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Shropshire Health Authority

Volume 118: debated on Monday 29 June 1987

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

10.1 pm

I am pleased that the Under-Secretary of State, my hon. Friend the Member for Derbyshire, South (Mrs. Currie), is to reply to the debate, although I apologise for keeping her in the House when no Division is expected. I hope that by the time we reach the end of our deliberations I shall have even more reason to be grateful for her presence. I am equally delighted that my right hon. Friend the Member for Shropshire, North (Mr. Biffen) is in his place. I believe that, although his new-found freedom will ultimately be to the detriment of the Government and of my party, it will be of great benefit in the battles ahead to safeguard the Health Service in Shropshire.

The condition of the Health Service in the United Kingdom was a major issue in the election campaign nationally, but no more so than in Shropshire and in my own constituency. The true picture behind the Government's provision of resources for Shropshire and for the Health Service nationally was grossly distorted by representatives of highly irresponsible trade unions involved in the Health Service who frankly could not care a great deal about the level of health care in the county and were far more concerned to make party political points. The fact that they have been so quiet since polling day is clear evidence of their partisan point of view. They were aided and abetted by a politically motivated senior officer in the Health Service. So as not to brand everyone, I shall brand the individual—the director of personnel—who has made his position very clear and public through the local media. This has been much to the detriment of the health authority officers because the facts of Government expenditure on the Health Service in Shropshire were not made clear to the electorate and on one occasion were completely misunderstood by the Socialist candidate who unsuccessfully opposed me.

The facts of the matter are that in 1978–79 revenue expenditure in Shropshire was £29·1 million and capital expenditure was £1 million. In 1985–86—the last figures available, which were confirmed in a parliamentary written answer last Session—revenue expenditure had risen to £61·3 million and capital expenditure to £10·3 million. I can therefore assure my hon. Friend the Minister that we are not necessarily arguing about the level of funding. The problem in Shropshire, within the West Midlands regional health authority, is one of equity and future plans for the Health Service. While the Government's commitment to the Health Service has been very clear nationally, and in our region demonstrably so, by the time the money was apportioned by the regional health authority the allocation to Shropshire was down to two thirds. I believe that clearly shows that although the regional authority may have the interests of other health authorities close to its heart, the interests of Shropshire are clearly nowhere near the regional authority's heart.

My hon. Friend the Minister, as a former chairman of the Birmingham health authority, may have some interesting points to make in the debate.

The fact remains that Shropshire is a growing county. No doubt much of its growth is due to the growth of Telford new town. I congratulate the hon. Member for The Wrekin (Mr. Grocott) on his election to the House. Hon. Members who represent Shropshire, or many of the people of Shropshire, could have doubted whether there was a need for a new hospital in the east of the county. Some of us were concerned about the effect that such a new hospital would have on the established county service. Indeed, some of us were sceptical about the need for such a large second district general hospital when, by inner city standards, county population is not considerable.

Despite that, our area health authority in Shropshire was instructed by the regional health authority to cut £750,000 from its 1987–88 budget. That means that over three years, in addition to the cost improvements that are being undertaken—very effective cost improvements indeed—the authority must save an additional £5 million. That means a reduction of 7 per cent., and that has to be considered in the light of the fact that Shropshire is already 10 per cent. under its RAWP allocation.

I wonder why there should be such a problem. Part of the difficulty lies in the growth of the population of Shropshire—about 7 per cent. It is the fastest growing population in the west midlands region. To meet growing population needs and the growing demand for hospital and health services, the individual members of the medical staff of Shropshire health authority, to whom I pay credit, have not sought to make this a party political issue. I have referred to their union leaders. Members of the Shropshire medical service have been superb in responding to the demands placed upon the Health Service. In fact, clinical efficiency has increased by 4 per cent. Considering the fact that the growth development funds for our area health authority were 1 per cent. a year, one would have hoped that the growing demands of east Shropshire and the need for a new hospital on that side of the county could have been met by such development. However, the area health authority had to turn to the development fund for an increase of 1 per cent. a year to meet the need for supplementary pay awards, and the effect of the growth was halved. That left many of us in the west of the county of Shropshire asking, "What price Telford district general hospital?"

In 1984, following a meeting with medical staff in the county, I was so convinced of the answer to the question that I led a delegation of consultants to meet the then Minister for Health, the present Chancellor of the Duchy of Lancaster. He gave the area health authority an assurance that the building of the Telford district general hospital could go ahead on the basis that the region could meet the shortfall. That assurance was given to the Members of Parliament who represent the county, the medical staff in the county, the area health authority and, as we understood it, the region. Where has that assurance gone now? Long before the Telford district general hospital is anywhere up and running, we find that the effects that it will have on the rest of Shropshire are already beginning to bite. That was not the picture that was painted to us before the hospital was commissioned.

