is happening.
The hon. Lady will be aware that in-patient activity rose in the past year and that the number of out-patients treated went up by another 6 per cent. to reach 149,000. She will also be aware that the number of patients seen during the past year was above the level at which the trust had contracted to provide. Leighton continues to be an effective hospital.
How is the deficit to be faced? The hon. Lady gave one version which I do not recognise. My information is that a number of measures will be taken, including the transfer of surgical patients to a day-case basis. That is not only good for patients, but it represents the way in which to treat more patients more effectively. It also reduces the number of acute in-patient beds. I am sure that the hon. Lady will acknowledge that that process is going on in hospitals in Britain and around the world. It is a necessary procedure and it probably should have been adopted earlier at Leighton with the establishment of the new day-case unit.
The combination of various wards with out-patient facilities will go ahead without any detriment to patient 112 care. I have already mentioned the rehabilitation service, which will improve discharge times and thus efficiency. There is no doubt about the fact that a number of management posts will need to be revised and that is one of the more painful actions that will have to be taken.
Consideration will also be given to the way in which support services and the so-called hotel services are provided. More market testing will take place to ensure that any costs that can be contained are contained. Investigations will also be instigated to consider how private-sector finance can be introduced in some areas. That is central to our policy. Those studies will identify the circumstances in which capital and outside expertise can be supplied by the private sector.
Income-generation schemes will continue to be sought to provide more revenue to the trust. A selective freezing of vacancies will be operated in an effort to ensure that there is a proper use of manpower. Such matters as the billing for ECRs—extra-contractual referrals —for patients coming from other districts will also be considered, as it represents a way in which the financial management of the hospital can be improved.
A sensible and sensitive programme of cost containment is under way. It is not sensible for the hon. Lady to tell her constituents and the rest of the public that her local hospital is in crisis. That will not help anyone. The hon. Lady must realise that she has an excellent local hospital. She should encourage the staff and management who are continuing to manage and run an excellent hospital in difficult circumstances.
The problems at Leighton hospital are surmountable, but that will not be possible if we adopt the style of approach that the hon. Lady displayed this evening.