§ Mr. David Bellotti (Eastbourne)
I thank those who have enabled me to speak this morning. I thank also the Minister for the time that she is to give to responding to the debate.
As a Sussex Member of Parliament, and as a keen supporter of Brighton and Hove Albion, may I take one moment to express my good wishes to the team on its success last night in reaching the final of the play-offs. The team will appear at Wembley in June. I wish the management and the players well on that occasion.
This is a very serious debate. When one looks at the figures of those who are waiting for national health service operations in the Eastbourne area, one can only be very surprised indeed. Last September we had 3,938 people on the hospital waiting list, over 1,000 of whom had been waiting for over a year. The position during the last six months—the most recent figures of all are those to March 1991—shows little or no improvement on those figures. Although the Government have encouraged health authorities, in Eastbourne in particular, to reduce the number of people who have been waiting for more than two years, that has been at the cost of those who have been waiting for up to two years. Today we still have 3,900 people on our hospital waiting list.
Perhaps even worse is the position of the notional time that it would take to clear that number of people. If there were no new people requiring hospital surgery and therefore hospital admission, it would take one year and 14 weeks for that number of people to be treated. Of the 191 district health authorities, Eastbourne is the fifteenth worst. We are in the bottom 8 per cent. for performance and for high waiting lists. I understand that the position in the south-east Thames area is the worst in the country. It has six of the worst 16 district health authorities out of the total of 191.
We have also suffered a massive loss of beds. Since 1983 there has been a 36.2 per cent. reduction in the number of beds available in the Eastbourne health authority. That has to be set against a south-east Thames average reduction of 30 per cent. and an all-England average of 21.2 per cent. We have lost a much larger number of beds than other district health authorities. During the October by-election that saw my election to this House. the Conservative candidate tried to claim—and did claim in writing—that we had 200 beds at St. Mary's hospital which, when visited, he could see had been demolished.
Since that occasion in October I have had referred to me a fairly large number of cases, to a few of which I wish to refer. I shall make the full details available to the Minister, but I am sure that she will understand if I refer to them as cases. The first case is Mr. A. Mr. A had been waiting to go into our district general hospital for major surgery for an aneurysm of the aorta—quite a dangerous condition that requires intensive care. Twice he was given a date for admission and twice it was cancelled. One can imagine the stress. On the third occasion he was admitted. He was prepared for surgery but he then had to be sent home, after preparation for surgery, because another emergency required the bed space. One can also imagine the stress on that occasion. The pressure on bed space in the district general hospital is just one of the problems that we face.
1100 The outpatient services, though, fare little better. There have been considerable cuts in joint funding, available with local authorities. The example that I want to give is that of Master Craig. He is a Down's syndrome child. The county has recognised that he has special speech therapy needs, but unfortunately that therapy has had to cease. He was obtaining 30 minutes of therapy each month—itself thought to be inadequate, but at least a help—but that has now been terminated. A letter from the district speech therapy manager of the district's community health services says that speech therapy will no longer be available in this caseuntil our funding and staffing levels are increased.A similar letter from the same speech therapy manager sent to all schools showed that speech therapists would no longer be available to visit schools to assess children. In other words, they would have to be known to have a need or be referred to a clinic by someone else, but it is not clear who.
On a further case I am pleased to say that my late predecessor obtained success during his time as Member of Parliament for Eastbourne. In March 1989 Master W experienced a problem obtaining a replacement for a national health service bone conductor hearing aid. After some months his mother went to the late Ian Gow who managed to secure that replacement by July 1989. At the time, a promise was given that a spare bone conductor hearing aid would be kept at Brighton or Eastbourne. In October 1990 the hearing aid went wrong again and Master W went to Princess Alice hospital in Eastbourne and was told that a replacement would be obtained as soon as possible. There were many telephone calls and many visits and, eventually, early this year, they visited me. By 3 February, some four months after the need arose, Master W received the bone conductor hearing aid that he needed. His mother commented that it came in a very nice case which will never be used and which was a waste of NHS funds.
The answer to those problems and many others that I could have listed is that we need more resources. We need to reduce waiting lists, increase beds and provide a better out-patient service. The response that we are being offered to those problems is an application for trust status. A year ago the majority of consultants, doctors, nurses and other professionals concerned said that they did not want trust status, so the health authority put the application back in the drawer. It has now been brought out again. The health authority consists of a group of unelected people with no mandate. It is claiming that it could increase staff and decrease waiting lists. However, the Minister and I know, because we read and check our facts, that that has not been happening in other parts of the country. We know of the cuts in staffing at Bradford and Guys and we know of the budget-holding general practitioners in Watford who seem to be able to demand a better service than GPs who do not have budget-holding status. Only yesterday I saw in the newspaper that a lady wrote that in her area of Oldham the waiting time for an appointment has increased from two weeks to three months.
