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Health Services (North-East Essex)

Volume 87: debated on Friday 29 November 1985

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

2.30 pm

I am grateful for this opportunity to raise the subject of health services in northeast Essex, especially at this time. Strong feelings have been aroused in my constituency about the threatened closure of a small children's ward and a proposal to shut a radiotherapy unit and a medical rehabilitation centre. I am concerned because these actions led to the Health Service being given a bad name, because a new general hospital has been built and considerable extensions are planned for the main hospital in my constituency.

We all know the expression, "spoiling the ship for a ha'porth of tar." I call this "spoiling the good name of the Health Service for the lack of even a penny'sworth of political sense." We need care, not management consultants. What is the use of spending all these millions of pounds on new hospitals and ruining it all by closing down such a small, valuable children's ward and two other valuable units?

Yesterday, I received a letter from one of my constituents showing a very human reaction. He commented on a pamphlet issued by the health authority entitled, "Clacton Coastline—a real community hospital." My constituent said:
"We are a community. We have our young. We have our middle-aged and elderly as well as our psychiatric and mentally handicapped. In times of illness, we all need treatment and care as near to our homes as possible."
I stress the words
"as near to our homes as possible."
It is all very well having grandiose hospitals 20 or 30 miles away, where excellent treatment can be given, but it is important to ensure that the treatment and care provided are as near as possible to the people needing the care. Just to show how cynical one's constituents become, my constituent states in a postscript:
"Does the leaflet contravene the Trades Description Act?"
It is a shame that the good name of the Health Service is ruined by such actions by the health authority. Those actions have made it a million times more difficult to get over to the people what is being done to improve the Health Service locally and nationally.

We welcome the opening of the new general hospital in Colchester. We welcome the develoment at Clacton hospital in 1986, which will include an additional ward, day hospital places for psychiatric and psychogeriatric patients and an improved X-ray service. We welcome the promise to build phase 2 of the Clacton hospital extension which will provide 50 badly needed beds for the elderly. I have pressed for that extension for a considerable time.

In spite of the improvements, we are considering cuts in these sensitive areas. Why? Strong feelings have been aroused among more than 500 people who, last Saturday, marched against these closures. I know that 500 people in East Anglia do not take to the streets unless they feel strongly about something. Twenty three thousand people have signed the petition against the closure, and there are 13,000 signatures against the threatened closure of the radiotherapy unit at Colchester. We are to face cuts in three areas: the children's ward, the Passmore Edwards medical rehabilitation centre in Clacton, and, possibly, the radiotherapy unit at Colchester, which will follow soon after the opening of the new district hospital. That would mean that patients must travel to Chelmsford.

During the past few years Clacton has also seen the closure of the Middlesex convalescent home and the maternity home, while, at the same time, there has been the acceptance of greater responsibility within the community for the care of the mentally retarded. All have resulted in considerable savings for the local health authority.

Directly I heard about the threatened closure of the children's ward I asked the north-east Essex health authority to withdraw the proposal. There is a conflict of medical opinion, but I have had the full backing of general practitioners and the Clacton hospital throughout the dispute. Again this week I asked the authority to give way, but again it refused. As the authority has refused twice, and bearing in mind the petitions and marches, I hope that the authority will put the case to the Minister for his decision.

Three years ago, when we agreed to the closure of the maternity home, we reached a compromise by accepting that the children's ward in Clacton hospital should be turned into a maternity ward, and that a place should be found for a children's ward of six beds. Despite accepting that agreement, the health authority is adamant that it now wants to close the ward. Is it not understandable that strong feelings and local anger have been aroused by the decision? If adequate research had been carried out, we would not have had any of the trouble, and, more particularly, the unnecessary anxiety placed on the seriously ill. People with cancer have enough to contend with, without all the worry and extra burden of having to travel long distances for treatment.

I do not believe that the local health authority realises that 46 per cent. of householders in Clacton are without transport, or is aware of the distances that must be covered to the nearest district hospital.

