§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Tinn.]
§ 11.24 p.m.
§ Mr. Keith Speed (Ashford)
I am glad to have the opportunity tonight to draw attention to the breakdown of the services to many patients in my constituency and the constituency of my hon. Friend the Member for Folkestone and Hythe (Mr. Costain), who later will seek to catch the eye of the Chair.
I wish to make it clear that my remarks in no way imply criticism of the doctors, nurses, supporting workers or administrators in the South-East Kent district, all of whom are carrying out a first-class job in most difficult circumstances. But the Minister should appreciate the background, namely, that within this district the borough of Ashford has been designated by the Kent County Council as a growth point over the next decade and in its structure plan. Indeed, already various Government Departments are being helpful by way of industrial development certificates and considerable housing, and industrial expansion is taking place within the town of Ashford itself. There are also the problems of the Shepway District Council related to the elderly population and pressures in both boroughs on the community services.
On 3rd March this year the hon. Member for Gravesend (Mr. Ovenden) initiated an Adjournment debate on the problems of the Kent Area Health Authority. He argued that within the whole of the South-East Thames Region the Kent area was worst treated. I think it is fair to summarise the Minister's reply by saying that he accepted that argument. I put it to the Minister that the two worst treated districts in the Kent area are Medway—which I understand the Minister is to visit later in the year—and South-East Kent.
The Kent Area Health Authority has received a boost to its revenue with an additional £3.3 million being made available from 1978–79 onwards. However, looking ahead, I understand that the regional health authority estimates that Kent will need an extra £38 million over 1351 the next 10 years to equalise services throughout the region. Of this, Kent needs £12 million just to maintain standards of service to the increasing population. Thus, a serious future problem remains.
In this connection I look particularly at what the Minister had to say about the Resource Allocation Working Party—RAWP as it is called—and the Minister might be able to say a little more about the matter tonight because it is of great importance. It has been represented as a battle between the London teaching hospitals and the area health authorities further removed from London. I hope that the matter is not seen in that light. Nevertheless, there appears to be a clash.
In the Adjournment debate on 3rd March, the self-same Minister who is to reply to this debate spoke of changingthe pattern of care towards comprehensive district-based services."—[Official Report, 3rd March 1978; Vol. 945, c. 943.]That is something I would very much wish to see. Indeed, in the South-East Kent district we could go a long way along that path if phase two of the William Harvey Hospital was proceeded with, but I shall have more to say about that in a moment.
I should like now to deal with the financial figures for the South-East Kent district. I understand that in the 1976–77 revenue allocations per head of population in the Kent Area Health Authority £35 went to Medway, £41 to South-East Kent, and £69 to Maidstone, while Tunbridge Wells, Canterbury and Thanet, and Dartford were up in the £80 per head range. The average for the South-East Thames Region was £76 per head. Therefore, South-East Kent, at £41 per head, was well below the average.
However, I accept that those are somewhat crude figures, and if we take the 1978–79 figures, adjusted for mental health and other services received—and perhaps these are more sophisticated figures and give a more accurate indication—I understand the position is that per head Medway received £44, South-East Kent £55, Maidstone £56, Dartford £70, Canterbury and Thanet £77, and Tunbridge Wells £77. Therefore, again Medway and South-East Kent are "tail end Charlie" and at the bottom of the queue in that form of measurement.
1352 This means that the problems currently faced by my constituents in some cases are quite serious. At the beginning of this year figures given to me for normal waiting times at the hospitals in Ashford for outpatient clinics were high and in some cases rising. Seventy-nine weeks was the waiting time for seeing the orthopaedic consultant for surgery, 16 weeks for rheumatism and rehabilitation, up to nine weeks for general medicine, 20 weeks for ophthalmology, up to 31 weeks for general surgery and 12 weeks for ear, nose and throat operations. Those are waiting times to see the consultants, who are desperately overworked, and are sometimes struggling hard and are starting very early in the morning to see their patients. On top of that there is the additional waiting time for the operation. I know from personal cases of which I have had experience that if people wish to have an operation in the South-East Kent district they have to wait a number of years in the case of some specialties.
