§ 2 pm
§ Mr. Fred Silvester (Manchester, Withington)
I have been hoping for some time that my name would he drawn out of Mr. Speaker's hat so that we could debate this subject and I am pleased that it has happened at last, though I am sorry for my hon. Friend the Minister for Social Security who has drawn the short straw of replying to the penultimate debate before the recess.
I hope that, although my hon. Friend has a carefully prepared brief from his civil servants, he will throw away some parts of it. I hope that he will not start by telling me that the NHS in the north-west has done relatively well. I know that, and I spend a lot of time telling people that fact. The growth rate in the north-west is 23 per cent. in real terms and is above the national rate. Those who live in Preston, Salford, Wigan, Blackpool, Burnley, Blackburn, Leigh, Bury, Oldham or Tameside will find new hospitals to prove it.
I also do not need to be told that the resource allocation working party system is very good for the north compared with the south, that an extra £52 million has been devoted to the north-west since 1979 and that RAWP is a good system for diverting resources. I know that, too.
I also hope that not too much of my hon. Friend's speech will be devoted to the fact that south Manchester is relatively well off and has 11 per cent. more than the RAWP average for other places in the area. I know that it is the third best in the north-west after Rochdale and Trafford on a hospitalisation index. I mention those facts to get them out of the way. They are agreed and we do not need to debate them.
Let us turn our attention to the nitty-gritty. The regional health authority plan says that Manchester is too attractive. Therefore, it is planned to reduce the number of patient treatments by 9,000 or 10,000—from about 76,000 in 1984 to about 66,000 in 1993. It follows that, with the removal of patients, there will be a removal of beds and of the staff and resources that go with them. The 9,000 or 10,000 patients are to be treated elsewhere in the north-west and the money will go to those districts. We are talking about a localised problem, but one of some magnitude.
While the loss is taking place, south Manchester, like other districts, is witnessing a growth in patient care, reckoned to be 2 or 3 per cent. However, unlike other districts, we are not getting extra money. Indeed, we are losing money. We shall have to deal with additional local patients by squeezing the service provided to them or by sending even more patients elsewhere. That is the basis of the problem.
My right hon. Friend the Secretary of State for the Environment recognised in yesterday's statement on the rate support grant that some authorities have less fat to remove than others, because they are already more efficient. We should apply the same principle to the NHS. Compared with other health authorities, the south Manchester authority is efficient and the fat does not exist.
Over the three years up to 1985–86, south Manchester has increased patient treatments by 11.5 per cent. and increased bed throughput by 13 per cent., at a time when 1481 its revenue has fallen by £3 million. It is the only district in the north-west that has managed higher activity on a lower budget.
My hon. Friend the Under-Secretary of State for Health and Social Security claimed in his latest letter to me that south Manchester's efficiency was the result of a massive increase in Government investment. It is true that £5 million capital was spent in the district between 1982 and 1984. However, let us be clear what that means. About £1.25 million of that is going on the cardiac and renal services, which are regional specialties. About £2.8 million is going on the Duchess of York new pediatric unit.
That is being paid for out of the savings—which will accrue by changing from the old service to the new unit —of £600,000 a year. All that the district is obtaining, therefore, is the bridging facility while that money comes in. Meanwhile, to pay for the other on-going expenses at the district level, capital expenses — for example on maintenance—are being severely cut.
The improved cost per patient of the district is due not so much to Government investment, as the Under-Secretary claimed, as to good management and increased efficiency. I emphasise the point about efficiency because the district has the second lowest management costs of the region, at under 3 per cent.
The support costs at the Withington and Christie hospitals are low compared with similar establishments. The staffing at the nursing levels is traditionally lower in the district than in hospitals generally, and the cost per activity in the district is the lowest in the north-west. One might compare, for example, the Royal Marsden with the Christie, two cancer hospitals of international repute. The cost per patient at the Royal Marsden is twice that at the Christie.
To meet the targets and budgets set for the district, the people there have not been idle. We have already closed one geriatric ward, having been told that the region has facilities elsewhere. Let us hope it has. One children's ward is being compressed for a year until the new unit opens. We can live with that. Two chest medicine wards have been closed. Again, the region says that it has scope elsewhere, and we hope it has. The maternity arrangements have been completely reorganised to make savings. Other savings have been made and yet others are projected.
