HC Deb 06 March 1996 vol 273 cc356-69 4.11 pm
The Secretary of State for Health (Mr. Stephen Dorrell)

With permission, I would like to make a statement about the emergency and intensive care services of the national health service.

The health service exists to provide health care to those with a clinical need. No aspect of its work is more important than its capacity to respond promptly and effectively to emergency need as and when it arises. This winter has seen those emergency services put under considerable strain. At times of peak pressure, some parts of the country have seen increases in the emergency work load of up to 20 per cent. compared with the same period last year.

In those circumstances, resources have inevitably been stretched, but, despite the pressure, the clinical needs of the overwhelming majority of patients have been met. That is a testament to the skills and dedication of the professional staff of the NHS. All of us, and particularly those who have needed to rely on the emergency services, owe them a debt of gratitude.

I told the House earlier this year that I would undertake to ensure that we learn the proper lessons from the general pressure on the emergency services this winter. I shall set out to the House this afternoon the steps that I am taking to ensure that that happens. First, it is important to separate consideration of emergency care from consideration of intensive care: they are separate, although related, issues.

Taking emergency services first, I have today charged the chief executive of the NHS with a specific responsibility of reporting to me at the end of June and again at the end of September on the plans being made by each health authority for emergency services in its area. The chief executive has written to all health authorities and trusts setting out the ground that he expects those plans to cover. In the short term, they will need to show how resources will be managed to meet short-term fluctuations in the work load. They will need to consider the use of admission wards; improving access for patients in the accident and emergency department to hospital diagnostic facilities; the relationship with local social service departments; and a number of other issues that have been shown by experience to contribute to the efficient running of emergency services.

Health authorities must also address a number of longer-term issues. First, they need to consider how they intend to strengthen the purchasing function in emergency care in order to bring a clearer focus on patients' expectations of those services. Secondly, a considerable amount of work must be done in work force planning for A and E services.

Thirdly, I have asked the chief medical officer to undertake a review of emergency care services outside hospital. It is important that health authorities plan for a full range of services, and do not rely only on hospital accident and emergency departments.

Finally, in relation to emergency services, there is one measure of quality of service about which most patients feel strongly: the time spent waiting in an accident and emergency department. The patients charter already contains a standard that calls for a person's immediate assessment on arrival in the department. The chief executive's review of health authority plans for the emergency services will also examine the scope for developing other standards that are understandable by patients and accepted by the professional staff as relevant indicators of quality.

I turn now to intensive care provision. Today I am publishing the report of a professional working group that has been examining best practice in the use of intensive care. The report underlines the need for a clearer professional consensus on the most effective use of intensive care facilities, and it sets out proposals for the development of that consensus. It also stresses the importance of specific discussions between health authorities and trusts about the allocation of resources to intensive care. Decisions about the resourcing of intensive care cannot be subsumed into general arrangements for other areas.

The report makes two other important recommendations. First, it recommends that plans for intensive care services should make provision for high-dependency beds that can offer care that is more intensive than ward-based care, but less intensive than a fully staffed intensive care unit.

The report concludes that, in those hospitals that have them, these intermediate facilities relieve the pressure on the intensive care unit with the result that NHS resources, both human and financial, are used more effectively. I shall be looking to health authorities to apply these findings in their own areas.

Secondly, the report recommends that the case for a national database to improve the management of intensive care bed availability should be examined. There is no doubt that the emergency bed service has been responsible for a major improvement in intensive care bed management in London and in the south-east since the system was extended last spring. The NHS will now be considering the proposal for a national register, and I shall announce the conclusion of that process this summer.

Finally, I turn to paediatric intensive care. The report of the inquiry into the treatment of Nicholas Geldard, which was published yesterday, highlighted some important failures in the service that he received. The sympathy of all hon. Members will go to Nicholas's family, who have suffered a tragic loss. The north-west region of the NHS has already made clear its determination to address the local issues that were highlighted by the report.

