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National Health Service (London)

Volume 124: debated on Friday 18 December 1987

The text on this page has been created from Hansard archive content, it may contain typographical errors.

12.1 pm

This debate on the crisis in London's Health Service comes at an important time. For understandable reasons the debate is shorter than it might have been, and that is regrettable.

Earlier this week we had a statement from the Government on health spending in Britain and how they are planning to increase it to cope with the present crisis. Many of us were sceptical when the statement was made and, having had a couple of days to look at the details and the figures and do calculations for our own areas, I can reveal that the amount allocated for the four Thames regions—if all the money was spent in London alone—would meet only half the needs of the crisis. In fact, the four Thames regions cover far more than Greater London.

Because of the background to the debate, it is worth putting on record the fact that the levels of health spending in this country, despite all the best efforts of the Government in their huge propaganda machine, are woefully inadequate when compared to any other industrial country that is seeking to run a proper Health Service. The figure for this country of total health spending per capita is $161, compared to $232 in Australia, $220 in West Germany and $141 in Japan. Therefore, only Japan comes lower than the level in this country. One can make many more comparisons which will always show that health spending in Britain is significantly lower than in any other comparable country.

There are three early-day motions on the Order Paper today concerning London's health emergency. All three are in the names of the London group of Labour Members, all of whom have signed them. The first
"deplores the closure of 590 acute beds in inner London and a total of 1,000 hospital acute beds across London since May 1987, and the crisis of funding imposed by cash limits on London's health service which will result in increased suffering and hardship for Londoner".
It calls for more money for London. However, that money has not been forthcoming.

The second motion, which is in many ways just as important, deals with the loss of rate support grant to London local authorities, which has undermined the quality and level of service of community care and social services that local authorities provide. The motion reflects the real nature of the Government's policies for London. It calls on Her Majesty's Government to restore the loss of £4·4 billion in rate support grant and to make a further £35 million available to allow district health authorities to avoid further cuts in health facilities. There is a close correlation between the two.

The third of our emergency motions deals with staffing in London. There is a crisis in Health Service staffing in London because of low pay, privatisation and a loss of morale. That is a measure of the low regard that the Government have for Health Service staff in London. We are calling on the Government to make substantial improvements in the 5·5 per cent. offer for London weighting and to fund the Thames region sufficiently to enable it to pay any new offer to health authority staff.

Those of us who have been involved with the Health Service for a long time—for many years I was a full-time official of the National Union of Public Employees, and I am sponsored by it in the House—know full well that the consequence of the Government's not funding health authority pay awards is that it creates a false division between Health Service staff and the needs of patients, when in reality they are very much the same. We resent the way in which these divisions have been brought about.

The crisis that we face is that, despite the money that the Government announced this week, which is inadequate, we are facing an immediate series of cuts in London over the Christmas period. Camberwell health authority is closing 110 beds at King's College hospital for two weeks; Wandsworth health authority is closing nine wards for two weeks—the number of beds in each ward varies; Islington health authority is closing the Royal Northern hospital, which is located in my constituency, and moving patients to the Whittington hospital from 18 December until 4 January. Additionally, there is an attempt to close the hospital altogether.

Merton and Sutton health authority is closing eight wards for two weeks, one of which will be permanently closed thereafter; Brent health authority is closing six wards for an unspecified period. Again, there is concern that those wards will not reopen. Barnet health authority, in which the Prime Minister's constituency lies, is closing Victoria maternity hospital because of nurse shortages. It is £1 million overspent and the Victoria maternity hospital will be closed indefinitely pending consultation on its permanent closure. That is an activity that we have seen increasingly within the Health Service.

Since the beginning of this year the number of beds lost in London health authorities is staggering. I shall not quote every example, but Brent health authority has lost 50 beds, Harrow 32, Hillingdon 75, Paddington 92, Bromley 58, West Lambeth 137, Hampstead 112, and Haringey 127. Haringey health authority no longer has any acute services within the borough. There has been a process of cut and closure in every hospital in the borough of Haringey. The nearest emergency services are at the North Middlesex hospital, which lies just inside the borough of Enfield.