The first of our units has gone out to competitive tender, and that represents a continued search for slimness in an already fit athlete. Nobody denies that those efforts should continue, and they will, but what is currently proposed is, frankly, daft. The Under-Secretary had the cheek in his letter to me to say:We are not, in fact, asking South Manchester Health Authority to reduce its services. We are requiring it to live within its means.He should not insult my intelligence or that of the people of south Manchester. The regional plan precisely and overtly requires south Manchester to reduce its services, and the budget allocated is based on that premise. Therefore, we can live within the means set by the region only by reducing services.
The district has struggled and has managed, on the whole, to maintain services to the patient. Despite much local propaganda, it is generally true that services to the 1482 patient have not been badly affected and are still very good. However, we are storing up severe long-term problems. Some of our facilities are now under great strain and matters such as maintenance will get progressively worse.
However, even what we have accomplished is not enough. The original deficit for the current year was £3 million. By the prodigious efforts that I have described, the authority got it down to £900,000. We now have the pay award which, on our calculations, will add £750,000, so that the deficit will rise to £1.5 million. To achieve that, we are having to look at a 4 per cent. across-the-board cut in services. That will affect the medical as well as the support staff and other facilities. To pretend that this is not a cut in south Manchester is to debase the Government's case. This cut is taking place in a region which is expanding and doing well, but it is certainly a cut and no semantics will overcome that fact.
Is this policy sensible? The Government are undoubtedly right in saying that people on the whole would rather be treated locally so that they no longer need to go into Manchester. However, this takes time. We are not responsible for GP referrals. We cannot be responsible for the speed or the absence of facilities in neighbouring districts. We cannot help it if, as is apparently the case, Christie hospital is bogged down with smear tests referred to it from Merseyside and all over the north-west. The hospital does not have the ability to cope. If these reductions occur, our ability to cope will be diminished. If there is to be a transfer to other parts of the north-west, there must be a link between the transfer and reduction of resources.
There is a grey area between those treatments that are purely local and can be treated in district hospitals elsewhere in the north-west and those that are recognised as regional specialties. The reputation of teaching hospitals, especially these hospitals, continues to act as an attraction. Why not? It is difficult to argue that there is any point in destroying excellence simply because it fits into an administrative pattern.
A new element has entered this confusion. We are told that the reduction in the number of patients in south Manchester will no longer be 9,000 by 1993 but will be only 1,200 because Trafford will no longer have its new general hospital. Instead of losing only 3,500 patients, Trafford will lose 9,000 and the additional patients will come across the border to the Wythenshawe hospital.
By 1993, the reduction in south Manchester will be less than originally imagined. Will there be more money? So far, there has been a resounding silence on that question. Will my hon. Friend the Minister guarantee that revised higher budgets for south Manchester will be rapidly produced between now and 1993 to take account of the fact that the case load will be different? We must have that information as soon as possible.
The facilities which are being closed to meet budgetary requirements will be needed if there are to be additional patients by 1993. Do we really envisage that we will remove facilities, with good teams and people working together, in order to have a downturn in the late 1980s, and that we shall try to reconstruct these facilities in the early 1990s? Does that make any sense? Will my hon. Friend urgently consider the programme with the region and the district between now and 1993 in order to avoid breaking up this year teams which will be needed later?
1483 My hon. Friend the Minister and I are good Tories. One of the aspects of being a good Tory is to be sensitive to the speed of change. They may not think that in the GLC, but it is generally true. No amount of accountants' rhetoric can change that. Even if the region is right —I have doubts about some of its policies—there is no way in which this change can take place at this speed. The change will be too quick and unmanageable.
The co-operation which was supposed to occur between the region and the district has not taken place. The regional chairman, Sir John Page, has clearly said that, if he had more money, he would not give it to the south Manchester district. There are 19 districts and, if 18 benefit and one loses, it is no good taking the matter to a vote. But the Minister has ultimate responsibility for it. which he cannot overcome.
I remind my hon. Friend that in 1983 the Government gave a special grant to Tadworth Court hospital over and above its regional allocation direct from the Department. It then gave £890,000 for each of three years. Far be it from me to suggest that that occurred because it was in the south of England and because there was intense media interest in the matter. I am sure that nothing of that kind occurred to influence the decision. But I will not even ask for the £1.5 million that we are short of; I will settle for the same as Tadworth Court. Will the Minister give us £890,000 or some other suitable sum which will help us through the transitional period?
