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Leicestershire Area Health Authority (Finance)

Volume 979: debated on Thursday 21 February 1980

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Motion made, and Question proposed, That this House do now adjourn.—[ Mr. MacGregor.]

10 pm

The debate which I am initiating tonight is in my name, but the concern that I shall express is shared equally by the nine Members representing the city of Leicester and the county. I know, for instance, that the hon. Member for Leicester, South (Mr. Marshall) is in the Chamber to express the city's point of view. I hope that the hon. Gentleman, and any other of our colleagues who happen to be present, will have the opportunity of catching your eye, Mr. Deputy Speaker, should they wish to do so.

It is safe to say that our nine Members have been jointly concerned about the inadequate provision of funds for the Leicester area health authority over a number of years. It has not been difficult to set aside party differences in a combined effort to secure proper financing for the Leicester area.

We have had more than one Adjournment debate on this subject. We have written joint letters to different Ministers responsible for the social services expressing our concern. In the previous Parliament we went as an all-party delegation to see the then Minister with responsibility for these matters. All these efforts have been directed towards securing equality in the provision of funds for the Leicester area. It is because of the continuing dissatisfaction of us all with that provision that this Adjournment debate is taking place.

First, I make it transparently clear that we are not, especially at this time of economic stringency, asking for new money. However, we are urgently demanding that a fairer way be arrived at for distributing the sums that are already provided. In other words, we seek, to put it crudely, a fair share of the cake.

To deploy my argument, I shall of necessity have to refer to one or two figures and place them before the House. I ask the House to consider the issue in a twofold way. First, I ask the House to consider the expenditure per head on health services in the 14 national regions, including Trent, in which the Leicester area finds itself. Secondly, I ask the House to consider the situation within the Trent region and to consider the funds allocated to the Leicester area health authority within the Trent region.

If we consider Health Service expenditure nationally for the 14 regions over the past six years—my right hon. Friend the Secretary of State was good enough to provide me with the figures in a written answer shortly before Christmas—we see that the Trent region has been consistently at the bottom, or next to the bottom, of the 14 national regions in Health Service expenditure per head of population. It is that consistent bottom place, or next to bottom place, that the region has occupied for so long that disturbs us all.

In 1974–75 the money spent on the Trent region was £61 per head compared with £85 per head spent on the region that took top place—North-West Thames. The Trent region was bottom then. It was bottom again in 1975–76, when the money spent was £81 per head compared with £108 in the top region, which was again North-West Thames. In 1976–77 the figure was £93 per head compared with £121 per head in North-West Thames. In 1977–78 it was £105 per head compared with £134 per head in North-West Thames. In 1978–79 the figure for the Trent region was £120 per head compared with £148 per head in North-West Thames. In 1979–80 the Trent region is bottom but one, with £132 per head compared with £163 per head for North-West Thames.

It can be seen from those figures for Health Service expenditure that the Trent region has been consistently deprived. Within the region—and this is what brings the Leicester and Leicestershire Members together tonight—there are eight area health authorities, of which Leicester is one. I remind the House that Leicester is an authority with special problems associated with a large immigrant population and that contrary to the national trend the population of Leicester is growing.

If one compares expenditure by the eight authorities in the region in each of the last five years for which figures are available, one sees that expenditure in Leicester has been well below that of the other seven areas.

To show the consistent discrepancy in Leicester, I quote the following figures. Expenditure per head in the city in 1974–75 was £55 compared with £61 in the region and £85 in North-West Thames. In 1975–76 the Leicester figure was £73 per head as against £81 in the region and £108 in North-West Thames. In 1976–77 the Leicester figure was £83 per head against £93 in the region and £121 in North-West Thames. In 1977–78 the Leicester figure was £95 against £105 in the region and £134 in North-West Thames. In 1978–79 the Leicester figure was £109 against £120 in the region and £148 in North-West Thames.

It is felt by my colleagues and myself, regardless of party, that these figures speak for themselves. The figures emerge from written answers that I received from my hon. Friend. What my hon. Friend did not supply, to my regret, were projections of expenditure in the immediate future. I should have thought that it was not too much to ask what the 1980–81 and 1981–82 allocations would be. I can assure my hon. Friend that those figures are awaited with the utmost anxiety in the city and county of Leicester.