The main national issue that arose from the case was the availability of paediatric intensive care beds. The NHS is already committed to increasing this provision. I agree with the finding of the inquiry that the time for talk and discussion about this issue … is over". I have asked the chief executive to prepare a specific report on the implementation of these plans. It will be presented by the end of April, and it will be published.

Health authorities have a difficult task in balancing the competing priorities of different parts of the NHS. This year is not yet 10 weeks old, and already the House has considered three important aspects of health care in its debates: the emergency services, the mental health services and the primary health sector. The hospital service must also meet the needs of patients who are put on waiting lists. These are all important services, and patients' needs must be met.

The Government have already announced that the real revenue resources of the NHS will increase next year by £500 million—that is new money available to increase the level of care available to NHS patients. The process that I have announced today will allow us to ensure that a proper proportion of that growth money is used to address the needs of the emergency patient, whose needs must be met without sacrificing the other important objectives of the national health service. I commend them to the House.

Ms Harriet Harman (Peckham)

I thank the Secretary of State for his statement. On the casualty crisis, I welcome the fact that he has adopted three of the proposals in the five-point plan that I set out following his statement in January. Although he rubbished our proposals at the time, now—three months later—he says that he will monitor the problems carefully.

Will the Secretary of State please report to the House on the information that he receives from the chief executive in June and September? He says that someone will be appointed in each area to examine how local resources can best be used to address the problem and that specific attention will be paid to those people who are in hospital, but who could be cared for at home or in residential care.

We welcome all that, but the right hon. Gentleman has still failed to address two central problems in the casualty crisis. First, it is the cuts in hospital beds that leave patients waiting on trolleys in accident and emergency departments. Whatever his charters say, why can we not have a moratorium on bed closures? Secondly, there is still a shortage of accident and emergency staff. He said that health authorities must undertake work force planning, but does he plan to do anything about it?

It is hard to find words to express the sense of outrage and betrayal that everyone must feel on hearing how 10-year-old Nicholas Geldard died. The North West regional health authority inquiry team was shocked and dismayed by what happened to him. Although there are many organisational failures that the Secretary of State must address, does he acknowledge that the Geldard inquiry team concluded that, while Nicholas's life was hanging by a thread, no intensive care bed could be found for him, so he had to be taken by ambulance across the Pennines through a blizzard in the small hours of the morning?

Will the Secretary of State admit that the Geldard report confirms that it was not a one-off, tragic case, but that, every week in the north-west, children are turned away because there are no intensive care beds for them? Will he admit that the problem is not only in the north-west, but throughout the country?

Is it not the case that, having heard what happened to Nicholas Geldard, every parent in the country thought, "That could have been my child—it could have been me"? Every parent in the country will now fear that, if a child falls ill, the NHS might not be there.

Will the Secretary of State tell us how many children are turned away from intensive care units throughout the country each day? Should he not give the House that information today?

Why, when the Government trumpet patients charters for dozens of minor NHS procedures, will they not guarantee an intensive care bed for a child who is gravely ill? Does not the Secretary of State recognise that the shortage of intensive care beds means that patients face cancellations of heart operations—sometimes repeatedly? How many patients each year have operations cancelled because of the lack of intensive care beds? Is that not information that he, as Secretary of State, should know? Should he not tell the House today?

Does the right hon. Gentleman not recognise that patients waiting for transplants die because, when an organ becomes available, the operation cannot go ahead if there are no intensive care beds? Is not the final irony the fact that, although seriously ill patients are waiting for liver transplants, Leah Betts' liver could not save a life in Britain, but had to be flown to Spain?

The NHS must have the spare capacity to respond to emergencies. The Government do not understand that it is not slack in the system; it is a safety margin. Will the Secretary of State tell the House what he believes is the safe occupancy level for intensive care beds? Many operate at up to 100 per cent. occupancy. The Intensive Care Society believes that there should be an occupancy level of no more than 70 per cent. Does he agree with that?

