§ Ms Margaret Hodge (Barking)I am pleased to have this opportunity to set out my real concerns about the state of the health service in my constituency. Two weeks ago I published and sent to the Minister a document entitled, "Health in Barking: Getting a Raw Deal?", a dossier of the worst health cases that have come to my attention during my 18 months as a Member of Parliament. I have been deeply shocked by the poor quality of health care that is encountered by all too many of my constituents. A Member of Parliament's surgery is the last resort for many people, yet we see probably only the tip of the iceberg because, as we all know, many people do not know who their Member of Parliament is, do not know that we hold surgeries and do not think that we can help.
Of course there are many highly skilled and dedicated professionals in the health service in Barking, and I know many of them. But too many of my constituents are being short-changed by the national health service. Too many of those who have come to see me have suffered unnecessarily and for the wrong reasons. Their stories are partly about under-resourcing, but they are also about bureaucratic bungling and unacceptable standards of care.
What about those who do not come to the surgery? I spend a great deal of my time visiting the old people's luncheon clubs in Barking where I meet the people who are most dependent on the health service. Elderly women with chronic conditions often say to me, "I can't get to my hospital appointment any longer and the GP is just too busy." For those women the hospitals are too far away, ambulance services have been cut, public transport is hopelessly inadequate and they cannot afford the taxi fare, so they do not go. Their health is not regularly checked, so they lose out and will probably never know the impact that that will have.
Barking is served by the Barking and Havering health authority. My constituency is the area of greatest need in that district, yet it has the poorest services. We have the highest concentration of elderly people. Infant mortality rates are twice those in the more affluent neighbouring Havering, and 10 per cent. higher than the average for England and Wales. However, the hospitals are all concentrated in the areas of lesser need. That is happening in the knowledge that 40 per cent. of local people do not have access to a car.
The area is changing. The Barking reach development will not only increase the population but will mean an expanding number of children. By the year 2001, the number of under-14s in Barking will have increased by 10 per cent. Those changes will bring new challenges tomorrow to a health service that is already failing to meet the challenges of today.
Barking has long been denied its fair share of health resources, and decisions in recent years have made a bad situation even worse. There is no hospital in my constituency: Barking hospital was closed. There is no hospital in the borough. Rush Green hospital in Dagenham has gone and, despite protestations from all local Members, the Government recently condemned the nearest hospital at Oldchurch to a slow death by deciding to close its accident and emergency unit.
Unbelievably, within months of deciding to close Oldchurch, the health authority has decided to conduct a new review of acute services in our district. The acute 345 services have been reviewed and re-reviewed, and are now to be reviewed again. What bungling incompetence. Hardly is the ink dry on the Minister's signature on a document to close yet another accident and emergency unit than the authority realises what we have been telling it for months, that the other hospitals simply cannot cope.
I shall briefly reflect on the miserable story of Barking hospital. Shortly before the first world war, local people collected money to build a hospital to meet their medical needs. The hospital was built by the voluntary efforts of local people. New blocks were added in the 1930s and 1960s. In the 1980s, some £6 million was invested in a new maternity wing which opened in 1987, and further moneys were spent on a nurses' training centre. Just four years later, despite a vigorous campaign that was led by my predecessor, Jo Richardson, it was decided to close that hospital.
Anyone who visits that site today would see a shocking testament to the Government's health reforms. Perfectly sound buildings are lying empty, windows are smashed, and forgotten beds are strewn over empty wards. Money has been wasted while patients suffer. Little remains on the site. There are four acute elderly wards and a minor injuries unit which, ironically, is housed in the £6 million purpose-built modern maternity unit. It is a tragic waste of hospital resources.
The withering away of Barking hospital is just one of many causes for concern in my constituency and, taken together with the decision to close the accident and emergency department at Oldchurch hospital in Romford, it is a disaster. It means that poorer people in Barking will have to travel to the richer edges of Essex, which is 12 miles from the centre of Barking, to be treated in what is now their local district hospital. Many of them have never heard of Harold Wood hospital, nor have they been to it. They cannot even find it. Public transport is dire and they cannot afford taxis.
