§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Walter Harrison.]
§ 4.24 a.m.
§ Mr. Michael O'Halloran (Islington, North)
At this late hour I wish to bring before the House the problems of many of the hospital services in the London borough of Islington. Should the plans of the Camden and Islington Area Health Authority take place, they will adversely affect the constituencies of both my hon. Friend the Member for Islington Central (Mr. Grant) and my hon. Friend the Member for Islington South and Finsbury (Mr. Cunningham) as well as my own.
It will help the House if I give the background to the present situation which is now under discussion in Islington. Early in 1971 I had occasion to raise in an Adjournment debate the situation at the the Royal Northern Hospital in my constituency. It was then under threat of closure. It was given an assurance by the then Minister, the hon. Member for Barkston Ash (Mr. Michael Alison), that there was a future for the Royal Northern Hospital. The situation now appears to have changed dramatically. Camden and Islington Area Health Authority, in its recent report, is proposing the closure 576 of the Royal Northern as part of its plans to expand the Whittington Hospital. The area health authority says:The effective planning and development of the resources of the Whittington Hospital is considered to be an urgent necessity so that by the end of 1986 the acute services for Islington District will be concentrated on one site. In the short term, and until major capital improvements at Whittington Hospital have been accomplished, it will be necessary to make intensive use of the facilities of the Royal Northern. After that, the hospital should close.But no indication is given as to how it will be possible to close that hospital or of its present use. Neither is there a functional analysis of the use of beds, and no waiting times have been given. The Royal Northern provides half the out-patient services in Islington. Can these be replaced by services at the Whittington site? The Royal Northern has to close its doors at the present time to some emergency medical and surgical admissions because of insufficient beds. Can these services be replaced at the Whittington?
The Royal Northern suffered last year through the closure of the Grovelands convalescent home, and as a result 88 per cent of its acute medical or orthopaedic beds are occupied now by patients over 65 years of age. Yet it has no geriatric service at all, compared with 52 per cent for the Whittington, 46 per cent at the Royal Free and 24 per cent at other Camden hospitals. Furthermore, concentration of services at the Whittington would mean as many as 1,183 beds on a single site—a figure contrary to the Department of Health and Social Security guidance.
I believe that the 10-year time scale for closure is unrealistic. Where are the resources for the massive rebuilding of the Whittington which this would necessitate to come from? We in Islington do not want promises. We want reality. It would be realistic to plan for a district general hospital on both the Whittington and Royal Northern sites. It would also be economic, as it would take advantage of some of the latter's better facilities and of the considerable amount of land still available there.
Planning should start now for an Islington district general hospital, with a Royal Northern and a Whittington branch, complementing, and not duplicating, each other's services.
577 I may add that I have had to raise through Questions in the House the day-to-day affairs of this hospital, including normal maintenance of the lift service.
I come back to the Whittington Hospital. We hear of plans for the rebuilding of this hospital, but to the people of Islington this is just another bit of pie in the sky. There is nothing definite proposed, and no allocation of finance has been made, while the neurosurgery unit, transferred 22 months ago to the Royal Free Hospital in Camden because of a breakdown of one of its services, still has not been returned. But today I learn that the temporary removal will become permanent. This was decided by the regional health authority against the advice of both the area health authority and the Islington community health council.
The neurosurgical unit at the Whittington has been an integral part of Islington's health services for the past 20 years. Together with neurology, neurosurgery—which was placed at the Whittington as part of an enlighted attempt to upgrade the old LCC hospitals—has contributed to the Whittington's reputation both for service and for post-graduate teaching.
Those concerned have been struggling for years to build up a reputation for teaching, without the benefits of being a teaching hospital, although in recognition of the teaching, it actually does it has recently been designated a university hospital.
