§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. McLoughlin.]
§ 12.2 am
§ Mr. William O'Brien (Normanton)I am grateful for the opportunity to talk about what I term my local hospital. Pinderfields hospital, which is located in my constituency, is an acute services general hospital, offering good and much needed services to the people of Wakefield. The hospital has wards in permanent buildings and temporary buildings. The temporary buildings were erected in the early 1940s to provide medical treatment for wounded personnel in the forces during the second world war.
On at least three occasions, programmes have been launched to replace the old outdated wards with new, modern wards with modern facilities. In the past 17 years, the Government have made a number of promises to build new premises. The most recent promise, of 1995–96, was made under the private finance initiative proposals. The publicity and hype about those proposals have now faded, due to the Government's policy on hospital mergers. I want to make it clear to the Minister that we do not need a merger, and that we want to develop our own Pinderfields hospital.
People who rely on Pinderfields for medical services keep asking when the new buildings will be ready. Perhaps I could extract a response from the Minister on that issue. The conditions under which nurses and staff work, and the premises in which patients receive treatment, would not be tolerated by many hon. Members, who would demand changes and improvements.
The hospital has recently been under tremendous pressure because of the number of referrals from general practitioners and the number of admissions through the accident and emergency unit. The local newspaper, the Wakefield Express, is a creditable newspaper with a creditable reporter. On 10 January, its headline read: "Hospital on brink of crisis". That referred to Pinderfields hospital. Health officials admitted that, had there been a major accident or incident in December or January, the hospital would have had to close its doors to all but the most urgent cases. Due to the dedication and sterling work of the staff at the hospital, it remained open and continued its good work.
Wakefield area health authority provided funding for extra beds to cope with the high demand. It opened a short-stay surgical ward at the nearby Clayton hospital to help to minimise the impact on waiting lists. That was sound judgment by the health authority.
My concern is heightened by the fact that the Wakefield area health authority is facing an overspend in its budget of about £5 million in the current year. It also has an over-commitment of almost £6 million on the expected budget allocation for 1997–98. The hospital is facing a financial crisis, and the stress on the staff due to the extra admissions and the heavy work load is exacerbated by the overspend on the budget and the cuts required to keep within budget. The staff are conscious of the fact that further economies must be made to keep within the budget provision.
There is no evidence of unjust spending. The hospital works within the Government's guidelines, and there are no surpluses. The problem is with the formula for the 866 allocation of resources, as set by the Department of Health. Pinderfields hospitals faces a deficit of £3 million in the current year, with a further debt of £3 million for the fixed costs of the transfer of neurosurgery from Pinderfields to Leeds later this year. Will the Minister explain how such a crazy situation arose? Pinderfields had a first-class neurosurgery unit, which provided a first-class service. It was a regional unit stationed at Pinderfields, but it was stolen from us and located in Leeds.
Why should we have to pay £3 million fixed costs? That will push the hospital budget further into deficit. Why should the purchasers of services from Pinderfields hospital pay the costs of the neurosurgery unit that no longer exists?
All the health agencies in Wakefield, including Wakefield and area health authority and the three trusts, are concerned about the funding formula applied by the Department of Health for health care in Wakefield. I readily accept that there is no perfect formula for allocating resources, but there are fairer formulae than the one that currently applies there. How, for instance, did the Minister arrive at his decision that the population in our area was falling, which was one of the reasons for reducing our resources? I do not consider that to be true.
Why are we penalised for being a low-paid, low-income area? That is how the formula applies in Wakefield and we are being told that, in some areas where incomes are higher, we do not need as much. Why should the fact that only 1.75 per cent. of our population consists of ethnic communities influence the allocation of resources?
Does the Minister take into account the elderly population who suffer from respiratory diseases? A mining community such as ours contains chronically sick people, and a significant number of children and adults are troubled by asthma. The Wakefield and Pontefract asthma group is committed to addressing the apparent gap in provision between hospital and community, and to developing closer collaboration between primary and secondary care.