If, as my hon. Friend says, the figures are not available, why are they not available? Surely the allocation of funds is not left to chance. There must be some form of forward planning. We have asked some reasonable questions and we expect answers tonight or later.

My hon. Friend the Minister for Health, in a letter to me dated 19 October 1979, in response to an approach that I made on behalf of Leicestershire Members recognised the deprivation of the area. He assured me that he was keenly aware of the problems of relatively under-resourced areas such as Leicestershire. He also said that within the region the RHA recognised the degree of Health Service deprivation and the need to improve the level of funding in the next four years.

Other Members wish to take part in tonight's debate. However. I must refer to the role that the Leicester area health authority has played. It has been aware of the way in which its activities are restrained by continual deprivation. In September last year the authority arranged a meeting with local Members of Parliament which most attended. The authority presented three papers to us, one of which was entitled "A Fair Share for The Population of Leicestershire". A key paragraph of that paper states:
"Leicestershire has been for many years, and continues to be one of the poorest provided areas in England in terms of financial resources available for health care … The national average number of in-patient cases treated in the 'acute' specialties in 1977 was 88 cases per 1,000 population, whilst the comparable figure for Leicestershire was only 67, which after allowing for variations in the incidents of disease in Leicestershire, represents a short fall in service of 21·5 per cent."
The paper states that the figure is attributable to a shortfall in funding.

Those hon. Members who hold regular surgeries in their constituencies know about the shortfall in funding. It is a human problem. People come to us because they cannot be admitted to hospital for an operation without waiting for years. They cannot have a Health Service consultation without a wait of many months.

The principle of the NHS is sound. After 20 years of making excuses I can no longer be proud of the service. I urge the Minister to do something for one of the most deprived regions.

10.13 pm

I congratulate the hon. Member for Harborough (Mr. Farr) on raising an important issue. He was responsible for initiating the last Adjournment debate on the inadequacy of financial resources available to the Leicestershire area health authority. On 16 July last year my hon. Friend the Member for Nottingham, North (Mr. Whitlock) raised the general question of the inadequacy of resources available to the region. He also drew attention to inadequacies in the Nottingham area.

It is important to impress upon the Minister and the Department that expenditure per head of population in the region is well below the national average. We receive many complaints in our surgeries about the length of waiting lists for hospital and out-patient treatment.

The personnel in the medical service in our region and area and the numbers of doctors, nurses, midwives, professional, technical and ancillary staff, taken per 100,000 of the population, are below the national average. We impress upon the Minister the need to rectify this situation.

The resources allocation working party suggested a formula. It reduced, to some degree, the discrepancy over the past few years. But that by itself is not sufficient. If I may introduce a note of acrimony in this arms-across-the-sea debate, the realocation alone will not resolve the problem. I urge the Minister—despite all the pressures upon him from the Treasury and other Ministers about public expenditure cuts—to realise that the only way to rectify in the short term the deficiencies in our area is by an injection of new money. I urge the Minister to consider that as the only action that is likely to remedy the deficiencies in our own area.

10.17 pm

I should like to record, from a slightly unusual position on the Back Benches, support for my hon. Friend the Member for Harborough (Mr. Farr). The fact that half of the Leicester and Leicestershire Members of Parliament are here, unusually for an Adjournment debate, demonstrates yet again how strongly we feel about this matter. None of us is satisfied by the lack of progress which has been made over recent years in getting this position right. The figures that my hon. Friend gave about the relative position of Leicester within the Trent region, and the relative position of the Trent region against the national average, demonstrate all too clearly that progress, if any, has been minimal.

We accept that the cake available is of a limited size at the moment, but we want a better share of it. We want an indication, not just an assurance, that things will get better. We need figures to which we can attach our hopes so that we know that our constituents will be better served, not in 10 years' time but, I hope, in a year or two.

10.18 pm

I associate myself with all that has been said. I thank and congratulate the hon. Member for Harborough (Mr. Farr). There are wide divisions between the Leicestershire Members of Parliament on many issues, but not on this one.

We in Leicestershire are near the bottom of the league in one of the worst-off areas in the country. We are a developing region, to which people are coming. We are a region of great need. We have the desperate problem of people who do not receive the health service that they require. Unlike the hon. Member for Harborough, I am proud of our Health Service, but I am not proud of the way in which the allocations are divided.

