HC Deb 07 June 1996 vol 278 cc898-906

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

2.30 pm
Mr. David Chidgey (Eastleigh)

I am grateful to have had the opportunity to initiate the debate. For many months there has been growing evidence that in Hampshire, my home county, the concept of the national health service being free at the point of use is fast becoming a myth.

More and more people in Hampshire are finding that when they need health care they are faced with a stark choice: they can turn to the NHS and become hostages to fortune with extended waiting times, or they can resort to private health care. An added twist to the wheel of fortune, or misfortune, is introduced when account is taken of where someone happens to live in the county and whether he or she is registered with a fundholding general practitioner. As a result, the NHS has become a two-tier health system in Hampshire, with patients treated not on the basis of need but on whether funding happens to be available to meet their needs.

I intend to demonstrate that as a result of the failure of the Government's health policies and a failure to deliver those flawed policies, people in Hampshire are being denied access to basic health care, whether it is heart surgery or dentistry, care for those with mental disorder or care for those who need the services of a chiropodist. Care is being either postponed or withdrawn.

When the Minister replies, I hope that he will not merely resort to boasting about the increase in NHS funding, welcome though that increase may be. He knows well that health care needs are increasing and that in the United Kingdom we provide less for health care as a percentage of our gross domestic product than many other developed nations.

I hope that the Minister will take on board the particular issues that are having an effect on health care in Hampshire, which I had the opportunity to discuss briefly with him some days ago.

My constituency is served currently by the North and Mid-Hampshire and the Southampton and South West Hampshire health authorities. In 1997, boundaries will change and Eastleigh will be entirely within the Southampton area. At present, however, Eastleigh is suffering from funding crises within both authorities. I shall explain. In Southampton, there has been a shortfall of £11 million in funding for hospital services. That is the difference between the cost of maintaining services at 1995–96 levels and what the health authorities and GPs can afford to purchase for the coming year.

Through savage savings, including sacking about 400 members of staff, much of the shortfall has been met, but the impact on patients is severe. Instead of waiting nine months for treatment, cardiac patients will have to wait a year. Those involved in non-urgent cases will have to wait 14 months. That is the stark reality behind the Minister's statement in reply to an earlier debate on Southampton hospital services, when he said that there may be some slippage in waiting times as the financial problems are resolved."—[Official Report, 7 May 1996; Vol. 277, c. 147.] There has certainly been some slippage. It is an appalling situation for a hospital trust that had more than matched the Government's patients charter by increasing efficiency and reducing waiting times. As Jane Ransome, the obstetrics and gynaecology clinical services manager, said: Everyone from the consultants to the cleaners have worked so hard to get waiting times down to six months. Now to have to let them go out again because of shortage of money is just soul destroying. Recently, I took the opportunity to visit Southampton general hospital's cardiac unit and I was shown its ground-breaking work in heart surgery. The innovative techniques developed by the director and his team are breathtaking. They use microtechnology to replace open-heart surgery. Patients who would have stayed for more than a month are now released from hospital in only a few days. It is a remarkable achievement, but it seems that that team and all that it has done is to be a victim of its success.

The director of the unit told me that his major worry was whether it could attract enough purchasers to maintain the high level of expertise that it had created. Cuts in the hospital trust's funding can only add to that concern. As Mr. David Moss, the chief executive, has said: We are going to have to take out beds and theatre lists and it is a painful process for everyone". Under the Government's policies, patients' suffering will be selective. As The Southern Daily Echo, the paper in my constituency, reported only last month: local fundholding GPs who get a budget to buy hospital treatment for their patients are not affected by the latest cash squeeze on services. They will continue to have fast-track access to services in what has become a two-tier health care system for patients in Southampton. As I have mentioned, Eastleigh is split between two health authorities. My constituents in the south are suffering increased waiting times in Southampton, while for those in the north, health care services are being cut across the board as the North and Mid-Hampshire health authority battles to meet its budget.