Does not such suffering influence the Minister's decision on a formula for the allocation of resources? We need money to ensure that our hospitals have a respiratory consultant. Research shows that the recording of information with such a consultant is far more accurate and revealing than it is with a non-respiratory consultant.
Earlier, I referred to the transfer from Pinderfields of the neurosurgery unit, which used to generate an income of around £3 million a year, which helped to provide services at the hospital. I consider the loss of that £3 million a betrayal of Pinderfields and of my constituents.
Wakefield community health council raised the loss of revenue with the regional health authority, which promised that £1 million would be given in assistance, that a "regional centre of excellence" would be provided at Pinderfields and that an MIRI machine—which is a kind of scanner—would also be provided. None of those promises has been fulfilled. Mr. Ron Beneford, chairman of Wakefield community health council, agrees with me that all at Pinderfields hospital feel betrayed by the regional and national health authorities.
Will the Minister give me an assurance that the promises made to the community health council will be fulfilled? If we cannot rely on promises made in good 867 faith, how can we trust the people who made those promises and reneged on them—or the people in authority—in the future? The funding of health care and the formula for allocating resources are fundamental to Pinderfields hospital.
As I have said, there is a massive acute services deficit in the Wakefield area, yet it is reported that GP fundholders in the district have underspent by £7.6 million over the past three years. Why is primary health care in surplus, while secondary and acute health care are in crisis? The malaise is caused by crazy accounting.
Pinderfields hospital provides intensive care and high-dependency units, but additional demand could leave the hospital in difficulty. Last year, Wakefield health authority considered the provision of intensive care and high-dependency units at Pinderfields, and there was some investment in additional units. That investment had a serious impact on the health authority's budget. Will the Minister assist Wakefield health authority to cover the cost of the extra intensive care units that had to be provided?
I have spoken about promises. When the maternity hospital at Manygates in Wakefield was closed, a new maternity unit at Pinderfields was promised, but the promise was not fulfilled, and we again feel betrayed by the Government. My constituents use Pinderfields hospital and the staff there would like to be able to see to the needs of patients. One of my constituents who suffers from multiple sclerosis needs Interferon treatment. Pinderfields would like to treat that constituent with Interferon, but cannot do so because of the cost. My constituent tells me that patients in the south of England can get treatment without difficulty. That is another example of the north-south divide.
The treatment that the hospital can afford to give my constituent makes her feel worse, and she complains about the deterioration in her health because of what I have described. I have written to the Secretary of State for Health on this matter and received a response, but the issue has not been resolved.
Pinderfields hospital contains the Yorkshire regional spinal injuries unit and the famous burns unit. Because the neurosurgery unit is being stolen and taken to Leeds, there are fears that, if Pinderfields and Pontefract hospitals are merged, we could lose two prestigious units and finish up with two cottage hospitals. That is another reason for objections to the proposed merger.
I have made the case for Pinderfields hospital to be given special consideration by the Minister. I seek fairness and justice, and that is not unreasonable.
§ 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 Normanton (Mr. O'Brien) and to congratulate him on securing time to debate a subject that is linked to health services in Wakefield—Pinderfields hospital. This is the fifth time since January 1995 that we have had an opportunity to debate health services in Wakefield. Opposition Members certainly deserve full marks for persistence. I acknowledge that you also have an interest in this area, Mr. Deputy Speaker. I, too, have an interest, because, as the hon. Gentleman will be aware, I went to school in Wakefield. I have known Pinderfields over many years, particularly when I was a teenager.
868 I have listened to the hon Member's concerns and the case that he has outlined against the proposed merger of the trusts at Pinderfields and in Pontefract. I am aware of the strong local feelings on the proposal. However, as I said in the Adjournment debate in November on the proposed merger of the two trusts, it seems that some hon. Members might be trying to link two separate issues—the management of the acute trusts at Pontefract and Pinderfields, and the delivery of services.
The consultation, which, as the hon. Gentleman knows, ended last week, was on a proposal to merge two trusts, not on a proposal to change the health services in the Wakefield area.
The proposal that is under discussion in Wakefield, and in Pontefract, is a proposal to merge two trusts—or, to be more exact, to dissolve two trusts and create one new one. It is a proposal to change the management structure of NHS trusts in Wakefield, and it is not a proposal to change the services.
