NHS: Patient Services and Resource Management (Hansard, 18 November 1982)

§ Lord Hunter of Newington
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)
My Lords, decisions on the best way of providing patient services are for local health authorities to make, taking account of local circumstances as well as of national policies. Government initiatives to improve the use of resources are intended to strengthen and complement the efforts of local management.

§ Lord Hunter of Newington
My Lords, may I thank the noble Lord for that reply. In the present situation, which is nearly an emergency from the point of view of long delays in operations and consultations, does the Minister not feel that other developments should be deferred? The Government have recently declared their policy that additional resources should be used to improve the treatment of the confused elderly and return mentally subnormal to the community. Do they still think that these should be the priorities under this exceptional situation? Secondly, may I ask whether the Government have had discussions with the medical profession on these matters and have taken advice from the Royal colleges about medical priorities?

§ Lord Trefgarne
My Lords, it is, I fear, an inevitable consequence of industrial action such as we have seen recently in the health service that there should be some resultant difficulties like the extension of waiting lists to which the noble Lord referred. As for priorities, the 630 noble Lord asks us to accept that, for example, shortening of the waiting list should be a priority at the expense of some other important areas to which we have recently drawn attention. If the noble Lord has visited as many hospitals for the subnormal, for example, as I have recently, he would not so readily point the way in the other direction.

Lord Wallace of Coslany
My Lords, even ignoring the implication of industrial action—the necessity of which of course is regretted—are the Government aware that financial stringency imposed on health authorities is having a serious adverse effect on patient care, as for example the proposed closure of Tadworth Court Hospital?

§ Lord Trefgarne
My Lords, the proposed transfer of patients from Tadworth to the St. Mary's Hospital at Carshalton, which has been referred to in the press recently, will of course have to come to Ministers for approval. Naturally, they will want to consider that matter very carefully. On the general question of resources for the health service, it is not true that we have reduced health service resources. On the contrary, we have significantly increased them.

§ Lord Molloy
My Lords, may I ask the Minister this question: Within the sphere of reorganisation, is he aware that the closing of Tadworth Court Hospital is causing great dismay and great perturbation not only within that particular area but, as the national press of this country has revealed, right throughout the nation? Therefore, does he not think it despicable that the Great Ormond Street Hospital should be played off against the Tadworth Court Hospital, and the choice is that one will be severely cut back or the other abolished? Is he not aware that within the field of cystic fibrosis—one of the most agonising complaints from which a child can suffer—Tadworth Court has done so much? May I plead with him to use his influence to get this decision stopped and allow Tadworth Court Hospital to proceed with the magnificent work that it is doing on behalf of a portion of the children who are so stricken but still are members of our nation?

§ Lord Trefgarne
My Lords, nobody will disagree with the noble Lord about the importance of the work being carried on at Tadworth Court. But the fact is that the facilities there are not being fully used. The proposal is to transfer those facilities to the St. Mary's Hospital at Carshalton. The noble Lord will be aware of that. The two hospitals, Great Ormond Street and Tadworth Court, are, as the noble Lord will know, operated by a single special health authority, and it is the proposal of that board—as it is called—that we shall have to consider.

§ Lord Beloff
My Lords, may I ask my noble friend whether, in looking at the resources, he will look at the position of those specialised hospitals which have to depend for their money on the districts while their patients may come from all over the country and indeed, in cases requiring special skill, from all over the world? It seems curious that this fact was overlooked when the new system was brought in. I am thinking particularly of a small London hospital such as St. Mark's, which has a world-wide reputation in a 631 particular branch of surgery which the inhabitants of the district are unlikely frequently to need recourse to.

§ Lord Trefgarne
My Lords, my noble friend puts his finger on an important point. One of the features of the so-called RAWP formula is to provide funds for things called "cross-boundary flows", which goes some way towards meeting the anxiety expressed by my noble friend. I agree that the RAWP formula may not work as efficiently as it should in this particular area, and that is certainly a matter we would want to keep under review. I certainly share my noble friend's admiration for St. Mark's, because that is another of the hospitals that I have visited recently.

§ Baroness Masham of Ilton
My Lords, may I ask the Minister whether he is aware that there is tremendous patient anxiety about the threatened closure of the breast cancer screening clinic at the Marsden Hospital? Would he please look into that? Also, does he realise that once these specialised services are run down they may never be run up again?

§ Lord Trefgarne
My Lords, I am aware of the anxiety which the noble Baroness refers to. Again, it is a case of achieving the best use of limited resources. It is not always wise to spread resources right across the country, in other words, to duplicate facilities all over the place and not achieve their full use anywhere. However, I am certainly aware of the anxiety that the noble Baroness refers to and, of course, that too will be carefully considered by Ministers before any decision is taken.

§ Lord Byers
My Lords, may I ask the noble Lord whether he will reconsider what he said about duplication? There is no question of duplication in the case of the Royal Marsden. There are only two other units in the country and this is going to be a source of grave anxiety to thousands of women.

§ Lord Trefgarne
My Lords, nonetheless it is a case of using facilities to the best effect. There are other facilities which provide the services at the Royal Marsden, and naturally we need to be certain that they are all used to the best advantage. At the same time, of course, we need to take into account that it is not possible, for example, to have such facilities in one location only.

§ Lord Molloy
My Lords, may I ask the Minister, bearing in mind what he said about the—

§ The Lord Privy Seal (Baroness Young)
My Lords, th noble Baroness, Lady Hylton-Foster, has risen to speak several times. Perhaps we should take her question next and then, I would suggest to the House, we might move on to the next Question.

§ Baroness Hylton-Foster
My Lords, would the Minister agree that the local health authorities should be encouraged to bear in mind that those patients who are still waiting for treatments and operations deserve some special consideration now so that their complaints are no longer aggravated by further delay?

§ Lord Trefgarne
My Lords, it is, I fear, the case that those who enter the waiting list as non-urgent may, if they have to wait a very long time, then become an urgent case. Then, of course, they are differently considered.