§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Greg Knight.]11.48 pm
§ Mr. Robert Wareing (Liverpool, West Derby)
The subject of this debate—the future of medicine in Liverpool —comes from the title of a report commissioned by Sir Donald Wilson, chairman of the Mersey regional health authority, which was itself a response to a £3.4 million reduction in the authority's budget as a result of a Government diktat.
The document produced for the Mersey authority is, in effect, purely a cost-cutting exercise, and has nothing whatever to do with an improvement of conditions for Liverpool patients. One of the major anxieties of the people of Liverpool is the proposed closure of the accident and emergency unit at Broadgreen and Walton hospitals. At present, Broadgreen hospital caters for 45,000 attendances a year; under the proposals, those would be transferred to the Royal Liverpool hospital, whose own A and E unit has 80,000 attendances a year. That hospital — in the centre of the city—also expects to receive 30,000 eye patients who would normally have gone to St. Paul's eye hospital, which is also due for closure in the near future.
It is estimated that some 10,000 of the 80,000 attendances at the Walton unit are likely to be transferred to the Royal Liverpool. That will double the number of attendances there, and will, I believe, require the enlargement of the hospital, at who knows what cost. Patients who now attend the emergency unit at Broadgreen hospital are mostly from the suburban estate and residential areas of Liverpool—and, indeed, casualties on the M62, the end of which is just a few hundred yards from the hospital entrance. When I say that the hospital has been telephoned on standby six times in the past six months by Liverpool airport, hon. Members will realise the importance of the unit.
There is no doubt that Broadgreen is also of great benefit to many people who live on the perimeter of Liverpool, being situated in Queens drive, the main ring road linking the north and south of the city. Anyone who knows Liverpool and its traffic conditions will realise that there is considerable congestion in the rush hours between the Royal Liverpool—the city-centre hospital—and the outskirts of the city. Ten years ago, just before Christmas, I myself suffered a serious road accident in the Walton area, and was only too glad to be sent to such a handy hospital as Broadgreen.
A case has recently come to my notice. A 19-year-old girl living within the Broadgreen catchment area was received by the hospital and resuscitated. I am told by staff at the hospital that, had it been five minutes later, she might well have died. Certainly she would not have reached the Royal Liverpool in time to be rescued at that time of day.
Accidents and emergency patients now using Walton hospital, are to be transferred to Fazakerley hospital. Anyone with any notion of the traffic conditions between that hospital and Queens drive, at the north end of the city, will know the bottleneck at the end of Walton vale, by the Black Bull public house. It will be difficult for ambulance drivers to negotiate that stretch of territory. Many people 557 living in the north of the city would be almost unprotected if they had an accident without the option of Broadgreen and Walton.
The six clinicians who published the report either acted out of ignorance of traffic conditions in Liverpool or—perhaps even worse—if they acted in full knowledge of Liverpool's travel logistics, what they are recommending for the citizens of Liverpool is criminal. We can expect more avoidable deaths in the future. It is believed that 5,000 road accident deaths could have been avoided last year. We can expect many more. Unless the Minister is prepared to do something, he will have to shoulder some of the responsibility for deaths that could have been avoided. He ought to reconsider the proposed closure of the accident and emergency units at Broadgreen and Walton.
Coronary patients who are successfully resuscitated at the Royal Liverpool hospital are sent to the coronary unit at—guess where?—Broadgreen hospital. An elderly person who fractured a leg or hip and was taken first to the Royal Liverpool hospital would then have to be sent to the geriatric unit at Broadgreen for specialist care. It is essential that the Broadgreen and Walton accident and emergency units should remain open for the people of Liverpool.
The report also suggests that the number of beds in Liverpool should be reduced by 1,125, or 25 per cent. There are now 4,500 beds, 500 of them for paediatric patients. If the proposals are pushed through by the Mersey regional health authority, there will be only 3,000 beds for adult patients. That will have implications for the university's medical school. There will be a greater turnover of patients, many of whom will be sent out into a community ill fitted to look after them, as the amount of money provided for social services in the city has also been greatly reduced.