The responses to consultation on the merger proposal are now being considered by the NHS executive. It is likely to be referred to Ministers for consideration shortly. I must and will keep an open mind until the appropriate time. As I have said, I am aware of the strong local opposition to the proposal, including from local hon. Members and from the local community health councils. On the other hand, I am told that there is strong clinical support for a merger from local consultants and from general practitioners.
As I said in November, Wakefield health authority has announced that it will look again at its health strategy, and will hold a separate public consultation on that later this year.
The Secretary of State for Health is required to consult on proposals to establish new health trusts. There has now been a long consultation, lasting from July 1996 until the middle of this month, on the proposed merger of Pinderfields and Pontefract trusts. As soon as it was realised that more was needed to be done to fulfil the statutory requirements, Wakefield health authority was asked to consult on behalf of Secretary of State, and the consultation period was extended. That has meant that consultation has taken longer than might have otherwise been the case.
However, the extra consultation period will certainly not be wasted. All the views expressed during both periods of consultation have been passed to the NHS executive, and will ultimately be seen by Ministers. The extension has allowed local people almost double the usual time to express their views. There can be no doubt that the consultation period has been thorough.
Many factors need to be taken into account when considering a proposal such as this. We will carefully consider the adequacy of the consultation process and the views of local people, including those who took the time to sign a petition organised by Normanton town council and presented by the hon. Member for Hemsworth (Mr. Trickett) recently. We will also look at the likely impact on effectiveness, efficiency, and accessibility of the potential creation of a new trust. Any potential economies of scale will have to be balanced against any possible loss of patient choice.
I can assure hon. Members that this is most certainly not a fait accompli. We had a statutory responsibility to consult publicly, and we will weigh the results both fairly 869 and carefully. We will look closely at the interests and the health of the people of the Wakefield health authority area.
The hon. Gentleman and his hon. Friend the Member for Wakefield (Mr. Hinchliffe) have previously expressed concern about the results of past consultations. I understand their feelings on this subject. In particular, they have cited the investment in rehabilitation which the former Yorkshire regional health authority had planned to place in Wakefield, following agreement that neurosurgery should be concentrated in Leeds. There were good reasons for concentrating neurosurgery in Leeds, but I understand the way in which the hon. Member for Normanton expressed his feelings this evening.
We cannot turn the clock back to 1994, because the regional health authority was abolished in March of that year, almost three years ago. We live in a changing world, but it is also a fact that the NHS executive northern regional office has offered support in the form of research and development support worth around £50,000 for an academic development in rehabilitation medicine. So at least something will come to Wakefield out of that situation, which is now past and gone.
The hon. Gentleman also reported on the winter pressures that he has experienced in the local hospitals in the Wakefield area, particularly in Pinderfields hospital. Although the position is undoubtedly difficult at this time of year—it usually is—the trust is coping and has coped well. Indeed, I hear that some general practitioners have complimented it on its performance.
Some non-urgent elective admissions have had to be cancelled, but the Pinderfields hospitals trust chief executive has emphasised that the percentage is small—about 33 out of around 1,000 planned operations. Hospitals cancel operations occasionally, but they try to keep cancellations to as few as possible because a cancellation is undoubtedly extremely unfortunate for the patient concerned—it is very disappointing indeed. It is only right that emergency and urgent cases should have priority.
As the hon. Gentleman said, the trust has made six new beds available at its Clayton hospital to ease the pressure on Pinderfields. A similar thing has been happening throughout the country. Admissions units have been opened and additional beds made available where possible. I am glad that Pinderfields was able to make that effort to ease the pressure. I am sure that that sort of sensible management move has helped during this winter.
Once the proposal for a merger is decided, we can look at the management arrangements. Meanwhile, Pinderfields hospitals trust has an able acting chairman and an experienced acting chief executive, in a trust that has also recruited 25 new consultants since 1993—a considerable investment in the appropriate skilled health care for the area.
