§ Motion made, and Question proposed, That this House do now adjourn.—Mr. Neubert. ]10.23 pm
§ Mr. Michael Mates (Hampshire, East)
I am glad to give the Minister this opportunity to answer some of the questions that my hon. Friends and I have been raising about the resources allocation in the south-west Thames region to one of its districts.
In the west Surrey and north-east Hampshire district health area there have been proposals to close and reduce three facilities, action which would have a major impact on the lives of people living there. I refer to the closure of the Fleet hospital, the cessation of surgery at Farnham hospital and the closure of a ward at Frimley Park general hospital.
Had such a proposal been tough but fair and in line with Government policy, I should have been inclined to accept it and explain to my constituents the rationale behind it, because in general terms I believe that the Government's policy is right. However, the effects of the proposal, if it were implemented, would be neither fair nor reasonable, a fact that has been accepted by the regional health authority and the Department of Health.
Historically, the district has been under-funded and this lack of resources has been exacerbated by the fact that we live in an area where growth in house building, and therefore new population, has been particularly rapid. The cumulative effect of this is that those within the area, my constituents among them, are being unfairly and ever increasingly discriminated against in the amount of health resources they receive.
Under the RAWP formula, which is the main plank of the Government's policy, the district is receiving about £78 per patient against a national average of £100 and a regional average of £109—in other words, considerably less than the resources to which it should be entitled. In our region, this imbalance is as great as in any region in the country. For example, the Wandsworth district receives £156, per patient, more than double the amount that is received by west Surrey or north-east Hampshire.
In addition, the district's performance indicators, which are the Government's measures of efficiency and productivity, are the best in the region. The cumulative effect of this is that the district with the least resources but the best record of efficiency is continually under-funded while others which operate less efficiently continue to be over-funded.
§ Mrs. Virginia Bottomley (Surrey, South-West)
I thank my hon. Friend for raising this subject. I am also involved, as my constituency contains Farnham hospital. I ask my hon. Friend to reaffirm that in our district the efficiency of patient turnover and cost effectiveness are amongst the best in the country. Nobody is seeking an unfair allocation of resources. We all want a fair allocation of resources and the avoidance of waste in the interests of patient care. However, am I not right in thinking that our figures are among the best in the country?
§ Mr. Mates
My hon. Friend is quite right and no doubt the Minister will agree. These facts are not in dispute. am sure that the Minister will agree that the sum total of these facts is an intolerable situation. However, despite the representations made to the Ministry, it is not prepared to 975 intervene in the region's management decisions. Despite representations to the region, it is not prepared to intervene in the district's management. The current jargon which has been used by the Minister himself is that management must not be second-guessed. I applaud the Government's efforts to sharpen up management, but they cannot simply back away from highly political decisions by saying that they are not prepared to intervene.
The Minister's job is to see that his policy is having the effect he intends. If not, he has the right and the duty, to give directions that the Government policy is carried out.
I recognise that the region has a difficult task in allocating its shrinking resources. I fully support the Government's decision to reallocate the resources from where they have been historically spent to areas where a new need has arisen. My point is that this admirable policy is being implemented only in a few health districts and that the Minister should ensure that his policy reaches down to the sharp end of the Health Service. We boast, and rightly so, that our record in health service provision in the past six years is second to none. The present policy should result in that excellent record being enhanced. If the Government are unable or unwilling to carry out fine tuning, when for a number of understandable reasons the policy is not working, we shall lose the argument.
My constituents are in an area where an unwanted growth in housing has been foisted upon them and it is no use telling them that the Government's policy is fair and sensible if the reality they see is the closure of and reduction in health services which are already under strain. Nor would I wish to try to do so.
Many Members try to plead special reasons why their constituents should be more favourably treated than others. This is not one of those occasions and forms no part of my argument. I am asking the Government for nothing to which our people are not entitled, nor am I asking the Government to change their policy. I ask only that, having frankly admitted that my constituents are being disadvantaged because of Government policies, the Minister should take steps to correct the situation. Thus I will be able to report that the Government's programme for distribution of health resources is sound and sensible, which I believe it to be, and it is seen to be fairly operated.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
I am grateful for the opportunity which my hon. Friend the Member for Hampshire, East (Mr. Mates) has given me and the House to discuss the important problems to which he has drawn our attention. I congratulate him on the way in which he has demonstrated his concern. I know that that concern is shared by my hon. Friend the Member for Surrey, South-West (Mrs. Bottomley) and others of my hon. Friends whose constituents serve within the relevant district health authority area.
Before turning to the details of the district and the problems to which my hon. Friend has referred, I hope that he will allow me to make one or two general points to set the issue in context. The title of the debate, which my hon. Friend requested, was "The Allocation of Resources within Regional Health Authorities". It is important to recognise that the resources that we are allocating nationally are increasing and have increased during the 976 period of this Government at a significant rate. I know that my hon. Friend recognises that, but it is important that the message is communicated again and again to all our constituents. We have doubled spending in cash terms, and in real terms the increase has been over 20 per cent.