Today, the Secretary of State says that he will publish another report in April, but have there not been numerous reports on intensive care? Eight years ago, the Association of Anaesthetists for Great Britain and Ireland produced a report entitled "Intensive Care Services: Provision for the Future".

In December 1993, a report was published by the British Paediatric Association's working party on intensive care and, on behalf of the Department of Health itself, came the Metcalf McPherson report. The problem is not that there have not been enough reports; the problem has been the lack of action.

Will the Secretary of State admit that there are not enough intensive care beds, and tell us how many more he believes there should be? The Intensive Care Society says that we have only 1,500 such beds but that we need 2,000. Does the Secretary of State agree with the society?

The Secretary of State referred to high-dependency beds, but will he admit that the development of such beds, although welcome, does not solve the problem of too few intensive care beds? Why does he fail to acknowledge and tackle the shortage of specially trained intensive care nurses? That failure is a disgrace and an insult to doctors, as they are the ones who have to turn away very sick patients, knowing that it might cost those patients their lives. Doctors have to make those decisions every day, yet the Secretary of State implies that they have to do so because they are somehow mismanaging their beds. The plain fact is that there are not enough beds.

Does the Secretary of State remember that the NHS changes were the Government's response to the 1988 intensive care beds crisis? The Government imposed the internal market on the NHS, with the result that there were more managers than ever before, but the problems got worse.

Why does the Secretary of State think that providing more managers is the answer to every problem in the NHS? A sick child needs a hospital bed, not a manager. Why should anyone be turned away from intensive care when an extra £1.5 billion is being spent on managers? Does the Secretary of State recognise that this is a question not of technicalities but of fundamental principle—the principle that, in an emergency, one can count on the NHS?

We cannot accept that a critically ill person whose life could be saved should be turned away. This more than anything else symbolises the Tories' failure on the NHS—if they cannot run the emergency service, how can the NHS be safe in their hands? Why does not the Secretary of State understand that it is not a matter for managerial adjustment, fiddled figures or more reports? Now is the time for him to face up squarely to the depth of the crisis and take action. If he cannot, he should not be running the NHS.

Mr. Dorrell

The final point that the hon. Member for Peckham (Ms Harman) made in her long tirade was very close to the final point that I made. I quoted the report on the availability of paediatric intensive care beds and said: the time for talk and discussion about this issue … is over". That is precisely why I have set up a process that will demonstrate publicly by the end of April the delivery of our targets for the availability of paediatric intensive care beds. There is no doubt about the need now to deliver a proper level of paediatric intensive bed space. It will be done and accounted for to the House by the end of April.

The hon. Lady began by welcoming a number of the announcements I made about the emergency services. I am grateful to her for that. She asked what was being done about staff in accident and emergency departments. She might like to know that, since 1990—this information is not based on some politically convenient figure—there has been an increase in the number of doctors and nurses committed to accident and emergency care. That shows that we have been increasing staffing resources, and we shall continue to ensure that staffing resources available to accident and emergency departments are sufficient.

The hon. Lady was confidently expecting at the end of last year that there was going to be a shortage of junior doctors at 1 February this year, when the rotations came through the accident and emergency departments. My hon. Friend the Minister for Health took action just before Christmas to ensure that there would be sufficient junior doctors to man accident and emergency departments.

Ms Harman

There are not.

Mr. Dorrell

The hon. Lady says that there are not, but we have conducted a census of accident and emergency departments. Senior house officer vacancies are currently running at 4.5 per cent., which does not imply a service with a massive inability to recruit.

I am grateful to the hon. Lady for her welcome for the steps we are taking to strengthen the emergency services and to ensure that the lessons which must be learned from this winter's experience are learned. The hon. Lady was keen to argue that we need more intensive care beds.