The Minister's stock answer may be that the reason for the cuts is a reduction of Liverpool's population. Between 1985 and 1994, it is estimated to fall by 10 per cent. As we have seen with the balance of payments, the Government cannot do their sums. This is another example. A 10 per cent. reduction in the city's population does not justify a 25 per cent. cut in the number of beds in its hospitals. The number of people in Liverpool over the ages of 80 and 85 is expected to increase. They, more than any other group, have contributed to the National Health Service and they deserve far more consideration than the Mersey regional health authority or the Government seem willing to give them.
Population statistics are not sufficient. The Liverpool hospitals are regional centres, providing services not just for the people of Liverpool and Merseyside, but for the people of north Wales, the Isle of Man, the north-west and even further away. According to a recent estimate by the Office of Population Censuses and Surveys, between 1984 and 1987 there was an increase of more than 4.8 per cent. in the birth rate, so there should be no reduction in the number of paediatric beds at the Alder Hey children's hospital or at the children's hospital in Myrtle street in the city centre.
The report accepts that there will be an increase in the number of people living into their 80s. yet it is 558 recommended that the Park, Rathbone, Garston and Sefton General hospitals should close, all of which have beds for elderly patients.
As I have said the report is the result of the work of six clinicians—a very narrow technical group. They ignored many interested people. Indeed, the people of Liverpool were ignored. The community health council is against the proposals, but it was not consulted. Even the district health authorities were not consulted. St. Helens and Knowsley health authority was not consulted despite the implications in the closure of the accident and emergency unit at Broadgreen for the Whiston hospital in its area.
The nurses were not consulted in connection with the report and the district nurses were also ignored. The general practitioners received no consideration at all. Community workers and consultants who care for the elderly were not asked for their views. Liverpool is supposedly one of the healthy cities under the scheme sponsored by the World Health Organisation, which was not consulted about the proposals which apparently have been accepted by Mersey region and by the Government. The proposals are opposed by the community health council, the National Union of Public Employees, the Confederation of Health Service Employees, the Manufacturing, Finance and Science union, the Royal College of Nursing and the medical board of the Broadgreen hospital. To my knowledge, 28 consultants have opposed the proposals in the report.
At the end, the report, states that 123 people responded to the survey which led to the final report. That does not mean that those people agreed with its conclusions. It would have been better if the report provided some tabulation to show the attitudes of the 123 people who were interviewed.
The people of Liverpool are virtually at one with the attitude that I have expressed today. They believe that it is an utter scandal that an accident and emergency unit just a few hundred yards from the end of a major motorway should face closure, but the people of Liverpool have not been consulted about that. I urge the Minister to intervene by listening to the people of Liverpool and consulting them and then, one hopes, setting the current proposal aside. Of course we want efficiency in our hospitals, but the report is not the right way to achieve it. It is an utter disgrace for the provision of accident and emergency services in our city.
§ 12.4 am
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)
I congratulate the hon. Member for Liverpool, West Derby (Mr. Wareing) on obtaining this Adjournment debate and on making his points so clearly and forcefully. I share his interest in ensuring that there is a fair, decent and comprehensive health service for the people of Liverpool and that that service should be properly organised. Since joining the Department of Health a year ago, I have visited Liverpool four times, because I share the hon. Gentleman's great interest in ensuring that a proper National Health service is supplied not only to the hon. Gentleman's constituency but to the great city of Liverpool.
The report on the future of medicine in the city of Liverpool is a radical strategy for improving services, and it contains about 27 recommendations. It was commissioned by the Mersey regional health authority and the 559 university of Liverpool, and is the work of six eminent local clinicians. Their remit was to look critically at not only the immediate problems facing Liverpool hospitals but the pattern of services needed to meet the needs of the people of Liverpool and the surrounding area up to and into the next century. Any suggestion that that was purely a cost-cutting exercise is not true. There was no diktat from central Government, either to carry out the review or in directing its conclusions.