In fact, waiting lists are growing. We are among the six worst in the region. It is getting worse. The sadness is that, to try to meet the budget for the construction of Telford district general hospital, the area health authority has had to use the allocation that was announced by the former Secretary of State for Social Services to tackle waiting lists. That money has had to be used as bridging finance to save the existing Shrewsbury hospital services and allow the continuation of the Telford district general hospital. Indeed, during the election campaign, my hon. Friend the Minister intervened to assure the residents of Shropshire that the casualty service operated by the Royal Shrewsbury hospital, based in my constituency, and the proposed Telford district general hospital, based in the constituency of the hon. Member for The Wrekin, would operate on alternate days.

So far removed are the people who make up the regional health authority geographically and practically from the health needs of our district of Shropshire that they can contemplate such a nonsensical idea in one of the largest geographical areas of the country without any reference to the medical staff. That is why I shall make it a continuing cause during my time as a Member of Parliament to seek the dramatic change, for which I called in the debate on Thursday, in the health structure of the country by the abolition of regional health authorities, which are little more than a time and money-consuming bureaucracy.

My hon. Friend the Minister may bring to the attention of the House the way in which day surgery can alleviate the growth of waiting lists. She expressed that concern during her visit to Shropshire. Our problem as laymen and as Back-Bench Members is that the method for the statistical evaluation of day surgery varies not only nationally but within the region, so it is difficult to judge how effective it can be. We must also take into account the fact that Shropshire is a large geographical area and cannot be compared with an inner city such as Birmingham, where hospital travelling times are considerably less than would be found in the constituencies of my right hon. Friend the Member for Shropshire, North and my hon. Friend the Member for Ludlow (Mr. Gill).

One of the main centres for day surgery in Shropshire was the Cross Houses hospital in Shrewsbury, which had to close to finance the building of Telford district general hospital. Far from the position getting brighter, we have many more problems ahead.

There is no doubt that the county of Shropshire has had more money from the Government in real terms, but the Members of Parliament who represent Shropshire say to my hon. Friend the Minister that the demands are greater. I speak not only in medical terms, because that is a problem facing the entire country, with the developments in medicine and the greater demands that people make on the Health Service. That is compounded by the growth of population in Shropshire, not all of it indigenous. If government policy is to create a new town in the county, there must be a moral obligation on the Government, regardless of their political persuasion—the new town has been sustained by government of both political persuasions—to ensure that the indigenous population of the county does not carry the burden exclusively for that accelerated growth.

Whether the complications in Shrewsbury that have arisen because of the building of Telford district general hospital have anything to do with the marginality of the political majority in that seat is a matter for speculation. I know what my view is.

It will be marginal yet again. Perhaps for short-term political gain, the rest of the county is paying an exceedingly high price—I believe too high a price. The duty of the Government and of my right hon. and hon. Friends at the DHSS is to make the regional health authority move towards hitting its RAWP target and to honour the promises that were made to us that the construction of a second district general hospital in Shropshire would not annihilate the provision of cottage hospitals or the excellent reputation established in Oswestry and in Shrewsbury as centres of medical excellence.

That is the challenge that faces us, and my hon. Fricnd and her colleagues had better be prepared for a long-drawn-out battle, because, regardless of our political persuasion, we will not allow the Health Service in Shropshire to be hacked to pieces.

10.13 pm

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

I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Mr. Conway) on his success in the ballot and on the efforts with which he puts the case for his constituents. I am also pleased to see in his place my right hon. Friend the Member for Shropshire, North (Mr. Biffen) and my hon. Friends the Members for Fylde (Mr. Jack) and for Stroud (Mr. Knapman). It is nice to know that colleagues from other parts of the country take an interest in activities in Shropshire. I also see the hon. Member for The Wrekin (Mr. Grocott) in his place, and I am pleased that he is taking an interest in the welfare of his constituents.

My hon. Friend the Member for Shrewsbury and Atcham has discussed this matter with my hon. Friend the Minister for Health, and he has written to my hon. Friend and tabled several parliamentary questions during the past few months. I take issue with his latter words. The Health Service in his neighbourhood is not being hacked to pieces or hacked into anything. In fact, it is steadily being improved, and the result of that is an improvement in the services that are available to my hon. Friend's constituents and to the neighbourhood at large.

I shall put the matter into context. I am sorry to disappoint my hon. Friend, but we have no plans whatever to abolish the West Midlands regional health authority. In fact, it is one of the most important in the country and its expenditure has increased from £433 million in 1978–79 to £974 million in 1985–86. That is a real terms increase of 19 per cent. over and above inflation. Since then there has been a further increase, and this year the West Midlands regional health authority will receive over £1·1 billion, which makes it, in cash terms, the largest region in the country. That brings the region within £25 million of its target share of resources, according to the RAWP allocation.