On 26 November, the day that the House was last debating the crisis in the Health Service, the London Evening Standard reproduced an excellent report from London Health Emergency. It outlined a few of the problems. Bloomsbury health authority has a budget of £137 million and has not overspent. That has been achieved by the authority saving £1·3 million by freezing vacancies and other such matters. Hammersmith and Queen C'harlotte's, which has a budget of £46 million, is overspent by £700,000. The main cause of that is the underfunding of pay awards and the need to upgrade kitchens and dining rooms. Greenwich, which has a budget of £65 million, is overspent by £250,000, and even to achieve that figure it had to introduce savings of £750,000. In effect, the cut is £1 million on a budget of only £65 million. That is an enormous cut in one year.

In the current year we have lost almost 1,000 beds. That must be considered against the background of what has happened in the Health Service in London since 1979. The Minister is always keen to quote the state of the Health Service under the last Labour Government, but we must consider the success of the Conservative Government in providing for the health needs of the people of London. In 1979 there were 64,736 National Health Service beds in National Health Service hospitals in London. The great achievement of the Government has been to reduce that figure to 52,708.

If anyone were to consider the cuts that have taken place in the past eight years in particular health authorities he would be astounded. Let us take one or two at random. The City and Hackney district health authority had 1,990 beds; it now has 1,686. Waltham Forest district health authority had 3,311 beds, and that number has been reduced to 2,407. Barnet district health authority had 2,841 beds and that number has been reduced to 2,324. In my authority—the figures are available only from 1982 because of Health Service restructuring—the number of beds has gone down from 1,177 to 866. It is one of only three authorities in London which have fewer than 1,000 beds available for their populations. Those figures are a measure of the disaster that faces the Health Service in London.

The Minister has spoken of the problems of Health Service spending in London, but there are a number of confusing aspects. London is covered by the four Thames regions—there is no London health authority. I believe that it would be better if there were such an authority, because I am fed up with the idea of inner-London health spending always being compared with spending in outer-suburban areas. I have absolutely no wish to see the home counties suffering health cuts, but I believe that the way in which the RAWP formula has been operated by the Government has resulted in the biggest cuts taking place in some of the Thames regions.

In fact, the sub-regional RAWP movements have resulted in a permanent process of cuts, closure and decline in every inner-London health authority. Although we do not want cuts anywhere else, we ask the Government to recognise that there are enormous health needs within London. We are not indulging in special pleading for London at the expense of other parts of the country: we are seeking a cash increase that will help the people of London. It is important that that is on the record.

In the years between 1982–83 and 1985–86, the North East Thames health authority, which covers my constituency, has lost 0·9 per cent. in real terms in capital revenue allocations. It has also suffered as a result of the sub-regional RAWP figures.

It is also important to consider the regional var: ations in hospital costs for in-patients. The costs in London are considerably higher than those in any other part of the country. That is why London weighting is available for staff and why we ask the Government to take proper account of the increased costs in London. Building costs, land costs and transport costs are all higher in London. The efficiency of any service—the ambulance service, or anything else—is markedly less in London because of the continuous, inevitable congestion.

Let us consider the costs for hospitals with more than 300 beds. In the North West Thames regional health authority, the cost per patient per day is £108·97. The equivalent figure for the Oxford authority is £99·72, arid for the West Midlands, regional health authority it is £95·86. The average in England is £99·63. The costs for acute beds in those regions are as follows. The cost in the North West Thames health authority is £81·80. The cost in the west midlands is slightly higher than average and the average for the whole of England is £79·79. It is important that the Government should take account of those figures.

When the Minister made his statement this week, he said that, as a result of the total increased allocation for extra services in the Thames regions, the North West Thames health authority would receive £4·7 million, North East Thames health authority £6 million, South East Thames health authority £5·3 million and South West Thames health authority £4·3 million. We should compare those figures with the needs identified in our early-day motion, which require £38,257,000. That sum is needed to avoid the immediate acute crisis that faces the London Health Service. That is a measure of how far we have still to go, and of how little we have achieved so far.

There is a serious staff crisis in the London Health Service. There have been large numbers of job losses because of a process of privatisation and of deliberately keeping vacancies in the Health Service. Anyone who visits a London hospital from year to year can see how bad the situation is becoming. One sees the generally scruffy appearance of the entrance areas to so many hospitals. People have to wait a long time. One comes across cases of double bedding—or hot bedding, as it is called—whereby patients are shuffled from bed to bed at enormous speed. In some hospitals people are treated in the corridor.