§ Mr. Wareing
Does the Minister agree that Sir Donald Wilson, the chairman of the district health authority, attempted to prevail upon the Secretary of State last August to alter the situation so that there would not be a cut in expenditure and so that the proposals would not have had to be carried out?
§ Mr. Freeman
Following the successful settlement for the National Health Service announced by my right hon. Friend the Chancellor of the Exchequer in the Autumn Statement. My right hon. and learned Friend the Secretary of State for Health will shortly make announcements concerning regional allocations. They will be significantly better than the planning assumptions that were used by all the regions, including Mersey, in the summer. The allocations will be on the basis of weighted capitation—that is to say, on the resident populations of the regions, weighted for demography, morbidity and the relative costs of providing services. The allocations will be better than those assumed last July in the early planning for next year.
The review to which the hon. Gentleman has referred was not instituted or pressured for reasons of financial savings in either the region or his own district. It was a cool, rational and radical look at future provision for services.
In common with other large cities, Liverpool is having to face the fact that, under a fairer system of allocating resources to districts, it will be receiving less money than it has traditionally been used to. That is true. It is simply because, as the hon. Gentleman said, the population of Liverpool is declining.
In future, health districts will be funded on the basis of their resident populations and not on the services they provide. Revenue allocations based on resident populations will be weighted for demography, morbidity and the relative cost of providing services, as I have already said, and regional health authorities will also take into account other factors in allocating funds to districts. Liverpool has a falling population which it is predicted will continue falling into the late 1990s.
The hon. Gentleman said that the OPCS forecasts a fall of about 10 per cent. in the population over the next five years, and I agree with him. It will have implications for the recruitment of nurses and doctors. The report starts from that point and suggests how, within financial constraints, services can be better co-ordinated and improved. It sets out a vision for the future. The districts concerned have only just begun considering the suggestions and it will be some time before the report's proposals can be integrated into their overall planning.
Some of the service changes which the report recommends are already in train and form part of the plans that the Liverpool and South Sefton health authorities have been working on for the past two years. Liverpool health authority published its strategy for acute and community hospitals as long ago as 1987. This set out 560 its proposals to centralise children's services at Alder Hey, and women's services at a refurbished Royal Infirmary next door to the Royal Liverpool hospital. Ophthalmic services will be transferred from St. Paul's eye hospital into a district general hospital, possibly the Royal Liverpool. There has been substantial capital investment in these rationalisations. The aim is to improve the quality of service and in due course achieve revenue savings from the reduced overheads.
I believe that the hon. Gentleman referred to Walton, where the centralisation of acute services in south Sefton, on the site of the Fazakerley hospital, involves the closure of the much-loved, but old-fashioned, Walton hospital. This strategy has been approved after formal consultation and without formal objection by the community health council.
This package of developments has therefore been subject to proper public consultation or is still being considered, where that consultation has not commenced or been concluded.
§ Mr. Wareing
I am obliged again to the Minister. Is he taking on board the points that I have made about congestion at certain areas in the city? Unless he does that, he is ignoring completely what is troubling so many people, especially about the closure of the accident and emergency unit at Broadgreen. The front gates of that hospital are only a few hundred yards from a major motorway, where there are accidents, and it is situated on a major arterial road around the city. What could be more ludicrous than closing that unit? How can the Minister justify it?
§ Mr. Freeman
I was going to deal with that point a little later, but it might be for the convenience of the House if I dealt with it now. The report suggests a number of radical solutions. However, it is a report only; it is for the districts themselves to decide what the future provision of services should be. This is only an element in their considerations. Any proposals that the district makes will be subject to the full consultation prodedure, involving the community health council, with which the hon. Gentleman must be familiar, and in the case of certain proposals, that is clearly some way off.
The report is merely a suggestion. It is not being forced on the districts either by the Department of Health or by the region. The districts will make up their minds about the future provision of services, and when they do, they will make firm proposals, which will be a matter for public consultation.
The factors that the hon. Gentleman has mentioned, are valid and I am sure that they will be considered. If there is consistent objection by the community health council, the proposals will come to Ministers for final consideration, but we are still some considerable way from that position.
