HC Deb 24 January 1996 vol 270 cc325-32 1.30 pm
Mr. Gerry Sutcliffe (Bradford, South)

I am grateful for the opportunity to raise my concerns and, more importantly, those of my constituents, about health provision in Bradford. I know that my hon. Friend the Member for Bradford, West (Mr. Madden) will wish to comment on this important matter.

It is my belief, as I hope to prove today, that Bradford people are losing confidence that their national health service will be able to meet their medical needs when they require it. I have no intention of talking down the health service. I am proud that it was a Labour Government who set up the national health service based on need. Indeed, I pay tribute to the doctors, nurses and health workers, who are acting above and beyond the call of duty. I shall read an extract from a letter that one of my constituents, Mrs. Jean King, whose mother is in hospital, wrote to the chief executive of Bradford hospitals trust. She says: I am writing both to compliment and complain. The compliments are directed at your nursing staff and the complaints are directed at your organisation. All credit must go to the staff, they never complain they just get on with their duties as best they can. They look tired, stressed and they are definitely overworked. I am sure that they know they have not got the time to give the sort of service they used to give. My mother has become depressed and distressed, not because of her illness but because nobody has the necessary time to give her the sort of care which used to be available for patients. My mother is only one of many needy patients on that ward who try not to trouble the nurses because they can see how busy they are. In another letter, one of my constituents, Mr. Key, makes further mention of the shortage of staff. Unfortunately, his wife passed away in hospital. He said that, in the last few days of her life, she was concerned about being moved into a side ward, as she feared that she might not be heard because the staff were so busy. Eventually, to benefit her family, she agreed to go into a side ward. She died with the alarm button in her hand.

There are many other cases that I could quote, but the constant theme remains the same: grateful thanks to the doctors, nurses and health workers, but harsh criticism of the system.

Bradford nurses still have not received their pay rise in their pay packets, due to the financial crisis facing the hospitals trust. That crisis is based on the faltering relationship between the purchaser, Bradford Health, and the provider, Bradford hospitals trust. The evidence is that, in the past, both parties had to go to arbitration to confirm their financial settlements, as Bradford hospitals trust claimed that it was not receiving the appropriate funds. To balance the books, the trust has had to make efficiency savings, which have resulted in savage cuts in the number of staff, the closure of wards and the loss of beds. That in turn has affected morale among hospital workers, who have seen the quality of their service deteriorate and the number of skilled and qualified staff reduce. At the same time, the number of administrators has increased, due mainly to the bureaucratic relationships and complexities of the purchaser-provider split.

In Bradford, we have seen an increase in the need for charitable donations to provide much-needed equipment, particularly in the care of cancer and heart patients. The death two weeks ago of my constituent, Mr. Geoffrey Cranswick, was a great tragedy, not only for a loving family who lost a special person but for Bradford. Mr. Cranswick collapsed in his doctor's surgery. His general practitioner tried to save his life, and hospitals in the area were contacted for an emergency admission to intensive care. Bradford royal infirmary has only five intensive care beds, four of which were in use at the time. The fifth bed was unavailable because of staff shortages. Eight other hospitals were contacted in the region until a spare bed was found, in Scarborough. Sadly, Mr. Cranswick died just after arrival in Scarborough.

Bradford's population of 485,000 deserves more than just five beds. Following the announcement of Mr. Cranswick's death, the director of nursing services commented: For the size of our population we look to be lacking in Intensive Care beds at the moment". That is somewhat of an understatement. In December, 19 people needing intensive care had to be transferred outside the Bradford area.

The irony is that Mr. Cranswick was a tireless worker for the British Heart Foundation. I believe that a full inquiry is needed into the circumstances of his case. I hope that his family's pleas for extra intensive care beds will be heeded as a fitting memorial to him. I have a relevant quotation from our local evening paper in Bradford, the Telegraph and Argus, which said: There is obviously a nationwide problem. It is hard to work out whether the crisis is the result of a shortage of funds—or due to mismanagement of resources and bad planning. The Secretary of State for Health is the man ultimately responsible for sorting out the mess. The Government created the new-look NHS. They must ensure that it stops failing people when they are in desperate need. The indications are not good. When I raised a question in the House about the problems of purchaser-provider splits, I was told that it was a matter for the chief executive of the trust and for the commission. I believe that to be an abdication of responsibility. The Government should and must act when things go wrong.

Again in December, the hospitals trust had to subcontract more than 1,000 patients to other private and NHS facilities because it did not have the capacity or the notice to make arrangements. Some £1.9 million was found by the regional health authority out of "unrenewable resources" to meet the backlog of cases that had been waiting almost 12 months. There were 516 general surgery cases; 322 orthopaedic cases; and 278 urology cases. Operations were carried out in the private sector at premium rates by consultants who would have carried out the same operations within the NHS. I urge the Minister to investigate how it was possible for such a situation to occur.