Removal of the unit will have a disastrous effect throughout in the attraction of good junior medical staff and paramedical staff. Recently, representatives of the Royal College of Surgeons visited the Whittington to assess its suitability for post-graduate training in anaesthesia but deferred their report until a decision on the future of the neurosurgical unit was made. That decision has now been made. If they withdraw recognition of the senior registrar (training) post now under consideration—as they may well do now that the neurosurgery is to be retained at the Royal Free—it is likely that further services will be withdrawn, resulting in more reductions in surgical facilities to the people of Islington. No similar effect world have been felt at the Royal Free Hospital where there is already a multitude of training posts.
578 How can the people of Islington accept such vague proposals for rebuilding the Whittington Hospital when they see that its most glamorous service has been taken away from it. It was estimated that its reinstatement at the Whittington would cost £816,000. The Minister, in a reply to my letter of 10th May to the Secretary of State, stated in his reply of 1st June.OI understand that the number of locations of the Neurosurgical Units in North East Thames is a matter for continuing study, as was announced at the time of the publication of the Regions Draft Strategic Plan, some months ago. The Regional Health Authority do not expect to be in a position to receive reports of consultations and advice before the July meeting at the earliest and may well be unable to arrive at a decision before study of these. A decision of the Regional Health Authority is therefore unlikely before the Autumn. The Islington Community Health Council need not fear that executive decisions will be taken by the Regional Specialist Advisory Sub-Committee, but that Sub-Committee does have a duty to recommend, and an Authority making a decision on such specialist subjects will normally invite and receive advice from such an Advisory Sub-Committee. In the event that a Health Authority wishes to make a major change of use to a hospital and that change is opposed by the Community Health Council, then the matter will he referred to the Secretary of State for decision. No permanent change of use has yet been decided upon by the Regional Health Authority".The North-East Thames Regional Health Authority has now taken a decision to keep the neurosurgery unit at the Royal Free Hospital in Camden. That decision will have a disastrous effect on the Whittington Hospital, and I hope that the Minister will give me his assurance that he will request the Secretary of State to intervene to reverse that decision.
Other hospital closures in the borough of Islington include the City of London Maternity Hospital in my own constituency—which could provide community facilities for the elderly and mentally ill, or be used as a health centre in view of its excellent physical fabric—and the Liverpool Road Hospital in the constituency of my hon. Friend the Member for Islington, South and Finsbury. Islington is becoming a hospital graveyard.
Islington, although sited in one of the richest health areas and the richest region in the country, is one of the poorest of the London boroughs and is the poorest in health facilities in the region. It is also one of the oldest of the London 579 boroughs and it is now going through a great transformation. Areas are being demolished and new homes are being built. We have lost a great deal of our industry, which has moved out of London, and the population has declined over the past 10 to 15 years. I shall compare our financial allocation in Islington with that of the London borough of Camden which is covered by the same area health authority.
Although the population of Islington is roughly the same as that of the two Camden areas combined, it receives less than one-third of the financial allocation. It is still further deprived under this year's allocation. Planning points to a reallocation in the direction of the two Camden districts and not towards the poorer district of Islington. Less than half as much is spent on an Islington patient as on a Camden patient. The AHA bed norm of three per 1,000 population is based on the social deprivation of Islington, yet it is being applied over both Islington and Camden, resulting in bumping up bed provision in Camden and benefiting Camden disproportionately to its needs. Furthermore, the March 1976 figures show that the cost of keeping a patient in hospital in Islington is £.32.16 a day compared with £41.65 in Camden, that is, roughly 25 per cent. less.
An examination of staffing levels reveals still further deprivation in Islington compared with the two Camden areas. Islington has 30 consultant psychiatric sessions, compared with 98½ in Camden; 29.72 physiotherapists compared with 86 in Camden; and only one consultant geriatrician compared with Camden's three. Thus, about one-third as much manpower is allocated to an Islington patient as to a Camden patient. This is totally unacceptable to the people of Islington, who feel that measures should be taken towards redistribution of resources into Islington, rather than away from it as is now indicated. Nor is this disparity made up in the community services, where the ratio of health visitors to population is one to 509 in Islington, whereas in the two Camden districts it is one to 274 and one to 207 respectively.