The people of Eastbourne want to know whether the future will be better than the present. They want answers to various questions. For example, will trust status enable unelected people with no mandate to sell buildings? Could one of our hospitals be sold and work concentrated on another? Could unlimited private work be accepted? I met the chairman of the group making the trust application 1101 and he told me that he thought that it could take in extra laundry from Eastbourne to make a profit. Should that be happening, and will it be possible as it would would divert people from their proper tasks? Will those unelected people be able to hire and fire staff without reference to elected bodies or to Government? Will they be able to take people from abroad who can pay more rather than the people in Eastbourne who have great need?
Those questions are in the minds of my constituents now. I have asked the chair of the group making the trust applications whether he will hold a community referendum. He said no. Therefore, I intend to hold such a referendum. I shall be circulating to every household in my constituency the details of the proposals and inviting them to say whether they support them. I shall do that in June so that the results can be made available to the Minister when the application is considered in mid-August. Does the Minister believe that she should abide by the result of the referendum, so that the people of Eastbourne can have a major say in the provision of health services? The service is far too big to be made a political football; we should listen to local people.
I want to deal now with related health matters, some of which come under the social services department. There are more people over 75 in east Sussex than in any other social service provider in England. Eastbourne has a large proportion of over 75s, and indeed of over 85s. There is a great need for residential care, especially nursing homes. In Eastbourne, the number of private nursing home beds increased from 1,065 in 1984 to 1,411 in 1990. That is a cause for much concern, unless Government grants enable those places to be maintained. Fears were expressed only this week to the Select Committee on Social Security that funds might not be made available to support those people.
There are many mentally handicapped people in Eastbourne, because it is a nice place to live and the quality of life is high. I recently visited an excellently run private home for mentally handicapped people, the Heatherdene. It is concerned about funding for individuals in its care.
Linden Court in Eastbourne is a training centre for mentally handicapped people, but cuts in social security benefit have led to concern about not only residential places but the buying power of people in contributing to that establishment.
A deaf mentally handicapped child has attended Hazel Court school in Eastbourne for the past four years, having moved from Hackney. He is now becoming an adult but wishes to continue with the adult training that is available at Linden Court. The county council has said that Hackney must pay his costs of £200 per week and £35 a week for a taxi. He having lived in east Sussex for four years, one would have thought that the council could meet the bill. His mother described the decision as heartless and uncaring and asked how can we expect Hackney to contribute.
Just before Christmas, I tried to raise with East Sussex county council the saga of a residential home called Milton Court. In late September, county councillors were promised that a report on care in that home would be made on 11 October. In early October, I met a man who had been transferred from a day centre at the residential home to another day centre, having been told that it was 1102 to close. No report was tabled at the social services meeting on 11 October, but staff had been sent a letter saying that their jobs would cease and asking whether they would transfer elsewhere. There was no matching joint finance from the district health authority for the future intentions for that home.
The county council has much responsibility in this matter. Councillors were not told the truth. They were told that investigations with a local housing association might be brought forward. Unfortunately for the county council, the previous day I had attended a meeting with the housing association, which had told me it had only just received a letter asking whether that might be possible, and of course it was not. The funding from the district health authority was not going to be sufficient to carry out that project. The county councillors were not told what would happen in Milton Court and, in the meantime, the staff were given letters of dismissal. The staff were also told by the director of social services not to speak to councillors. That does not seem the way to plan for care in the community.
There were also proposals earlier this year to close eight residential homes in east Sussex. The number of beds in the county is to decrease from 1,212 to 772, a loss of 440. In the editorial in our local Evening Argus the editor summed up the position well when he said:East Sussex has one of the highest percentages of old people in the country and the numbers of those aged 85 plus are rising. The suspicion is that there simply may not be enough homes for those who cannot cope by the mid 1990s.Into that scenario the county council recently announced the closure of another residential home in Eastbourne, St. Anthony's Court. To save just £138,000 a year the council plans to close an absolutely wonderful home. The home has a friends' organisation to raise money for extras. I recently attended a fun day at which two local primary schools sang and provided entertainment for those who live there. The staff are superb and the buildings are perfect, yet the county council wishes to sell the home.