Bradford hospitals trust has shut down its capacity to match its budget provision. The trust's chief executive raised concerns with my colleagues and me about the seriousness of the financial situation. In the contracting year 1994–95, the trust was required to carry out 76,500 finished consultant episodes from a budget of £80.5 million. In 1995–96, it has been requested to supply 79,500 FCEs for £82.1 million—an increase of £1.6 million for a further 3,000 operations. In effect, it is a 4 per cent. increase in requirement, but with an increase of only 2 per cent. in funds.

Needless to say, the health commission does not accept the figures and makes the case that the trust is the provider and that it must be competitive on its prices to win contracts. That would be understandable if we were talking about a business, but we are not. Nor are we comparing like with like. Bradford hospitals trust depends on Bradford health commission for more than 90 per cent. of its budget. The trust forecast that it is heading for a finance deficit this year of £5 million. It says that further financial pressures are unavoidable on issues that have been agreed by the Government—the cut in junior doctors' hours, and more medical education—but have not been budgeted for.

The only method of retrieving the shortfall is for further cuts to be made in an already beleaguered service. The trust maintains that it is cost-effective, low priced, and an efficient production unit. It points to several local and national indicators to prove the point. What is clear to all of us in Bradford who use, and depend on, our hospitals is that we cannot afford more cuts. Yet we discover that the new formula funding for the regional health authorities means that Bradford will receive £5 million less next year, on top of the £5 million shortfall for this year.

Taxis ferry patients across the city, because the trust operates on two major sites. X-rays and scanners are available only at one site. We need more money and more investment, not less money and further cuts. Staffing levels on the wards are the lowest in West Yorkshire. On most wards, 19 staff provide 24-hour cover seven days a week. On others, there are six nurses—three qualified from the Royal College of Nursing and three auxiliaries—to 51 patients. When there is absence through sickness, the staff have to go to the management to arrange cover instead of using agency nurses.

All training courses have been stopped until the end of the financial year as the training budget has been used up. Nurses and staff are not allowed time off to attend courses to develop their skills. They have to pay for the courses themselves and attend them outside working hours. Staff working on Christmas day had to pay for taxis to get to work because there was no public transport and when they applied for a refund they were told to deduct the amount of the bus fare. That is outrageous.

In 1994, a document was launched in Bradford outlining the strategy for health until 2000. It pointed out Bradford's medical requirements and all the agencies involved gave a commitment to make Bradford a healthy place with healthy people able to depend upon first-class health provision. If present trends continue, that will become a worthless piece of paper to put alongside the patients charter. We do not want more words; we want a health service that provides for us when we are in need.

The trust recognises that it has a problem. It forecasts increased waiting times and says that current contracts will mean that people will be on waiting lists for more than 12 months. It believes that a cost reduction programme will make matters worse, putting the trust at greater risk of complaints and litigation. Bradford people cannot afford that. I urge the Minister to investigate and put matters right. If he does not, the Government cannot continue to say that the health service is safe in their hands. This is not a matter of the numbers of patients being treated; it is a fundamental question of providing an effective, efficient and caring public service.

In 1991, the Bradford hospitals trust was launched as a flagship of the new approach to health provision. It saddens me to say that it is floundering and in danger of sinking. The casualties will be the decent people of our city, people who cannot afford to buy their way out through the private sector if they are in trouble.

It is a great privilege and responsibility to represent Bradford, South. I hope that the Minister will take the issues seriously and not respond by quoting statistics showing the throughput of operations. I hope that he will show a genuine desire to get to the heart of the issues and to put matters right.

Doctors, nurses and health workers in Bradford deserve better support. People in Bradford know what the problems are and they deserve better treatment. I hope that the Minister will investigate all the matters that I have raised and ensure that Bradford receives proper and appropriate health care.

1.44 pm
Mr. Max Madden (Bradford, West)

I congratulate my hon. Friend the Member for Bradford, South (Mr. Sutcliffe) on securing the debate and allowing me a brief opportunity to participate.

The Under-Secretary of State for Health is new to his portfolio, but I am confident that the briefing material given to him before the debate will have said that concerns about the NHS in Bradford have been put to the House by different Members of Parliament representing the city during the past 10 years or so.

I do not want to be alarmist—what I have to say is substantiated by what my hon. Friend said—but the NHS in Bradford is in deep crisis and unless the Government intervene decisively, that crisis will deepen. Those who depend on the NHS in Bradford are clearly not receiving the quality of service to which they are entitled and all the prospects are that that quality of service will deteriorate unless decisive action is taken.