Everyone in Essex and East Anglia is grateful to my hon. Friend for raising the matter. I hope that he will stress that the arrangements for the treatment of cancer are still at a consultative stage, and that he, like me, will have been sending large numbers of letters and making representations about it.

My hon. and learned Friend, like all of us, takes a great interest in health facilities in northeast Essex. I agree that the arrangements are at a consultative stage, but I do not think that the authorities realise the difficulties that arise from announcing consultation. Good government flourishes in the dark. It is far better to have consultation between the people who must make the decisions without making it public. A great deal of worry has been caused by that not being the case.

Many cancer patients must rely on public transport to take them to their radiotherapy centre. The extra miles to Chelmsford will place an additional burden on an already overstretched ambulance service, just as it will if the children's ward is closed, and all young patients are sent to Colchester. It would also be difficult and expensive for young mums to get to the new hospital to visit their children.

Regarding the proposed closure of the Passmore Edwards medical rehabilitation centre, the district should develop its own facilities, but that will take about five years. Until then I am against the closure.

In short, we feel that we have been treated unfairly by these threatened closures. If more money must be found for north-east Essex, let me make some suggestions where we may be able to find it.

I fear that as long as north-east Essex stays in the northeast Thames regional health authority, we shall not get a fair deal. We would be far better off, and our problems far better understood, if we were in the East Anglia health authority. How can an authority that deals with the problems of London understand the problems of the country districts? The health problems of an urban area are entirely different from those in country areas. The problem of distances is not understood. That is one reason for the difficulty that we are having in north-east Essex.

North-east Essex is the worst funded region in the north-east Thames region. We are not getting our fair share of the region's revenue. I draw the Minister's attention to the performance indicators taken from the Health and Social Service Journal of 26 September 1985, of which I have sent him a copy. Our performance indicator shows north-east Essex at 82, while the London boroughs are double that figure, with Islington at 194. Will Ministers keep up their pressure in their reviews of the Thames region to accelerate a redistribution within the region? Will they please take a far tougher line with London and speed up the process of shifting resources to Essex? I hope that the Minister, in his reply, will tell us what action has been taken to see that a much more fair redistribution takes place.

Will the Minister also deal with the more equitable redistribution of national health resources? The authority claims that it is all very well to achieve equity at a faster speed when there is adequate growth, but where there is a modest amount of cash a redistribution has become far more difficult. It claims that that has resulted in a real cut in the region of 0·3 per cent. It goes on to say that, when it takes into account the fact that, due to increasing numbers of elderly persons and advancing technology, 1 per cent. growth is needed merely to stand still, the financial problems become real indeed. Will the Minister comment on that?

The second national problem, and a more difficult one that affects us, is the shortfall in pay awards. Is the funding of the health authority, allowing for 4·5 per cent. inflation, adequate, bearing in mind that major groups have reached the pay norm? This is costing £350,000 in the current year and will cost £1·2 million next year if the gap is not met. Unless that is sorted out quickly the health authority tells me that next year planning will become difficult.

I hope that as a result of what I have said my hon. Friend will be sympathetic to the problems that we face and understand the reasons for the strong feelings that exist. We must find a fair solution to those problems and not spoil the good name of our National Health Service, of which we have good reason to be proud.

Again, I underline that we are just not getting our fair share from the north-east Thames regional health authority. I ask my hon. Friend to press the north-east Thames authority, which, after all, considers London as its major objective, to see that we get our fair share of funds. We have made our sacrifices, but it is up to the authority now to do what it can to help with the small sums of revenue that these closures entail. I am sure that it could easily afford it if it got the redistribution right.

2.43 pm

The Parliamentary Under-Secretary of State for Health and Social Security
(Mr. Ray Whitney)

I am grateful for this opportunity to respond to my hon. Friend the Member for Harwich (Sir J. Ridsdale). I am particularly happy to note that also present in the Chamber are my right hon. Friend the Member for Colchester, South and Maldon (Mr. Wakeham) and my hon. and learned Friend the Member for Colchester, North (Sir A. Buck). Like my hon. Friend the Member for Harwich, my right hon. and hon. and learned Friends take a close interest in the health affairs of their constituencies and the health authority of north-east Essex. I am, as I say, particularly grateful to my hon. Friend the Member for Harwich for giving me this opportunity of seeking, I hope successfully, to allay his concerns.