This may arise because there is a deliberate policy—this is what is happening in fact, anyway—that a significant proportion of the patients in South-East Kent should be treated either in London or in Canterbury, or outside the district. It has been brought to my attention that this is the case. The resident population of the district is 240,000, and increasing, while the catchment population is 180,000. I believe that the difference is for those who are supposed to be treated outside, far away.
The Minister will know, looking at what he said in the Adjournment debate on 3rd March and also because he is a sensible man, that the cost of public transport is growing. It means a very real burden indeed if the friends and relatives of patients have to commute from the South Coast or Ashford to London. There is almost a total lack of public transport where I live, in Rolvenden, in the borough of Ashford, and to get to Canterbury by public transport and back is a day's hike, although the actual distance may be only about 30 miles. It is an area with which you will be well acquainted, Mr. Deputy Speaker.
I believe that these waiting times contrast badly with other districts in the region. From the figures that I have had I can say that they certainly contrast badly with the waiting times in hospitals 1353 in the London area health authorities. Apart from complaints by patients—I have had many of them—for the first time in my history as an hon. Member in this House for nine and a half years I have received complaints from general practitioners who, in desperation, have written to me asking whether anything can be done about it.
The new William Harvey Hospital is, as the Minister will understand, the linchpin of the provision for health services in the district. There are some questions that I want to ask the Minister about the hospital. First, will he confirm that phase 1, when the hospital opens, will provide only 30 extra acute beds in the district? I accept that these are high quality buildings and high quality services—but I believe that that is the situation.
Secondly, I understand that only five, or, at the most, six, operating theatres instead of the seven that were expected will be available. Is that so?
Thirdly, I understand that the 10-bed isolation ward that was originally planned is not to be opened, and that staffing submissions by all the departments in the new hospital are expected to be cut by 10 per cent. The medical photography department will not be opened, and there will be no physiotherapy department. This is quite important from the orthopaedic point of view, because I am told that patients will have to be bused from the William Harvey Hospital across the town of Ashford to the old Ashford hospital, a couple of miles, and back again, for that kind of treatment. I do not think that that is satisfactory.
I wonder whether the Minister can tell us when the opening day will be, because from articles that appeared recently in the local Press there seems to be considerable confusion. The information that I have received, from talking privately to people, is that, although the commissioning team is working flat out—I do not criticise it—I understand that it will be a further year before the first outpatients are treated at William Harvey, and it could be 18 months before the hospital is commissioned. I am sure that all my constituents and those of my hon. Friend will be most interested in any up-to-date news that the Minister can give us on that matter.
1354 I say to the Minister with all humility—because this hospital has been planned under both Governments and I am in no way criticising him personally—that the William Harvey as it stands at the moment is only half a hospital. I wonder whether the hon. Gentleman will confirm what I understand to be the situation, that many of the services, such as power, heating, and the pathology laboratories, are designed and have the capacity for a 700-bed hospital, including phase 2.
If phase 2 went ahead, it would include high priority facilities to which the Minister and his Department quite rightly pay attention—geriatric and mental illness accommodation, rehabilitation, and the physiotherapy department that I have already referred to. If this were allowed to go ahead, it would provide a balanced hospital, good career prospects for those working in it, and a proper and comprehensive service for the 250,000 resident population in the South-East Kent district. This population increases considerably in the summer months.
Can the Minister clear up whether phase two is dead—I hope that it is not—whether it is deferred or whether we can expect that, some time in the future, it will go ahead? Any sort of definitive statement would be enormously helpful for many of my constituents inside and outside the medical profession.