If it were true that we had 1,500 intensive care beds in the health service, the hon. Lady would be right, but we have 2,500 intensive care beds—as I published in a parliamentary answer to her predecessor—including beds that provide coronary care. Every definition of intensive care facilities includes those that are used for planned surgery need as well as those that meet emergency need. That is precisely why I said in my statement that it is important to distinguish the emergency services from the intensive care service, which meets both emergency and planned need. We have 2,500 intensive care beds in the health service.

There is not much point in setting up a review engaging the professional expertise of those who work in the service, as we have done, and then ignoring its conclusions. The conclusion of the professional review, which I am publishing today, is that the best way to ensure that we meet intensive care need in the health service is to provide the high-dependency beds—which I mentioned in my statement—behind the intensive care facilities.

I would have hoped that the hon. Lady would welcome that provision as a step towards the delivery of an intensive care service for adults and children that will meet the needs for intensive care of the emergency patient and the planned patient of the health service.

Several hon. Members


Madam Speaker

Order. After that very long initial exchange, there will have to be brisk questions and answers.

Mr. Roger Sims (Chislehurst)

Is it not clear that, when distressing problems arise, they are due not to any fault on the part of clinicians or to lack of resources, but to shortcomings in bed management? May I therefore welcome my right hon. Friend's statement and, in particular, his strengthening of the patients charter, which will give an incentive for better and more efficient use of beds?

My right hon. Friend may recall that, when I initiated a debate on intensive care bed provision in London last July, following the incident in which one of my constituents had to be helicoptered to Leeds, I suggested that there should be some form of national computer register of intensive care bed availability. I welcome his statement that that is now being considered, and I hope that it will be brought into effect as soon as possible.

Mr. Dorrell

I am grateful to my hon. Friend. As I said in my statement, exactly that principle is now working in London and has improved intensive care bed management in London and the south-east since it was extended last April. Against the deadline that I announced, we shall review the idea that the computer register should be extended to cover the whole country.

I am grateful that my hon. Friend welcomed the charter proposal. We need to ensure that the charter sets out clear standards for service that are acceptable to patients and are also recognised by those who work in the service as relevant measures of quality.

Mr. Alfred Morris (Manchester, Wythenshawe)

Is it not deeply shocking and grossly unacceptable that 64 hospital beds are now being closed in south Manchester, including four intensive care beds about which I tabled a parliamentary question to the right hon. Gentleman last Wednesday for priority reply today? While we both know the reasons given for these closures, is there anything he can now do against the background of his statement today to help, and, more especially, to save the four intensive care beds—because, as he knows, and indeed as we all know, closing intensive care beds costs lives?

Mr. Dorrell

The number of intensive care beds in the north-west, Liverpool and Manchester is being not reduced but increased. Paediatric intensive care provision in the north-west has risen from 20 to 30 available beds since 1993, which reflects the investment in available space. I have already announced to the House the steps that I am taking to ensure sufficient paediatric intensive care beds and that they are effectively used.

Dame Angela Rumbold (Mitcham and Morden)

I warmly welcome my right hon. Friend's comments about the use of intensive and emergency care beds in the Greater London area. When he writes to chief executives in central and outer London hospitals, perhaps he will address a problem identified by my two local hospitals. A number of elderly people admitted to intensive care beds have been unable to move elsewhere, so continuing to occupy beds that could be used to better purpose. There must be closer co-operation between local care in the community social services and health services. If that were given high priority, it would help enormously.

Mr. Dorrell

My right hon. Friend is precisely right, which is why the relationship between hospitals and social services departments will be specifically addressed by the review.

Mr. Simon Hughes (Southwark and Bermondsey)

If some of the improvements that the Secretary of State identified are delivered, that will be welcome. Does the right hon. Gentleman accept that the test of whether the health service is working is whether it meets the needs that are clearly apparent? Does the right hon. Gentleman intend to ensure enough A and E consultants throughout the country?