I also recognise that the Pinderfields hospitals trust is facing a complex set of interdependent issues. As I have said before, the ultimate goal is to ensure that sustainable, high-quality and cost-effective clinical services are provided with modern facilities. Although the consultation on the proposed merger and, separately, the configuration of health services will take time, those 870 processes should ensure that whatever solution emerges is based on informed debate among the public and the professions. I am committed to seeing that that happens.
The hon. Gentleman also, very fairly, raised the question of the finances of the health authority, the trust and the GP fundholding practices, which, as he knows, are extensive in the Wakefield area. I must point out that, in November, we announced that an additional £1.6 billion would be available to the health service next year to safeguard and improve patient care.
Hon. Members have criticised the funding for Wakefield, but the health authority is above its weighted capitation target. Despite that, it will receive an integrated revenue cash increase of £5.3 million next year, which is a real-terms increase of £2.3 million, or 1.6 per cent. Surely that is not a cause for complaint. Wakefield has done rather better than the average, despite the fact that it is over its capitation target.
The hon. Gentleman was also concerned about how that capitation target is made up, and was worried that the needs of Wakefield people were not taken into account. I acknowledge his interest in the problems of asthmatics and in the National Asthma Campaign. I was glad to hear about the activities of the Wakefield and Pontefract asthma group. I am sure that that is very relevant. I can well imagine the sort of respiratory diseases that are common in that area.
I assure the hon. Gentleman that the formula, particularly next year, when it has been adjusted to take account of community health needs, including mental health, is more focused on need than it has ever been in its history. If anything, the sort of area in which Wakefield is situated will have gained from the reformulation of the formula for the cash handed out next year.
I also want to stress that the work on the formula is undertaken as a result of the effort and research by York university. It is independent, and considers objectively the population needs of areas such as Wakefield. It is as objective a measure as we can possibly make it. That is the basis on which the Wakefield health authority gets its money.
The hon. Gentleman was also concerned about the trust's finances. Certainly, I would not deny that there have been some problems over the finances—that has been the case for some time—but I am assured that the situation is not deteriorating but is, on the contrary, improving, and that a firm three-year plan is in place to resolve the problems. That will be affected by the merger, but it is none the less in hand to put things on a sound footing. There is no reason to believe that that sensible approach will not be successful.
The hon. Gentleman further expressed concern about the amount of money in the GP fundholding system and asked in effect whether it could in some way be transferred to help with the problems in the acute hospitals. My point about that is that it would essentially destroy the whole point of the GP fundholding system, which is that, where fundholders generate surpluses, they can put them back into improving primary care. They must be allowed to do that.
871 The health authority may hold those surplus funds for the moment, but they are in effect held in trust on behalf of the GP fundholders who generated them, and it is right that they should go back into primary care. We are, after all, talking about a primary care-led service.
I am sure that the hon. Gentleman will be aware that Wakefield is at the cutting edge of a primary care-led system, because about 82 per cent. of the population are in 33 GP fundholding practices, and it is expected that that proportion will rise to nearly 100 per cent. by April this year. Wakefield is setting a trend in that area, which will be extremely good in the medium and long term for the health of people living there.
I should also point out that Pinderfields has benefited recently from considerable additional investment. For example, an advanced eye surgery unit was opened last year at a cost of £500,000. It is considered one of the best in Europe, and will certainly reduce waiting times for eye surgery.
§ Mr. William O'BrienWill the Minister address the point about the historic debt from the transfer of 872 neurosurgery, which will cost the trust about £3 million, when the transfer of the service is not the trust's responsibility?
§ Mr. HoramI take the hon. Gentleman's point, but, in the transfer of the neurosurgical unit to Leeds, revenue is lost but so is cost; so that would not necessarily disadvantage Wakefield, considering the net position, balancing revenue and cost. However, the point was new to me, and I shall certainly investigate it and perhaps write to the hon. Gentleman. I am not sure that he is right: the situation is probably more balanced than he thinks.
The burns unit in Pinderfields is famous and, considering it alongside the other facilities that are available, the situation in Wakefield is extremely promising. The combination of primary development, in which Wakefield is well ahead of most other parts of—
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-eight minutes to One o'clock.