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Coventry District Health Authority

Volume 124: debated on Friday 11 December 1987

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

2.31 pm

I wish to begin this half-hour debate on the crisis facing the Health Service in Coventry with the apologies of my hon. Friend the Member for Coventry North-East (Mr. Hughes), who intended to be here today, both to support the debate and to make his own contribution. Yesterday afternoon his wife Ina was taken to hospital, suffering from a suspected heart attack. Let me place on record my hope, and no doubt that of all hon. Members present, that it is not a serious condition. I also wish to thank my hon. Friend the Member for Livingston (Mr. Cook), who is shadow Secretary of State for Social Services, for staying at least for the beginning of the debate.

The core of the debate is the Government's underfunding of the Coventry district health authority, and the authority's consequent inability to deal with the growing crisis facing the Health Service in Coventry. The position is deteriorating daily, as is witnessed by the large volume of letters that I receive from constituents and others in Coventry who are experiencing the effects of the crisis. Only this morning, I received a letter from Carol Cilia, a single parent with three small children who lives in Coventry, South-East. The letter reads:
"Dear Sir,
I was diagnosed as having the early stages of cervical cancer from a smear test taken August 1986 … finally called for final laser treatment on 19 November 1987 … was taken to a Day Room on B1 east (Gynaecological Ward). Due to this ward having to cut its beds from 52 to 26, there were no beds available for use and 10 of us sat for 7 hours in the day room, watching people have lunch, tea and coffee whilst we were not allowed to eat or drink … We had to change into operating gowns in the treatment room and see the doctor in the scan room. The ward had men from rather over-crowded wards in it, so sitting round in a gown which revealed everything was also disturbing. Finally the first patient taken down to the operating room at 2.00 p.m. whereupon the laser broke down. Walsgrave only has one laser for … neurosurgery; ear, nose and throat as well as cervical cancer. It is therefore not surprising that this one piece of vital equipment sometimes gives up. We were kept until 4.00 p.m. whilst they tried to mend it. Unfortunately, they could not and we were all sent home after a very stressful day. I was called again for laser surgery on 3 December and went through the same procedure. This time, however, they managed to find us beds, but not on the gynaecological ward. I was placed on the men's ward which for such a personal thing as cervical cancer was extremely embarrassing when in-patients asked what I was there for. Again I starved and thirsted all day only to discover at 4.00 p.m. that the laser had broken down once more, and I was sent home without treatment. I am a single parent with 3 small children. I also have a pressurised job with Community Programme for Warwickshire County Council where I am the Personnel Officer and Training Advisor. I organise training for 400 long-term unemployed people under the government's scheme to re-introduce them to the work situation and up-date their skills."
This lady adds that she loves her job and refers to the stress that her condition is placing on her in the service that she is trying to give to the 400. She continues:
"I have no complaints against the hospital. They are attempting to cope in a situation outside their control. Both the consultant and the nursing staff were also upset about the delay and have done their utmost to correct the situation. However, there is little they can do without money being fed into the hospital for new equipment … and for re-opening beds that have been taken away. I cannot understand why the government insist that they are putting in more money … into the health service as in my experience, and everyone else at the hospital, it is on the brink of disaster."
I hope earnestly that, when the junior Minister replies, we shall not get the litany of 10-year-old National Health Service statistics that we have had to put up with over the past seven weeks from the Prime Minister every Tuesday and Thursday. We want to deal with what we are only too well aware of—the effects of the crisis on real people such as Ms. Cilia, whose letter I have read.

I understand that last night Mr. David Loughton, the general manager of the hospital at Coventry, said that the plans for a special unit for separate gynaecological operations are laid out, but the cash has not yet been made available. The Minister will have received a copy of the letter from which I have quoted. I accept that she may not be able to reply to it today, but I hope that she will give an assurance that the case will be investigated on behalf of my constituent.

The morale of NHS staff in Coventry is being undermined by the deterioration of the service that it provides. This is exacerbated by low pay and worsening conditions of work.

Another of my constituents, Andy Sutcliffe of Binley, a medical physics technician, complains about the 5 per cent. pay award to him and his colleagues, which was paid in November. Back pay is owed and it will not be paid until after Christmas.

Another of my constituents, Mrs. Hall from Wyken, is a state registered nurse. She has worked on the night shift for 14 years. She complains bitterly that special duty payments and out-of-hours moneys are being threatened by the Government. She speaks of becoming increasingly alarmed and revising her opinion on strike action to defend services and wage conditions in the Health Service.