I have not always supported the authority, especially over its long-term care policy, but I support its claim that its problems stem from the fact that it has had to fill the gap left by the closure of Cambridge military hospital in Aldershot, with little, if any, extra funding. As a result, it is facing underfunding of £7 million a year, every year. The immediate effect has been savage cuts across a wide range of health care services, not just in Eastleigh, but throughout Hampshire.

Hundreds of people and practitioners have written to me, to other Members of Parliament in the region, to the community health council, to the health authorities and to Ministers. The community is alarmed, disgusted and, in many cases, desperate as the NHS crumbles before its eyes. The most vulnerable people, for whom health care can make the difference between a tolerable and a miserable quality of life, are bearing the brunt of the cuts.

Time does not permit me to spell out the litany of service cuts, but let me give the Minister some graphic examples. Community dental health services have been reduced by 25 per cent., which means that, in Andover, dental sessions will be reduced from 16 to 10 a week. Dental surgeons running Andover's dental health centre have written to me. They say: We are a practice with eight dentists providing NHS dental care for almost 20,000 people in Andover and the surrounding area. It is becoming increasingly difficult to cope with the huge influx of patients who wish to continue to be treated under the National Health Service. Patients of the practice are now having to wait four months for an appointment for routine treatment. The Community Dental Service provide a necessary and very valuable service in the area, particularly for children, the elderly and the handicapped who are most in need of treatment. Any cut in the CDS budget will result in fewer patients being treated and increased pressure on what are already inadequate levels of service. That dental health centre is facing 25 per cent. cuts. In Eastleigh, we are to lose four of our 18 weekly dental sessions. In Winchester, sessions will be cut from 22 to 16 per week.

Staff at the orthodontic department of Winchester's hospital have also written to express their great concerns to me. Without going into great detail, the letter states that 99 per cent. of their patients are children aged eight to 17, that, because of their limited budget, they can treat only those with the most serious malocclusions, and that, if patients are not treated, later in life they will face prolonged surgical procedures and, in some cases, severe emotional problems, which would require far more costly treatments.

Such appliances are made and used only in specialist units under the supervision of a consultant orthodontist and his highly trained and dedicated team. The general dental practitioner would not be able to undertake that type of treatment due to lack of qualification, experience and time. The £160,000 to run that department is a small price to pay to enable around 1,000 patients each year to receive orthodontic treatment. Those are just two examples from the many letters that I have received from practitioners and patients.

Given that Eastleigh is faced with the loss of one quarter of its specialist dental services, the local health care trust can afford to recruit only a salaried dentist as a safety net for patients who are unable to find an NHS general dental practitioner. That is no substitute for specialist orthodontics and it forces trusts to ignore the plight of many thousands of my constituents without access to an NHS dentist. Some extra dentists have been provided, but the number is still woefully inadequate to meet the needs of people who cannot readily find an NHS dentist.

Another example is the 20 per cent. reduction in the family planning service, which means that the well woman and psychosexual clinics in Eastleigh will be discontinued. Dozens of women of all ages and clinical practitioners have written to me expressing their shock and distress. Dr. Angela Stewart, senior clinical medical officer, states: These cuts are directly against the Government's guidelines in 'The Health of the Nation' and in particular the quest for a reduction in teenage pregnancies. They also deny their right to choose where they go for such services. Mrs. Marlene Wood, a family planning nurse for more than 30 years, lives in Hedge End and works at a clinic in Winchester county hospital. She wrote: Of particular concern is that one of 'The Health of the Nation' targets is specifically aimed at reducing teenage pregnancies. Youth advisory clinics are targeting this group of people. Where will they go when the clinics close? Those cuts are only part of the dismal picture for Hampshire residents. Eastleigh's GP consortium has for years carried the burden of a relatively low general medical services allocation. The amount that it receives per patient from the North and Mid-Hampshire health authority is £375, compared with an average of£425 for the whole area. When patients transfer to the Southampton and South West Hampshire health authority, they are underfunded compared with the Southampton average of £413. The Eastleigh GP consortium is a dedicated team that spares no effort in serving my constituents, but it is caught in a vice of underfunding from the two health authorities that will tighten each year that cuts continue. Dr. Tim Frank, the consortium's co-ordinator, told me: Eastleigh is underfunded because of the legacy of the burden of underfunding from North and Mid Hants being left with Southampton and South-West health commission. Tensions are increasing as decisions to cut particular services are made at the expense of others.

