§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Brooke.]2.30 pm
§ Mr. Julian Critchley (Aldershot)
My hon. and learned Friend the Minister for Health has had a hard day, and I have no wish to add unduly to his burdens.
The district health authority responsible since 1 April 1982 for the management and provision of health services for my constituency in Hampshire is the West Surrey and North-East Hampshire health authority. As the name implies, it includes part of Surrey and part of Hampshire—the whole of Rushmoor borough and a major part of Hart district. Just over half of the population of the health district are in the Hampshire part, which includes my constituency. The health authority is one of 13 in the south-west Thames region, while the rest of Hampshire rests happily within Wessex region.
I emphasise two major problems facing the new district health authority that were inherited from Surrey area health authority. Those problems are in addition to the great difficulty of relating Hampshire county council, Surrey county council and five district or borough councils, and at the same time having to manage outside our area a large mental illness hospital at Brookwood, which also serves other health districts. The first problem is that, although our health district is relatively under-provided, it is within an over-provided region. Secondly, the rate of growth of the population following housing and employment development since 1979 has outstripped the provision of Health Service facilities and the money provided. The current targets for housing and population growth to the end of the 1980s would repeat the growth from 1971 to 1981, but as yet there is no major capital development scheme for the district.
The effects of the growth in need for health services, without additional funds or facilities, have created frustration and concern among the general public, their elected representatives and the Health Service workers and professionals in the district. They feel strongly that there has been inadequate resource allocation, to an unfair extent, in recent years and that, despite efforts towards far greater efficiency, we risk losing adequate standards of provision.
To illustrate the nature and seriousness of the problem in our area I offer the following evidence. The population of the Hampshire part of the district increased between 1971 and 1981 by more than 17,000, or more than 14 per cent. The Surrey part of the district grew almost as fast, and there were more than 32,000 additional residents in the health district by 1981, out of a census count of 1249 265,000. This part of Hampshire and Surrey is within area 8, which is a major growth area as part of the strategy for south-east England.
Within the health districts, the fastest population growth over the past decade, and forecasted also for the next decade, is in Hart and Surrey Heath. Frimley Park hospital was one of the first to be built to an identical design—a best-buy hospital opened in 1974. When it was planned it was decided to have a lower provision for acute specialties than the norm, and the number of beds was related to a population of 170,000, after some account had been taken of the military hospitals within the district.
The funding for the new hospital was, like the capital cost, extremely closely controlled. There was, at the same time, a closure programme of small local hospitals to release money. I am advised that insufficient allowance was made for the change in activity level. Since its opening the hospital has reached and surpassed its planned performance level. Emergency and other non-waiting list work accounts for more than half of the total. There have not been sufficient funds to use the intensive and heart care unit fully. The result is that there are an increasing number of occasions when the unit, a major accident unit, has to stop admitting emergencies. In addition, it has been the practice for the health districts to be given targets for reduction in expenditure on a pro rata basis. The combined effect of such restraints has resulted in 37 beds at Frimley Park and Farnham hospitals not being used because of a lack of funds.
The health district has a lower than average proportion of residents over 65 years, following the inflow of new population and a higher than average birth rate. There is a similar increase in the number of elderly as elsewhere and there is a shortfall in hospital provision for the elderly. There is a very short length of stay in specialties, with an increase in the work for community services. There are no facilities within the district for psychogeriatric patients.
The rapid increase in the population, the movement of families and the higher than average child population make additional work. However, the expenditure per resident on community health services is the lowest of the 13 in the region. In 1980–81 more than £500,000 extra would have had to be spent in the district to reach the national average. The health district has fewer in-patient facilities available for acute mental illness than the regional health authority 1982 guidelines and, indeed, has fewer than the two other Surrey health districts for which Brookwood hospital provides a service.
There are no specific National Health Service facilities within the district for the younger chronic sick or for mentally handicapped children. Restrictions on local authority spending and the population increase have also limited the ability of both county councils to provide additional services or take on extra commitments within the health district for groups such as the elderly and the mentally ill.
The district has had to make efficiency savings in 1981–82 and 1982–83 in real terms. In 1983–84, the 0.5 per cent. requirement—£150,000—will, however, be made available for re-use within the district following the RHA's decision to ask four London health districts to produce additional savings as the region's contribution to redistribution of NHS resources within England. That gesture is, in part perhaps, thanks to the delegation from my part of the world that went to see the Minister and other authorities last December.
1250 Expenditure on mental illness and community services is already low. The cost per patient per day at Frimley Park and Brookwood hospitals, which account for two thirds of the district's expenditure, is among the lowest in the region, as is the cost per case at Frimley Park hospital, which has one of the fastest throughputs and shortest lengths of stay. Ironically, increasing the number of patients being treated, while being more efficient and more effective, would increase total expenditure. The local view is that the hospital has gone beyond the optimum point. One symptom is the need to cancel planned admissions.
I am aware that the health district has already done many of the things that any good housekeeper would do to reduce expenditure; for example, rationalising the number and size of unit, reducing management costs and running productivity schemes.