These constituents speak on behalf of hundreds of Health Service employees in Coventry. We have had lobbies and meetings with the Minister and her current gaffer. There have been meetings also with the right hon. Member for Sutton Coldfield (Mr. Fowler), who was the Secretary of State for Social Services and is now the Secretary of State for Employment. There was a 40,000-strong petition—the greatest petition ever in the history of Coventry — to protest about the threatened closure of the Whitley hospital. The reluctance of NHS workers in Coventry to request the assistance of their brothers and sisters in manufacturing and other industries in Coventry to support them in taking action in response to the crisis is fast disappearing, especially with the experience of the past seven months and the effect of the cuts in Coventry.

What does it mean to be on the waiting list? I have no doubt that the Minister will refer to the welcome reduction of about 1,000 of those on waiting lists during the past year or so, but there are still about 5,000 who are waiting for an operation or appointment. Four days ago I received a letter from another constituent, Mr. Barnett of Stoke Green. In October 1986, he was given a note by his doctor to take to the referral hospital. The doctor wrote that X-rays and blood tests should be taken because of chest pains. Incidentally, the pains have become much worse over the past three or four weeks. Finally, Mr. Barnett was given an appointment in August 1988.

That is the position for hundreds or thousands in Coventry. Almost every day there are features in the local newspaper and the regional press about the state of the Health Service, cuts in specialist services, bed closures, delays in building programmes, 100-hour working weeks for junior doctors, cancelled or delayed operations and cuts throughout the region and district that are now affecting every family in the area to some extent. Patients in Coventry and elsewhere do not know whether they will stay in the same hospital from one week to the next.

The cuts are enthusiastically carried out by Government appointees on the district and regional health boards. We know that from the experience of our recent Lobbies over the threatened closure of the geriatric hospital at Whitley, in Coventry, South-East. The district health authority's original decision was passed by exactly the same number of votes, despite the 40,000 petition and the hundreds of people who expressed dissent in other forms, including lobbies of the district health authority.

When the matter went to the regional health authority, it occupied 10 minutes of the committee's time. The majority of the members of the committee had not had the papers relating to the closure for more than 48 hours before the meeting. One delegate abstained, I believe completely wrongly, because he had not had time to study the papers. I do not believe that those members, the majority of whom were appointed by the Government, have a heavy heart when they make these cuts and decisions on financial grounds. They have alternatives. They could do what the district health authority in Leeds did or what the heroic Socialist council in Liverpool did, which is refuse to implement the cuts on behalf of the Tory Government. They could do on an individual basis what the general manager in the Berkshire health authority did on being requested to close hundreds of beds—that is, resign. Four of his colleagues who are consultants in the area refused to carry out the surveys necessary to make the Government's cuts.

The cash crisis affecting the district health authority in Coventry was first revealed in its most recent detail to a meeting at the beginning of April which was attended by my hon. Friend the Member for Coventry, North-West (Mr. Robinson), the hon. Member for Coventry, South-West (Mr. Butcher) and me. We were told that the underfunding by the Government of the Coventry district health authority was the punitive amount of £1·5 million this year. The district health authority managers and chairman proposed to implement £1 million-worth of cuts and hoped that the Government would produce the additional £500,000. Despite lobbies and meetings with Ministers at all levels in the DHSS, that additional £500,000 has never arrived. Three weeks after that meeting, like a bolt from the blue, the local press made it clear that the health authority intended to meet that local gap in finance by closing Whitley hospital for geriatric patients. That was never mentioned at our meeting with the district health authority.

Last week, I received a letter from the Minister offering to meet a delegation and me to discuss the closure of Whitley hospital, as part of the statutory procedure, now that the closure has been approved at district and regional levels, before it is approved by her Department. I welcome that offer and at present I am trying to arrange a delegation and date, and I shall shortly contact her office. I do not want to pre-empt the discussions that we shall have then, but I should like to give a couple of minutes of background information and ask two questions which I hope she can answer before the meeting.

Whitley hospital is the NHS facility for the elderly in Coventry. Its closure would end the care of the long-term frail and elderly by the NHS in our city. Seven years ago, it was planned to be the second district hospital and was to be upgraded to 500 beds. Four years ago, it was redesignated as a centre of excellence for rehabilitation services. Those detailed plans have been quietly buried as the financial crisis of underfunding continues.