Furthermore, Islington, the poorest district in one of the richest areas in the richest region in the country, has no health services facilities for the mentally handicapped, no domiciliary hearing aid 580 services, no psychiatric cover in accident and emergency departments, no night nursing services, and few geriatric beds. Staffing levels in geriatrics show Islington's deprivation still further. I have already pointed out that Islington has only one geriatrician to Camden's three, but in other medical sessions—senior registrar, registrar, senior house officer—the figures are 44 for Islington against 87 for Camden, although our populations are the same. Where rehabilitation staff are concerned, Islington has one physiotherapist to Camden's three and one occupational therapist to Camden's seven. Camden is allocated much more than Islington. What steps are being taken to remedy this? We do not want resources taken away from Camden, but we want parity. Our application for a second geriatrician has failed for the second year running. Can the Minister explain why?
According to the National Health Service Planning System, of which the Secretary of State is the guardian, planning should come from the bottom rather than the top. But this is not happening in Islington where the regional authority takes decisions which are contrary to both the area health authority and the community health council's recommendations. Islington cannot plan without additional resources, yet all the evidence is that resources are being taken away from Islington and given to Camden. Neurosurgery is the most frightening example, for it will affect not just resources but standards of medical care here.
I therefore appeal to the Minister and the Secretary of State to intervene now before it is too late, to restore to Islington its essential health services, the return of the neurosurgical unit to the Whittington Hospital, to ensure that the Royal Northern Hospital remains open, and to approve an Islington General Hospital, with a Whittington and a Royal Northern Wing, being ungraded in order to take its place on an equal footing with hospitals in neighbouring Camden, and with adequate resources at its disposal to ensure parity on the basis of population between the boroughs of Islington and Camden, and with the rest of the United Kingdom.
I can assure my hon. Friend that the fight to retain good hospital services will continue. I pay tribute to Islington Community Health Council and its officers. 581 who realise the situation and have been foremost in putting the views of the people of Islington. I hope that I have indicated that we in Islington are fully aware of the problems and will not accept a dispersal of our hospital services outside the borough. I would ask the Minister therefore to assure me that the Government are aware of our problems in Islington and that such dispersal will not take place.
§ 4.40 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I thank my hon. Friend the Member for Islington, North (Mr. O'Halloran) for raising this topic which is of importance not merely to his own constituents but to others throughout the region. It will allow me the opportunity to say something more to the House about our present efforts to bring a more coherent pattern to the planning of services not only in Islington but within the National Health Service as a whole. One positive benefit is being developed from the reorganisation of the health services in 1974, and that is the emergence of a co-ordinated planning system.
An essential feature of the management arrangement, which the Secretary of State requires health authorities to adopt, is a system of control in which performance is monitored against plans and budgets. Planning systems are seen as a principal means of achieving, a clear line of responsibility for the whole National Health Service down to and within area health authorities, with corresponding accountability from those authorities back to the Secretary of State through the Department.
The National Health Service planning system was introduced in April last year and is intended to encourage the maximum devolution of responsibility for deciding the future patterns of service to those who provide the services, within guidelines set down by this Department. The aim is to ensure the most effective use of resources in the local situation for the benefit of those who use the service.
The NHS planning system is a two-tier system operating simultaneously at both strategic and operational levels. At a strategic level the aim is to devise broad strategies, priorities and resources for the period up to 10 to 15 years ahead. 582 Strategic plans will be produced at the area authority level, but with a district input, and similarly a strategic plan will be constructed at regional level for the entire region and taking into account area strategic plans. Such plans will be produced every fourth year and reviewed annually within departmental guidance which will provide an overall national framework.
Operational plans are intended to take a sharper focus by examining in detail action proposed for each of the next three years ahead. That is to say, firm plans for year one, provisional plans for year two and outline plans only for year three. The three-year plans are produced annually at district and are incorporated into area plans. Annually the regional health authority will submit progress reports to the Department on operational progress made against the background of this strategic plan.