As previously stated, the health district now has a shortfall in hospital-based service provision for nearly all specialty groups as compared with the average. More and more patients are sent by GPs outside the district for surgical and other conditions. The demand within the district is depressed artificially because there is not enough capacity to provide NHS care within the districts—it is a vicious circle of declining expenditure.
Patients requiring non-acute care and those who require community-based health service care and support can get those only within the district, and the little available is being spread thinner and thinner. The recent population increase without matching funding to develop services has meant that there has been a cut in provision. The RHA's recently published figures for resource allocations to districts for 1982–83 compared with 1979–80 show that west Surrey and north-east Hampshire had the lowest increase in spending power.
Change is needed in three main ways. First, the district should receive additional revenue at the earliest possible date to provide more community services and to make the best use of existing facilities. Secondly, the RHA should include additional, general acute specialty hospital facilities in its major capital programme, with a start at the earliest possible date. Its current review of its programme has included a feasibility study of an addition to the Frimley Park hospital of 110 to 120 beds, plus support departments. Thirdly, we need an opportunity to achieve an overall balanced Health Service provision in the district.
The district has been told that it will not receive any development moneys from the region for 1983–84. That decision is regrettable, given the weight of evidence available. The region appears to be incapable both of saving money to pass to other regions and of moving resources internally quickly enough to keep pace with population changes that have taken place in west Surrey and north-east Hampshire. That is especially so when its capital allocation is insufficient.
Will the Minister consider how, either in overall allocations of revenue and capital to the regions, or in specific guidelines, the needs of west Surrey and north-east Hampshire might be met sooner than appears possible? The district will be making proposals through its region for a pilot project under the care in the community programme. Success with that, or with other bids for special funding, would also help to meet our requirements.
There is a need for close co-operation between local and health authorities, with the aim of harmonising plans for the development of housing, personal social services and 1251 health services. There seems to have been some improvement. However, the DHSS cannot cope with, or keep up with, the ambitions of the Department of the Environment. Is it not high time that my right hon. Friends got their acts together?
§ The Minister for Health (Mr. Kenneth Clarke)
I am grateful to my hon. Friend the Member for Aldershot (Mr. Critchley) for raising this important issue. He has taken a close interest in it for a considerable time and he and my hon. Friend the Member for Surrey, North-West (Mr. Grylls) have been with deputations to see Mr. Tony Driver, the chairman of the south-west Thames regional health authority. He came to see me in December and put the case that he has developed in the House this afternoon. He has been concerned for a long time about the need for additional health care facilities in the west Surrey and north-east Hampshire district health authority. This Adjournment debate has followed on closely from the debate that has just taken place on the welfare state.
The particular problem in this district health authority is not so much that cuts have been made in terms of reduced spending or resources, but that the DHSS is having to keep up with the expected population growth, which is expected to be rapid, in the area it serves. He has helped to make me well aware of the pressure that is now being imposed upon the health services in the west Surrey and north-east Hampshire district. I appreciate his final point of the need to ensure that we match planning which gives rise to population growth with planning for a future health provision. Perhaps those two matters could be tied more closely together in future in his part of the country than they have been in the past.
The south-west Thames regional health authority is initially responsible for allocating capital and revenue resources to each of its districts. It has ensured that much development has taken place in this district and more is planned. I appreciate that there is pressure on all health services in the district and that the throughput in the beds at Frimley Park hospital is already high, especially in the surgical specialties. That does show, as my hon. Friend said, that there is an urgent priority for more acute beds to be provided.
Work has been proceeding to identify the possible scale of the additional provision that would be needed and the way in which it might most quickly and cost-effectively be provided. My hon. Friend referred to the work that the officers of the regional and district health authorities have recently done by way of detailed analysis of the probable future population to be served. That analysis was carried out to assess the future needs for acute beds in the district. A feasibility study has been undertaken of the proposed extension to Frimley Park hospital because an extension to that hospital is the most sensible way of coping with future demands.
I am told that both authorities have agreed a planning population of 300,000 for acute services as a basis for an immediate development in the district. They have also agreed that there can be an acute bed ratio lower than is normally found throughout this region because, as my hon. Friend said, there is a younger age structure in the population as compared with the average.
1252 The officers of the two authorities have taken account of other matters, such as the expected population growth to 1990–91, the contribution made by the military hospitals to both military personnel and the civilian population, the cross-boundary flows of patients within different districts inside the south-west Thames region with the Wessex and Oxford regions and the unusually young population that I have referred to.
On this basis, the health authorities have agreed that there will be a need for 110 extra acute beds within the district. Those beds could most effectively be provided by building on land that adjoins Frimley Park hospital. That land is to be purchased from the Ministry of Defence. That is one good piece of news which emerged last year. The difficulties that might have arisen about the purchase of that land have been completely resolved.
The estimated capital cost of extending Frimley Park hospital is now thought likely to be about £7.8 million. That will impose additional revenue consequences by way of extra annual costs being incurred of up to £3 million. The regional authority has considered the feasibility study of Frimley Park hospital and the region's finance panel examined that study yesterday. A full report on that and other proposed schemes for inclusion in the south-west Thames forward capital programme will be put to the regional health authority for a decision on 13 April.