My hon. Friend and I have been told on a number of occasions that when the William Harvey Hospital is opened there will be a 24-hour casualty service. I am sure that the Minister is aware that his right hon. Friend the Secretary of State for Transport has announced that work is due to start this summer on construction of the M20 motorway between Folkestone and Ashford and, within the next couple of years, on the section from Ashford to Maidstone which will then link up right through to London.
The William Harvey Hospital will be within a few hundred yards of an access point to that motorway, which will carry very heavy European traffic down to Folkestone and along to Dover, which is the biggest passenger port in the country and which is expanding fast. I see the role of the William Harvey Hospital in relation to the M20 as similar to that of the Luton and Dunstable Hospital in relation to the M1. Apart from serving constituents, it will be important for the 1355 hospital to serve a long and busy section of motorway. I hope that the Minister can give an assurance that there will be a 24-hour casualty service and that there will be enough consultants and registrars to operate it. We shall be most concerned if that were not to go ahead.
In resources and services, the South-East Kent area has been a Cinderella for too long. I am concerned that the undoubted advantages that the William Harvey Hospital will bring may be used to stifle improvements elsewhere and that the facilities at the new hospital will not come up to earlier expectations. We heard what the Chancellor of the Exchequer said earlier about hospitals and waiting lists, and perhaps I can put in the first bid just a few hours after his Budget.
I hope that the Minister will accept that I put these suggestions and questions in a constructive and unpartisan manner, and I shall listen with very great interest to the answers he gives.
§ 11.38 p.m.
§ Mr. A. P. Costain (Folkestone and Hythe)
I am grateful to my hon. Friend the Member for Ashford (Mr. Speed) for sparing me three or four minutes of his precious debating time. I heartily support all he has said. I could read out the waiting times that I was given when I telephoned local doctors today, but they are similar to those given by my hon. Friend and I shall not delay the House on them except to say that one doctor told me that there was an 18-month wait before he could get an orthopaedic case into an outpatient department for examination. That man is out of work. It is an appalling situation.
The Minister will realise that the difference in procedure at the Royal Victoria Hospital caused a great deal of concern in Folkestone. More than 20,000 people signed a petition within a week of the announcement and the petition was sent to the Minister. The Shepway District Council has put a strong case for a community hospital and the South-East Kent District Plan confirms that, but we have had no information that it will continue along those lines.
I wish to make a special plea about the casualty unit. We have a main motorway close to two of the largest passenger ports in the world, yet the accident service 1356 closes at 5 p.m. I am afraid that my constituents are not so clever that they have accidents only between 8 a.m. and 5 p.m. The position is appalling. In the summer we have a quarter of a million people in our area. However, we do not have accident hospital facilities after 5 o'clock or 6 o'clock in the evening. After those hours it is necessary to go on to Canterbury.
Another problem is the ambulance service in Lydd. The service shuts down in the evening and the men are put on call. That situation is now being examined by the Kent county authority. I hope that we shall get some result. If we do not, I assure the Minister that I shall be coming back at him. The problem is acute, and I hope that he can give us some assurance that he is doing something about it.
§ 11.40 p.m.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)
My colleagues and I in the Department acknowledge that the people of Kent are at a disadvantage in the provision of health service facilities compared with other parts of the region. Hitherto we have examined some of the broader implications, but we have tended not to examine the alleged deficiencies in detail. The debate allows us some opportunity to remedy the situation in at least part of Kent.
I concentrate first on the specific aspects of the health services in Kent that were referred to by the hon. Members for Ashford (Mr. Speed) and Folkestone and Hythe (Mr. Costain). I shall then move on to consider some of the wider issues of general health service provision within Kent and the South-East Thames Region of the National Health Service.
I note that the hon. Member for Ashford has absorbed a large part of what I said on 3rd March. There is not a great deal of hard advance on that.
