West Lambeth Health Authority: Cuts (Hansard, 9 May 1990)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, West Lambeth, like all health authorities, must operate within its resources. To enable it to do this in 1990-91, after consultation with medical and nursing staff, the authority has agreed a package of measures which includes a reduction of around 60 beds at St. Thomas's Hospital and a corresponding loss of posts.

§ Lord Ennals
My Lords, I am grateful to the Minister for her Answer. Will she confirm that in its 1368 decision the West Lambeth Health Authority has decided to cut not only 60 beds and 60 medical and nursing posts at St. Thomas's but also four psychiatric wards at Tooting Bee, the geriatric ward and 50 per cent. of the family planning service, with a severe cutback in operating theatre time? Does she accept that, with ward closures, and including Charing Cross, Central Middlesex and Westminster, this brings to about 500 the number of hospital beds that have been closed in the past few weeks?

§ Baroness Hooper
My Lords, I said nothing about 60 posts being lost in the process. I simply mentioned a corresponding loss which we expect to represent existing vacancies and natural wastage.
As concerns Tooting Bee, the South Western Hospital and community services, changes that were being made were part of the reorganisation. It was planned to transfer them into the centre at St. Thomas's. In many cases it represents much better facilities for operations.

§ Lord Ennals
My Lords, is the noble Baroness saying to me that the health authority can do without four psychiatric wards, the geriatric ward and the family planning service? I cannot believe that for a moment.

§ Baroness Hooper
No, my Lords. I should like to remind the noble Lord that as part of the good news about St. Thomas's Hospital he should not overlook the splendid new south wing development due to be formally opened in July. It cost over £13 million. The fine new accommodation for the Dreadnought Seafarers' Hospital opened in September 1988 and the Baroness Lane-Fox Unit opened at the end of last year.

§ Lord Hailsham of Saint Marylebone
My Lords, has my noble friend observed that, with the exception of the single supplementary question from my noble friend Lord Harmar-Nicholls, every supplementary asked during this Question Time has involved pressure to expend further sums of money? On the assumption that each of those suggestions was worthy, is it not also clear that all of them cannot be fulfilled?

§ Baroness Hooper
My Lords, I am sure that my noble and learned friend is absolutely right. I also wish to draw to the attention of the House the importance of the National Health Service reforms that we are introducing. They will very much help the situation which has been referred to in the Question.

§ Lord Williams of Elvel
My Lords, does the noble Baroness, with her noble and learned friend, recognise that very few supplementaries have come from the Benches opposite? Does that imply that Conservatives are not prepared to engage in these debates?

§ Baroness Hooper
Not at all, my Lords.

§ Lord McColl of Dulwich
My Lords, does my noble friend agree that part of the problem of St. Thomas's Hospital is that resources in the NHS have been 1369 moved out of London into the provinces? Does she further agree that the person who had a great deal to do with the movement of resources was none other than the noble Lord, Lord Ennals, himself?
Further, does she accept that part of the problem at St. Thomas's Hospital is that a device was used called "the suspense account"? If one receives a bill and does not know what to do with it one puts it in the suspense account, also known as "the dustbin". This is a perfectly reasonable device so long as one looks in the dustbin at regular intervals. The failure at St. Thomas's resulted from not looking in the dustbin for a period of about a year.

§ Baroness Hooper
My Lords, I am well aware that the noble Lord, Lord Ennals, has considerable experience with the predecessor of the West Lambeth Health Authority. He had to threaten it with the use of default powers in order to encourage it to restrain its overspending. I am grateful to my noble friend for having drawn my attention to the "dustbin" or suspense account.

§ Lord Mulley
My Lords, the two questions from the other side perhaps illustrate why it is better that they should remain silent. Does not the noble Baroness think this situation a scandalous waste of the resources of the highly skilled and dedicated staff of St. Thomas's? I speak from personal knowledge of them. They cannot do a full job because unfortunately they cannot carry out surgery without beds for people after their operations. The hospital has had to close a further 60 beds in addition to the closures that have already taken place. This means that the national loss and London's loss are that much the greater.

§ Baroness Hooper
My Lords, it remains the aim of the West Lambeth Health Authority that the 1989–90 activity levels should be maintained through 1990–91. As I said in my original Answer, the measures were agreed only after lengthy consultations with medical and nursing staff. It was on the understanding that they would have the least possible effect on patient services. One advantage is that services should not be subject to the sudden curtailments of recent years, when last minute efforts were made to stay within cash limits.

§ Lord Annan
My Lords, how far is the reduction of these services due to the fact that there has been an attempt over the years to rationalise teaching and research at St. Thomas's Hospital with that at Guy's Hospital? Does this reduction in the number of beds flow from the decision to try to rationalise the teaching and research in both hospitals?

§ Baroness Hooper
My Lords, I am not aware that that is so. However, I know that there is a history of overspending by this authority. I emphasise that, with the White Paper and National Health Service and Community Care Bill proposals under which the money will follow the patient, a hospital such as St. Thomas's, which has expertise in so many clinical fields a central location and an internationally recognised name, is bound to benefit.

§ Lord Barnett
My Lords, if the point made by the noble Lord, Lord McColl, is correct and the Minister agrees with it, is it not a serious matter? Should it not be reported to the Public Accounts Committee and the National Audit Office?

§ Baroness Hooper
My Lords, I am not quite sure which aspect of my noble friend's question the noble Lord refers to. When the regional health authority discovered the extent of the current overspending it commissioned a report—namely, the John Barnes Report. That report was published towards the middle of April and it concentrates not only on the underlying problem but on finding solutions to it.

§ Lord Callaghan of Cardiff
My Lords, I am one who has benefited from treatment at St. Thomas's, for which I am extremely grateful. Does this cut result in a worsening of the service to the patients? Has there been any lessening in demand by the patients, or is it alleged that there is inefficiency in their treatment? How can it be justified that after 11 years of this Government we should have to reduce health services in one of the poorest areas of London?

§ Baroness Hooper
My Lords, I refer the noble Lord to a previous Secretary of State for Health, or for the DHSS as it was in those days, who had similar problems with this authority. Everybody must operate within some cash limit and we aim to achieve the most efficient use of available funding and to ensure that patients certainly do not suffer.

§ Lord Ennals
My Lords, will the Minister confirm that the RAWP formula, which was referred to by the noble Lord, Lord McColl, was introduced by me 13 years ago? It received the support of both sides of another place. It has not been stopped because it succeeded in its purpose. Further, does she accept that some of the blame for what has happened at St. Thomas's has been put on the former finance director for spending too much time on health service reforms? We should bear in mind the fact that that hospital has just voted by a margin of five to one against becoming independent and self-governing as the National Health Service Bill requires it to be. Is that not one of the matters that is causing the problems in the National Health Service and St. Thomas's at the present time?

§ Baroness Hooper
My Lords, I am well aware that the RAWP formula was originally introduced in 1978. The John Barnes Report to which I referred earlier identified a disorganised and hoping-for-the-best type business culture in the authority as one of the chief sources of its financial problems.