To put that into context and to explain the way in which the regional health authority will be making its decisions in April, I shall give an explanation of what the region has been doing. After I met my hon. Friend on his most recent deputation, I had a discussion with the regional chairman, Mr. Tony Driver, and his officers and examined the ways in which they are handling their capital programme, and they explained that to my full satisfaction.
As my hon. Friend is aware, the region's capital programme is under considerable pressure, with all 13 districts in south-west Thames, including west Surrey and north-east Hampshire, seeking capital investment for district general hospital developments at a time when the region is not only trying to keep up with the growth in population in parts of Surrey and Hampshire, but also has an important policy objective of trying to divert capital and revenue resources into improving services for the mentally handicapped. The south-west region has many hospitals for the mentally handicapped and there is a clear need to improve some of the services as rapidly as possible. Against that background, the region has recently undertaken a comprehensive review of the capital programme, in consultation with its districts, in an attempt to make a broad assessment of overall priorities by considering districts' bids for capital against a set of common criteria.
Several new feasibility studies have now been undertaken, including that on the Frimley Park hospital. As I have said, the regional health authority will be asked to decide which schemes should be given a firm place in the forward capital programme. On 13 April, therefore, the regional health authority will be deciding from a number of bids whether to extend Frimley Park and finding what can be fitted into a realistic capital programme. Having heard my hon. Friend's argument, I trust that the region will give the fullest possible weight to the case that he has put forward on behalf of his constituents, bearing in mind the likely increase in the number of his constituents in future. We appreciate that the region is having difficulty with its capital programme, because of 1253 the demands of the growing population and the need to make some new provision for the mentally handicapped. We have already helped the region with its recent programming difficulties by giving it a £2 million strategic loan for 1983–84, and have promised it a further £3 million in 1984–85 and 1985–86.
If the proposed extension to Frimley Park hospital is approved by the regional health authority in April, and gets through the subsequent checks that my Department carries out, the aim will be to start work on the extension in 1986, and to complete the development by 1989–90, when it is expected that the demand for those additional beds will be made to the extent that has been calculated.
I realise that between now and the end of the decade there will be some difficulties for the west Surrey and north-east Hampshire district health authority, particularly, as my hon. Friend said, in the provision of community services within the district. The south-west Thames region has taken steps within its resource allocation policy to help the district with its immediate revenue problems. With the Government's full support and approval, the south-west Thames region is committed to a policy of revenue redistribution among the districts in its region in order to move towards resources that are more fairly distributed and that allow equal access to health services for those in the different parts of the region. At the moment, the region has some rather over-resourced districts, particularly nearer to central London, and some under-resourced districts, where the population has grown most quickly, further away from London.
The pace at which the region moves towards equalisation of resources depends on several factors, including the need for development of particular services and the pace that it can achieve, in practice, in rationalising services in the relatively better provided districts, to ensure that a proper level of service is provided within realistic resource levels. In addition, it must bear in mind the time needed to recruit and train staff, and to provide facilities to improve or increase services to patients who are in the relatively less well provided districts. For that purpose, south-west Thames region regards my hon. Friend's district health authority as one that is less well provided for. However, the present figures seem to show that the area is somewhat over-resourced for its population, although it is proper to regard it as under-re sourced, given the rapid growth in the population and the demand that is imminent.
The south-west Thames region is redistributing resources by asking its above-target districts to meet 1254 between them the 0.5 per cent. efficiency savings that the region has agreed with us to contribute towards the development pool that we are using to develop services nationally.
Therefore, the 0.5 per cent. efficiency savings that we are looking for from the region are all being found from the above-target districts. The other districts, which include my hon. Friend's district, are not being asked to make any contribution towards that national development pool. Like any organisation with a large budget. they will be able to make savings by increased efficiency and in other ways. The 0.5 per cent. saving is a modest measure of what can be achieved by good management by bodies of that size year by year. Any sums saved in that way will all be available to be put towards developing the local services in the district.
Although the west surrey and north-east Hampshire health authority is shown on present measurements to be above its revenue target, the region has nevertheless allowed it to retain what would otherwise have been its contribution to the efficiency pool. It can use its own resources in the way that I have described. That will go some way towards helping the district to make better use of existing facilities, such as reopening closed beds and increasing the throughput in existing beds as far as possible. It should help them to look at ways to develop community nursing and other services.
I hope that I have been able to give my hon. Friend an assurance that the health care needs of the west Surrey and north-east Hampshire health authority have not been ignored or overlooked. Plainly, he will continue to press Ministers in my Department and the regional health authority on the matter and make sure that we do not ignore or overlook them.
The next immediate decision that we are awaiting is the decision to be taken by the regional health authority in April on its capital programme. We shall see whether the extension to Frimley Park hospital can be included. If it can, that will be good news for my hon. Friend's constituents. I hope that I have also been able to give him some reassurance about the way in which the revenue demands of the district might be met over the next few years to make it clear that there is no question of any improvements of efficiency and cost-effectiveness made in his district being taken away from the district. They will all be available to develop better patient care.
Question put and agreed to.
Adjourned accordingly at four minutes to Three o'clock.