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Nhs (Cornwall)

Volume 301: debated on Wednesday 26 November 1997

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12.30 pm

As the Minister and his colleagues are aware, health provision in Cornwall is facing huge cuts. Local hospitals in particular face the axe—although we must not forget that Treliske hospital and other central patient care services are being forced to make savings too. That has led to a tidal wave of local concern and protest. For every local closure there is a local protest group. My hon. Friend the Member for St. Ives (Mr. George) is on his way now to support one in advance of tonight's consultation meeting. One group is not pitted against another; they support each other, one and all, as people in Cornwall have always done. They want a fairer deal for the county's NHS. I shall explain why they believe that it is not getting one.

To take a local example, the Penrice maternity unit in St. Austell faces the axe. It is the only place where women in Cornwall can have their child outside the high-tech and expensive facilities of Treliske. By comparison, Devon has nine delivery units. The Exeter area alone has four— mostly used less than Penrice, although we are told that the use of Penrice is too low to support its continuation. Government policy favours such units, and just months ago plans were agreed for new buildings for Penrice maternity unit. Now it faces the axe.

I shall read some comments that have been written in the visitors' book since the closure was announced. One says:
"I am expecting my third child and after having my second child here, I was impressed with the care and time given to me."
Such comments are made repeatedly about Penrice. Another reads:
"The care and attention given to my wife when Alexander was born 3 years ago was first class and the principal reason for her choosing Penrice again. Residents in North Cornwall have enormous distances to travel for hospital care—keep Penrice open."
The most recent comment in the book says:
"Having just had my first baby daughter here at Penrice, I feel very strongly about keeping this maternity unit open. From the first minute I arrived and was taken into the delivery room I was made to feel relaxed and at home. With the help and advice of all the staff, I stayed calm and was able to deliver our baby naturally. It would have been very stressful to travel to Truro to deliver her. After the birth I was given all the care, attention and advice I could have wished for, from everybody. After my five day stay, I felt ready to go home and start my new life as a mother, because of all the care I received here. Truro is a much needed unit, but it would be a terrible mistake to close it. Please keep Penrice open. We need it."
Those comments speak for themselves. I could have read any number from the visitors' book to illustrate the level of local support.

Perhaps it would be helpful if I placed in context NHS services in Cornwall. Cornwall is Britain's lowest-wage economy, and is for the most part badly served by public transport. Our communities are dispersed across a relatively large area. In recognition of that, most public services, including local government, the police, and, more recently, the fire service, have long benefited from substantial allowances for the extra costs arising from the need to serve a scattered population. That is only right. The local provision of services for people living in such rural areas necessarily entails a higher cost. Yet traditionally, the Government have made no such allowance for the NHS.

The costs are exacerbated by the fact that Cornwall is surrounded on all sides by water. Most of the county simply cannot rely in an emergency on other hospitals just across the border to the north, west, or south. Yet NHS funding in Cornwall has traditionally been very low in comparison with the rest of the country.

In Scotland, each person benefits to the tune of £514 each year, and in Wales the figure is £546 per person. Both Scotland and Wales exhibit similar features to Cornwall, with areas that are remote, surrounded by water and served by poor transport infrastructure. Yet inhabitants in Cornwall enjoy just £441 per person for our NHS—around a fifth less.

To make a comparison closer to home, Somerset, with the same population, has two district general hospitals, but Cornwall has one. With only twice our population, Devon has four. I hope that the Minister agrees that there is a discrepancy in the figures. No wonder our local NHS is overstretched. The prospect of another £5 million-worth of budget savings is making Cornish people angry. That is the context in which the health authority must act.

Neither the trusts nor the health authority have a deficit. There has been a shortfall of funds of up to £5 million a year in recent years—but it has been plugged by using non-recurring funds and money held in reserve. The £5 million shortfall was reported publicly a year ago, and a shortfall of between £3 million and £4 million before that was reported publicly as long ago as the end of the 1995–96 financial year. The problem is not new, although it has grown as demands on our hospitals have increased. It is one of which the Government have been very much aware, although I accept that it is a legacy of the previous Conservative Government, which Labour Ministers have had only six months to address. Now, however, our local NHS has been told to close the gap—a £5 million saving every year.

Against that financial backdrop, admissions of all types have risen by a quarter in Cornwall in just five years, from 85,000 to more than 115,000. That puts tremendous pressure on overstretched doctors and nurses, and, as I am sure we can all imagine, the effects are even more marked given the extra costs of maintaining local hospitals in rural areas such as those in Cornwall. A further stark indication of the pressures on the services in Cornwall is that emergency admissions have increased at an even faster rate—by 16 per cent. in just three years, which is substantially faster than in surrounding health authority areas.