The total number of in-patients treated in the region has risen from 548,000 in 1979 to 666,000 in 1985—an increase of 21 per cent. Waiting lists are much shorter than those that we inherited in 1979. They have dropped from 89,000 in 1979 to 79,000 in 1986, which is a reduction of nearly 12 per cent. In addition, the West Midlands regional health authority will receive £2·88 million this year from the national waiting list fund, which will enable an extra 12,000 cases to be treated.

The capital programme in the west midlands is also the largest in the country. Nineteen major capital schemes have been completed since 1979, 15 are under construction, and a further 32 are approved to start. As my hon. Friend has said, those schemes include the new development at Telford. The total capital allocation for 1987–88 in the west midlands is nearly £90 million—£88·8 million to be precise. In fact, the allocation to the west midlands has been the largest in the country for some years. Large sums of money are certainly being allocated to that region.

My hon. Friend mentioned funding for Shropshire district health authority. I can confirm the figures that he gave. In 1985–86, gross revenue expenditure was £61·3 million. Again, there has been a further increase since then. In 1987–88, the current year, the total amount of the initial cash allocation to that health authority is £65·6 million, which is an increase of more than 7 per cent. on the previous year. Pay awards and waiting list money are on top of that. Therefore, there has been a substantial increase in the amount of money going to that health authority—from £52 million in 1982–83, when it was founded, to £65 million now.

However, as my hon. Friend has said, hospital activity has also risen sharply in Shropshire over recent years. That is partly because of population growth, especially around Telford. I must admit that, as a former housing chairman in Birmingham, I accept a small modicum of responsibility for that. It was under our control that we offered the good burghers of the city of Birmingham the opportunity to live in the leafy lanes of Telford. Happily, many people have settled there. However, as my hon. Friend said, they expect the same quality of service as they received from the great teaching hospitals in Birmingham, and they have a right to expect that.

The increase in hospital activity in Shropshire has come also from the much improved service, and with that people's expectations of the treatment they can have has tended to rise. Between 1982 and 1985 the number of inpatients treated rose by 16·5 per cent. In 1985, nearly 52,000 in-patients were dealt with by the Shropshire health authority. A total of about £400,000 has been allocated to Shropshire for its waiting lists. Full details have not been finally agreed for all of that, but already about £125,000 is being spent this year. That will especially assist those patients being treated by the ear, nose and throat departments, as well as those in ophthalmology. We look forward to seeing the rest of that money being committed shortly.

We are aware that many people believe that the changes that are taking place in Shropshire are putting a strain on the district's current resources. I accept that my hon. Friend feels deeply about Shropshire being seriously under-funded. However, I hope that he accepts that that is taking place against the background of a rapid increase in resources to that neighbourhood. I accept his point that the question is not how much, but the way in which the money is used and allocated in the region.

I should underline the fact that the allocation to a district health authority is a matter for the regional health authority. Ministers and officials have no intention of starting to decide the allocations to more than 190 health authorities. The regional health authority takes into account a calculation which is based on the RAWP formula for district health authorities, but it is only a guideline. We have asked regional health authorities not to cause rapid fluctuations in the sums that go to the districts and to take into account local needs.

As a result of the growth in the demand for services and the rapid change in population, the west midlands region looked at the Shropshire health authority district and some years ago decided on a major investment in services in Shropshire in the shape of the new hospital at Telford. Many people in the east of Shropshire were looking to Wolverhampton for their hospital services. However, it was agreed that Telford should get the new hospital and a new £24 million unit, which I visited last year, is scheduled to open in 1989.

Before Telford stage one could go ahead, several major meetings were held in 1983 between my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), who was then the Minister for Health, local Members of Parliament, clinicians, regional and district healt authority chairmen and others. A funding package for the Telford district general hospital was hammered out. Without that agreement Telford phase one would not have happened.

It was always accepted that the opening of the new general hospital would mean a review of existing services in Shropshire. Historically we have had a network of small community hospitals throughout the country providing a good service.

This is a crucial point and I am grateful to my hon. Friend for allowing me to intervene. We understand the point that she makes so ably. The problem in Shropshire is that cuts in hospital provision and the closure of hospitals, such as Cross Houses, which have been on the cards for many years—long before I became the Member of Parliament for Shrewsbury and Atcham—are happening before Telford is up and running. The assurance that was given by my right hon. and learned Friend, now the Chancellor of the Duchy of Lancaster, was that that shortfall would be met by the regions so that we would not face those closures until after the new district general hospital was in operation. If that was the case, I doubt whether we would be having this debate.

I shall come to that point in a moment, but I should like to develop my argument chronologically so that we can see what happened.