I am very serious about these matters and I should be more than grateful if the Minister would put away his Civil Service brief and look at the problem seriously for himself, remembering my three questions. I am sure that he desires, as I do, not to tarnish a very good record in the National Health Service, and particularly in the north-west. But we cannot make that stick if we allow the region to inflict severe and unnecessary damage on one of the finest centres of medical skill. care and research in the country.
§ The Minister for Social Security (Mr. Tony Newton)
Despite the kind words of my hon. Friend the Member for Manchester, Withington (Mr. Silvester) at the outset about my having drawn the short straw in being here at this time, I am glad that he has had the opportunity, thanks to his luck in Mr. Speaker's draw—or whatever other mechanism is used for deciding when the debates take place—to bring this subject before the House this afternoon. It enables me to pay a well-deserved tribute to the assiduity with which my hon. Friend advances the cause of his constituents and brings the arguments before the House and before Ministers. It also gives me an opportunity to make some comment on the points that he raised.
My hon. Friend will realise that, in pre-empting some of the points that he expected me to make, I shall not be entirely diverted from some observations about what I take to be the record of the present Administration in providing resources for the Health Service in the north-west, but I shall also try to make some response to my hon. Friend's specific questions.
I do not need to tell my hon. Friend that resources in this area are undoubtedly not limitless, any more than are resources in any of the other fields with which Ministers are concerned in this or other Departments, but often the demands can he limitless. Clearly, there is a very large demand for health services, particularly when we take 1484 account of the increased number of things that can be done with modern techniques and modern knowledge. One of the main reasons for some of the pressures that we face is the very success of modern medicine, with the much wider range and scope of treatment that it can offer.
It is remarkable that south Manchester, like many other districts throughout the country, is treating many patients today who a few years ago would have had no hope whatever of being treated. That is part of the background to our debate. Even allowing for my hon. Friend's comments, that record has been assisted by a very considerable investment in the south Manchester district. Health Service resources will always—it is probably in the nature of things — be catching up with medical advance, but there has been a considerable investment and it has played a part in the achievements to which he referred and which I want to emphasise.
Equally, I accept that our job as Ministers in the DHSS is to look at all the demands, taking account of and making a judgment about priorities. We have to make as fair and just decisions as we can among the many competing claims. More specifically, we have the responsibility—I refer particularly to the Minister for Health and the Under-Secretary of State dealing with health matters — of dividing the money available to the Health Service between the 14 regional health authorities in England. My hon. Friend will understand how sorry my right hon. and learned Friend and my hon. Friend the Under-Secretary are that they were unable to be here this afternoon.
It is the job of the regional health authorities to divide their share among the district health authorities that manage local health services. That allocation of resources to districts must be taken at regional level because at that level are the people who have some genuine understanding of regional and local needs — the people close to the coal face, to use a fashionable metaphor. It is the job of districts to spend prudently the money that they are allocated, as a result of their judgment of what is needed, and not as a result of a decision imposed by Ministers from the centre.
Whatever adjustments one might make to the balance of that decision-making process, it is clear that it would be wrong and unacceptable for south Manchester, or anywhere else, if Ministers attempted to second-guess every decision made at regional or local level.
We are well aware that historically the north-western region has been a deprived area and needs our special attention. My hon. Friend fairly acknowledged that the Government have made great strides towards reducing the inequalities that have existed since the NHS began. Our plans are largely to complete a redistribution of health resources among the relatively well off and relatively poor areas within the next 10 years. The total additional revenue allocation for the north-west this year is £43 million—5.5 per cent above the 1984–85 level. As my hon. Friend is aware, the region is moving quickly towards its revenue target within that framework and will be only 1.8 per cent. below it this year. That should be compared with the fact that it was nearly 11 per cent. below its target in 1977–78 under the Labour Government.
I wish to emphasis the fact that the capital allocation in the north-west this year is the second highest in England. The north-western region receives about 11 per cent. of the national cake for new buildings. About £1 billion-worth of new hospital schemes are being planned, designed and built.
1485 I hope that it will be common ground between my hon. Friend and I that the north-western region is better off now than it was; it is being more fairly treated in relation to other health regions; it is treating more patients and, I understand, receiving fewer complaints about services than ever before.