The issue is not limited to the transfer of resources because services have improved for patients. That is a measure by which we can stand to be judged, and we are happy to do so. There is often talk about waiting lists, but I regard that as a poor proxy measure. Our achievements in terms of the number of patients treated are much more significant. Only last year, the number of day cases treated nationally rose by 11 per cent. to 903,000 and the number of in-patient cases rose by 2.6 per cent. to 6.18 million. At the same time, we have seen capital expenditure increase significantly. In the five years between 1980 and 1984, there were 36 major new hospital schemes. Progress continues with over 75 major schemes to a total value in excess of £850 million.
My hon. Friend would rightly ask, "What about distribution?" I am sure that my right hon. and hon. Friends recognise that the significant transfer of resources to health care is commendable, especially at a time when public spending is rightly under pressure. But is distribution unfair, not least in the district health authority in my hon. Friend's constituency?
Reference has been made to the formidable animal called the Resource Allocation Working Party. The policy of RAWP has been in operation since 1976 and its objective has been accepted by virtually all those concerned, at least in outline. When it pinches on their own interests, however, different views often obtain. There is a broad acceptance of the ideas of RAWP, which are based on the principle of providing equal opportunity of access for health care needs for people at equal risk. The fundamental emphasis is on equality of access. Successive Governments have accepted and implemented the RAWP approach.
As my hon. Friend knows, the RAWP approach involves a complex calculation both of the revenue and capital implications of the target and the fair share of resources. Revenue targets are based fundamentally on relative populations. Population figures are weighted, first, to reflect the make-up of the population by age and sex and to reflect the use that the population makes of health services as analysed over six main blocks of services. Secondly, standardised mortality ratios are used, which the RAWP recommended could be used as a proxy for relative need for health care. This is a complex matter, but it has been accepted that it produces answers which will help to achieve equality of access to health care.
Other factors in the RAWP calculations reflect cross-boundary flows of patients, the existence of teaching facilities, the funding of a small number of supra-regional services and, in the case of the Thames regions, for London weighting. The capital formula is similiar to the complex revenue formula, but is based on population figures projected for the five years ahead of the year of allocation and they deliberately ignore cross-boundary flows.
The application of the RAWP formula to the south-west Thames regional health authority undoubtedly poses a difficult task for that authority over the next 10 years. As a Thames region, it will be expected to release an element of its historically high level of funding for redeployment elsewhere. At the same time, within the region, it has to 977 plan for revenue to be redistributed from some of its districts, including some in London, to others which its own internal RAWP formula shows are in need of extra money. My hon. Friend has referred to the needs of his district.
Without going further into the minutiae of these calculations, I should like to stress that it is for the regional health authority to determine in the first instance the basis of the principles that we have set nationally. I recognise my hon. Friend's point about the final responsibility of central Government. The district and regional levels are crucial factors in the balance of the operations of the Health Service. The DHSS has received and is examining regional strategic plans which set out the regions' intentions over the next decade. Those plans require ministerial approval. Obviously, my ministerial colleagues and I will be reviewing them carefully.
The south-west Thames regional health authority plan is being considered by the Department. It is expected that it will be with Ministers at the end of the year. Ministers will also have the opportunity to discuss the services and resources with the regional chairman and officers at the annual ministerial review meetings. There is a balance between the responsibilities and duties at the district and regional level and the DHSS.
§ Mr. Whitney
My hon. Friend talks about the "immediate threat of closure". The proposal—it was no more than that — with respect to the three hospital facilities to which he referred has now been withdrawn. As I understand it, there is no immediate threat of closure. There is a need to ensure that within the RAWP formulae —nationally clown to district health authority level—the proposals are implemented at a measured and sensible pace. There is a strict limit to the pace at which they can be pursued. I hope that my hon. Friend will accept that the proposals which were floated and which caused such concern have been withdrawn.
§ Mr. Whitney
If my hon. Friend will allow me, because we are running fast out of time, I wish to draw his attention to two resources that are being moved into the district and must be taken into account in all the calculations. The west Surrey and north east Hampshire district will be receiving more than £5 million extra a year in revenue over the next 10 years. It is important to recognise that already this year that district has had significant financial help from the region. It has received an additional £400,000 a year in recurrent revenue; it has had non-recurrent bridging finance to help the mental illness sector to the tune of £644,000. The region has agreed to underwrite overspending in the mental illness sector this year of £200,000. That adds up to £1 million.
Planning has also started on an extension to the main district general hospital at Frimley Park to provide 110 978 extra beds. This will cost in excess of £7 million, and the region hopes to start work on it in 1987. Recognising that the district has a low base of capital stock, it bought the Brompton hospital site in the district last year at a cost of about £3.5 million. We should compare that with the position of a district in the same region which has to find ways of coping with a reduction of £1 million this year and nearly £14 million a year by 1994.
