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Orders Of The Day

Volume 113: debated on Wednesday 25 March 1987

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Criminal Justice (Scotland) Bill Lords

Order for Second Reading read.

Ordered,

That the Bill be committed to a Scottish Standing Committee.—[Mr. Sainsbury.]

Leicester Royal Infirmary

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

11.58 pm

On 4 December last my hon. Friend the Member for Harborough (Sir J. Farr) and I had the pleasure of detaining our hon. Friend the Under-Secretary of State for Health and Social Security on a debate on the Trent regional health authority. Tonight my topic is much more specific—the funding of the Leicester royal infirmary in my constituency. Like everyone else in Leicester, I shall refer to it as the Royal.

My plea is for more money to secure the upgrading of some archaic wards which have the reputation as being among the worst in the country. My plea is backed by my hon. Friends in the city and county. I am pleased to see that I have their support in massed ranks and that my hon. Friends the Members for Harborough, for Rutland and Melton (Mr. Latham), for Loughborough (Mr. Dorrell) and for Leicester, East (Mr. Bruinvels) are present. I am grateful for their support.

My plea is also supported by the physicians' group at the Royal and by the "Fair share for health" campaign of the Leicester Mercury, which, under the executive editor, Laurie Simpkin, has done such a splendid service in highlighting the deficiencies in these wards.

The problem that I wish to draw to the attention of the House is within limited bounds. It involves five acute medical wards and, to put the matter shortly, there is not enough money to bring those five wards up to the modern standards that are exhibited in the rest of the hospital. These wards represent a small minority of the hospital, but the high standards elsewhere throw them into stark relief. I have had the opportunity of seeing what the conditions in those wards are like, because on Friday 13 February I was shown round by Dr. Frank Nichol, chairman of the Royal's physicians group, and his colleagues, to whom I express my thanks. To put it in a nutshell, the wards present a dismal sight. There are insufficient bathrooms, too few lavatories, inadequate space and poor access. One ward has a wooden mobile ramp for access, which has to be moved.

It is especially sad to me, with a daughter who has worked as a nurse for a number of years in the National Health Service, to see how her colleagues must care for patients in what can only be described as squalid Victorian conditions. I believe that my opinion of those wards is shared by my hon. Friends who are in the Chamber. They have taken the opportunity to see the conditions for themselves.

I shall flesh out my remarks with a few details about the five wards in question. St. Agnes ward has one lavatory and an old sink. Where I come from it is called a slopstone. I thought that they had passed into history, but apparently one or two have been preserved for posterity. In St. Margaret's ward there is a tiny lavatory and an old bath. Both those wards appear to have had no work done on them for a long time. The three other wards have had some recent cosmetic improvements made to them, but they are still well below par. Oliver ward has only three lavatories for a considerable number of patients. Marriott ward—it will loom large in my speech—has two toilets for 34 men. The modest improvements that have been carried out recently have been paid for by a trust fund that was set up for the benefit of patients, not for the purpose of structural repairs. Fielding Johnson ward has 34 patients—there should only be 28—and a day room is being used for beds. Those five acute medical wards are desperately in need of further upgrading.

The problem must be seen in context—our wretched inheritance from the Labour Government and their policy of hospital building cuts. In 1974 those wards were unacceptable, and they were even more unacceptable when the Labour Government left office in 1979. It is sheer cant, humbug and hypocrisy on the part of the Opposition parties, aided and abetted by their friends in the trade union movement, to complain about Government policies or the National Health Service. Those parties, acting together, did much to damage the NHS. If they had any sensitivity, they would maintain a shamefaced silence.

In the city and the county we are being subjected to the cynical cry of cuts in services, but in truth there has been an unprecedented growth in the Leicestershire health authority and especially the Royal. That growth has taken place since we took office in 1979. The funding of the Royal has gone up from £11·5 million in 1977–78 to £39 million in 1985–86. The Leicestershire health authority has experienced a real growth in revenue funding of 34 per cent. from 1978–79 to 1986–87.