I have long argued that one accident and emergency unit serving 400,000 people is just not enough, and that is evident from the cases that I describe in my dossier. The majority of those cases are of people who have been let down by the various local hospitals and they include several which, tragically, ended in death. Each case is unique, but there is a pattern consisting of a mixture of long waiting lists, under-resourcing and occasional incompetence. I shall illustrate that with just one example, which is by no means the most extreme in the dossier.
Mrs. T, a constituent, went to King George hospital a year ago. She had very high blood pressure and her heart was beating erratically. In the casualty department, she was left without help for hours. She complained, and was finally given an ECG. After that, she was again left for 35 minutes waiting to be examined by a doctor. Mrs. T is diabetic and has to have a regular eating pattern. She felt so ill that she left the hospital without seeing a doctor. Six months later, she was admitted to King George hospital with acute pancreatitis. She was told that she needed a gall bladder removed, and an appointment was set for a month later for an internal camera investigation.
On the morning of her appointment, Mrs. T rang to check that a bed was available, and was assured that there was. However, later that day the hospital rang to say that 346 no beds were available and that her admission would be delayed by another month. Subsequently she was put off twice again because of a lack of beds. She was so appalled that she and her husband reluctantly joined a private health scheme.
I know of dozens of similar cases, but I have to say that I expect that they are only a small proportion of the total. The people of Barking are remarkably reluctant to complain. That was brought home to me by the stark contrast between the campaign over the closure of the A and E service at Oldchurch and the massive campaigns around St. Bartholomew's and Guy's. I am seeking to give voice not only to the 60 or so constituents who have taken the trouble to come to see me, but to the hundreds of people in Barking who have not had the confidence to do so.
Much of this might not matter so much if the primary health care service were good. It is not. Some dedicated and skilled practitioners work in Barking, but the infrastructure is not sufficiently robust to cope with the additional pressures brought about by the hospital closure programme.
Recently, the family health services authority conducted a survey on the quality of premises in Barking. Patients have to see their doctors under unacceptable conditions. Of the 55 GP premises in the borough, almost three in four are classified as poor, only three are considered to be good, and none falls into the best classification.
If one then considers the statistics on GP case loads and GP support, one finds equal cause for concern. One in four GPs in Barking work as single practitioners. The average list size for GPs is almost 2,500 patients—it is 2,464. If one compares that with the national statistics, one finds that only 8 per cent. have a list of more than 2,500 patients. Barking residents are again getting a raw deal. Indeed, there is more cause for concern. One in 10 practices have no practice nurse, there are few training doctors, and professional training facilities for Barking GPs are not good.
All those factors show. My dossier does not simply describe cases in which individuals were given the runaround by their GPs: it includes two cases where, on the face of it, death might have been avoided if the GP had acted properly for the patient as a first point of call.
My constituent Mr. Ayling is still in regular contact with me. He lost his daughter Maria because nobody spotted early enough that she had a thrombosis as a result of taking one of the pills that we now know to be dangerous. Mr. Ayling is still fighting for an honest account of the treatment that his daughter received from the local health services. He has been forced to take legal action to obtain even a proper inquest into Maria's death. In the end, I think that he will receive some financial compensation, but we all know that nothing is enough to make up for the loss of one's child. It is in the memory of Maria and others like her that I am fighting in this public way for the Government's recognition and for action to give my constituents a fair deal from the NHS.
The local health authorities may not like this and may want to work behind the scenes. In a recent letter to me, the chairpersons of the FHSA and the district health authority stated that:
the number of complaints are few.347 Indeed they are, but that shows a lack of understanding by the authorities of Barking people. They do not easily complain; they are not comfortable in challenging authority. But since I have started raising the issues locally, I have been inundated with constituents' letters supporting what I am doing. My first duty is to them.Barking is a wonderful part of east London, with strong, close-knit communities. It is an area rich in tradition, which is about to undergo major changes with the advent of the channel tunnel rail link and the massive new community of Barking reach. Our local health service is under strain. I want to be sure that we can meet the new challenges and opportunities that we face. I ask the Minister to respond to three specific issues.