There is a clear distinction between strategic and operational planning. Strategic planning takes place in the light of broad strategies passed down from the Department to the region and area including the district, but operational planning activity is centred on the district, the basic planning unit, from which plans flow through the area authority to the regional authority. Here they are approved by the regional authority for action if they conform with regional strategy and guidelines. But it is important to recognise that there is also a good deal of interaction with operational planning providing a test of feasibility for strategic plans.
What we are seeing now is the emergence of the first of the strategic plans. There should be consultation on both strategic and operational plans with a wide range of interests and, when the system is operating fully, there should generally have been ample opportunity for consideration of developing ideas by all those with an interest, before they become firm proposals for the first year of the operational plan.
The North-East Thames strategic plan for the years up to 1987 was issued following a meeting of the regional health authority in December last year, it was received in my Department in January and is now the subject of examination. This plan, as I have explained, was derived from considerations of wider 583 guidelines and inputs from the strategic plans of its constituent areas. Let me say straightaway that the plan is still a draft. Consultation was extended within the region up until the end of June this year. Further, the authority still has to consider a number of topics of particular importance and considerable complexity. It is quite improbable, therefore, that a firm strategic plan will be received by my Department from the North-East Thames region until about November of this year. In the meantime the draft strategic plan which has been received will be considered by my right hon. Friend the Secretary of State together with those strategic plans received from the other regions, to see how these accord with the guidelines issued to the regions from the Department. Although it is intended that strategic plans will be fully revised every four years, it seems extremely likely that at first more frequent revision will be needed until the planning system itself has become fully effective.
I turn now to the North-East Thames draft strategic plan and to the aims and constraints identified in it. The Secretary of State is committed to seeing a fairer distribution of resources among the regions of the country. In order that the more deprived regions should receive a level of growth of about 3 per cent., the Thames regions are being held to a much lower level of growth. This year North-East Thames region received 0.27 per cent. as its share of the growth money available nationally. It is against this background that the North-East Thames strategic plan is trying to devise strategy to achieve the following aims.
First, the region must redistribute resources within its own allocation and between areas. The outer areas of London and the area of Essex have a growing population and the pressures there on the health services are increasing. There are also pockets of deprivation in London itself where the health services must be improved. My hon. Friend obviously feels strongly that Islington is one such area. Secondly, it is the Government's policy that resources should move towards those long-stay and community services which have been neglected in the past. Thirdly, a rationalisation programme of services requires a consider- 584 able capital programme of expansion, and five major hospital building starts have been identified for the next decade.
These then are the aims of the regions strategy, and the strategic plan concerns itself largely with the problems of either freeing or creating resources so that these aims may be achieved. A regional resource allocation working party has considered the allocation of revenue within the region and, following the pattern of the Department's own working party on resource allocation, has identified those areas whose revenue needs to be increased, and by the same token those areas whose present allocation of resources greatly exceeds the target figure derived from their consideration.
This then describes the background to my hon. Friend's anxieties. I shall now explain how those anxieties should be regarded and what position for planning and consultation for services within the Islington district has been reached.
Amongst the six topics of great importance and considerable complexity, which the region has not yet covered in its draft strategic plan and for which the period of consultation was extended until the end of June, are particular issues of importance to Islington. These are the needs of the university for teaching purposes, the level of bed provision within Camden and Islington, and the number, size and siting of neurosurgical units within the North-East Thames Regional Health Authority.
In response to the regional health authority's draft strategic plan, the Camden and Islington Area Health Authority planning group was asked to undertake a review of the in-patient services in the area and to determine the level of expected in-patient provision required for the decade ending 1986-87. This review was to be consistent with the service needs for a changing population and the teaching needs of the area's two undergraduate medical schools. The planning group began its task in January this year in conjunction with the district management teams and the Area University Liaison Committee. The time scale imposed required the authority to produce its strategic proposals in terms of the guidelines by the end of June this year for submission to the regional health authority. The review was programmed 585 over the period January to April of this year so that each specialty was subjected to a study of the existing use of resources district by district.