A case was reported recently in a well written article by a constituent of mine in The Guardian. My constituent's son broke an arm. She would be the first to admit that she is a relatively comfortably off person, in that she has access to a car. When she took her son to the local Whittington hospital she found that he could not be admitted even though the X-rays were done there, so he had to be taken to the Edgware hospital, to which she was able to drive him, and after a four-hour wait he was admitted. Others, who are not so lucky, have to rely on ambulance services, which are so overstretched that they cannot meet these demands.

I wish to give some figures about the Paddington health authority — an inner-city authority. There has been a long-term plan of reduction of facilities at St. Mary's W2 hospital, which has now finally been closed. There have been reductions in service at St. Charles's hospital, and everything has been centralised in St. Mary's on the Praed street site. The effect of that is to make travelling more difficult for everyone and to create a large, impersonal hospital. The privatisation of the staff there has resulted, at St. Mary's in Praed street, in 60 catering jobs and 280 domestic jobs being lost, and the privatisation at St. Charles's hospital has resulted in the loss of 170 domestics. Bringing in the company Mediclean has resulted in a different atmosphere, which is hostile to the needs and aspirations of staff, and in considerable difficulties for union organisation and representations.

Before I allow the Minister time to reply, I want to draw his attention to one or two other matters. I shall deal first with the London ambulance service, which was the subject of a lengthy debate following the passage of the Consolidated Fund Bill, during which we were able to show that the service is finding it increasingly difficult to meet the needs of the people of London—especially for emergencies. On the night of the King's Cross fire, about 40 ambulances were unavailable for service. I would be the first to praise the heroism of the police, station, fire and ambulance staff, but it is not good enough to shed crocodile tears in the House about the needs of the London emergency ambulance service if, at the same time, funding is not provided so that the ambulances can do the job properly. Many people are fed up with Ministers going around hospitals after disasters like ghouls, when they are not prepared to pay the money that is needed to avoid such accidents in future.

The problems of the service are compounded by a general shortage of staff and controllers, which in turn leads to enormous stress among the staff. Ambulance staff are not particularly well paid. Anyone who has watched them at work will realise the terrifying stress of trying to drive an emergency patient through London's traffic, knowing full well that there is another emergency after that—and another after that—with the attendant fears that one might arrive too late because of the traffic and the shortage of ambulances in the first place. That must be understood.

The unions concerned, NUPE and COHSE and others, produced a report on ambulance stress.

In 1980 the London ambulance service covered a total of 9,101,000 miles. That has been reduced by 1987 to 8,238,000. In every area fewer emergency ambulances are available, even though they are working efficiently and hard. Emergency ambulance miles covered have kept up, but at the expense of non-emergency services and by increasing the use of hired cars, minicabs and volunteer drivers, which is an unacceptable way of doing things.

Islington health authority is in an inner-city area and is facing a long-term cut in health standards. The Friern Barnet psychiatric hospital is to close and its patients will be forced into the community. The social services department is worried that it will be unable to meet the needs of those people, in the same way as Camden and Haringey are also unable to meet them. The Royal Northern hospital is closing temporarily over Christmas and will close permanently soon after that. The Southwood hospital is also to close.

People in my constituency are greatly worried that the Health Service is becoming increasingly unable to cope with the needs of patients. Indeed, in the constituency of my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) the lack of funding for the elderly assessment centre at Bart's hospital is causing great concern, and we look forward to an announcement from the Minister that he will support that venture.

Health is much more than a series of statistics, although that is the only way in which one can present it in the House. Health means the knowledge that the Health Service is available for all those who need it, at the time that they need it. In London, that is increasingly no longer the case. Waiting lists become longer and longer, small hospitals are closed and large hospitals are closing wards and operating theatres. There is great concern among the staff, who either leave or continue to work in such appalling conditions that we wonder why they stay in the employment of the health authority.