The regional chairman wrote to all district chainnen within his region, asking them to examine their spending patterns for the year and, if an overspend was projected, to put forward a package of measures to bring them back to target. The west Surrey and north east Hampshire distrct made public possible ward arid hospital closures to curtail spending before having discussions with the authority and before going through the normal consultation process. As I have said, those plans are not going ahead.
The regional health authority has had to work out a policy for moving resources which it believes to be fair to every district—those that are under-provided as well as the better off ones. When decisions are made, much importance is attached to timing and to the minimum disruption both to the gainers and to the losers. It will be a matter of judgment how fast a pace can be sensibly maintained. In the timing we have to take account of the redistribution of resources to gainers and of the anticipated opening of major capital projects.
In the case of the west Surrey and north east Hampshire district, the bulk of its additional revenue will become available in 1990 and 1991 when the new extension to Frimley Park hospital should be ready to open. By then the district will be getting an extra £4.5 million a year out of a total of 5.1 million planned for 1994.
It has long been our view that every health authority in the country should make every penny that it receives count in the service to patients. It is important that those districts which can show they are not so well off as they might be do not just sit back and wait for more money. They must review every aspect of their services to make sure that they are fully effective and efficient. We have asked authorities to provide cost improvement programmes which show a saving of at least 1 per cent. of their revenue base. Districts can then retain these savings to be used for service development as they think necessary. We have also encouraged authorities to put some of their housekeeping services — cleaning, laundry and catering — out to competitive tender as a means of making savings. The House should know that the south west Thames region has already made enormous progress in this area and is to be congratulated on the excellent results achieved.
I am aware that this district, as well as the Basingstoke and north Hampshire health authority will be affected by plans to build more dwellings in the area up to 1991. Naturally that causes concern to the health authorities which have to provide extra services for the additional population. I know that both districts have made representations to my right hon. Friend the Secretary of State for the Environment about alterations to the structure plan which will propose that the number of new dwellings should be increased to 20,000. I assure my hon. Friend that I will write to the chairman of the two regional health authorities concerned and ask them whether these developments were taken into account when their 10-year resource plans were drawn up. If not, I hope they will 979 consider looking again at the level of provision set aside for these districts in the context of their resource distribution policy.
I hope that what I have said will go at least some way —I must not be too optimistic—to reassure my hon. Friends that we recognise the pressures. I hope that they understand that the movement towards meeting their RAWP targets is happening, although it will not be at the pace that we should all like for reasons which I hope that we all understand. Nevertheless, the movement is in the right direction. The problems of the area are understood at district and regional levels and also in the Department, but we must continue to look for the good housekeeping which experience has shown can be achieved throughout the country.
I now appreciate that the alarm and dismay that was caused when the proposals were floated had a singularly unfortunate impact in the constituencies of my hon. Friends. I hope that they now recognise that the very significant transfer of resources that we are making to our health effort is producing results throughout the country and that their district is not being neglected but will be able to look forward to an increasing share of the resources available in years to come. We must, however, be governed by the realities of the problem and the need to balance, in this case, the demands of inner London against the growing demands creating by the rising population of my hon. Friend's district.
§ Mr. Deputy Speaker (Mr. Ernest Armstrong)
Order. The hon. Gentleman must not make another speech unless the Minister has not yet concluded his remarks.
§ Mr. Mates
All that my hon. Friend the Minister has said reinforces the points that I have made. We are indeed short of resources, and resources are being reallocated slowly—I understand all the arguments about that—but proposals, for example, to close a ward at Frimley Park hospital when we are getting ready to build a whole new 980 extension make the whole problem, which is really just an accounting problem, even more ludicrous in the eyes of the people in the district.
My hon. Friend the Minister talks of the proposals having being been withdrawn as though that meant that the problem had gone away. In fact, by refusing to carry out the region's instructions the district health authority has now put itself in the red, so the problem has not gone away. Indeed, there is a risk that it will get worse in the next six months and that even more severe cuts will be required next April when the overspend will have grown because the savings will not have been made because the proposals have been withdrawn. The Department's complacent view that it will all come out in the wash may be true in four or five years' time, but it is not true for those actually being deprived of patient care at this moment.
§ Mr. Whitney
I hope that my hon. Friend will accept that people are not being deprived of patient care at this moment. The proposals have been withdrawn, but the Department is certainly not complacent. There is an overall framework—we seem to agree on that—and the movement towards it is steady. Indeed, on the figures that I have given, I would say that the movement is impressive. Nevertheless, we must look to the district to play its part in meeting the imperatives which none of us can escape. Much has been achieved in many other districts by way of cost improvements and, indeed, rationalisation. From time to time that must include hospital closures because there are many small, inefficient and inaccessible hospitals. I make no comment on these particular instances, but in some circumstances that may well make sense because it is a major part of our policy—and one which I certainly stand by —that having appointed regional and district health authorities we must, within very broad parameters, allow them to make their management judgments within the resource implications that we impose. I was about to say "resource constraints", but it is important to recognise that the district health authority will have an expanding budget at its disposal. We look to the authority to use that expanding budget sensibly.
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes to Eleven o'clock.