The pressures on Eastbourne will not decrease because homes in adjacent towns such as Hastings and Peacehaven will also be sold. The reduction of 440 residential care places is to fund an additional 179 day care places. The equation does not add up. Our care in the community strategy, which we want to put in place for 1993, will require more day care and respite care places and the loss of residential care places will scupper that policy.
The management of social services in east Sussex has not been good, but recently it has become chronic. Last year it overspent by £1.6 million without telling any of the councillors. It is closing many homes and has appointed at high level many additional top managers but very few grass-roots social workers. The Minister should investigate the social services department in east Sussex and especially the actions of the chairman of the social services committee, Councillor Pat Wright, and the director, Mr. Nicholas Holbrook. If she does not, the strategy for community care will be scuppered.
There have been no Government funds to plan community care. The threat now faced by local authorities, which will have community care responsibility devolved to them in 1993 and which will also have the possibility—no, the probability—of massive local government reorganisation in 1994, is a recipe for chaos, for 1103 confusion and for poor standards. Local government needs to know where it is going and it needs to have the resources.
Some essential services will fall between stools. Will the Government give some assurances about authorities, such as East Sussex, that want to plan over a five or 10-year period on "in" and "out" packages? The promises made today must hold for the future.
An example of a service that will fall between stools because the planning is not there for it is the drug misuse service. In Eastbourne, there are three voluntary organisations—the Libra Trust, the Seaside Centre, run by the Young Men's Christian Association, and Open Door. They provide, with grant aid, support for young people who have a drugs problem. Will the trust that is proposed for Eastbourne district general hospital and the community care plan which will come into force for the county council in 1993 take on board the need for grants for those bodies? I fear that they may not.
Eastbourne has unique challenges. We need answers and action, not ideas which are not welcome and which do not inspire local confidence. The health and well-being of our community is at stake. The people whom I represent need and deserve to know what the Government intend to do to help them.
§ The Minister for Health (Mrs. Virginia Bottomley)
I congratulate the hon. Member for Eastbourne (Mr. Bellotti) on seeking this opportunity to discuss the health and welfare needs of his constituency. However, I was disappointed by his biased and lopsided account because, before coming to this debate, I studied the situation in his area. In his discussion of health and welfare, he singularly failed to draw attention to a group that is doing outstandingly well in Eastbourne—the general practitioners. I am pleased to report to the hon. Gentleman that 88 per cent. of his general practitioners reached the higher target—the 90 per cent. target—for child immunisation and that 70 per cent. of them reached the higher target—the 90 per cent. target—for cervical cytology. That is one of many examples.
In East Sussex, there has been a substantial drop in the number of patients whom each GP has to look after. There has been a big increase in the number of practice staff. On the basis of the new GP contract, GPs are clearly providing an excellent service for patients.
I began by mentioning the family practitioner services because they are often the basic building blocks of not only our hospital services but our social services. I was enormously impressed on 12 February when I asked Councillor Pat Wright, the chairman of the social services committee, who seemed to me to have done an excellent job, together with the first-rate director of East Sussex social services, Nicholas Holbrook, and a councillor from Eastbourne borough council to speak to me and to take me through the practical steps that they were already taking to implement care in the community. In many respects, they are ahead of others, especially in their work to co-ordinate their proposals with housing authorities and in integrating their plan with health authorities.
The hon. Gentleman began with the question of waiting lists. It is a fortuitous circumstance that his debate should coincide with today's report by the Select Committee on Health on waiting lists. The hon. Gentleman is one of the 1104 first to learn that, today, we are able to announce the most dramatic improvement in the number of patients who have been waiting an unacceptable length of time. There has been a 38 per cent. fall in the number waiting over two years and a 19 per cent. fall in the number of patients waiting over a year. The hon. Gentleman and I will both agree that it is unacceptable for patients to wait for such long periods. However, I must make it clear that one patient in two is admitted immediately. The judgment on hospital admission is based on clinical priority. The average for patients who are not admitted immediately is five weeks. The hon. Gentleman is right to identify the need for further progress in his health authority, as in others, on cutting down the number of those waiting.