The announcement this week of some increase in funding shows how scared the Government are over the increasing protests about the level of health spending. They have been frightened by publicity and by letters from leading doctors. They now realise that every family knows that there is something badly wrong with our hospitals, wherever they may be throughout the land. We need a large increase in Health Service spending in London, and we need it very quickly, to stave off the crisis that we are facing this Christmas.

However, it must go further than that. Barbara Young, the spokesperson for the hospital managers, has said that any money often comes too late to stave off ward closures. The Minister could do us a good turn today by announcing that he is prepared to alleviate the crisis in London by giving the Health Service the money that it needs, now.

12.22 pm

I listened carefully to the hon. Member for Islington, North (Mr. Corbyn), who put a powerful case. He drew attention to problems that are well known, but unfortunately he did not suggest the solutions. When tackling the problems of the Health Service, we must take a long-term view as to where the money can be found. We cannot constantly print it, as the previous Labour Government did, to meet demand, and to reallocate the money from other areas is always a controversial issue.

A long-term solution must be found, but where the short-term emergency in London is concerned, the hon. Gentleman was unfortunate in that his debate has come just after a statement that has gone some considerable way towards meeting it. Indeed, the existence of the emergency is not denied by my hon. Friend the Minister for Health.

Outsiders—I speak for myself, as I am an outsider to the Health Service—meet experts in the Health Service who can generally put an absolutely convincing case for what needs to be done, backed by figures and arguments that leave one in no doubt of the justice of their case. However, the next expert one meets will probably say the exact opposite. We are then left in doubt about what action to recommend.

I want to make one recommendation that is especially relevant to London. We are handicapped by the regional structure in making long-term plans. I am not suggesting that we should embark on yet another reorganisation, and I certainly do not suggest that we should set up a health ILEA. However, I noted the hon. Gentleman's comments about organisation in London, and there is a serious element of truth in his statement that we are unable to plan for London as a whole. The Department should undertake a review of the major London hospitals, especially the teaching hospitals and the great specialist institutions. It should be recognised that they are of service to the whole country and, in some cases, to the world. They are not merely of service to the region in which they happen to be located.

I feel that decisions have been taken about those major institutions based simply on the regions in which they are located, and not in the best interests of London as a whole. That problem cannot be tackled except by the Department. I put forward that problem for my hon. Friend's consideration and hope that, in due course, a satisfactory solution will emerge.

12.25 pm

I shall, necessarily, have to reply briefly and shall not attempt to pick up all of the points made by the hon. Member for Islington, North (Mr. Corbyn) and by my hon. Friend the Member for Kensington (Sir B. Rhys Williams), partly because, as the hon. Member for Islington, North has acknowledged, some of his comments on the London ambulance service have been the subject of recent debate and discussion in the House. However, I should like to comment on some of the major points made by the hon. Gentleman and my hon. Friend.

I observe gently and in no spirit of aggression that part of the hon. Gentleman's speech complained about what he called privatisation, but what I call competitive tendering in relation to certain support services in London hospitals. Given that on our estimate competitive tendering has saved about £100 million throughout the country, money which has been left in the Health Service and has therefore been available for spending on patient care services, all the problems that the hon. Gentleman has discussed would be £100 million worse if we had not pursued those competitive tendering policies.

Well, if we are to argue about who is using statistics contentiously, I may have one or two comebacks against the hon. Gentleman.

I think I shall quote statistics because I noticed that, when referring to the additional sums that I announced on Wednesday for health authorities throughout the country for the current year, 1987–88, and for next year, 1988–89, the hon. Gentleman selectively picked only one element in the increased funding for the current year for the Thames regional health authorities. In doing so, the hon. Gentleman virtually halved the amounts that they will actually receive. I should like to put on record the fact that for 1987–88 what I announced on Wednesday means an additional £11·4 million for the North West Thames regional health authority, £9·6 million for the North East Thames regional health authority and £7 million for the South West Thames reginal health authority.

I acknowledge that part of that money—sizeable only in relation to South East Thames — is related to the storm damage that occurred in what has become known as the hurricane of last month. Nevertheless, even allowing for that, those are substantial sums. The hon. Gentleman left out of his own statistics the fact that they include significant sums in recognition of the acute pressures that AIDS has placed on some of the Thames regional health authorities, especially the North West Thames regional health authority, which covers the constituency of my hon. Friend the Member for Kensington. Within the totals that I have already given, from Wednesday North West Thames has received an additional £6 million for AIDS, North East Thames £2·5 million and South East Thames £1·5 million.