Full discussion with district management teams and the medical school representatives was maintained throughout the review and consultation with advisory committees, community health councils, local authorities, family practitioner committee and staff organisations was undertaken during the period 27th May to 15th June 1977.
It is recognised that this period of consultation was not as long as most organisations would have wished. Nevertheless, note was taken of their comments and many were incorporated into the report to the Camden and Islington Area Health Authority. This report has now been accepted by the area health authority and has been submitted to the regional health authority. This review of in-patient services has yet to be considered by that authority. Indeed, even at its planning meeting yesterday, the document was not on the agenda. I understand that regional officers are still at work on the document preparing recommendations for consideration by the regional authority. I am of course aware of many of the proposals contained in that document, such as the increase to be expected in the role of the Whittington Hospital as a district general hospital in the coming decade and the consequent closure of the Royal Northern Hospital and the City of London Maternity Hospital during the same period. I am aware, too, of the disquiet of the community health council, not to mention that of my hon. Friend, at some of these proposals and their disagreement with them.
The subject of neurosurgery and the location of the units within the North-East Thames region was discussed at the planning meeting of the regional authority yesterday, and I know that the regional health authority has recommended that neurosurgery should be permanently located at the Royal Free Hospital. The regional and area authorities will now be discussing the next step.
I am aware of the anxieties of Islington and the hopes of the area health authority for the return of its neurosurgical unit to the Whittington Hospital and also of the effect that it is felt that the absence of this unit is having on other 586 aspects of the hospital's work, such as medical education and training there. I am also aware of the extra cost involved if such a decision is made. Perhaps I can reassure my hon. Friend by empasising the procedures which will have to be followed if a hospital be closed or a change of use, such as permanent relocation of neurosurgery, is to be affected notwithstanding the planning procedues which have already been followed.
In general, the initiation of these procedures rests with the appropraite area health authority. In this case if the area health authority decided that such a closure or change of use, arising from these strategic plans, would be beneficial, it would have to institute formal consultations. The procedures require the authority to prepare a consultative document covering such matters as the reasons for its proposals; an evaluation of the possibilties of using the facilities for other purposes, for the disposal of the site; implications for the staff; the relationship between the closure or change of use and other developments and plans; and the transport facilities for those patients who might be affected by the proposals contained in the document. The AHA will invite comments from a wide range of bodies. Those hon. Members whose constitutents were affected would also be informed of the proposals.
The area health authority would then seek the community health council's views on the comments it received and on its own observations on those comments. The authority would then review its original proposals in the lights of the comments received. Unless there was strong local opposition it could then implement its original proposals, provided that the community health council agreed. The regional health authority and my Department would be informed of the decision.
However, if the community health council objects to the authority's proposals, it is required to submit to the authority a constructive and detailed counter proposal, bearing full regard to the factors, including restraints on resources, which led the authority to make its original proposal. The matter must then be referred to the regional health authority and if the regional health authority is unable to accept the views of the council and wishes to proceed with the 587 closure or change of use, it falls to my right hon. Friend the Secretary of State to act as arbiter.
Nothing I say today should therefore be construed as prejudging the issues. the region's draft strategic plan has yet to be seen by my right hon. Friend, the Camden and Islington review of inpatient services has still to be considered by the regional health authority for incorporation into that plan and finally, any firm proposals for action will need to be the subject of formal consultations 588 following the pattern that I have just described.
I hope that that will at least reassure my hon. Friend that no final decisions have been taken and that there will be a further opportunity for him and his constituents and those who speak for them to continue with their attitude and opposition if necessary to the proposals that have been made.
§ Question put and agreed to.
§ Adjourned accordingly at eight minutes to Five o'clock a.m.