In case I am challenged on that, I shall use in evidence a letter from the regional health authority chairman, Sir James Ackers, who is responsible for allocating the budgets to Coventry, to Dr. Taylor of Dudley road hospital. I received it at the end of November and it deals mainly with Birmingham. Nevertheless, Sir James Ackers writes:
"We have been able, over the past few years to continue to expand the quantity of health care provided but we have been particularly affected in the last two years by outturns in salaries and prices considerably higher than the assumptions in the resource planning. This has meant the five Birmingham Districts have had to find a sum of approximately £4 million from their allocation over the last two years".
In Coventry, almost £2 million has had to be found.

If Whitley is sold to private enterprise, I do not believe that the Department of Health and Social Security will make savings. For a start, the district health authority will have to pick up interest charges on the sale. The cost of running that private enterprise hospital will be transferred from the budget of the National Health Service to the DHSS. As much, if not more, will end up being paid by the Government although they will be able to claim a cut in NHS money.

I hope that the Minister will be able to answer some questions before I arrive with the official delegation. First, what is the purpose of a statutory procedure for the district and the regional health authority considering a closure which arrives on the desk of the Secretary of State if, before the decision is taken in London, people in Coventry are acting as if the decision has already been taken? I refer to three things — first, the architects and surveyors designing the women's hospital at Walsgrave, which, according to the overall plan in Coventry, is to be funded by the proceeds from the sale of Whitley, have been appointed before the sale of Whitley has been agreed.

Secondly, Coventry churches housing association—which has nothing to do with the Churches, and is the designated body to which the hospital is supposed to be sold — for six weeks has had an office on the site of Whitley, in the old GP unit. The organisation has its own plaque on the wall outside the door of the office, yet it has not been given the authority to buy the hospital. It has set up operations on the site already. Is it a sham that we are going through? The Secretary of State is supposed to be reviewing the case properly, yet the organisation that is designated for the sale has already set up its office on the site of Whitley.

Finally, yesterday, Coventry city council planning department—the department of economic development and planning — issued, under the Town and Country Planning Act 1971, a development plan direction notice that the regional health authority has applied for outline planning permission for the residential development at the "old" Whitley hospital in London road.

Thus the council, the housing association, the architects and surveyors are acting as if the Secretary of State had already given his approval. Will my trouble in organising the delegation be worth while? The only assurance that the Minister can give me today to prove that that is so is that everything is fair and above board, and, on the balance of evidence, that she intends to reject the application from the district and regional health authorities; otherwise everyone in Coventry will assume that that has been planned and has gone through.

I should like to refer to a couple of points that the Minister made to me in a letter of 27 November. The first is about incontinence pads supplies. She wrote that she understood that the difficulties of the supply of incontinence pads to my constituents and others had been effectively resolved. The thickness of my file should illustrate the problems that have arisen over the past few weeks because of the district health authority's decision to stop the supply of incontinence pads to mentally and physically handicapped bairns and elderly folk. I have had distressing letters from, among others, a constituent called Mrs. Flint on behalf of her mother, Annie Tarry, MENCAP, the family practitioner committee, the community health council and Coventry council for the disabled. I have also received a letter from an anonymous person, who says:
"there isn't much I can do about it on my own. I don't think there will ever be a march of the Incontinents to Downing Street. It is a very embarrassing problem I and thousands of others suffer from. Not something I have the courage to shout about. So I will hide behind you, and hope you can. I enclose a copy of a letter I have sent to the Director of Nursing."
There is complacency about that problem being solved. My hon. Friend the Member for Coventry, North-East, in his maiden speech in the Chamber, talked about what it is like to sit in a cold room where the central heating does not work, in incontinence pads that are soaked with urine. Mrs. Flint's mother dries hers out on a radiator overnight because the supplies are not there.

At Boots or White's the chemist in Coventry, people are told that there will be no more supplies of incontinence pads for the next 10 days, and that when they arrive, they will cost £4 per pack of 10. Let the Minister tell those people in Coventry that the problem of incontinence pads has been solved and that their distress is a figment of their imagination.

I have received letters from the local medical committee about the third of a million pounds in cuts that the health authority is demanding. If there are any serious winter illnesses or infectious diseases in the city, the chairman, Dr. Keenan, says that in the light of the cuts in hospital services, the health authority will be unable to cope.

The hospitals in Coventry are being funded by raffles, sponsored events, charitable appeals and donations. Walsgrave hospital has lodged an appeal for an intensive care unit under what I suppose is the attractive slogan of the "I care" appeal. Coventry and Warwickshire hospital is launching an appeal for redecoration and for the provision of carpets and curtains in the outpatients department — but, more than that, for beds and operating tables in the hospital. Yesterday, the Coventry Evening Telegraph donated a £2,000 prize that was won by a reporter and photographer to buy a computer and software for a consultant orthopaedic surgeon to check that all new babies born in Coventry do not have hip weaknesses.