As the House has been told on numerous occasions, Bradford suffers from deep poverty. That poverty is endemic and breeds all sorts of health demands. Clearly, Bradford NHS is incapable of meeting those needs at present and, as time goes by, without the injection of additional funding, it will continue to be unable to meet those growing and important needs. We suffer particularly from high rates of heart disease. Thankfully, our infant mortality rates have improved substantially in recent years, but there is continuing concern about infant mortality and the health of children in our district.

As my hon. Friend said, the NHS in Bradford is grotesquely underfunded. That has been the case ever since the NHS trust was first established there. Public warnings were consistently given about that underfunding, which were reaffirmed by the Select Committee on Health which visited Bradford at that time. Those warnings were never heeded, but I appeal to the Minister to do so today and to take action.

The morale of nursing and medical staff is at an all-time low. There is gross understaffing. As my hon. Friend said, the nursing staff-patient ratio is not only below the regional average but way below the national average. Considerable burdens are imposed on staff, who experience great stress and there is unacceptable dependence on temporary or so-called bank or agency nursing staff.

There is also considerable anxiety about the need to increase the number of consultants, in comparison not only with Airedale but with the rest of Yorkshire. My hon. Friend rightly spoke about the language that we now hear so much of in the health service—for example, throughputs and activity rates. We are dealing not with supermarkets but with those who are desperately trying to provide the best quality of care and service in Bradford, as is the case throughout the rest of the country. That is not being delivered in Bradford today and the main reason for that is the underfunding.

As my hon. Friend has already said, it is no good the Minister saying, as he may well do, that the funding is adequate and that the matter is one for the trust and the health commission—once better known as the health authority. Despite the new name, the reality remains the same, and that is that there is serious underfunding, which is historical. Unless action is taken, the consequences of that underfunding will continue and there will be more unfortunate cases, such as that of Mr. Cranswick, which has illustrated the need for urgent action now.

Some particular incidents have caused considerable concern recently. My hon. Friend referred to the decision to spend nearly £2 million on reducing the number of those who have been on waiting lists for nearly a year which, as the Minister will have heard, has resulted in that money being spent primarily within the private sector. It is unacceptable that nearly £2 million of taxpayers' money should be spent within the private sector.

The absurdity of that is compounded because most of the operations were carried out by NHS consultants who should and would wish to carry out those operations within the NHS. That decision was politically driven. The Government clearly said that they wanted to reduce waiting lists and did not care how it was done. In Bradford, the result was that money that should have gone into the NHS went predominantly into the private sector.

I hope that the Minister will give us more than sympathy today. I hope that he will call urgently for information about the situation. If he agrees with the views expressed not only by me and by my hon. Friend today but continually by many others who are desperately concerned about health in Bradford, I hope that he will find a way of injecting substantial funds into the NHS in Bradford and do so urgently.

1.48 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam)

I am glad to have the opportunity to respond to the hon. Member for Bradford, South (Mr. Sutcliffe). I congratulate him on securing time in the House to debate the important matter of health care in Bradford. I acknowledge, too, his long-standing concern and his local knowledge. I well understand his feelings following the sad death of Mr. Geoffrey Cranswick, his constituent. He made an eloquent plea not only on the general question of health care in Bradford but on the particular question of intensive care beds, which are a material factor. I also acknowledge what the hon. Member for Bradford, West (Mr. Madden) said. He too has a great deal of knowledge about, and concern for, health matters in Bradford. I promise not to give too many statistics, but we must include a few facts in dealing with this case.

Before referring specifically to Bradford, let me say a little about the position in the country as a whole in order to put the matter in context. The number of available intensive care beds has increased by nearly 90 in the past four years. We recognise that the lack of intensive care provision has provoked criticism. It is sometimes claimed that the problem is due to a shortage of qualified nurses; retaining highly qualified nurses can be a problem, but—as my right hon. Friend the Secretary of State confirmed only last week in Health questions—we now have 1,000 more qualified nurses than we did in 1990. Indeed, the number of qualified general intensive care nurses increased by more than 18 per cent. between 1990 and 1994.

It must be stressed that intensive care is precisely that: it is a very intensive business. Between five and seven highly trained nurses are required to deal with one bed in an intensive care unit. That is one reason why we are encouraging the development of high dependency units, which can take some of the strain off intensive care provision.

In response to the claims of shortage in provision, the Department of Health commissioned a study from the London School of Hygiene and Tropical Medicine, led by Professor McPherson. His report, which was published last year, identified considerable variation in provision; it also found a significant number of inappropriate admissions. It must be recognised that what capacity we have must be used sensibly: it should not be misused in the handling of cases that do not necessarily justify intensive treatment. Following the publication of the McPherson report, a working group of medical and nursing professionals was formed to draw up guidelines for admission to, and discharge from, intensive care. It is expected to complete its work early this year.