I shall say a few words about the history of the hospital. The Royal is an ancient and important hospital. It was founded in 1771. It is by far the largest hospital in the county, and it is an important teaching hospital for the university medical school—a school of increasing repute. Leicestershire health authority is the largest authority in the country, serving an area with a population of about 800,000, some of whom receive treatment at the Royal. The scale of the operation was brought home to me in striking detail when I visited the headquarters of the ambulance service at Carlton Hayes and saw the computerised service and the logistical problems and complexities that must be confronted by a health authority of that size and diversity.

May I pencil in some of the more recent background. It is a cause for pride, not for grumbling. My hon. Friend the Minister had the opportunity of seeing Glenfield hospital. A hospice has been opened by LOROS. Both facilities set fine examples for others to follow, and the Royal has also had great success. Between 1980 and 1986, in-patient work load increased by 22 per cent., day cases by 50 per cent., out-patients by 14 per cent. and maternity services by 8 per cent. Using a slightly different time scale, there has been an increase from 29,000 in-patients in 1977–78 to 45,000 in 1985–86. That has been accompanied by an increase in medical staff.

Those increased services have been delivered with more efficiency. The cost per case throws up interesting comparisons with the region and with national criteria. At the Royal the cost per case is £618. In the Trent region the average cost is £686, and the national average is £724. Inpatient throughput based on annual discharge per bed shows the same favourable picture. In the Royal it is 54, in the Trent region it is only 50, and nationally it is only 47. We have had very cost-effective growth at the Royal. It is a busy, efficient hospital, and there has been good housekeeping. I am sure that my hon. Friends who represent the city and county agree that we should pay tribute to the doctors, nurses and staff at all levels. The people of the city and county are profoundly grateful to them. A price has had to be paid for that success, just as successful businesses sometimes have to pay a price and require additional injections of cash to cope with and promote their success.

Having sketched in some of the recent background, .I should look to the foreground before considering the specific problem of the five wards. We expect that in the not too distant future phase 4 will be completed. When it is, it will provide a considerable increase in the number of acute beds, and we all welcome it. At least £18 million will be spent on it. Formal approval was given for the project on 22 March 1985, and it is estimated that work will begin on the site in September this year. On an optimistic estimate, it will be open in the spring of 1991. It will provide 360 general acute beds and 96 acute geriatric beds. But a blind spot has occurred between planning in the recent past and planning in the near future. This has caused the unfortunate situation in regard to the five acute medical wards of which I have spoken.

I draw the attention of my hon. Friend the Minister to the chronology of the events that relate to the five wards. As long ago as 1982 there were plans to upgrade the Marriott ward. They were delayed through lack of funds and put back to the mid-summer of 1983. In mid-summer 1983 they were postponed again, but in January 1984, as a result of savings from the re-siting of the children's wards, it appeared that funds would be available and hopes were raised. In June 1984 the district management team agreed that £100,000 could be spent on upgrading Marriott ward and said that work would he likely to start in 1985–86. In March 1985 the news was even better. The sum that was apparently to be available was £250,000, and that was apparently confirmed by the unit administrator. Consultant architects were brought in and plans were drawn up, and in September 1985 the plans were agreed.

In October 1985, however, a bitter blow fell. The new unit general manager informed the physicians group that, sadly, the money that was thought to be available was not available. All that has happened since then is that some minor cosmetic improvements have been carried out to Marriott ward, and something similar will be done to Spreece ward. The promised upgrading of the wards, which looked likely to come to fruition not long after 1982, has progressively retreated like a mirror. There has been promise and there has been retraction. That state of affairs, understandably, has not only undermined the morale of the staff, but has dismayed the public at large and caused widespread disappointment, which we, as hon. Members for the city and county, strongly share.

With that background of facts, I come to the argument itself. Looking on the bright side, it will be about four years before phase 4 comes into operation. In view of the history of delay of phase 4 and of other projects at the Royal, it is feared that the additional beds will not be available in the spring of 1991, as is now being promised. The reason for that fear is that phase 4 has not yet even been put out to tender. Therefore, it is thought to be unlikely that, with such a large scheme, work can begin on site in September of this year as had originally been envisaged.