I recognise that the implications of all that for south Manchester are of interest to my hon. Friend. The district development for teaching has continued rapidly. A number of facts, some of which my hon. Friend has mentioned, should be emphasised. There has been £5 million of capital spending within the district during the past two years. A new day unit for elderly, mentally infirm patients is in operation. My hon. Friend referred to the £1.25 million in revenue that has been spent on cardiac services and kidney dialysis. Those services are of great importance to many people. He also referred to the new paediatric unit at Withington hospital and an acute leukaemia treatment unit at Chistie hospital which are due to be started this year at a cost of £3.6 million.
The district is one of the best funded in the region, and it is the highest funded per head of the population of the north-western region's three teaching districts. In the light of what my hon. Friend said, I do not wish to place great emphasis on that, but in south Manchester it is easier to gain hospital treatment quickly than in many other districts in the north-west, such as Bolton and Blackpool.
Looked at from one point of view, the challenge facing the region—it has its difficulties— is to move other districts towards south Manchester's position. That is the task to which the region has been directing its attention in its new strategic plan. I am in difficulty this afternoon because that new plan was submitted to the Department only recently, and clearly neither officials nor Ministers have had the opportunity that they would wish to consider it.
I am inhibited from giving clear-cut answers to my hon. Friend. It is too early to give a considered reaction to a plan that has only just been received. Against the background of the regional priority, it is clear that south Manchester will continue to develop. This year alone, 50 more open-heart operations are planned at Wythenshawe hospital, making 900 in all, and 41 more renal dialysis treatments are planned at Withington, making 268 in all. That is the sort of development of which we can all be proud, especially those living in south Manchester.
To come closer to the heart of what my hon. Friend was saying, there is the problem that some of that progress could be endangered if the district continues to overspend its cash limits. I understand that £2.8 million is likely to be overspent this year. Unless that is checked, that is money pre-empted from the development in south Manchester and other districts. Under any Government, not just this Government, health authorities must live within their budgets. The regional health authority is therefore working with the district to find ways to reduce the accumulated overspend while continuing to provide the current excellent level of service. They are trying to bring spending under control in ways that go beyond the present arguments and genuinely wish to lay the 1486 foundations for future developments in south Manchester. It is important that that should be achieved because, unless it is, it could put in jeopardy the progress that has been made to make south Manchester the centre of life-saving surgery, which undoubtedly it is.
The district authority has set a budget for 1985–86 that can be contained within its cash limits by making better use of its facilities and cutting out waste. In all of that, the proposals are being carefully monitored by the region to minimise the impact on patient care. As far as possible, the region and district hope to reduce the deficit.
Some of the proposed changes may have an effect on the number of beds in certain specialties. For example, a reduction in the number of chest medicine beds might mean that chest medicine would have to be absorbed by neighbouring districts. But, as my hon. Friend acknowledged, if people can receive the care they need closer to their homes, that is an advantage rather than a disadvantage.
I want to pick up the specific questions raised by my hon. Friend. He referred first to guaranteeing revised higher budgets to take account of changes occurring in the plans in other parts of the north-west. He mentioned preserving teams for facilities that might be needed to meet the outcome of the first question. He raised a point about being sensitive to the speed of change. I thought that he was chancing his arm with his parallel with Tadworth, but I understand the spirit in which he put that forward.
I acknowledge my hon. Friend's questions and their importance. He will not expect me to respond specifically this afternoon against the background that the Government are considering the region's strategic plan that underlies his questions. However, I undertake to ensure that my right hon. and hon. Friends will carefully consider his questions; I will ensure that they are brought to their attention. I have no doubt that they will have those questions in mind when considering the region's plan, as they have a duty to do, and when reaching conclusions upon it.
I thank my hon. Friend for ensuring that these concerns are fully and properly brought to the attention of Ministers. I appreciate the spirit in which he has done that. In spite of the fact that there is a large task for us all in this matter, I see no reason to believe that south Manchester, together with the region—and I hope with the help of Ministers —will not succeed in dealing with the difficulties to which my hon. Friend adverted. There will be good cause for the local community and everyone concerned in the north-west, and south Manchester in particular, to be grateful to them for doing so and to my hon. Friend for his efforts to ensure that these considerations are properly taken into account.
§ It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.