Both the hon. Member for Bradford, South and the hon. Member for Bradford, West said that this should be a matter for the Government. In fact, the Government—or, rather, the professionals whom they have commissioned—are examining the whole business of intensive care, including intensive care in Bradford. Last year, we also asked local health authorities to review local intensive care provision in the light of Professor McPherson's report. We are also supporting the Intensive Care National Audit and Research Centre with a grant of £400,000. Both performance and outcome are being examined. I agree with both hon. Members, however, that we should consider not merely short-term but medium and long-term benefit.

Let me now deal with the position of local health commissions, and Bradford health commission in particular. It is the responsibility of district health commissions, or authorities, to use their resources to meet the health needs of their populations. The hon. Member for Bradford, South expressed the fear that resources for Bradford might be insufficient, but let us look at the facts. In 1995–96—the current financial year—Bradford health commission received over £200 million, an increase of £9.6 million in cash terms, including an increase of £1.6 million for development. Furthermore, in the next financial year, beginning in April, Bradford is to receive £210 million—another substantial increase in cash terms, including a real terms increase of £1 million. While the hon. Gentleman clearly believes that Bradford's health service is underfunded, the fact is that it is receiving substantial amounts each year in addition to what it already has.

Mr. Sutcliffe

The worries that we have expressed are not merely our personal worries; they have been substantiated by the hospital trust management, which says that it faces real shortfalls.

Mr. Horam

I hear what the hon. Gentleman says, but the fact remains that we are increasing funds for Bradford in real terms.

Let me be more specific. One of the ways in which Bradford has benefited from the extra money is through improvements in its accident and emergency department. After Bradford health commission had completed its own review, the results of which were published last September, it was able to assist with A and E services at Bradford royal infirmary, which is part of Bradford Hospitals NHS trust. The commission also provided an extra £140,000 for A and E staffing. This year, the trust has increased the number of staff in its A and E department by one consultant, four senior house officers and eight nurses. It has invested a total of £420,000, and a new computer system has been installed.

The hon. Gentleman, however, is concerned about not just A and E but wider health matters. The trust has also appointed eight additional consultants, including three anaesthetists and a general surgeon. As recently as the end of 1994, my hon. Friend the Minister for Health opened a new wing at St Luke's hospital in Bradford, which is part of the trust. The development cost £25 million.

The hon. Gentleman raised the sad case of Mr. Geoffrey Cranswick. I shall not go into that tragic case at length, because it has already been dealt with exhaustively, and we probably agree about what happened. Following the case, however, Bradford health commission's chief executive visited the trust—I believe that he did so the day after the events with which we are dealing—to discuss the need for more intensive care beds. To that, extent prompt action was taken, as it should be in such cases.

As I explained earlier, the health commission's contract allows for the funding of five intensive care beds, so the recent difficulties are not related to funding. In this case, as the hon. Gentleman admitted, they were due to staff shortages. Two people were not available because of flu, and there were four more shortages because of the inability to attract properly trained nurses. That is a problem, but it does not relate specifically to funding.

Mr. Madden

I am sorry to interrupt the Minister when he has only a few more minutes in which to speak. May I ask, however, whether he has received any representations from either Bradford health commission or Bradford Hospitals NHS trust regarding the allocation of resources and the need to increase those resources?

Mr. Horam

No, I have not. What I have received is a report on the position. I looked into it after the hon. Gentleman raised the issue in an Adjournment debate. I am assured that much joint work is now being done to bring about a better understanding of the pressures on the service in Bradford. That involves more co-operation between the commission and the trust—the specific point about which the hon. Gentleman complained.

As the hon. Gentleman will be aware, the commission and the trust have been working together on a programme called "Making Bradford Better". He did not mention it, but I am sure that he knows of it. The project evolved from joint discussions and work, and is intended to effect early improvements in specific patient services. Specific programmes include dealing with emergency admissions and the Bradford eye service. Whatever may have obtained in the past, the relationship and level of understanding between the commission and the trust are improving. I acknowledge that great effort is needed to ensure the continuation of that joint work, which clearly benefits Bradford.

On the occasion in question, only four intensive care beds were in service. There should have been five, and it is clearly vital for that fifth bed to be returned to service as soon as possible. It is accepted, however, that five beds are not enough to serve the 500,000 people who live in the Bradford area. Six beds should be available as early as possible, and the commission and the trust assure me that every effort will be made to achieve that.

I mentioned high dependency beds, which can take the pressure off intensive care beds. There are plans to fund an additional four such beds.

The hon. Members for Bradford, South and for Bradford, West may never accept that Bradford has enough money, and I would probably feel the same if I were in their shoes, but funds have been increased substantially. Moreover, as far as I am aware, co-operation between the trust and the commission is becoming better and better. Such co-operation must exist if the problems are to be solved. Specific attention is being paid to the question of intensive care and high dependency. I hope that all those factors will lead to an increase in Bradford's health provision, and I join both hon. Members in paying tribute to the work done by the professionals.

It being 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.