Does the Secretary of State acknowledge the rising demand for intensive and paediatric intensive care beds because of the health service's success in keeping alive people who previously would have died? Some regions have an overall bed shortage. If the review concludes that more money is needed to buy what are expensive NHS resources, will the Secretary of State go into battle in the forthcoming Treasury expenditure round for money to meet the service's basic care needs?

Mr. Dorrell

The hon. Gentleman asks whether I am committed to ensuring sufficient A and E capacity to meet demand. The answer is yes. At consultant, junior doctor and nursing level, we have seen the fastest growth among professional staff in A and E departments in recent years, with a 35 per cent. increase in A and E consultants.

We need to ensure that, if demand continues to increase, as it seems reasonable to expect, we have growing professional resources to meet it. We shall keep a close eye on intensive bed capacity, although the position is more open. One conclusion of the review that I am publishing today is that one in six patients currently occupying an intensive care bed do not need the level of care provided in intensive units. In those circumstances, a substantial increase in capacity is available if we can meet those patients' needs in the kind of high-dependency bed described in my statement.

Sir Donald Thompson (Calder Valley)

Does my right hon. Friend recall that, when a Labour Government were in charge, hospital admissions were at the whim of the union convener? He said who should go into hospital, and his friends would not bury the dead that resulted. [HON. MEMBERS: "Oh."] Does my right hon. Friend agree that emergency intensive care and what has become routine intensive care should be used as flexibly as possible—but that such flexibility will lead to even more smears and less help from the Opposition?

Mr. Dorrell

My hon. Friend is precisely right. The reaction of Labour Members is a reminder of how much they dislike being reminded of their record in government in respect of the national health service. Labour was responsible for the only cut in recent years in funding available to the NHS, and for cutting nurses' pay during its time in office. My hon. Friend reminds the House that Labour was responsible for a state of affairs in which access to hospital was determined not by doctors but by the local NUPE official, as he or she then was.

That is the record of Labour in office. My hon. Friend is quite right to remind the House of that, and to draw a sharp contrast between what used to happen and what happens today, when the overwhelming experience of NHS patients, whether they need emergency care or planned care, is that care is delivered to a higher standard than ever before in the history of the NHS.

Ms Ann Coffey (Stockport)

I am grateful to the Secretary of State for offering the sympathy of the whole House to the Geldard family, but that really does not go far enough. The inquiry into Nicholas's death was a damning indictment of the health service on that night. The right hon. Gentleman should apologise to the Geldard family for the failures of that night, because ultimately the responsibility is his, and the situation should have been sorted out a long time ago.

Mr. Dorrell

Hon. Members' sympathy is real and is felt on both sides of the House—I agree with the hon. Lady on that. It is important, following the inquiry, that all necessary steps are taken to ensure that such circumstances do not happen again. The regional health authority has made a series of announcements since the publication of the inquiry, stating that it will take the various measures that the inquiry recommended to improve the quality of care. I have announced what I intend to do about paediatric intensive care units around the country.

A further matter that local interests in Manchester must address is the fact that some of the report's most stinging criticism was aimed at the failure of the health service and local authorities to allow the reorganisation of neurosurgery services and paediatric services in the city. The health service has proposed plans for the consolidation of neurosurgery and of paediatrics. Those plans were opposed by Manchester city council, and that has delayed their implementation.

We need to ensure that all the lessons are learned, not just some of them. The regional health authority is learning them. I have made it clear to the House that I am learning them; I hope that others will do so, too.

Mr. Richard Tracey (Surbiton)

I strongly support the point made by my right hon. Friend the Member for Mitcham and Morden (Dame A. Rumbold) about hospital beds, especially in south-west London.