A common theme runs through the stream of letters and telephone calls that I have received from constituents, patients and medical practitioners. There is deep dismay and anger because the enforced cuts in health care are decimating services that prevent health problems from escalating. Savage cuts to solve current financial problems will lead to serious ill health for many more people over time—storing up a legacy of a growing need for extensive and costly health care in the future. Even given the Government's discredited health care policy, there is no excuse for ignoring the lack of equity.

The Department's response to pleas for help has been at best crass and at worst insulting. The response to Southampton's £11 million shortfall was an announcement by the Secretary of State for Health that five more intensive care beds were to be provided for Hampshire children, which was a disgraceful distortion of the truth. Those five so-called new beds already exist. Southampton general hospital had, on its own initiative, decided to reorganise the beds into a dedicated children's unit. While Ministers scramble to take the credit, no extra money or facilities will be provided. Last year, Southampton had to refuse almost one in every three patients needing intensive care, cancelling major surgery for some patients at the last minute.

In response to the savage cuts in services in the Winchester and Eastleigh Healthcare trust, the junior Health Minister—the hon. Member for Winchester (Mr. Malone)—is quoted as welcoming the fact that the programme included no elimination of patient services. However, well woman clinics and some chiropody services have been eliminated. As I said earlier, a whole range of patient services have been savagely cut.

I need make no apology for mentioning the junior Minister in his absence. I have lived in his constituency for more than 25 years and I am one of his constituents. I declare an interest in the Winchester hospital—two of my children were born there. One was critically ill, but was nursed with great skill and care through those early weeks and is now enjoying remarkably robust health and appetite for life.

Only last year, late on the night of Good Friday, my wife was admitted to Winchester hospital, critically ill. Again, as on a number of occasions over the years, the care and the skill of the staff at Winchester saw us through a health crisis to full recovery. I, like so many others in the area, have the highest regard for the dedication of the staff at Winchester hospital. I take strong exception to the cavalier and dismissive response to the cuts in its patient services.

When I opened the debate, I referred to what I believe to be the crux of the funding crisis—the impact of the closure of the Cambridge military hospital on the North and Mid-Hampshire health authority. Having brought the matter to the Minister's attention before the debate, I hope that he can respond positively. The Cambridge, in common with other military hospitals, provided a wide range of services to otherwise national health service patients. The area it served fell within both the South Thames health region and the South and South West health region, so it shared a burden with two regional health authorities—which, at the time, acted with a great deal more autonomy from the Department of Health than regional health authorities do today.

The unexpected speed of the closure of the Cambridge allowed the regional authorities little time to assess their new health care responsibilities. As a result, the South Thames region made provision for its additional responsibilities, but the South and South West region did not. With hindsight, that was clearly the wrong decision and it has left the North and Mid-Hampshire health authority with a continuing funding crisis. The powers exercised by the regional health authorities have now been taken over by the Department of Health. Therefore, it falls to the Minister and his Department to correct past mistakes.

The North and Mid-Hampshire health authority will have to find an additional £7 million a year to provide NHS treatment for patients previously cared for by the Cambridge. The authority has hardly any reserves to help cover this year's costs. It has brokered a £5 million loan from the Department to see it through this year. Much has been made in the press of the Minister's statement about a one-off £5 million grant recently allocated to the authority from the NHS emergency fund. In reality, it is merely the conversion of a loan into a one-off grant. The additional £5 million referred to by the Minister in his letter to the community health council in March is not new money at all; the only new money is the interest payments that will be saved which otherwise would be paid on the loan. To resolve that long-term funding crisis, it is essential that the one-off grant is translated into a £5 million uplift in the annual budget, year on year.