Even when phase 4 is completed, because of the ever-increasing demands upon the facilities at the Royal, it is likely that the wards will still be needed. Therefore, the argument that they have a short life in front of them and all that is required is some temporary tarting up to eke out the remainder of their existence seems not likely to be borne out by events.

How pleased we would be if these wards were to follow into history the great string of other unsuitable premises that we inherited from the last Labour Government. We take pride in having closed them and replaced them with modern and much more suitable facilities. However, that will happen only if sufficient funds are made available. These buildings are sound and, with appropriate upgrading, could provide facilities well into the next century. But more cash is required if those urgent, long-term improvements are to be made.

I turn to the real burden of my request to my hon. Friend the Minister. It is also made on behalf of my hon. Friends with neighbouring constituencies who are here tonight. The Royal has been a victim of its own success. It faces other problems, which I could have dwelt on tonight, but as time is limited I have limited my remarks to these five acute wards. They are a sample of a somewhat wider problem. We are convinced that, although the present level of funding, based on the resource allocation working party, has been vastly increased, it is not good enough. We are aware that RAWP is being re-examined, but some people fear that the shrill battalions from London and the home counties will succeed in persuading the Government that they should have a greater share. We shall resist that attempt most strenuously. We are not prepared to see that happen. The Royal is suffering from underfunding, and I am here tonight to ask my hon. Friend, on behalf of the Government, urgently to do something to put it right.

12.17 am

The Parliamentary Under-Secretary of State for Health and Social Security
(Mrs. Edwina Currie)

In the 10 minutes that are left to me I shall endeavour to answer some of the detailed points that have been made by my hon. and learned Friend the Member for Leicester, South (Mr. Spencer). I congratulate him on his success in Mr. Speaker's ballot for this Adjournment debate. This is the twentieth time, so far, that I have responded to an Adjournment debate, and it is the second occasion on which I have faced the formidable ordeal of addressing those of my hon. Friends representing Leicestershire constituencies, who are ranked behind me in considerable numbers. It is such a pity that the hon. and learned Member for Leicester, West (Mr. Janner) has seen fit to find something else to do tonight, despite his occasional professed interest in the health of his constituents.

Health funding in Leicester has undoubtedly been a matter of considerable local interest for many years. I join my hon. and learned Friend in congratulating the Leicester Mercury on its campaign over many years, for the result has been a change in the whole system of funding and in a reallocation of resources throughout the country, as my hon. and learned Friend described. The efforts of the Leicester Mercury and of my hon. Friends in Leicestershire have led to a dramatic improvement in health services, particularly during the lifetime of this Government.

The Trent region is a major growth region. It also serves my constituency of Derbyshire, South. Spending in Trent has risen by 27 per cent., compared with the average for England of about 19 per cent., between 1978–79 and 1986–87. That is the highest increase in the country. In 1978–79 the Trent region was 8 per cent. below its target. Now it is about 3 per cent. below its target. That shows the Government's commitments to the hitherto rather less well funded regions. The benefits are then passed on to the districts.

As for capital, of the 14 regions, Trent has received the third highest capital allocation in England, after the west midlands and the north-west. Some £58·7 million will be spent on capital projects in 1987–88. That has increased Trent's share of the capital programme substantially.

I have taken the points that my hon. and learned Friend made about London, and it is worth reflecting that London still has twice as many acute beds for its population as does the rest of the country.

A large number of new building projects are under way. In Trent, £80 million of new building projects are due to be started in the current year, while 21 large projects at a total cost of £125 million are under construction or have recently been completed. On 4 April I shall be visiting one of the most recent of those, the new development at the Derby city hospital in Mickleover, which is mainly staffed by my constituents, who are serving it very well.

Money has been spent in Trent region on a 32 per cent. increase in doctors and dentists in 1985 compared with 1978. That is nearly 900 more doctors and dentists. Our constituents were neglected by the last Labour Government. That is one of the most substantial increases that has been reported around the country.