The previous Government and this one indicated that they intended to rectify this matter. Let them do so soon. There is now vast unrest, unhappiness and tremendous hardship in the Leicestershire area.

10.19 p.m.

I am most grateful to my hon. Friend the Member for Harborough (Mr. Fan) for raising the question of funding within the Health Service. His speech highlighted very effectively the difficult problems facing the Leicestershire area health authority at the moment.

As a Member for a constituency within the North-West Thames region, I felt somewhat humble listening to the league table that my hon. Friend read out. It is absolutely clear to the Ministers in the Department that this matter greatly concerns my hon. Friend and other Leicestershire members of Parliament, as is evidenced by the support that he received from my hon. Friend the Minister of State, Department of Industry and from the hon. Member for Leicester, South (Mr. Marshall) and the hon. and learned Member for Leicester, West (Mr. Janner). I assure all of them that my right hon. Friend the Secretary of State is only too aware of the tough decisions that health authorities throughout the country have to make in keeping within their budgets and determining which of the many competing demands on their limited resources should be given priority.

I readily concede that the Leicestershire area health authority has a very difficult task in attempting to improve health services in the county. There is no dispute that the area has suffered, and still suffers, from a legacy of low Health Service funding. No one could argue with the statistics that my hon. Friend produced. The authority has the daunting task of undertaking new capital developments, including a major teaching hospital, as well as maintaining the growth of medical education.

I have looked through the correspondence in the Department. There is no doubt that the Leicestershire Members of Parliament have bombarded it with effective representations about the problems affecting their county.

Like other health authorities throughout the country, Leicestershire AHA has to make difficult decisions on competing priorities against a background of rising demand and limited resources. We have to accept that such decisions, difficult and unpopular though they may be, have to be taken if health authorities are to manage within their budgets. I am afraid that it is inevitable in the present economic climate that some highly desirable health improvements must regrettably wait.

However, it would be wrong to think that progress is not being made. A major building programme is under way in the Trent region and new hospitals are being opened, not only in Leicester but in Nottingham, Sheffield, Barnsley and Rotherham. The last few years in Leicester have seen the first two phases of the redevelopment of the Leicester Royal infirmary come into operation, and I was delighted to learn that Her Majesty the Queen is to open phase 2 next month. It will be a proud day for Leicester.

Also, new ward blocks have opened at the general hospital and the Glenfield community hospital, and Trent RHA has plans for the third Leicester DGH on the Glenfield site. These developments should go a long way towards providing the people of Leicestershire with the health service that they have every right to expect, though a great deal remains to be done, particularly in community hospitals and community health services in general.

Funds to open these have to be found from within the region's overall revenue allocation. Another major factor is the commitment, endorsed by successive Governments, to the expansion of medical education: Trent is unique—outside London—in that it contains three medical schools, Sheffield, Nottingham and Leices- ter. The Leicester medical school is producing its first graduates this year—a proud moment indeed for all concerned—and we can look to the school for an increasingly important contribution to the supply of well trained doctors in the years to come.

All these developments will require substantial resources, and my hon. Friend will need no reminding that central Government is several tiers removed from where decisions are taken on the allocation of resources by AHAs. I know that he will not expect me to pretend that there is any prospect of direct central Government help for Leicestershire AHA. Indeed, one of the keystones of our policy towards the Health Service is that decisions should, as far as possible, be taken not from a distance by people who are inevitably remote from local needs and circumstances but by those who have first-hand knowledge of them. So whilst decisions on resource allocations to regional health authorities are taken by Ministers centrally it must be for RHAs to determine allocations to the area health authorities, and they must be responsible for allocating funds to health districts.

My hon. Friend pressed me about next year's allocation. The cash limits have not been fixed. We are aware of the urgent need to provide these at an early date so that planning can take place. I can assure him that a decision will be announced shortly and that he will be among the first to know of it.