We regard the William Harvey Hospital as a major step towards correcting the deficiencies in the NHS in South-East Kent. The project has taken longer than we would wish. Planning for the new district hospital started about 10 years ago, and successive Ministers have continued to regard it as a worthwhile development. When it is opened it will provide over 300 acute beds and a full 1357 range of supporting services. I believe that it will bring a noticeable benefit to the people of South-East Kent. I cannot, unfortunately, comment on the extra number of beds that will be provided, but I shall write to the hon. Gentleman.
The hon. Gentleman asked about the opening date. I regret that there has been some further delay in opening the hospital. Full in-patient service is not now scheduled to be available until February or March next year. Outpatients are likely to be admitted about a month earlier. This has resulted from a delay of four months, from April to July of this year, in the handover from the contractors. The commissioning of a new hospital is a complex and somewhat lengthy business. Commissioning will not be able to begin until July, with hand-over taking place in February or March of next year.
The population of East Kent is fairly widespread and, therefore, no single location for the hospital could be expected to please everybody. However, Ashford has a great deal in its favour. I understand that the hon. Gentleman visited the construction site in January 1976 and at that stage said that he was favourably impressed with the range of modern facilities that could be provided. I believe that when the hospital comes into operation next year many of South-East Kent's health problems will start to be seen in a different light.
The hon. Gentleman asked some specific questions about services at the hospital. The Kent Area Health Authority would want to see further development on the William Harvey Hospital site. In other words, it would like phase 2 and it intends to build it. However, once phase 1 is completed phase 2 will have to contend for priority with much needed developments in other districts such as the Medway district. At this stage I do not know how the order of priorities will eventually sort themselves out.
It is also the authority's intention to operate a 24-hour casualty service at the William Harvey, but the way of achieving that continues to be a matter for discussion. It is essentially a matter of medical organisation. There are some who consider that, for the time being, the best course on medical grounds would be to concentrate the accident and emergency 1358 service on existing facilities at the Kent and Canterbury hospital.
§ Mr. Moyle
That is the view of some of the southern medical people there. These matters will have to be argued out.
A small physiotherapy department is being set up for in-patients, but as the hon. Gentleman supposed, for the foreseeable future outpatients will have to receive this service at Ashford Hospital.
There will be seven operating theatres, as planned, but it is thought probable that no more than six theatre teams will be required to meet surgical needs in the first phase.
Both hon Gentlemen referred to the question of waiting lists. Unfortunately, this problem has been with the National Health Service for many years. Some of the waiting lists reflect limited resources, but do not always reflect limited financial input. This is particularly true of orthopaedic surgery where recent developments in surgical techniques make new treatments possible and they have created a greatly increased demand. This is combined with the blocking of orthopaedic beds by an increasing number of frail, elderly females who break the necks of their femurs and things of that sort. This rapid increase in demand, plus the bed blocking, must be related to the many years that it takes to produce the appropriate consultants, who are coming along, but there is still a substantial gap.
A further contribution towards improving the waiting list position in South-East Kent should result from the extension and improvement of the orthopaedic ward at the Buckland Hospital, Dover. This programme is due to start in the current year, and its effect should be felt in about two years. Other developments include geriatric wards at the Queen Victoria Hospital, Deal, and a geriatric day hospital at the Royal Victoria hospital, Folkestone.
Inadequate management may also be a cause of lengthy waiting lists. We are therefore actively engaged in an exercise to improve the management arrangements for hospital waiting lists with a view to a reduction of waiting times. A circular has gone out to all health authorities publicising the techniques of good management with regard to waiting lists—for example, the advantages of holding 1359 waiting lists for hospital in-patient admissions which are common to a number of consultants within one specialty, increased use of day surgery and five-day wards, and the provision of regular information about waiting lists to consultants, management teams and general practitioners so that patients may be given the opportunity of accepting earlier treatment at a hospital farther from their homes.
The hon. Member for Folkestone and Hythe raised some cross questions about Folkestone hospital. I am well aware that the fate of the acute services provided there has been a matter of concern locally since early 1976 when the district management team initiated discussions on the rationalisation which might result from the opening of William Harvey.