Is my right hon. Friend aware that my local hospitals in Kingston have a logjam of 40 beds—St. Helier hospital has a logjam of 60 beds—caused by elderly patients who are not acute or emergency patients but who are awaiting assessment and placement in nursing home beds by the social services department? Will he do something about those social services departments, particularly in Surrey county council, in Richmond, and in Merton? Or can we introduce some new form of bed—a nursing home bed—to cope with this state of affairs, because it is truly affecting the desperately needed acute services?

Mr. Dorrell

My hon. Friend is entirely right to stress the importance of the relationship between hospitals and social services departments. In both the cases to which he referred, councils that are controlled by Liberal interests were responsible for those social services departments.

My hon. Friend asked what we are doing to ensure the best possible partnership between the NHS and social services departments. Part of the answer is contained in my statement: the need to ensure that accident services are planned in conjunction with social service departments. Another part of the answer is the huge increase in the resources that the Government have voted to social services departments throughout the country.

Social services departments in local authorities are some of the fastest growing programmes in any part of government. In looking for the partnership that my hon. Friend rightly says is necessary, we are entitled to look at the level of resources that have gone to social services departments, and then look for the partnership that is indeed necessary to ensure that we deliver an efficient and effective hospital service.

Mr. Barry Sheerman (Huddersfield)

Why do Ministers never say sorry and never take responsibility? It is always someone else's fault. Nowadays, people have heart attacks, or are knocked down, and no one can find a hospital to take them to. Surely those people do not need a patients charter; they have a patient's right to receive treatment speedily, close to the communities in which they live.

As the right hon. Gentleman knows, our experience in Yorkshire shows that people no longer feel that that is a guarantee. When will he accept that, after 17 years, it is his Government's responsibility? Our local managers say that they have been knocked sideways: junior doctors are telephoning around the country in the middle of the night trying to find beds. What a way to run a health service.

Mr. Dorrell

The hon. Gentleman suggests that I have sought to avoid my responsibility. I have done no such thing. I accept responsibility for ensuring that, within the health service, we have emergency services that continue to provide care of an extremely high quality, and intensive care facilities that meet the need and are properly and efficiently structured.

I was not trying to shuffle off my own responsibility when I reminded the House of the responsibility—mentioned in the report on the Geldard case—that rests with local interests in Manchester which have resisted change that the committee considered necessary. I am concerned to ensure that my responsibility is discharged, while seeking partnership with others to ensure that theirs is also discharged.

Mr. Barry Field (Isle of Wight)

Will my right hon. Friend commend Southampton hospital trust on the construction of a new neurological unit, which will be among the finest in the country? After all, time is often the difference between life and death.

May I also draw my right hon. Friend's attention to a phenomenon that I observed at first hand at St George's hospital here in London? School child after school child, returning home from school, popped into the accident and emergency unit to ask for aspirins, and to ask whether there would be a dishy doctor to dispense them. On inquiry, I have found that that is not untypical at a number of inner-city hospitals.

Doctors face double jeopardy. If they refuse to treat the children, they may be criticised for doing so; on the other hand, such a "pop-in centre" must constitute a complete misuse of the resources and facilities of the health service.

Mr. Dorrell

As my hon. Friend the Minister for Health has reminded me, my hon. Friend's local hospital provides a showcase example of the way in which a modern hospital service should work. As for the less desirable service that he has discovered in London, I shall gladly look into it and see whether I agree with his comments.

Ms Jean Corston (Bristol, East)

Last month, Southmead hospital trust in Bristol announced the closure of eight paediatric intensive care beds. That leaves 25 such beds for children with acute medical conditions, and represents a 25 per cent. cut in the service. The aim is to save £43,000 between now and 1 April.

The trust has acknowledged that children from the city will have to go outside Bristol for treatment. Is it not the case that we now have an 11-month health service? Does the Secretary of State accept that Bristol parents do not want another report or review, or more delay? They want a properly funded health service.

Mr. Dorrell

I remind the House that the Government have voted £500 million of new money to develop the NHS further next year. I am not referring to the huge increases in resources that have been provided in earlier years. I agree with the hon. Lady that we should not have another plan for paediatric intensive care, and I have been working on a very short time scale in order to demonstrate that that aspect is being delivered.