As may be expected, waiting lists have increased as a result of that pressure. In Cornwall, the increase has been by more than 3,000, leaving us with more than 13,000 people on waiting lists in October this year. The number of those waiting more than 12 months has increased by more than 6,000 per cent.—a rise from just seven people in October last year to 447 people this year. That is a huge increase by anybody's standards. For example, I have been trying to help people blinded by cataracts who, with a simple operation, could see again but who face a sightless wait of 12 to 18 months for treatment, which may come too late. That is happening even without the proposed financial cuts.

Demand has risen and waiting lists have grown longer—and grow longer daily. I hope that most people would recognise a clear need to expand capacity to meet the demand on services and reduce waiting lists. The Government's announcement that they are transferring funds from other Departments this winter to help across the NHS—including Cornwall—is welcome. We argued for that and it will help to make a difference this winter, but it will not resolve the long-term plans that are affected by the proposed cuts.

As waiting lists have gone up, bed availability has gone down. In 1991, average bed availability was nearly 2,000 beds. By this year, that figure had already fallen below 1,700. Although the number of acute beds has been increased by a couple of hundred, we still have an average of fewer than 1,000 daily acute beds serving the entire population of Cornwall and the Isles of Scilly. The number of daily geriatric beds has already fallen from almost 400 to just over 300—in a county with an above-average and rapidly increasing elderly population. Some of the most distressing letters that I have received on this issue have been from those who care for patients with Alzheimer's disease, who are extremely concerned about the loss of provision, especially local provision that would allow them to visit patients and stay in contact. The average number of daily beds for mental illness has already been cut by more than 200—from more than 550 to just 341.

The problem is compounded by the lack of provision of alternatives that are desired by the health authority, but which it cannot afford to fund. Of course, all those pressures are compounded by the march of medical technology and the increased demand generated by improvements in medical treatment afforded by new drugs and treatment. The county also expects to face cuts to its social services provision that will affect its ability to provide residential and nursing care beds to take people out of hospitals. That in turn places more pressure on hospitals.

My hon. Friend will know that, on behalf of my North Cornwall constituents, I warmly support all the points that he has made. He referred to the county council. Can he confirm that, at the council's meeting yesterday, it agreed to make representations to the Secretary of State for Health to reverse the shortfall in funding for the NHS? The vote was unanimous, with the exception of the Labour group. It is important to make it clear that it is not only my constituents and I who support my hon. Friend's points but—to all intents and purposes—the people of Cornwall.

It is a shame that the Labour group did not support the motion, but one understands the constraints it felt because the party is now in government. At local level, many Labour party members have campaigned to save local services and the hon. Member for Falmouth and Camborne (Ms Atherton) has supported the services in her constituency. The vote may not have been unanimous at the county council, but the Minister of State should be under no illusions about the views of his supporters.

That is the situation faced by inhabitants of Cornwall, before we even consider the latest round of threatened cuts. The service strategy on which we are being consulted proposes the closure of four community hospitals and the maternity unit at Penrice, as well as the axing of a further 129 beds. That is not the end of the story. Other services such as rheumatology are to be restricted.

The health authority has been a dealt a dead man's hand. It must choose between the provision of acute and non-acute services; between emergency treatment and preventive treatment; and between one vital local hospital and another. Clearly, that is unacceptable, so it is a relief to discover that, for the first time in a long time—as we try to pick a way through this mire of bed cuts, budget cuts and increasing waiting lists—we in Cornwall have a sympathetic ear at the Department of Health. It is a relief because it is vital that we develop a clear strategy for dealing with the crisis that is swamping health services in Cornwall.

The Minister may say that the reaction is not just sympathy and that things have changed. Well, they have changed a bit. It is true that, for the first time, next year's NHS funding will make an allowance for our scattered geography. An element of allowance has been allowed for our extra ambulance service mileage. That is a significant step forward and more than was achieved under the previous Administration. Naturally, having argued for it, I welcome it.

However, I hope that the Minister agrees with me that the increase is in no way enough. Other formula changes have actually cut our allocation. Overall, the effect on the provision of cash for the NHS in Cornwall was to raise the formula allocation by just 0.01 per cent. In other words, for every £100 Cornwall previously received for our NHS, we have gained just lp next year. Even taking that increase together with the extra national NHS funding announced for next year—in which we will share—we are only £400,000 better off than previously expected. That money is welcome, but against the prospect of £5 million cuts it will do no more than help save perhaps a few threatened services. It will not come close to sorting out the major part of the cuts, let alone the general underfunding of the NHS in Cornwall, which the community health council put at £10 million even before the cuts.

I suggest that we must focus on three key areas. The first priority must be to make clear, in the public's mind and our own, the lines of responsibility for the closing of the community hospitals in Cornwall. It has been widely reported that the chairman of the health authority would close the hospitals regardless. That has been an unfortunate misrepresentation of what was said and has served to muddle the debate. The health authority has made it quite clear, while making no guarantees about the security of individual services, that, if extra money was on offer, it would revisit and change the proposals in its consultation document.