First, I ask the Minister to halt any closures—including the planned closure of the A and E unit at Oldchurch—until two things have happened. We must have in place good primary health care that can cope with the legitimate demands of people in Barking, and the authorities must complete their latest review of the acute services for local residents, to ensure that we do not simply close facilities today and find that we have to create new ones tomorrow.
Secondly, I urge the Minister to instruct the authorities to expedite the review of the Barking hospital site so that our precious health resources are not left to waste and decay. We want that site used for health purposes, and brought back into use quickly. Thirdly, I ask the Minister to examine new ways in which we can recruit and retain quality GPs in urban areas such as Barking. We will never get the health services to which my constituents are entitled if we do not bring in effective measures to tackle the problem.
Those are practical measures that will offer reassurance to people in my constituency who are desperately worried about the state of the local health service. My constituents are not professional whingers. The complaints that I have compiled in my dossier are real, and an enormous cause for concern. There are many dedicated and hard-working people working in the health service in my constituency. There are also many elderly and deprived people whose needs are not being met. We owe it to both groups to make things better, so that, once again, people feel safe and certain that they will enjoy the first-class service to which they are entitled.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)I am pleased to have the opportunity to respond to the hon. Member for Barking (Ms Hodge) and I congratulate her on securing time to debate the very important topic of health care in Barking. Although it is obviously important to her, it is important to all of us. I listened carefully to her points, including the three final issues. I can confirm that I have read her report, which she kindly passed to my right hon. Friend the Secretary of State.
Obviously it is always regrettable when a patient has to wait for a lengthy period for necessary treatment under the national health service. It is equally regrettable when operations are postponed at the last minute—the hon. Lady cited the case of Mrs. T, which was certainly regrettable—or when the care provided falls below the highest standards. However, the hon. Lady failed in her report and in this debate to take account of the very real improvements taking place in her area, as well as nationally, under the NHS.
348 In any part of the country there will inevitably be problems from time to time in an organisation as large as the NHS, but what is rarely mentioned by Opposition Members is the huge proportion of patients—I am sure that that must include patients in Barking—who are more than satisfied with the service that they receive.
In the majority of cases quoted by the hon. Member in her report, the main cause for complaint has been a delay in treatment being received. I certainly agree with her wholeheartedly that people have had to wait too long for treatment. That is why reducing waiting times has been a priority for the Government in their handling of the NHS.
In 1979, more than 185,000 patients in England were waiting more than a year to enter hospital. Today, that figure is down to 28,000 and falling. I am sure that that drop has affected Barking. That statistic alone demonstrates the scale of the progress that we are making. Admittedly, progress in reducing waiting times has varied—and still varies—throughout the country. It is undoubtedly true that some patients in the North Thames region, which includes Barking, have had to wait longer than patients in other parts of the country, and I consider that unacceptable.
I am glad to be able to tell the hon. Lady that concerted action is therefore being taken by health authorities in North Thames precisely on that point, so as to reduce waiting times for its patients. That action is already producing results. Over the past year, the number of patients waiting for treatment in the North Thames region has fallen more quickly than the national average, and the number waiting for more than a year has fallen by more than 21 per cent.
The hon. Member's local hospitals are at the forefront of those developments. In the past year, Havering hospital's NHS trust has seen a fall of almost three quarters in the number of patients waiting more than a year—that is a huge improvement. The number waiting for more than a year at the neighbouring King George hospital has fallen by more than a quarter in the three months from June, and that improvement is continuing.
I am also pleased to report that, from 1 April 1996, Barking and Havering health authority expects and hopes that no patient will have to wait longer than nine months for treatment from the time that they are placed on a waiting list. That is obviously its intention and aim, and I certainly hope that it fulfils it. Indeed, we shall be seeing whether it can.