Mr. Andrew Rowe (Mid-Kent)

Will my right hon. Friend remind us of the difference in cost between an intensive care bed and a high-dependency bed? Would not an arbitrary moratorium on the closure of hospital beds, as recommended by the Labour party, slow down the creation of high-dependency beds?

Mr. Dorrell

On the second point, my hon. Friend is right. To impose a moratorium on the closure of beds that local health authorities and local trusts believe do not represent the highest priority use of resources must, by definition, mean that fewer resources are available for higher priorities.

In round terms, the figures are that an intensive care bed costs between £250,000 and £300,000 a year, and a high-dependency bed about £100,000 a year. There is therefore a substantial saving. If a patient does not need intensive care and can be cared for clinically and effectively in a high-dependency bed, there is a significant saving in making that shift. The result will be a better use of health service resources, both financial and human.

Mr. Hugh Bayley (York)

Will the Secretary of State reflect on the fact that the increase in the intensive care bed occupancy rate may look good on the accountant's balance sheet, but that it is both insufficient and dangerous if, at peak periods, there are not enough beds for patients?

Will the right hon. Gentleman give a straight answer to the question of my hon. Friend the Member for Peckham (Ms Harman) on the Intensive Care Society's recommendation that the maximum occupancy level should, on average, be no more than 70 per cent? Is he committed to that figure? If so, how will he achieve it? Does he agree that, when the NHS fails to provide emergency treatment at a time of need, it means that we no longer have a comprehensive national health service?

Mr. Dorrell

I agree with the hon. Gentleman that one of the health service's central functions is to deliver emergency care as and when it is needed—that was where my statement began. I do not accept his proposition that I should accept an essentially arbitrary ceiling for the average intensive care bed occupancy rate, for this reason. Frankly, it is sensible to look for ways of increasing the average occupancy rate of a bed that is costing the health service between £250,000 and £300,000 a year.

Apparently, those on the Labour Front Bench are not interested in the efficient use of that money. I am interested in ensuring that we use the resources as efficiently as we safely, clinically and effectively can. The advice of the work that I am publishing today is that one of the ways of improving the effectiveness with which we use that resource is to ensure that, behind it, there is an intermediate resource—the high-dependency bed, into which the patient who no longer needs intensive care can be moved. Of course I will look for ways of increasing the effectiveness with which NHS resources are used.

Mr. Nigel Evans (Ribble Valley)

Does my right hon. Friend accept that it is not a case simply of resources? If it were, there would be no problem, as there has been a massive increase in NHS funding. If the Opposition believe that extra money should be made available, they have a duty and an obligation to say how much, and where they would obtain that money.

Does my right hon. Friend accept that people in the north-west, and in Ribble Valley in particular, will welcome today's announcement, because it is not a matter simply of Manchester? Blackburn, which covers part of my constituency, does not have sufficient paediatric intensive care facilities. Over Christmas, there was the tragic case of young Lewis Jackson, who had to travel from Clitheroe to Stoke-on-Trent to receive the care that he needed. Unfortunately, he tragically died.

Lewis's parents had to travel back and forth to see him there. They and other parents will therefore welcome my right hon. Friend's announcement today, that the time for talking is over and that action is needed.

Mr. Dorrell

I am grateful to my hon. Friend. I agree that we now need to demonstrate in a short time scale how a sufficient level of paediatric intensive care beds will be delivered. That is what I have undertaken to do.

Mr. Sam Galbraith (Strathkelvin and Bearsden)

Does the Minister not realise that his answer to the hon. Member for Mid-Kent (Mr. Rowe) was worrying? He seemed to imply that high-dependency beds would be in place of other acute beds. If that is the case, it will not solve the problem. In the same way that an intensive care bed can be freed up by moving to high-dependency beds, so a high-dependency bed must be freed up by moving to acute beds. If the number of acute beds has been cut, we are back to the problem we started with.