The provision of an accident and emergency service for a seaside town was raised by the hon. Gentleman. It is a common problem in seaside towns. I regret that there is no ideal solution. The answers that we have so far been able to give are the result of a thorough study by the health authorities. I wrote to the hon. Gentleman on 22nd September last, saying:I have been assured that the Area Health Authority and the District Management Team are very anxious to ensure that the best possible service is provided within the resources available to them and that the need to retain a minor injuries service at Folkestone will continue to receive their close attention. They are very conscious of the genuine concern of local people and as soon as a firm and realistic decision can be reached, details of this will be generally publicised.I take issue with the hon. Member for Ashford on the title that he gave to this debate—deterioration of the NHS in South-East Kent. I appreciate that he does not want to make party points. On the other hand, I would like to defend the National Health Service. The district's throughput of patients, as measured by deaths and discharges per available bed, has increased steadily in both the medical and surgical specialties from an overall average of 18¼ patients per bed per year in 1974 to 19½ patients per bed per year in 1977. I feel that in time, as the planning system improves, genuine deficiencies in service will be remedied.
I turn now to the Resource Allocation Working Party formula as it affects Kent and the South-East Thames Region. Redistribution carried on under this has resulted in the South-East Thames 1360 Regional Health Authority obtaining only one-third per cent. growth per year.
The hon. Member for Ashford put in what he regarded as an early post-Budget bid. Perhaps I can give him an early post-Budget reassessment of the South-East Thames Region's position. It is very tentative. It is likely that the region's rate of growth will double as a result of the statement of my right hon. Friend the Chancellor of the Exchequer this afternoon, and this will probably mean about £1 million extra for the region. Some of this, of course, will be hypothecated to various purposes such as kidney machines, and other various priorities which my right hon. Friend mentioned, and it will not all be available for revenue funding for the region or the area.
Let me give some statistics. In 1977–78 the allocation was £78 per head being spent in the Kent catchment population compared with £108 in Greenwich and Bexley, and £122 in Lambeth. Southwark and Lewisham.
I should deal here with the problem raised by the hon. Member for Folkestone and Hythe with regard to the Kent Area Health Authority. I am happy to say that the authority has announced an allocation of funds to provide a 24-hour ambulance service at the Lydd ambulance station, which serves Romney. Discussions with staff on arrangements for the services are now in hand.
On the allocation of resources in London, the indications derived from the RAWP formula are largely hospital based. The GP service in Kent is of very good quality.
Another message I should like the hon. Gentleman to convey is that people in South London tend to say that they have spent a great deal of money on their social services in recent years and that they are not sure that the people of Kent have done the same. They sometimes think that weakness in the Kent social services has been used as an argument for taking health service resources from South London. They say they have played the game properly for many years. I am not saying that this is true, but it is a message that perhaps the hon. Gentleman would like to convey.
On national policy, my right hon. Friend the Secretary of State has said: 1361I am determined that the resources of this national service should be more fairly shared. Redistribution must not only be between regions but within regions as some of the biggest inequalities are between rich and poor areas or districts. But in seeking a fairer distribution I am equally determined not to destroy the quality of excellence in the National Health Service, the opportunities for new discovery or the tradition of medical education of which we are rightly proud.This is a big problem in that most of the riches of the London region are locked up in three major teaching hospitals. The people of Kent will want the resources of those hospitals in the future to man their health services. When allocations were made for 1977–78, the RHAs were told that resource targets should be assessed for areas. It was discovered that it would be very difficult to 1362 make the allocation for that year stick when there was no growth and there was therefore a standstill last year. At its last meeting, however, the regional health authority considered the allocation for 1978–79, and it felt able to recommend a modest first stage of improvement in Kent's relative position, both in terms of capital and revenue funding. I hope that this will be the beginning of an exercise that will continue steadily in the future.
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at six minutes to Twelve o'clock.