In the Government's judgment it makes no sense to perpetuate the existence of a large number of old-fashioned hospitals, which are uneconomic to run and would be prohibitively expensive to modernise, when a better and more cost-effective service can be provided at a smaller number of modern centres. That applies not only to Liverpool, but to any large city or district health authority.
The other development that is already under way in the city is at Fazakerley hospital, managed by the South 561 Sefton health authority. This is a major capital development which will take place over the next six or seven years, and involves the transfer of services from the old-fashioned Walton hospital to the modern Fazakerley site. This will produce a large modern hospital with integrated services providing a good working environment for staff and pleasant surroundings for patients and visitors. The decision to proceed was taken only after looking at other options and is supported by doctors and other clinical staff and, as I understand it, by the community health council.
The hon. Gentleman well knows of other recent significant capital developments in Liverpool. At the Broadgreen hospital, to which he has referred, £12 million has been spent on a nucleus development. That is a new extension to the hospital and was opened in April this year. I am informed that work on a £4.5 million psychiatric unit has commenced. At the Royal Liverpool children's hospital at Alder Hey, £4.6 million is being spent on cardiac theatres that are to come into use early next year.
Those are major developments with demonstrable advantages. Most of the report's other recommendations are concerned with the more efficient organisation of medical services and training, and better deployment of professional skills. In particular it is suggested that a wider teaching and clinical base will be needed if the university medical school is to maintain its high reputation and compete with Manchester and other cities in offering first-class referral services.
That will be especially important for Liverpool when our legislation on White Paper proposals comes into effect, creating a highly competitive marketplace for medical services. It will also enable the university to play a major role in research and development. Many of those ideas have been around for some time, but the lines of communication between some specialties, hospitals, health authorities and the university have not encouraged their spread or facilitated their implementation. It is salutary that they should now be spelled out in a bold way calling for action or at least open discussion.
I am aware that a proposal which is causing considerable concern locally and to the hon. Gentleman tonight, is the suggested closure of the accident and emergency unit at Broadgreen. That is related to an anticipated reduction in population and the consequent difficulty of maintaining three viable all-risk accident and 562 emergency departments in the city. I must make it absolutely clear that it is still only a suggestion. The implications are considerable, and the districts concerned will be looking at them closely. The hon. Gentleman has already referred to a number of factors that they should rightly take into account. Detailed consideration in the light of local circumstances is essential.
The proposal to close the unit at Broadgreen may or may not be feasible. The regional health authority has simply asked the districts to consider it. Any major service change will, of course, be subject to the normal consultative process. It is not for Ministers to speculate on the outcome of local planning or discussion which has not yet even begun, or to interfere in that process.
The report also refers to a reduction in the overall number of hospital beds in the city. Again I must emphasise that this is not a Government directive to cut services. It is the considered view of clinicians, whose interest is the improvement of medical services, not their curtailment. The report points out that bed provision is expensive and that, if beds are occupied by patients who do not need to be in hospital, that takes up resources that could be used for improving treatment. Any reduction must be phased and accompanied by increased emphasis on rehabilitation services and day care. Hospital beds will still be available for those who need them. Again it will be for the health authorities concerned to examine the suggestion, to work out details and to ensure that any firm proposals are in the interests of patients, and that there is proper consultation on their conclusions.
The proposals come from the report commissioned by the Mersey regional health authority with the co-operation of the university, which was prepared by some distinguished clinicians. The regional health authority has merely asked the districts to bear the report in mind. It is not a diktat or a blueprint for the future.
Normal consultation procedures will apply to any proposals that the districts care to introduce as a result of considering not only the report, but many other factors. Recently, the population of Liverpool has been falling, and it is forecast to fall further. The hon. Gentleman and I want a fair, decent system of health care in Liverpool appropriate to the population. I am sure that the hon. Gentleman would not ask for more than that, and I am confident that that will be ensured.
§ Question put and agreed to.
§ Adjourned accordingly at eighteen minutes past Twelve o'clock.