Camden and Islington: Health Service Provision (Hansard, 28 June 1994)

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cuniberlege)
My Lords, it is for the trust and the health authority to agree on the provision of services to the people of Camden and Islington. The health authority has requested the trust to reduce its costs over the next two years, but that does not necessarily mean a reduction in care, as the trust is not the only provider. In Camden and Islington total spending on primary and community health services has increased from £85 million last year to £91.8 million this year.

§ Lord Rea
My Lords, I thank the noble Baroness for that Answer which is as ingenious as I thought she might make it. However, it does not alter the fact that the community health service trust is having to make do with less money in the next two years. Does not the recently announced plan of the Secretary of State for fewer overnight stays in hospital, more day cases, keyhole and even virtual reality surgery mean that there will be a need for more nurses in the community rather than simply maintaining the numbers that exist now? Does the noble Baroness remember that the Tornlinson Report suggested that primary health care services should be greatly increased? Do they not depend entirely upon community health services''

§ Baroness Cumberlege
My Lords, the noble Lord is absolutely right in the second half of his question. The Tomlinson Report recommended that we should have better services in the community and better primary care services. I think that my Answer explained that we will. In fact an additional £6.8 million will be invested in services for local people in Camden and Islington. Who provides that service is a matter for the health authority. If the trust has very high management and administration costs, then the health authority must ensure that those costs are reduced and more money is spent on patient care.

§ Lord Peyton of Yeovil
My Lords, is my noble friend aware that some of us feel that she is much to be congratulated on having made the position absolutely clear? She refused any temptation to fudge it. Is she aware that she will have warm support in urging hospital authorities—whether or not they enjoy trust status—that they must watch their costs? In that, my noble friend is absolutely right.

§ Baroness Cumberlege
My Lords, I am grateful to my noble friend for his support. He is right that we have to reduce administration costs. We recognise that an organisation which spends £30 billion a year, employs 1 million people and is very complex needs good management. But it is up to health authorities to challenge trusts to keep their management costs to a minimum.

§ Lord Molloy
My Lords, does the Minister agree that this problem applies not only to Camden and Islington but also to many other parts of the country? UNISON, the British Medical Association and the health visitors' association, are gravely concerned that more and more hospitals will be closed. Can the noble Baroness give the assurance that those organisations have misunderstood her policy, which is not to implement cuts or make reductions in hospitals, and that the Government will maintain the fundamental principles of our National Health Service?

§ Baroness Cumberlege
My Lords, the National Health Service should not be judged by the number of beds. It should be judged by the number of people who are treated and the care it gives as well as the health promotion work it does. We have seen an enormous increase in day case surgery, and people prefer it. When I go round hospitals, the question most frequently asked is: "When can I go home?" However good the care, people are anxious to get home and the new ways of working ensure that they do so as soon as possible.

§ Baroness Elles
My Lords, is my noble friend aware that millions of people in this country agree totally with what she said? I speak as someone whose daughter has just been in Charing Cross Hospital where she was treated and sent home within 24 hours, totally well, having been beautifully looked after. I can only express gratitude to the National Health Service for the care which my daughter received.

§ Baroness Cumberlege
My Lords, I am grateful to my noble friend.

§ Baroness Jay of Paddington
My Lords, is the Minister aware that all of us are agreed in commending the good work in the health service and in accepting that advances in medical technology will lead to greater day case surgery and so on? However, that does not meet the point that my noble friend raised in his Question. Will the Minister comment on the relative costs and finance for community care as opposed to hospital care? Is it not the case that after Tomlinson and the proposals, Making London Better, the Government said that they would give more money to community care in order to compensate for hospitals being closed? Are we not now 654 seeing an irresponsible position where hospitals are being closed without the compensating community care?

§ Baroness Cumberlege
My Lords, year on year we put more and more money into the National Health Service and more and more money into primary and community care. We are talking about a specific area of London: Camden and Islington. I have explained to your Lordships' House that in the current year the people of Camden and Islington will receive an additional £6.8 million for primary and community care. That is a tremendous record.

§ Lord Rea
My Lords, will the noble Baroness answer a specific question in regard to Camden and Islington and the provision of low-intensity nurse managed beds? A pioneer scheme has been proposed which would fit in with the recommendations that come from the Tomlinson Report for the provision of this type of bed, but the money is not forthcoming and I gather that this pioneer project will be turned down. Can the Minister give encouragement from the centre for the authority to finance the scheme?

§ Baroness Cumberlege
My Lords, there are a great many new schemes that have been proposed by Camden and Islington Trust. We are supporting many of those schemes. I think that the particular one to which the noble Lord refers is the home nursing scheme, which costs £1 million per year and supports only 20 patients at home. It is that sort of value for money that has to be reviewed. I have spoken to the chairman of the trust today and she agrees that a review is necessary and indeed that the trust's estate of 150 buildings needs rationalisation. There is room for greater efficiency and we are determined that the trust will achieve it.