Decisions about how and when to treat patients are of course made by clinicians—not by politicians or by managers. A doctor decides whether a patient is not yet ready for treatment or whether he needs treatment immediately, and his decision stands. Of those patients nationally who doctors judge can wait for treatment, the figures show that fully half are admitted to hospital within six weeks and almost three quarters within six months.
The hon. Lady complained about a lack of resources being devoted to the health service. Obviously, it has escaped her notice that the figure for 1978-79 was £6.5 billion, since when there has been a 70 per cent. increase. My right hon. and learned Friend the Chancellor of the Exchequer announced further substantial increases immediately after the Budget. Current spending on health will grow by £1.3 billion in the next financial year, equivalent in real terms to 1.6 per cent. Therefore, the Government have every reason to be extremely proud of 349 their record on funding and support for the NHS. In fact, the Barking and Havering health authority has received a increase for next year of 3.79 per cent.—about £171 million.
Obviously, I fully accept that, as the hon. Lady said, historically primary care in London, and especially in her area, has been underdeveloped and in need of substantial improvement. That goes without saying. However, welcome improvements are taking place as a result of the Government's efforts. The hon. Lady made a point about quality general practitioners. That is being tackled through current measures. Therefore, I take exception to her comments that over the past few years all the decisions have been the wrong way. The decisions in this area are profoundly in the right direction.
An example of that is the London initiative zone, which was established to concentrate effort and investment in those areas of London where primary care services are weakest. As a result, almost £4 million has been allocated over the last three years to improve the primary care facilities in the Barking area alone. The number of general practitioner practices in Barking and Havering classified as poor has fallen from 72 per cent. in 1992 to only 31 per cent. this year. That is a staggering improvement.
During the past five years, three purpose-built health centres have been opened. Indeed, the hon. Lady performed the opening ceremony for one of them. A further four health centres have undergone extensive refurbishment or been extended in the same period. More than 20 other GP practices have received funds to improve their premises.
Other improvements to primary care services include the near doubling of the number of practice nurses working in Barking and Dagenham since 1993-94 and an increase from 37 per cent. to 93 per cent. in the level of computerised GP practices since 1992-93.
The hon. Lady referred to the problem of GP recruitment and spoke about the quality of GPs in her area. There is a high proportion of one or two-doctor practices in Barking. The Government are well aware of the problems and, from September this year, introduced a series of special allowances for London to help deal with them. They are designed to attract new GPs into London, to encourage high-quality GPs to stay, to create capacity for practice improvement and to encourage GPs in single-handed practices and partnerships of two doctors to meet to work together on the development of primary care services.
All those allowances are payable only if progress is made in improving patient care through better practice organisation and training. They will encourage 350 collaborative working and help to overcome professional isolation, which is a problem in areas such as Barking and which can be experienced by some GPs in small practices.
Those initiatives complement new educational opportunities for London GPs, which we announced in October last year. They were drawn up with support from the London FHSA management and the local medical committees. We are making £15 million available for 1995-96, increasing to £20 million for 1996-97, to support that programme.
All the initiatives and improvements that I have cited demonstrated the great progress being made in primary care in particular, both in Barking and nationally. Obviously, in no way would I wish to play down the highly regrettable individual cases that featured so largely in the hon. Lady's speech. However, as I said, there is very firm progress in reducing waiting times still further, and, equally important, in improving primary care in an area that historically has been very deprived. The hon. Lady can be assured that I have absolutely no doubt of the Government's determination to achieve that.
I believe that, in the hon. Lady's part of the world, the local health authority, NHS trusts and GPs are working together very effectively. I hope that she will pay regard to that in any future remarks. She mentioned the letters of complaint that she had received about her remarks from the chairmen of the health authorities and from local doctors. I understand her position—a Member of Parliament must raise these matters. However, she should remember that it is right to be fair and to remember the effect of her comments on the morale of those working in the health service. Therefore, I hope that she will always present a balanced report. I assure her that progress is being made in the way that I have outlined.
§ It being six minutes to Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.