Mr. Dorrell

Unless, by addressing the relationship between the hospital and the social services department, we could reduce the current inappropriate use of ward space and ward beds. The answer I gave my hon. Friend the Member for Mid-Kent (Mr. Rowe) was not intended to suggest a trade-off between high-dependency beds and ward beds. That is not my position.

If, at the level of the individual hospital, managers conclude that there are higher priorities for the use of NHS resources than maintaining the prevailing level of ward bed space, it would be wrong for me to seek to second-guess them. The question that every manager must address all the time is: what is the most effective way of using the money? There is not a direct trade-off—the hon. Gentleman is right about that—but nor is there an insistence that the introduction of high-dependency beds must be accompanied by the maintenance of the same number of ward beds. That would be equally absurd.

Mr. John Marshall (Hendon, South)

I thank my right hon. Friend for what he said about accident and emergency departments. In view of the increase in the number of people using such departments, will he agree to reconsider the proposal that the Edgware A and E department be replaced by a mere minor accident unit?

Mr. Dorrell

As my hon. Friend knows, that was the subject of a decision announced many months ago. As he also knows, work is currently taking place concerning the range of services to be provided in the new Edgware hospital. I am not in a position to announce a premature conclusion to that process, but I note what my hon. Friend says.

Mrs. Helen Jackson (Sheffield, Hillsborough)

Will the Secretary of State confirm that, before his letter to Sheffield children's hospital just before Christmas, there was no national monitoring of the occupancy of intensive care paediatric beds? Does he agree that that absence of monitoring was nothing short of disgraceful? Has his announcement superseded the monitoring work that the children's hospital was asked to do only one month ago?

Mr. Dorrell

No, it has built upon the work that the children's hospital was asked to do at the end of January. The answer to the hon. Lady's question is that, if I had not believed that there was a need not currently being met, I would not have written to Sheffield hospital.

Mr. David Congdon (Croydon, North-East)

I welcome my right hon. Friend's statement, especially the idea that hospital trusts must pay proper attention to how they manage intensive care beds. Does my right hon. Friend agree that health authorities have a responsibility to consider carefully the level of resources that they allocate to trusts in their areas? Although we rightly try to switch resources from secondary to primary care, and succeed in bringing down waiting lists, does my right hon. Friend agree that it is crucial that health authorities do not forget the pressing need to ensure that we deliver a first-class emergency and intensive care service?

Mr. Dorrell

I entirely agree. An important conclusion that I hope health authorities and others in the health service will draw from the document that we are publishing today, is that health authorities need to address directly, within their local areas, the balance between acute services and primary care services, mental health services and other aspects of the NHS. Within the acute services, they must also address the balance between elective and emergency care.

Mr. Keith Bradley (Manchester, Withington)

The Secretary of State's response to what my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) said about the financial crisis that, because of management incompetence, faces south Manchester, was completely inadequate. Will he intervene today to stop the closure of 64 beds in south Manchester, and ensure that the inquiry set up by the regional health authority is made public? Will he belatedly agree to meet me to discuss bed occupancy and health care as a whole in south Manchester, to ensure that my constituents do not suffer because of the incompetence of the management over the past nine months?

Mr. Dorrell

The hon. Gentleman talks about my belatedly agreeing to meet him, but he and I know that we have met once to discuss the position in Manchester. As for the changed structure of service within the city, when the hon. Gentleman reads the Geldard case report, he will clearly see the emphasis that the inquiry team places on the need for a quick resolution of the difficult issues—I do not deny that they are difficult—surrounding neurosurgery and paediatric services in Manchester. I hope that he will agree to support those necessary changes. Of course my office is open to him—as it was last time.

Several hon. Members


Madam Speaker

Order. We are now going to move on.