When Telford is opened, Shropshire will have two large district general hospitals—the other being the Royal Shrewsbury hospital—and many other units. We all accept that some change has been necessary. This also offers an excellent basis for planning the development of community services for the priority care groups. I suspect that at the heart of much of our discussion tonight is a pull between the acute services that people have a right to have and a need to develop the priority groups—the Cinderella services that are not spoken for. That is the opportunity that the health authority is attempting to develop.

From what we have seen—I have checked again today—to all intents and purposes the 1983 package has held together, but there has been some shift in responsibility, which I hope is along the lines that my hon. Friend would want. The region's contribution has increased from the originally agreed £2·1 million to £4·1 million. That has more than offset a reduction in the contribution from the Shropshire health authority from £6·4 million, which was agreed in 1983, to £5·6 million now. The result is that the total Telford package is now estimated at a shade under £12 million ready for the opening of the new hospital. Within that figure the region has calculated that some £1·1 million of growth money will enable those community services to develop.

I take many points that my hon. Friend makes, but he will be aware that the community health council has a statutory role in this, as I have. If it objects to the proposed changes in the existing services, those proposals must come to Ministers, so I am a little cautious about commenting on any of the details about particular hospitals that he makes. If the proposals must come to us, we shall examine them carefully.

The regional health authority maintains that Shropshire has been treated no better and no worse than its other 21 district health authorities, some of which face similar problems of rapid population movements. During the past two years Shropshire has moved from that estimated RAWP target, but that has resulted from the increase in the population. From 1989 this position will be substantially reversed when the Telford district hospital comes on stream. Until that happens Shropshire must, in common with other districts, manage within its budget—everyone must do that. Shropshire should not be an exception in the way that my hon. Friend has suggested.

Assuming that Shropshire will make the savings that are looked for, the regional health authority acknowledges that it will have saved £2·2 million during the period 1984–85 to 1987–88, and that is £500,000 more than the regional health authority's target. However, the authority still believes that Shropshire can do more.

I should like to take issue with my hon. Friend about day cases. In Shropshire the figures for 1985, which are the latest that I have, show that the proportion of total discharges and deaths done as day cases—the proportion of total patients dealt with on a day-case basis—ranged from 12·8 per cent. in ophthalmology to 4·8 per cent. in general medicine. That makes Shropshire one of the worst counties in the country. In the case of general surgery it is one of the worst in the country with only 7·7 per cent. of all cases dealt with on a day-case basis compared with the bottom 10 per cent. nationally in those specialties of 9·8 per cent. The top 10 per cent. nationally in all those specialties are reaching between 25 and 34 per cent.

The neighbourhood that I represent is a large rural area and much of it is served by the Burton hospitals of Burton on Trent. Surgeons there tell me that they are achieving figures of about 40 per cent. of cases dealt with on a day-case basis. I honestly do not believe that Shropshire is that different from south Derbyshire. If such figures can be achieved in Staffordshire and south Derbyshire, I fail to see why more than 90 per cent. of the cases in Shropshire must be treated on an in-patient basis. Through my hon. Friend, I again urge the magnificent staff who work in Shropshire to look again at the way that other people do it and to see whether some proposals can be put forward. I have checked again today and I have been told that Shropshire has no proposals for promoting day cases until the new district general hospital opens. I believe that the regional health authority has a point when it says that working in that way it spends money that might be reallocated in different ways.

I understand that Shropshire also undertakes a lot of expensive weekend work. It has a poor use of day care—it is the second worst district of the region. In 1984, in gynaecology waiting times were twice the national average. There are also long turnover intervals. That is why we developed performance indicators, and that is what they tell us.

Is the Minister saying that, in her judgment and the Government's judgment, Shropshire already gets plenty of money for its health services and it is simply a case of the people who work in the Health Service in Shropshire being inefficient?

On the contrary, I am sure that they are extremely efficient. I merely suggest that Shropshire might look at the way in which some similar districts function to see whether there is an opportunity for it to do things in such a way that it would ease some of its financial difficulties. It is for each clinician to decide how he or she will look after his or her patient. However, those figures are available for discussion, and I am sure it they will he taken in the spirit in which they are offered.

To some extent, the solutions lie within Shropshire district health authority's own control. That is why we appoint health authorities and that is what we expect them to do. To some extent, it also lies withinthe region's control. In answer to the point raised by my hon. Friend the Miniter for Shrewsbury and Atcham, the region has agreed to advance Shropshire some £800,000 earmarked for the opening of Telford to enable rationalisation to proceed. It intends to relieve the pressure that my hon. Friend has identified. The result should mean no major loss of services as originally proposed in a closure package.

All the problems will be eased as the new hospital comes on stream, to which we are all looking forward shortly. It is not possible in a debate of this nature to respond to all the points that are made. However, I hope that I have addressed some of the key issues. I have no doubt that in the weeks and months ahead my hon. Friend will let me know about any outstanding points.

Question put and agreed to.

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