That one-off grant is no more than a sticking plaster over a gaping wound. As the community health council said in a response to the Minister only last week: The severity of the situation means there are no local solutions available. We are asking most urgently that you now address this unacceptable situation. We cannot emphasise enough how some of the most vulnerable members of the community are going to be adversely affected.

Can the Minister, in all conscience, ignore the depth of feeling—almost desperation—in that letter? Can he ignore the dismay expressed by medical practitioners throughout Hampshire's health care service? Can he ignore the distress felt by so many people in Eastleigh and across Hampshire, who have contacted me and other local Members of Parliament? In the interests of fairness and justice, surely he cannot.

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

I am pleased that the hon. Member for Eastleigh (Mr. Chidgey) has chosen to raise the important subject of health care funding. I am sure that he will agree that, too often, the House indulges in debates on health policy with little or no mention of how the services will be paid for.

Such is the geographical location of Eastleigh that the hon. Gentleman has a constituency interest in all three Hampshire health authorities—which, no doubt, is why he called his Adjournment debate "healthcare funding in Hampshire."

In April, all three authorities received a real increase in their budgets, from a total, combined cash boost of more than £26 million. That was part of another £1.3 billion injection into patient care that was announced in the Budget, and it shows the extent to which the Government are honouring their commitment to increase the real resources going into health care across the country.

Dealing specifically with authorities that concern the hon. Member for Eastleigh, the North and Mid-Hampshire health authority received an extra £7.5 million, which is an increase of 4.3 per cent., or 1.27 per cent. in real terms. That authority is close to its target level. Equally, the Southampton and South West Hampshire health authority had an increase of £10 million, which is an increase of 4.82 per cent. in cash terms, or 2.3 per cent. in real terms. Those are substantial increases in funding for the health authorities of concern to the hon. Gentleman.

The hon. Member for Eastleigh also referred, quite rightly, to the excellent work being done at the Southampton University Hospitals NHS trust. I fully agree with him that that work is exciting and forward looking. I can tell him that cardiac expansion at that trust—including extra ward and intensive therapy unit capacity—will be ready this autumn. A new patient management system—a £1 million, fully computerised patient records and appointment system—was opened there in March 1996.

The hon. Member for Eastleigh also referred to the excellent work being done about schoolgirl pregnancies in his area. Southampton and South West Hampshire health authority is spending an extra £180,000 over the next six years in a bid to cut schoolgirl pregnancies. The authority will open more family planning clinics for teenagers, which will offer contraceptive advice after school and on weekends, and increase the number of trained sex education advisers.

Mr. Chidgey

The specific point is that the clinics in my constituency of Eastleigh will close. The fact that there are extra resources in the city of Southampton will not help my constituents.

Mr. Horam

I think that there will in fact be a general increase in provision for the entire area. It remains to be seen exactly what happens in particular parts of the area. None the less, one cannot get away from the fact that a considerable effort is being made by the authority, which I think the hon. Gentleman should recognise.

Another development in Southampton is the new, £10 million hospital development for elderly people—the Southampton western hospital. Three new neurosurgical theatres at Southampton general hospital are due to open soon, at a cost of £6 million. All that is a huge investment in revenue and in capital terms in the area with which the hon. Member for Eastleigh is concerned.

As I said, and as the hon. Member for Eastleigh understands, he is served by several health authorities. At the top of the extra funds for health authorities this year is the North and Mid-Hampshire health authority, which is also of great concern to him. It has received a special allocation of £5 million, to smooth the adjustment process following the closure of the Cambridge military hospital, which we realised would have a knock-on effect on the area that he represents and on other parts of north and mid-Hampshire. That is why, over and above the increases that have come to that authority, there is the extra £5 million that the Secretary of State announced quite recently.