I should make the point that those are immediate additions to the money that is available for regional health authorities for 1987–88. I should like briefly to remind the hon. Gentleman and my hon. Friend that for next year, 1988–89, the four Thames regional health authorities will receive respectively an additional £68 million for North West Thames, £62 million for North East Thames, £51 million for South East Thames and £40 million for South West Thames. No doubt we could argue almost for ever about whether those sums are precisely right, but they ate substantial additional sums for those Thames regional health authorities.

I refer to the comments of the hon. Member for Islington about hospital beds in London and the RAWP process. As a Member concerned with North East Essex regional health authority, I am conscious that there are different perspectives on such matters. Indeed, for the first 10 years that I was a Member for Parliament for part of Essex, my constituents complained endlessly and, in my view, understandably, that despite the fact that the population was steadily moving out of London into Essex and, for that matter, into Kent, Hertfordshire and the other counties that surround London, Health Service money continued to be spent in London and on maintaining beds in London. The population, often, in my case, from east and north London, that had moved out to Essex was not getting the provision that it deserved.

Again, there is plenty of scope for argument about the pace and scale of change, but there is no serious room for argument that, against a background in which the population is moving fom within London to outside London, there must necessarily be consequences for the pattern of health service provision—

It is showing signs of stabilising. That, in turn, will be taken into account in our policies as they develop. We are reviewing the so-called RAWP formula. Among the matters which we are examining is whether social deprivation, which affects all constituencies, is weighted sufficiently. As I observed in the House the other day, for every group of Members that says to me that urban deprivation is not sufficiently recognised, there is another that says that rapid growth of population is not sufficiently recognised—

The Parliamentary Under-Secretary of State for Northern Ireland
(Dr. Brian Mawhinney)

Hear, hear.

There is a sizeable chunk of new hospital there. Perhaps for Hansard purposes, I should make it clear that my hon. Friend the Member for Peterborough (Dr. Mawhinney) is the subject of these interventions.

We shall take account of all these factors—including "rural scatter", as it is described in Cornwall. We shall, of course, take account of legitimate concerns.

The comments of the hon. Member for Islington, North on some aspects of hospital activity over the Christmas period, especially the Royal Northern hospital, were pretty misleading. It is well known that, apart from anything else, many patients do not care to go into hospital over Christmas and that there is a drop in the demand for elective surgery. Many people, if offered an operation over the Christmas period, would say that they would rather wait.

The Royal Northern hospital will close over Christmas, but as part of the health authority's normal reduction in service over that period rather than because of any effort to save cash. This year, for the first time and on medical advice, the health authority is concentrating in-patient services at the Whittington hospital — where my appendix was taken out some 13 or 14 years ago —rather than maintaining a reduced service at both hospitals. Out-patient services will continue to be provided at the royal northern during that period.

The hon. Member for Islington, North did slightly less than justice to his cause, in his comments on the closure of the Royal Northern, without acknowledging that the background to a consideration of that hospital's future is that fact that building has just started at the Whittington on a £16 million new development. It is proposed that all acute services will be transferred to the Whittington following the completion in 1991 of phase one of the redevelopment of the hospital, which started only last month.

I accept that there may always be arguments about what the total number of beds should be, but it is not reasonable to refer to proposals for closure of an old hospital without recognising that a great new hospital is being developed close by, which inescapably means considering the pattern of services.

The hon. Member for Islington, North and my hon. Friend the Member for Kensington referred to the planning of London health services. I have some sympathy with the view—which I think was highlighted by the report of the King Edward's hospital fund for London, which was published about a year ago after a get-together of the 12 inner-London health authority chairmen—that there is a need for further work to be done. We have set up a working party with the four regional health authorities and representatives of the inner London chairmen's group to examine the issues that have been raised. I take note of the suggestions made by the hon. Member for Islington, North and my hon. Friend the Member for Kensington. We expect to receive a report shortly, which we shall of course consider carefully.

I have rattled along a little, but I hope that I have commented on the important points raised by the hon. Member for Islington, North and my hon. Friend for Kensington.