§ Mr. Ieuan Wyn Jones (Ynys Môn)
I now understand what it means when hon. Members tell me that the timetable of the House is extremely fluid. I am reminded of the time when I was an advocate in the magistrates court, standing outside the court waiting for my case to come on, to be told that the best estimate was such and such a time, only to discover that that estimate was wildly inaccurate. I am grateful that I have not been caught out on this occasion.
I am grateful to the Minister of State for being here to respond to this important debate. In normal times, the Parliamentary Under-Secretary would have been at the Dispatch Box, but unfortunately he has been indisposed of late. I trust that the Minister will convey to him my best wishes and those of my hon. Friends for a speedy recovery. Indeed, I am sure that that is the wish of the House generally.
On 3 March of this year the Secretary of State for Wales approved plans by Gwynedd health authority to close a number of hospitals in the county and to transfer some services to other sites. This could be seen as the culmination of a long period of public discussion and concern which began in the autumn of 1987 when the plans were first announced.
What else, may one be forgiven for asking, is there to say? The Secretary of State has given what some will see as the final word on the matter, save that there will be a further short period of consultation on the future of Caernarfon cottage hospital. I say that some people might come to that conclusion, but my hon. Friends and I have not. I aim through this debate to highlight the profound concerns which remain.
The Secretary of State carries the ultimate responsibility for the provision of health services in Wales. That duty is clearly set out in section 1 of the National Health Service Act 1977 which states:It is the Secretary of State's duty to continue the promotion in England and Wales of a comprehensive health service designed to secure improvement—
I stress the word "comprehensive". It does not mean the provision of an unbalanced, incomplete or disjointed service, but that provision of services should be across the board, dealing with all aspects of mental and physical health for children, young, middle-aged and old people in the acute sector and in the community.
- (a) in the physical and mental health of the people of those countries, and—
- (b) in the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with this Act."
The Secretary of State is also charged with a more specific duty in section 3 of the Act, which states:It is the Secretary of State's duty to provide throughout England and Wales, to such extent as he considers necessary to meet all reasonable requirements—
That is the Secretary of State's remit. He fails in his duty if the Health Service in any part of Wales does not meet the general requirement in section 1 and the specific requirements in section 3 which are subject to some qualifications.
- (a) hospital accommodation;
- (b) other accommodation for the purpose of any service provided under this Act;
- (c) medical, dental, nursing and ambulance services;
- (d) such other facilities for the care of expectant and nursing mothers and young children as he considers appropriate as part of the health service;
- (e) such facilities for the prevention of illness, the care of persons suffering from illnesses and the after-care
1263 of persons who have suffered from illness as he considers are appropriate as part of the health service;
- (f) such other services as are required for the diagnosis and treatment of illness."
Neither the Secretary of State nor his Department have day-to-day conduct or control of the service. Under sections 13 and 15 of the Act, he has powers to direct district health authorities to carry out those functions on his behalf.
I shall outline the background leading to the rationalisation plan and seek to persuade the Minister to set up an inquiry under section 85 of the Act, having regard to the fact that the authority is not providing a comprehensive health service in Gwynedd.
The Welsh Office commissioned a firm of management consultants, Deloitte, Haskins and Sells, to report on the health authority's financial affairs. As the Under-Secretary of State admitted in a debate in the House on 14 June 1988, that was a direct result of Welsh Office concern at the way in which the authority ran its finances. The Under-Secretary of State for Wales said:I cannot say that I am satisfied with the level of financial management shown by the authority. That was one of the reasons for calling in management consultants. The consultants' recommendations bear out that."—[Official Report, 14 June 1988; Vol. 135, c. 549.]The report was scathing in its condemnation of the authority's management team and its lack of financial planning, budgetary control and management accounting system. I shall quote some examples of the comments in that report, but there were many others. Paragraph 54 states:Insufficient management action was taken".Paragraph 55 continues:We have to conclude that the authority's senior managers have not addressed the difficult but necessary task with sufficient urgency and co-ordinationand paragraph 86 goes on:Planning operates outside the general management structure".The clear implication is that the Welsh Office demanded that the authority implement the package of measures proposed by Deloittes to bring it back into balance and avert a major financial catastrophe. The measures suggested by Deloittes largely formed the basis of the rationalisation plan which was ultimately backed by the Secretary of State in toto except for the hospital at Caernarfon, which had a temporary reprieve.
