Guy's Hospital: Job and Bed Reductions (Hansard, 31 July 1985)

§ Lord Ennals
My Lords, I beg leave to ask the first Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)
My Lords, my right honourable friend the Secretary of State's approval is not required for job losses or temporary bed reductions. These are the responsibility of Lewisham and North Southwark 271 Health Authority, which is under a duty to provide patient services within the resources allocated to it. It remains necessary to rationalise acute services within this authority, and these bed reductions are in line with the strategy of the authority and needed to be made at some stage.

§ Lord Ennals
My Lords, as former Member for Norwich North may I express the hope that the intervention we heard from the right reverend Prelate the Bishop of Norwich is not in fact the last, and that he may make another one? Is this not the most serious cut yet to any of the major London teaching hospitals? Is the Minister aware that the chairman of the board of governors of Guy's, Professor Cyril Chantier, has written to hospital staff saying that patients will suffer? Is she aware that he said in his letter: Everyone must feel anxious, miserable and angry about what is being planned", and further, that the principal effect will be on general medicine and surgery, including chest and infectious diseases? Is this really the pattern for the future? Where do the Secretary of State's responsibilities start and stop?

§ Baroness Trumpington
My Lords, may I remind the noble Lord, Lord Ennals, that he was once my MP, but for a very short time? The need to save money in Lewisham and North Southwark district and in Guy's Hospital in particular does not relate primarily to RAWP reductions nor to the review body pay award, but to an overspending in the last two financial years of £2.3 million on multi-district services whose budgets are set by South-East Thames Regional Health Authority. The problems have arisen because the district health authority refused to take action to keep spending on these services within cash limits and it now faces the difficult task of repaying the deficit by March 1986.

§ Baroness Gardner of Parkes
My Lords, can my noble friend confirm that in this area there are two major hospitals Guy's and King's and that therefore the provision has been rather in excess of any other part of London, or possibly the whole country, and that the local health authorities must be the people able to decide? Can my noble friend explain also to whom the noble Lord, Lord Ennals, was referring when he referred to the "chairman of the board of governors"? As I understand it Guy's does not have a retained board of governors. Was he referring to the teaching hospital or the hospital itself, because surely that comes under the district?

§ Baroness Trumpington
My Lords, I thank my noble friend for her supplementary questions. I cannot answer for the noble Lord, Lord Ennals. But in answer to one of her supplementaries the South-East Thames Regional Health Authority's policies, which we support, are to move resources in line with the population movements of recent years. Districts like Medway have been relatively deprived of local health services for many years and need extra revenue. Lewisham and North Southwark Health Authority must reduce its acute beds in line with its future 272 resources assumptions, develop priority services and the pattern of services there must change to meet today's needs.

§ Baroness Lane-Fox
My Lords, is my noble friend the Minister aware that St. Thomas's also comes within the South-East Thames area and that there is great worry and difficulty caused to the big London hospitals by the effects of RAWP? Does she not think that there should be some deflection or rearrangement to preserve this invaluable source of medical science and specialist treatment?

§ Baroness Trumpington
My Lords, in answer to my noble friend, special financial recognition is given to teaching hospitals within RAWP. The service increment for teaching is an allocation for the extra costs of medical teaching. The specialised supraregional and multidistrict services often provided by teaching hospitals receive protection from the redistribution of resources through RAWP. RAWP targets are adjusted for the costs of in-patients coming from outside the district.

§ Lord Bottomley
My Lords, does the noble Minister not agree that in view of the worldwide reputation of Guy's Hospital it is tragic that any cuts have to be made?

§ Baroness Trumpington
My Lords, although radical changes are now required because of the difficult problems that the DHA has caused for itself by not taking earlier management action, there is every reason to be confident about the future of Guy's Hospital, which at the end of the 10-year planning period will still be an 800–900 bed hospital providing excellent facilities for patient care and teaching well into the foreseeable future.

Lord Paget of Northampton
My Lords, can the noble Baroness give us any indication of what the waiting lists for Guy's are? I am thinking particularly of operations such as the hip operation which relieves so many cripples of an enormous amount of pain. Is not what we are really seeing a squabble between the Government and the GLC which is being taken out on those who are suffering?

§ Baroness Trumpington
My Lords, in answer to the noble Lord's final supplementary, no. In answer to his point about waiting lists, the total waiting list for Lewisham and North Southwark district on 31st March 1985 was 6,481. The district health authority has said that some doctors who have been opposed to what they regard as cuts have been over-zealous in identifying patients on waiting lists in order to inflate those figures.

Lord Wallace of Coslany
My Lords, is the noble Baroness aware that she used the phrase "the health authority has a duty to provide services within the resources available"? Is she further aware that this is a common factor in many areas? The Bexley Health District, for example, next year faces being on the verge of bankruptcy and a severe curtailment of services in an area where there is not an over-supply of hospital accommodation.

§ Baroness Trumpington
My Lords, may I ask the noble Lord whether he was referring to another hospital, because I did not catch what he said?

Lord Wallace of Coslany
My Lords, what I meant to say was that, quoting the Bexley Health District, we are not over-supplied with hospitals but in point of fact the group is on the verge of bankruptcy and services will have to be drastically curtailed in the not too distant future unless further financial provision is made.

§ Baroness Trumpington
My Lords, the noble Lord's question is a little wide of the Question on the Order Paper today.

§ Lord Collison
My Lords, the noble Baroness mentioned the long waiting list for the hip operation, which gives great relief to people who suffer—I know this because my next door neighbour suffered for years. Can the noble Baroness tell us on average how long people have to wait for this service at Guy's

§ Baroness Trumpington
No, my Lords, not without notice.

§ Baroness Macleod of Borve
My Lords, may I ask my noble friend the Minister whether in view of the statement she has made the Secretary of State is happy about the constitution and the membership of the DHA?

§ Baroness Trumpington
My Lords, I cannot answer for my right honourable friend, but I feel sure that he abides by the wishes of the regional health authorities with regard to membership of the district health authorities.

§ Lord Ennals
My Lords, may I put two concluding questions to the noble Baroness? Is she aware that the budget for diagnostic services—that is, laboratory tests—will be cut and that requests for tests will have to be reduced to avoid delay? The chairman of the management board—I apologise for referring to him as the chairman of the board of governors—has said that there may be "dire clinical consequences". My second question is: do I presume from what the noble Minister has said that the Secretary of State no longer retains any sense of responsibility or any degree of responsibility for our great centres of excellence, of which Guy's is only one of a number? Is this not a tragedy?

§ Baroness Trumpington
My Lords, I really do not know why the noble Lord, Lord Ennals, assumes anything like what he has just said from anything I have said. I have said nothing about the total responsibility of the Secretary of State.
In answer to his remarks about diagnostic services, it is not unreasonable for the DHA to try to ensure that all requests for tests an investigations are essential so that resources are used effectively. There should be no cause for any detriment to patient services at Guy's. The savings which the DHA could make by competitive tendering, but which it is forgoing, would dwarf any planned savings on diagnostic services.