My hon. Friend quite rightly reminded the House that a long period of under-investment in the Health Service, not only in Leicestershire but in the Trent region as a whole, is the underlying cause of many of the deficiencies he has described. The recommendations of the Resource Allocation Working Party aim to secure a pattern of resource distribution based on relative health care need. Under the RAWP formula, Trent has emerged as one of the most needy regions and has received the third highest growth rate this year—2·7 per cent., compared with a national average of 2 per cent.—and the second highest in the previous two years-4 per cent. in 1978–79 and 2·9 per cent. in 1977–78 compared with national averages of 2·3 per cent. and 1·4 per cent. respectively. The result has been a steady move towards target from 10·1 per cent. below average, following the 1977–78 allocation, to 7·25 per cent. below this year.

It is always an unenviable task to have to decide the fairest way of allocating new resources, particularly as in present times, when they are so scarce. Not only is it impossible to satisfy everyone, it is scarcely possible to satisfy anyone. It has come as no surprise to hear of the difficulties of the better-off regions such as my own in making ends meet from a position of virtually nil growth in the past, and from the less well-endowed regions, such as Trent, about the need from their point of view for a much faster redistribution of resources.

My right hon. Friend supports the principle of a fairer distribution of health care across the country. I envisage that the RAWP process will continue to play a major part in this, as it is the best objective measure of health care need we have available to us at the moment. The ultimate decision has to lie with my right hon. Friend as to how quickly we can sensibly move resources around.

I can assure all hon. Members that the points that they have made will be carefully noted and taken very much into account in our consideration of national policies on health service resources.

However, we cannot afford to ignore the fact that the former Administration, in reaching decisions on the 1979–80 allocations, found it necessary to slow down the pace of change towards targets. This was mainly because of the very real problems being experienced by the relatively well-off regions, which found it impossible to rationalise their services and redistribute resources to their deprived areas on the very small growth in resources that had been allowed to them in the previous years.

We must not lose sight of the fact that in well-provided regions there are areas that are deprived even by national standards. Indeed, there are areas that are even worse-provided than is the Leicestershire AHA.

Our ability to continue the process of redistribution depends crucially on the additional resources available nationally. We have inherited from the previous Government public expenditure provision for the hospital and comunity health services which, for next year, gives us growth nationally of less than 3 per cent. This is not enough to cope with demographic demands and advances in medical technology, and will obviously set back the redistribution process. The provision of more resources will come from a stronger economy, which the Government are aiming to create the right conditions to bring about.

As for RAWP principles below regional level, regional health authorities have been asked to apply them in their allocations to areas. I know that Trent regional health authority is making every effort to achieve a fairer distribution of health service resources within the region, but there are constraints on the rate at which the legacy of inequalities within regions can be eliminated.

I fully recognise that Leicestershire has suffered a legacy of deprivation of health services, and I am conscious of the difficulties that lie ahead. It is true that, at present, the per capita funding of Leicestershire area health authority is the lowest in the Trent region. The RHA fully recognises the difficulties which Leicestershire faces in attempting to alleviate the acknowledged deficiencies in health services. The region has set a minimum growth rate for all areas and during the next few years, on present assumptions about future resources, it is expected that Leicestershire will receive the highest growth rate in per capita funding in the region.

Planning assumptions indicate that Trent will continue to be amongst those receiving the highest share of available resources on a national scale for the foreseeable future. Next year, we envisage small growth in real terms in the amount available to the National Health Service —about ½ per cent. overall and 0·6 per cent. to the worst-off regions. We are, of course, very aware that regions like Trent and areas like Leicestershire will be looking for continued redistribution of resources between health authorities. But the extent to which this can be done will clearly be restricted by the amount of overall growth money available next year and thereafter.

I realise that little that I have said today will have done much to lessen the hon. Members' concern. The only way in which I could have done so would have been to hold out a promise of substantial extra resources. This I cannot do. We cannot be expected to allocate more to the i rent region without depriving other regions around the country. Similarly, Trent RHA could find substantial additional funds for the AHA only at the expense of its seven other areas.

The lesson that we all have to learn, both in central Government and in health authorities, is that we must manage within the resources available to us. Those responsible for the Health Service at all levels are doing their best to redistribute resources as fast as available finances and other constraints will allow. There is a definite commitment on the part of the AHA to improve services in Leicestershire. It is a task that local management must tackle to the best of their ability, though progress, I am afraid, cannot be as rapid as they or I would wish.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Ten o'clock.