My hon. Friend was kind enough to refer to the good name of the NHS and to some of its splendid achievements nationally and locally in north-east Essex. He will be aware that since we came to office the real funds available to the NHS have increased by 20 per cent. Only two weeks ago, my right hon. Friend the Secretary of State announced a further increase for next year of 6·7 per cent. in the funds voted to the NHS. Added to that is the new look, post-Griffiths spirit of the better use of these truly vast resources which is delivering better health care in Britain. One manifestation of that was the opening of the new 280-bed Colchester district general hospital earlier this year, at a cost of £16 million. The need for a new hospital in that part of Essex was long recognised, and the hospital represents a major improvement in the health services available to all the residents of the district and to the constituents of my hon. Friends who are present in the Chamber today.

However, that is not the whole story. Other good news items include the developments in Clacton. I understand that a 28-bed geriatric ward, a rehabilitation department and a 30-place psychiatric and psycho-geriatric day hospital will open in the new year, and that two further 28-bed geriatric wards will be completed by 1988. That shows the health authority's commitment to developing services in what we regard as the priority groups: the elderly, the mentally ill and the mentally handicapped. There are many elderly people in my hon. Friend's constituency.

My hon. Friend mentioned three specific proposals. May I say at once that they are only proposals, and quite right too. The NHS is an open and consultative body. Although my hon. Friend suggested that he would have welcomed proposals which gave less cause for concern, even he might react strongly should that health authority present a fait accompli in any area. We are proud of our consultative process, although we recognise that it can be abused by creating anxiety and alarm which may prove to be unnecessary. It is incumbent on those of us who recognise the achievements of the NHS to allay that anxiety and to resist the occasional hysteria and grave anxiety that are sometimes created. Obviously, I shall make no direct comment on feelings in my hon. Friend's constituency, since they are for him to judge.

I shall consider the three proposals, leaving aside the financial pressures, because it is important to understand that they were made for non-financial reasons. The authority proposed them in terms of providing a better service for patients. It is true that if one or two of them are implemented, they will save money, but any money saved would be reinvested in further patient services or would help to fund other developments. It is not for me at this stage to pronounce on the validity of the better service argument, but it is important for us to recognise that the proposals were promoted in that spirit.

The proposals raise questions that are not unique to the north-east Essex district authority or to the north-east Thames region. There is the general question of where to locate services in a district that has many large population centres. We all accept that we cannot provide all facilities in all towns. It would make neither medical nor economic sense. Therefore, judgments have to be made, difficult decisions have to be reached and the right balance struck. The objective of our consultation process is to ensure that in each instance that judgment is right.

My hon. Friends will be aware that the closure of the children's ward at Clacton hospital is out for local consultation and comments have been invited to be in by 15 January. Should the community health council, which formally represents the views of the local community, object, while the district wishes to proceed, the proposal will be referred to the regional health authority. If it agrees, the matter will then come to Ministers. My hon. Friend will recognise that it would not be appropriate for me to comment on the substance of the proposal at this stage.

I understand that the health authority believes that children requiring admission to hospital will receive a better service if they are looked after in the paediatric wards at Colchester general hospital, where specialist facilities in terms of nursing and medical manpower, with supplementary facilities, are immediately available 24 hours a day. With children, that is particularly important. The considerations in this proposal are service ones, hoping to achieve the best use of resources and an arrangement that does not dilute the experience needed to develop good expertise.

Does my hon. Friend recognise that the general practitioners are locally in dispute over the medical opinion of the health authority?

I am aware of that, and it is by no means unique that there is a division between professional opinion, whether clinical or economic. It is not uncommon for those who work at a hospital to defend its existence. Many factors need to be taken into account, and one is the point made by my hon. Friend—the distance of the new general district hospital from Clacton. I am certain that the district health authority will take careful account of the points made by my hon. Friend.