The Leicestershire health authority, which is responsible for Leicester royal infirmary, is a major teaching district. Its funding in 1982–83, when its boundaries were first established, was £118 million. This year we will be spending £154 million, and as a result it is within 4 per cent. of RAWP. In real terms it has experienced a growth of 34 per cent. since the Government took office. Ten years ago it was perhaps 20 per cent. below what we now call the RAWP target, but it is on schedule to meet its target by 1994. Therefore, the result is much improved health care for the constituents of my hon. and learned Friend and his colleagues from Leicestershire.

Leicester royal infirmary is one of the oldest hospitals outside London, although the buildings that we are talking about do not necessarily date from 1771. The original cost of the hospital was £2,762, which shows what happens when we have inflation.

I take the point that my hon. and learned Friend made about wards. Five medical wards are under criticism and it has been recognised that they are unsatisfactory. Dr. Ian Pye, the chairman of the physicians group, called them old-fashioned, but the Leicester Mercury, in its edition of 20 February 1987, said:
"Despite their problems, the wards continue efficiently, with patients being treated and discharged at a higher rate than at comparable hospitals."
There is no question of the wards being dangerous, but they are open and crowded wards that Miss Nightingale would have recognised. However, three of those wards have been upgraded and £100,000 is to be spent on the other two. That activity is quite separate from the rebuilding that has been described. The DHA has decided not to spend further money upgrading the wards as they will be completely replaced in phase 4 of the overall development programme for Leicester royal infirmary. The Leicester Mercury called the new development an antidote, which was uncharacteristically ungenerous of it. An antidote it will not be, but a full replacement it will.

Phase 4 is due to start in September of this year, will be completed in 1990 and will be open to the first patients almost exactly four years from now in the spring of 1991. It takes some time to ensure that everything is working. I hope that they do not practise on patients. It will cost £18 million altogether.

My hon. and learned Friend has complained about the state of some of the wards, even after some money has been spent on them. One must ask whether it makes sense to spend even more—I understand that £300,000 would be required for two wards—when they will be completely replaced shortly. The decision whether to upgrade or wait until the new facilities are ready must be a matter for the district health authority. While I recognise the force of my hon. and learned Friend's feelings, I would take issue with him when he says that the increase in demand on the LRI will mean that these wards will still be needed. Surely that is both an increase in service that would need to be argued for, and indeed which might well perpetuate the use of facilities that have now been roundly condemned.

There are other developments under way. The bone marrow transplant unit has been brought into operation at the hospital, which will mean that up to 20 people a year will not have to travel to other centres. New monitoring equipment will be bought for intensive therapy, coronary care and theatres at the infirmary. Funding will be made available for extra nurses for cancer patients. There will be £226,000 spent on the purchase of new or replacement medical equipment in response to concern which has been expressed elsewhere about equipment, and £94,000 additional revenue will be made available for improving services for drug misusers, on top of about £360,000 that has been allocated under the drugs central funding initiative for a three-year period.

Will my hon. Friend consider visiting Leicester to see the Leicester royal infirmary, the wards and the bone marrow unit? The unit is in receipt of funds, but those responsible for it are keen to obtain additional moneys. There was £190,000 for the first year, and it is unfortunate that not enough space is available.

I understand that the unit was allocated an extra £115,000 for a full year, and extra services start half way through the year. There will be about £55,000 this year, and so on.

As for the invitation to visit, I should like to emphasise the Health Service for the future, that we are building. I would prefer to go when the first sods are cut, then when the first foundations are laid for phase 4 or I may have the opportunity to see phases 1, 2 and 3 of the existing development.

We want to build a Health Service for the future. We are concerned to build a service for our children and our grandchildren, and I am certain that that will happen as a result of what is being proposed. The day will come when the old wards will be phased out. That day will not be long coming, and I am sure that it cannot come quickly enough—

May I place on record the fact that Leicestershire Members are grateful to my hon. Friend the Under-Secretary of State and to my hon. Friend the Minister for Health for attending the debate?

It is entirely right and proper that we should be here. We have both visited Leicester recently and been enormously impressed by the efforts made by the consituents of all my hon. Friends who represent constituencies in Leicestershire to ensure that the Health Service in Leicester uses the money with which it is well supplied in the interests of all concerned.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes past Twelve o'clock.