The part played by the Welsh Office in the plan cannot be denied. It appointed Deloittes in May 1987 to report on the authority and that was quite clear from the terms of reference it gave. Arising directly from the instructions to the consultants are the hospital closure plans. In giving the consultants terms of reference which did not mention the need to have regard to the adequacy of health care in the county, the Welsh Office effectively directed the consultants to produce a report which would recommend cuts.
The Welsh Office wrote to Deloittes on 6 October 1987 referring to assurances of continued support to the authorityso long as they accept the need for full implementation of the programme".1264 When the authority told the public during the consultation period that the package had to go through as a whole, it obviously had that stricture very much in mind.
The inevitable question which now arises is why was the authority in such a financial predicament. The clear implication is that once again the financial difficulties arose in the 1980s, partly due to the authority's failure to control the capital and revenue costs of ysbyty Gwynedd. That is referred to in Deloittes report.
The willingness of the health authority to axe community hospital services because of financial pressure and its reluctance to give priority to community service development led many to believe that those with a preference for the further growth of ysbyty Gwynedd wielded real power at the expense of the outlying communities. In my opinion, the authority's current management structure contributes to the concentration of resources at ysbyty Gwynedd. The management team includes officers who represent geographical districts rather than clinical disciplines. There is a strong case for arguing that discussions on spending should be based on priorities within disciplines rather than geography. Effectively, that means that no one person is responsible for community services. As a result, weaker districts constantly lose out in the battle for cash. Cuts are nearly always made in community provision because of the geographical strength of the district in which ysbyty Gwynedd is located.
It is true that Gwynedd health authority has a strategic plan which includes plans for community hospitals, but they are nothing more than academic exercise. In my view and those of my colleagues, the authority should have grasped the nettle long ago. Clwyd health authority did so in the mid-1970s and it now has a network of small community hospitals with full attendant services. I challenge the Minister to say that Gwynedd has a single community hospital anywhere in the county which meets those basic requirements. I refer the Minister to the remarks of the junior Health Minister responding to a similar debate on 21 March setting out four basic provisions which are required for community hospitals, none of which are present in Gwynedd.
Gwynedd health authority says that it does not have the resources to contemplate such a programme, yet the Welsh Office claims that it is one of the best-funded health authorities in Wales, based on the latest capital and revenue formulae. Who is right? The debate continues and while statistics and formulae are discussed ad nauseam the public suffer. The general public, who are not responsible for the authority's financial crisis, have been denied a comprehensive health service. Elderly people are being denied dignity in their old age and some are being hospitalised and institutionalised due to the lack of adequate day-care facilities and support for carers. There is a chronic shortage of speech therapists for children with speech problems and elderly people who have suffered strokes. Gwynedd has 11 speech therapists when it should have 45. There is also intense pressure on physiotherapists and occupational therapists. I have seen elderly people suffering from senile dementia shunted from establishment to establishment because of the lack of adequate facilities to care for them. Relatives of elderly people have telephoned me late at night in desperation and at their wits' end because they have been told that they must find accommodation for their elderly relative urgently as the hospital bed is required by another patient.
1265 I am particularly worried about the lack of provision for the elderly mentally ill. Why should Gwynedd be denied these services? Who in reality pays the price for the health authority's inability to come to terms with its financial and planning responsibilities? Why has it failed to develope a coherent strategy? The health authority seems to get away scot free——
§ It being 11 o'clock, MR. SPEAKER interrupted the proceedings, pursuant to Standing Order No. 11 (Friday sittings).