What other Department has this flag-day approach to raising money? Does the Ministry of Defence organise flag days for Trident or cruise? Does the Ministry of Agriculture, Fisheries and Food organise flag days for the grain surplus? Does the Home Office organise flag days for the police or the other services that it runs? How much charitable fund raising was there for that £36 million new office building opposite 10 Downing street, which was opened yesterday for the Minister and her colleagues? Was there a flag day to pay for the Secretary of State's regency chandelier and his private bidet and shower room? Of course, he is not enjoying it at present; because of his health problems he is in a £195-a-day private hospital.

After the tragedy of King's Cross, the Minister correctly praised firemen, ambulancemen and hospital workers. She said:
"I am so proud of the health service staff and everyone else. They were so brave, dignified, impressive, professional."
She should say exactly the same to the ambulance workers in Coventry who, for the past 12 months, have complained about underfunding, understaffing and the under-provision of vehicles, which has meant the deaths of some people who have suffered heart attacks.

Finally, may I mention a matter that I have raised during the past six and a half weeks? That is the scandal and disgrace of the provision of heart operations for my constituents and those of other hon. Members who rely on Birmingham Children's hospital. There have been some successes. When the Under-Secretary of State for Trade and Industry, the hon. Member for Coventry, South-West, and the hon. Member for Rugby and Kenilworth (Mr. Pawsey) intervened on behalf of babies such as Ben Plant and William Pound, those few-week-old babies were given the heart operations that they urgently needed. But how many families have access to a Minister or a member of the governing party? How many families can telephone their Members of Parliament and arrange at short notice for their children's cases to be considered?

I asked the Prime Minister about this yesterday and she completely ignored the question. What would the Minister say to Adrian Woolford, the seven-year-old lad in Coventry who has waited two years for his heart operation? What would she say tonight in Birmingham to the dozens of parents meeting me and other hon. Members from the midlands, together with the doctors and nurses from Birmingham Children's hospital, to discuss the crisis of the cancelled and delayed operations? What would she say—

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

If the hon. Gentleman will give me a minute, I will tell him.

The Minister has had plenty of time during the past week alone to justify the problems in the Health Service. I have waited seven weeks for this opportunity. I appreciate that she wants time to reply, and I will do my best to conclude.

What would the Minister say to the parents of Chintu Kumar, the one-day-old baby from Coventry who died earlier this year after a 100-mile mercy dash from Coventry to Liverpool because beds had been closed in the intensive care unit of Birmingham Children's hospital?

We hear this morning that the Prime Minister has told her special adviser, Sir Roy Griffiths, that there are to be no more closures of hospital beds, in a bid to take the NHS out of the political limelight. She has said that there must be no more ward or bed closures for whatever reason. If that is true, I hope that it means the reopening of the intensive care beds in the children's hospital that have been closed in recent days. There is plenty of money kicking about for Zircon satelites, so there should be plenty of money to inject into the Health Service. It should not be, as the Minister has suggested, that people should be private patients and thereby bleed the NHS of staff. There should be a Health Service for the people, many of whom have paid their contributions for 40 years. It is supposed to be a free Health Service for those in need.

A crisis is facing the families of my constituents and those of my hon. Friends in Coventry and the midlands generally. Indeed, it is a crisis that faces the whole country. We do not want to hear today, or in any replies from Ministers, a litany of statistics — which the Prime Minister repeated yesterday—that sound like a cracked gramophone record. We want the task force approach that the Government can bring to bear in a war 10,000 miles away in the south Atlantic, when they moved heaven and earth to resolve a problem that they thought to be important. We understand the importance of the lives of our constituents, from the youngest bairn to the oldest person facing a lack of incontinence pads. They are just as important as anything that the Government consider important. We want money in Coventry and Birmingham, and we want it now.

Order. The Chair has limited power to curtail hon. Members' speeches, but it must appeal to hon. Members who have been fortunate enough to secure an Adjournment debate to recognise and uphold the conventions of the House.

2.56 pm

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

This is the fifth time that I have been at the Dispatch Box this week, but it is the first time in daylight. I congratulate the hon. Member for Coventry, South-East (Mr. Nellist) on his success in the ballot. I am only sorry that he has left me barely five minutes in which to reply. Will he please convey my good wishes to the wife of his hon. Friend the Member for Coventry, North-East (Mr. Hughes), who he said has recently been taken ill. I hope that she soon recovers.