In Eastbourne health authority, there has been an excellent advance in cutting down. There has been a 61 per cent. decrease in the two-year waiters. We want there to be more progress, and to help this year, as well as the increase of funding for the health authority of over £12 million in one year alone—going from £59 million to over £71 million in 1991–92 to spend on the health care of people in Eastbourne—there is additional funding from the region of £186,000 which is intended to help especially with the waiting lists for ear, nose and throat treatment, oral surgery, urology and gynaecology, which are important areas of progress and activity.
This year, we are spending about £60 million through the regions. We are making it clear that we must bring down the number of patients who wait for unacceptable periods. Today's excellent news on the progress made over the past year is a heartening first step.
The hon. Gentleman fell into the trap, as so many other hon. Members have done, of referring to the number of beds as an indicator of care. That is a naive approach, whether applied to care in the community or to hospitals. Increasing numbers of us can now receive support on a domiciliary basis in the community or day care. Reports from authoritative sources constantly stress the importance of moving towards more day care. I am pleased that the hospitals in the hon. Gentleman's area have been able to increase the number of patients treated—even at a time when they were rationalising bed use.
The hon. Gentleman went on to discuss the concept of the Eastbourne hospitals trust. I have already seen, and am most impressed by, the prospectus that has been produced. Over the next three months, it will be the subject of consultation with the people of Eastbourne because it is important that they should know and understand. The hon. Gentleman talked about the strengths and weaknesses of ballots and referendums. The key point is that these are complex issues on which people need to have an informed and reasoned discussion. Scaremongering and doom and gloom can play no part. When the Secretary of State decides whether to approve the Eastbourne hospitals trust, in his mind will be purely and simply the question whether that is a better way of managing the health service to improve the care of patients—national health service patients. That is the aim, objective and pride of our national health service.
The hon. Gentleman asked whether the trust would be free to undertake private work. We have no vendetta against the private sector. Many people wish to spend their resources on private health care. But the aim, objective and commitment of national health service Ministers, the management executive and the national health service trusts is to pioneer, develop and improve the quality of 1105 national health service work. The hospitals may admit private patients or patients from overseas. We have no objection to that. But our criterion, aim and objective is that it should be done to improve the care of national health service patients.
The hon. Gentleman asked about income generation —whether the trust could use the plant in the hospital to provide laundry services. That is a matter for the trust to consider. But its goal, its mission, its purpose in being, is to provide national health service work. That is the key to the national health service trusts.
The sort of policy objectives that we are considering are already taking off in Eastbourne. I have looked at some of the criteria established in the contracts between the purchaser authority, the commissioner, the Eastbourne health authority and the existing provider units. The criteria state that residents who are mentally handicapped shall be consulted in all aspects of their health or welfare. They state that acute patients must have an individual care plan with specific aims for care and at least a daily comment on their progress. They state that, on discharge, the general practitioners should be informed within one week of the recommendations for the patient. Those are the quality objectives to which we are committed and which our national health service reforms are already achieving.
The hon. Gentleman referred to care in the community. He spoke about resources in relation to drawing up preparations for the care in the community provisions. I urge him to consider the evidence. The increase in the social service spending that we have recognised this year is of the order of 23.5 per cent. That is the largest single increase in social service spending for 15 years.
1106 The hon. Gentleman referred to specific aspects of care in the community. For the first time, we are to have a drug and alcohol specific grant allowing spending to the order of £2 million for voluntary organisations—precisely the organisations to which the hon. Gentleman referred. What about the new work for the mentally ill? The specific grant, allowing £30 million worth of spending, will result in East Sussex receiving £330,000 towards its work for the mentally ill—a very important group. What about the money specifically for training for community care? This year, we substantially increased the amount that goes towards training those in social services for this important and popular development.
East Sussex has received £220,000 towards training social service staff so that they are properly and effectively prepared for the implementation of this important policy. The authority is working hard to ensure that the needs of the frail and vulnerable—those who are entitled to an effective quality of care in the community—are met. That will take time and detailed planning. Next year's plan, which is subject to consultation, will be a further and important springboard for progress.
The hon. Member for Eastbourne should have no doubt about the commitment and concern of those involved in social services and health care. If the hon. Gentleman is tempted to suggest that his party has reservations about national health service trusts, he should contact Councillor Marian Border. She is a Liberal Democrat councillor and a non-executive member of the Freeman Group of Hospitals NHS trust in Newcastle. We believe that that is a way of using the resources more effectively and powerfully to provide better patient care. It will be subject to consultation and detailed consideration before the final plans are announced in Eastbourne. I have been impressed by and warmly congratulate those people who have pioneered service improvements for the people of Eastbourne.