The second point concerns the proposed closure of the radiotherapy unit at Essex county hospital in Colchester. Again, this report is out for consultation and, for the same reasons, it would not be appropriate for me to comment. However, as there has been much misreporting on this, one point needs to be made clear. The proposal does not stem from a desire to save money. The purpose of the review is to determine what sort of cancer services—not just radiotherapy—the region should be providing.

I believe that the report argues the case for concentrating services, including radiotherapy, into specialised centres to improve the quality of the service to patients. It also argues that the present nine radiotherapy centres should be reduced to five, one at each of the proposed cancer treatment centres. Again, it would be up to the regional health authority to weigh up all the arguments at the end of the consultation period. I stress that this proposal has not been instigated out of a desire or a need to save money.

The third point is the closure of the Passmore Edwards medical rehabilitation centre in Clacton. This proposal is also out for consultation and, therefore, my position is the same as it is on the other two issues. Here again, the reasons for the proposal are not financial. In this case, the health authority's argument is that the main rehabilitation centre is best located as part of the district general hospital services in Colchester, where new rehabilitation facilities are already available, both at the hospital and the other major department, St. Mary's hospital, which is undergoing major improvement.

For Clacton, as for Harwich and Halstead hospitals, the proposal is that they will provide comprehensive outpatient and day-patient support. I understand that substantial improvements in the rehabilitation facilities are taking place at the Clacton and district hospital. This is a national trend. It is based upon the most modern and up-to-date judgments about the most appropriate clinical practice. However, it is entirely right that this should be a matter for consultation. The service to the public is the paramount criterion.

My hon. Friend referred to the financial issues. He knows that the aim of the resource allocation working party is a steady equalisation towards a more equitable distribution of health services across the country to meet local needs. Thereby we hope to correct the historic imbalance of services that has favoured London and the south-east at the expense of the rest of the country. The Conservative party made a firm manifesto commitment to that process.

North-east Thames still receives more than its fair share of the available resources. The pace of change is crucial. It must be carefully balanced. It must not take place too quickly, thereby creating unacceptable damage in London. However, we must move as quickly as we can towards the abolition of inequity.

It is important for north-east Essex to keep the matter in perspective. The rate of change must be measured. It was not until 1985–86 that the north-east Thames region started the year with an increase in its allocation that was below the forecast rate of inflation. It was given notice of this change through its forward planning assumption, to allow it time to adapt its plans. It has also been able to develop substantial cost improvements in patient care, even within a static or decreasing budget.

My hon. Friend made a bid for the transfer of north-east Essex out of the north-east Thames regional health authority and into the East Anglian regional health authority. I do not believe that north-east Essex is getting a raw deal from the north-east Thames regional health authority. It has benefited enormously in recent years from being in that region. I recognise that each district is rightly concerned about the needs of its local population. However, the north-east Thames regional health authority is sensitive to the requirements to which my hon. Friend referred. The chairmen of the regional health authorities discuss this point regularly with the Department.

My hon. Friend said that north-east Essex has one of the lowest levels of acute spending per head of population. He referred to certain statistics. However, those statistics were overtaken by the new district general hospital that was opened this year and by the increased revenue allocation. There was a real terms increase of 6·3 per cent. between 1982–83 and 1984–85.

We shall continue to watch carefully the development of the balance, but redistribution must be carried out at a manageable pace. While the acute services in the London region are rationalised, we must make available the resources that are needed in other regions, including my hon. Friend's region.

Our decision to implement the recommendations of the 1985 pay review body was taken with great care. Our judgment was that a total cost of £240 million could be contained in a year in which allocations would increase by over £500 million, with about £150 million being released through cost improvement programmes. In the financial year 1986–87 there is to be a 6·7 per cent. rise over spending in 1985–86. This has to be set against the forecast of a general inflation rate in 1986–87 of 4·5 per cent. One has to add to that the benefits of the authorities' growing cost improvement programmes. In north-east Essex, as elsewhere, the Government's record of diverting public resources to health provision is good. It is a record of which we can be proud. I hope that my hon. Friend shares that view.

The Question having been proposed at half-past Two o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned accordingly at Three o'clock.