I am sorry to hear about the specific difficulties of the hon. Gentleman's constituent who needed laser treatment for gynaecology. I know that he has sent me a letter, but I have not yet seen it. I will ensure that the matter is drawn to the attention of Mr. Guy, the chairman of the health authority.

On the supply of incontinence pads, I have written to the hon. Gentleman saying that the health authority had decided that
"it could no longer give a free service to private home owners and the Social Services Department."
I am surprised that the hon. Gentleman criticises me on the former, and I recommend that he has a word with his heroic Socialist colleagues on the latter. Perhaps they will provide money out of Coventry's considerable rates to assist, and thereby accept their responsibilities.

I am delighted to hear that.

I share the hon. Gentleman's concern about the children whose heart operations in the west midlands have been cancelled. I hope that he recognises that I am well acquainted with the Birmingham Children's hospital. I know of its constant efforts on behalf of sick children. I also know the problem that it has had for years in recruiting and training the right sort of nurses.

I wish to make three main points. First, we are concerned, and have been for some time, that there is no financial incentive for nurses to take the additional post-basic courses necessary to serve in specialised areas such as intensive care, coronary care, paediatric work and so on, which is working to the detriment of staffing in those areas. We commissioned work to address that question last year, and the proposals form part of a comprehensive clinical grading review will be put to the nurses and midwives review body shortly. It will be for that body to make recommendations to the Prime Minister.

As for the west midlands, departmental officials are in close touch concerning staffing at Birmingham Children's hospital and elsewhere to deal with the regional specialties. I am informed that proposals are in hand to increase the number of places for the registered sick children's nursing course. The regional health authority will pay for the tutors and 50 per cent. of the costs of releasing staff to go on it. New places will he provided not only in Birmingham, but in Coventry, Stafford, Stoke and Wolverhampton.

In addition, central Birmingham has applied to the English National Board for Nursing for approval for the post-basic paediatric intensive care course which, if agreed, would be the first outside London. It hopes to appoint a tutor early in 1988. My hon. Friend the Minister for Health is conducting the ministerial review of the West Midlands regional health authority right now, when all these matters are to be thoroughly discussed.

However, I believe that we can go further. My concern is that we should investigate whether we can avoid such terrible tragedies in the first place. In the United Kingdom about 6,000 babies are born each year with a defect that may kill them or cripple them for life, and such defects include the heart and lung complications suffered by the hon. Gentleman's constituent. The proportion of babies born alive with low birth weights—less than 2,500 grammes or 5 1bs.—is about 7 per cent. It was the same percentage over 20 years ago. When I examine closely regions where a sharp improvement in the perinatal mortality figures has occurred, I often find that the improvement is due to better care—which is marvellous —rather than due to a fall in the incidence of foetal handicap, which has not budged for many years. That is not good enough, as I am sure the hon. Gentleman would agree.

I have commissioned two of the most senior advisers, both of whom have medical qualifications, to check the research findings all over the world and advise me whether anything can be done to prevent abnormality in the first place. Much of it seems to occur in the very first weeks of pregnancy—perhaps at conception itself, but certainly when a woman may not know that she is pregnant. I recently met the Maternity Alliance, an umbrella body for more than 70 organisations, which shares my concern and I shall work closely with that body to establish what we know and what advice, if any, we can offer to parents, health professionals and all those who want to prevent such difficulties arising in the first place.

I have barely one minute left. Coventry was allocated £56·1 million last year and managed to spend £63·9 million. That is a gap of nearly £8 million. Some of that was found from in-year additions from the regional health authority and some was covered by the cost-improvement programme; Coventry has done very well on that. However, the overall result—from a health authority that knew what its budget was at the beginning of the year—was an overspend of just over £1 million. The regional health authority said that that could be carried over, but Coventry is overspending its budget again this year, although by slightly less, because of further cost-improvement programmes and the temporary closures. That is expected to leave a gap of just under £1 million by the end of the year. The regional health authority believes that Coventry health authority is adequately funded for the health needs of its people. On all the calculations, Coventry's allocated finances are bang on target.

I recognise the force of the hon. Gentleman's argument. Proposals have been put to us for permanent changes, some of which the hon. Gentleman outlined. I am sure that he will realise that it is not appropriate for me to comment in detail on the proposals while they are still under consideration.

The motion having been made after 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 at one minute past Three o'clock.