When Ministers considered how best this year's extra money for the NHS should be distributed, some key principles underpinned the process. The first was equity, which I stress to the hon. Member for Eastleigh. The formula that we use, which guides the allocation process, uses the best available and robust knowledge on health needs. It is being developed by York university and is generally considered to be as sophisticated an approach as one can get when considering real health need. Of course, any formula is capable of improvement and, indeed, work is under way to refine that process further. We can also interpret any formula flexibly. We want to look not only at what the formula says but at how we can guarantee continuity and stability.

Consistent significant growth in funding for the NHS means that we can gradually move all health authorities towards their target allocation. The hon. Gentleman quoted figures for per capita funding in Eastleigh. I recognise that the Hampshire authorities are a little behind their target allocation, but we hope that, by a process of levelling up over the next two or three years, all authorities will achieve their target level of allocation, which is based on a thorough understanding of the health needs of the people of the whole country.

Mr. Chidgey

rose—

Mr. Horam

I cannot give way. The hon. Gentleman consumed two thirds of the available time, and I must complete my reply.

Although the Hampshire authorities are currently below target in the areas that are of concern to the hon. Gentleman, they are getting closer. That is something that we all wish to achieve sensibly and systematically. As I said, one of the areas with which he is concerned is only 0.26 per cent. below the target level as we have agreed it.

In addition to the extra £26 million for the three Hampshire health authorities, the capital spending and the funds for pregnancy advice services that I have mentioned, an extra £300 million is going into the health budget for the country as a whole as a result of the efficiency improvements that we hope to obtain from the system. All that is available and the hon. Gentleman's constituency will get an appropriate share of it.

As the hon. Gentleman pointed out, comparing last year with this year is complicated in his particular case by the substantial local changes to health authority boundaries which took place on 1 April. He would be the first to agree that it is complicated, but I have studied his local situation carefully and can reassure him and the people of Eastleigh that they are receiving the correct level of increased funding after having made the necessary adjustments for the boundary changes. However, we plan to monitor the situation carefully and our flexible approach to resource allocation will allow us to deal with problems in future years, should they arise.

Clearly, from a commonsense point of view, it is a complicated situation. As I said, Eastleigh is getting its correct share but if, in practice, things turn out differently from how we expect, we can review matters when the time comes. I give the hon. Gentleman that reassurance.

A problem arises not only from the change in Eastleigh's position but from the special situation of north and mid-Hampshire, which is partly the result of the closure of the Cambridge military hospital. We have recognised that by allocating an extra £5 million to the North and Mid-Hampshire health authority this year to help it to manage this period of change. This grant is a critical component of an agreed action plan to deal with specific local pressures. The action plan aims to produce long-term solutions and to ensure continued stability. The special grant is clearly a key element in that.

I assure the hon. Gentleman that the Government will not play fast and loose with the NHS. We never have, either nationally or locally, and we shall stick to the principles of equity, continuity and stability when making future funding decisions, as has been the case since 1979.

The hon. Gentleman mentioned chiropody specifically. He must accept that medical need will still be met in full measure. No one who has a medically diagnosed problem will be unable to get the chiropody service that he requires. There was a certain amount of self-referral which may be affected, but people in medical need will still get the service that they require.

I have seen the hon. Gentleman's press notices containing charges about underfunded health services in Hampshire. Those charges are clearly untrue in this context. It is ironic that he should have made such charges only two weeks before Hampshire's health service received £26 million from the Government. He should perhaps have waited to see the real situation before making his unfounded charges.

Decisions on how best to invest the money that taxpayers put into the NHS are not easy. I am pleased that the hon. Gentleman's local health authorities and all those who provide patient care have been working closely together to ensure that local people receive the best possible care. Any politicians who claim that the NHS is underfunded should first say whether they would even match the Government's record of increased funding year on year.

The residents of Eastleigh can rest assured that the Government will continue to meet their commitments to ensure that a growing health service is matched by the growing funding that it needs—that is as true in Eastleigh as it is anywhere else.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.