Health Authority Consultation: Closures (Hansard, 7 December 1987)

§ The Countess of Mar
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)
My Lords, health authorities are not obliged to consult over urgent temporary closures, which those announced by the Central Birmingham Health Authority were. I understand, however, that the health authority has provided the local community health council with information on various aspects of the closures and will be discussing the closures with it.

§ The Countess of Mar
My Lords, if these closures were urgent, why were they not minuted in a resolution of the district health authority at the meeting on 15th September? Why was not the community health council consulted immediately after the closure, as is laid down in the 1985 regulations and also in the de Peyer letter of 1979? If district health authorities are forgetting to communicate with community health councils, could not a letter on similar lines to the de Peyer letter be issued not only to the administrators but also to all members of the district health authorities?

§ Lord Skelmersdale
My Lords, by definition, if closures are urgent of management grounds then there would not be time to consult on them. Having said that, the circular to which the noble Countess referred states that in cases of urgent temporary closure it is good practice for health authorities to consult on arrangements for the provision of interim services and re-opening. As I said in my original Answer, that is the good practice which the Central Birmingham Health Authority is following.

§ Lord Ennals
My Lords, can the Minister say how many hospitals and ward closures there have been in the past 12 months against the express wishes of the community health council? Is he aware that community health councils are no less conscious than the presidents of the three Royal colleges of the deterioration in patient care, the near breakdown of acute services, the depressingly low morale of the staff and the heavy responsibility on the Government to avert a crisis in the National Health Service?

§ Lord Skelmersdale
My Lords, this issue is not about cuts but about how fast services, in particular expensive specialist services, can grow. This year central Birmingham's allocation has gone up by 8.5 per cent. in cash terms. Last year it was 7 per cent. Altogether, spending on health services in Birmingham as a whole went up by 18 per cent. in real terms between 1978–1979 and 1986–1987. Within this total of course, difficult decisions have to be made about how fast individual services should grow, but quite properly these decisions are for local resolution. If the noble Lord wants to put down a Question on the total number of closures over the past 12 months, or whenever, he should do so and I shall do my best to answer it; but I am afraid I cannot do so at the moment.

§ Lord Hooson
My Lords, does not the Minister agree that, if closures are so imminent that they do not allow consultation, that points in the direction of bad administration?

§ Lord Skelmersdale
My Lords, I would not go as far as that, but I note that the Central Birmingham Health Authority has had three general managers in the past two years.

§ Lord Kilmarnock
My Lords, can the Minister tell the House whether there is any time limit on a temporary closure'? Is it not the case that some temporary closures are simply turning into de facto permanent closures without the proper intervening process of consultation?

§ Lord Skelmersdale
My Lords, if they turn into de facto closures I have no doubt that either I or my right honourable and honourable friends in another place will be kept fully informed and will ensure that consultation procedures, which we insist upon, are carried out. Of course if those consultation procedures between the district health authority and the community health council do not come to resolution, then through the good auspices of the regional health authorities they automatically come to Ministers.

§ Lord Molloy
My Lords, can the Minister confirm the various reports in responsible newspapers that if a general manager of a health department, region or district can bring about closure of a number of wards, or indeed the closure of a hospital. he is rewarded by an increase in pay, which is denied to British nurses?

§ Lord Skelmersdale
My Lords, I do not know whether the noble Lord has any evidence on that point. I have not seen the newspaper reports to which he refers. If he has background for that comment, I for one would certainly like to know.

§ Lord Ennals
My Lords, from the figures that the Minister gave in answer to my question, was he suggesting that the presidents of the three Royal colleges to whom 1 referred were inaccurate, did not know what they were talking about or were not close enough to the health service scene to say what I quoted they had said?

§ Lord Skelmersdale
My Lords, I was trying to say that there must be a rationale for reaching decisions on clinical need and on resources. The noble Lord will remember that even in his time as a distinguished Secretary of State for Social Services health authorities had to make ends meet year on year. We find ourselves in that difficult position today.

§ Baroness Fisher of Rednal
My Lords, is the Minister aware that the figures he gave for the Birmingham Health Authority are discounted by the chairman of that authority, who said that £30 million is owed, because it receives less than the target allocation that the region should have on its population figures? Closures will automatically take place if it does not get the target figure and it is £30 million short.

§ Lord Skelmersdale
My Lords, I am aware that the region is considering the basis of the remarks made by the district chairman and that it is looking with great attention at what is technically known as the sub-regional RAWP formula to see whether the Central Birmingham Health Authority has been under-funded.

Lord Wallace of Coslany
My Lords, is the Minister aware that most health authorities seem to regard community health councils as a bit of a nuisance, whereas—and I think that the Minister will agree with me—community health councils perform a vital service in protecting consumers' interests?

§ Lord Skelmersdale
My Lords, yes, I agree with the second part of the noble Lord's supplementary question. I have not heard suggestions that community health councils are being devalued by district and regional authorities. I hope that that is not true.

§ Lord Cledwyn of Penrhos
My Lords, does the noble Lord agree that there is now acute public concern about the alleged deterioration of the National Health Service? Is he further aware that a statement of the kind made by the three distinguished presidents has never before been made in this country? Will he therefore convey the exchanges that have taken place in the House to his right honourable friend and suggest to him that the time is overdue for a public inquiry into those allegations so that we and the people of this country can know the facts?

§ Lord Skelmersdale
My Lords, while I shall accede to the request of the noble Lord the Leader of the Opposition to refer your Lordships' comments on this subject and any others to my right honourable friend the Secretary of State for Social Services, I hope that he is not suggesting that I have been inaccurate in my answers.

§ The Countess of Mar
My Lords, the regulations clearly lay down that, where there are substantial variations in service, community health councils should be conferred with. Is the Minister aware that in February 1987 a letter was sent to the Birmingham Children's Hospital saying that there would he a shortage of nurses because student nurses were being withdrawn from cardiac wards? Is he further aware that a 25 per cent. closure of beds in the children's hospital, including 33 per cent. in the cardiac wards. is a major variation in the services?

§ Lord Skelmersdale
My Lords, I am grateful to the noble Countess for producing to me a few minutes ago the details on which she based her supplementary questions and, for all I know, her original Question on the Order Paper. As I understand the position, at that moment there was a proposal. It was not, in the words of one noble Lord, de facto.