I welcome the debate, because it addresses an important issue for the people of Cornwall. There has been a debate about exactly what the chief executive and the chairman of the health authority have said. Both the hon. Gentleman and I remember a meeting with those two gentlemen at which I explicitly asked, "If there was no financial problem for Cornwall and the Isles of Scilly, would you propose to close the four hospitals?" My office has a complete note of the meeting and both the chairman and the chief executive replied, categorically, "Yes." I hope that other hon. Members will confirm that. The chief executive and chairman subsequently appeared on Westcountry Television and made similar points. Now they appear to be changing their tune, and that is typical.

My understanding is that the chairman and chief executive have always said that they believe changes are needed. That is not the same as saying that they would close everything that it has been proposed should close. Indeed, they would look to open other services to replace some of those that might have closed.

I cannot give way, because I am running out of time. I do not want to cut the Minister's reply too short.

To make the position clear, I shall quote the chief executive's letter of 18 November, which states:
"I am purported to have said that if the Health Authority had limitless funds, we would still look to close all 4 hospitals which our consultation document proposes should be closed—I have never made such a statement."
However, the biggest element of confusion in the whole sorry mess is the assertion that the health authority could somehow take that decision unilaterally. As the Minister is fully aware, the final decision to close hospitals will be taken nationally, irrespective of the wishes of the chief executive. It is for the Secretary of State to decide the ultimate fate of Cornish hospitals. Indeed, the Secretary of State accepted that when Cornish Members of Parliament met him two weeks ago. There should be no confusion on the point.

Our second priority must be to make up the short-term funds that the health authority is so desperately lacking. John Banham has today proposed a 12-month moratorium. It is no good being told that the Government hope to help in the long run, if hospitals are closed this spring. Once shut, everybody knows that they will not open again. The voters of Cornwall resoundingly rejected the party of health cuts at the general election. They expect, and deserve, the NHS locally to be saved, just as the Prime Minister promised it would be before election day.

Given the Chancellor's announcement yesterday that there are funds to accommodate a cut to a 10p starting rate of income tax from April, resources are obviously available. The Chancellor also said that he has funds to cut business taxes to the lowest in Europe, so there must be even more resources available. The right hon. Gentleman has the option of using just a fraction of those funds to stop the closures. Lack of funds is not now— if it ever was—an excuse. Even if the funding were not permanent, it would give the health service the chance to find other solutions and win long-term extra funding.

Our third priority must be to establish a fairer way of distributing resources for the long term, so that such a crisis never returns. It is not just a question of Cornwall's rurality. Cornwall's services also suffer, as has already been indicated, by reason of its large coastline. Given the nature of that coastline, a journey to a place 10 minutes away as the crow flies can take four times that long once the streams, creeks and rivers that interrupt road and rail links are circumnavigated. Our people are a long way from district general hospitals—as much as 70 miles in some cases.

Cornwall provides a real example of the crucial need for fundamental reform of the needs assessment of our heath authorities. It cannot be right that the net effect of the formula changes is that Cornwall should get just lp in every £100 to address those geographical problems. By introducing any help at all, it is true that the Government have made a step in the right direction, but there is still a long way to go. I believe that Ministers recognise that and I hope that that recognition will be backed by real resources.

The local medical committee sums the situation up in its press statement of 20 November:
"The LMC on behalf of GPs throughout Cornwall and the Isles of Stilly believes that it is not possible to take £5 million funding out of local health services provision without causing severe and enduring damage.
GPs are unhappy with the Health Authority's current proposals to achieve these savings. We remain convinced that reducing the total number of hospital beds in the county can only increase the existing bed crisis in the District General Hospitals at Treliske, Derriford and Barnstaple. However, we believe any alternative scheme to make the same savings may have an equal or even more damaging effect upon patient care."

In other words, Ministers will have to choose in the spring, for the decision will be theirs: cut our NHS in Cornwall in one way or another, or find us extra resources—in the short term to keep the hospitals open, and in the long term to create a fair funding system.

I know that that is not easy, given the Chancellor's spending rules, but it is a simple hard truth that sometimes the only way to save a service that has been cut to the bone is to provide an injection of real cash. I realise that that will not be an easy choice for Ministers but, as I know that they will have to fight for it, I hope that they will agree that it is an option worth fighting for.

12.49 pm

I congratulate the hon. Member for Truro and St. Austell (Mr. Taylor) on securing the debate. This is an important subject, and I know the strength of feeling shared not only by Members on both sides of the House but in the local community, about the situation facing the health authority in Cornwall.

I am also aware of the hon. Gentleman's concern, which he has made crystal clear today, that the Cornwall and Isles of Scilly health authority is underfunded. He will recall that I met him and some of his colleagues some months ago to discuss those issues, and I know that they have had the opportunity to meet the Secretary of State. They will be aware that my hon. Friend the Member for Falmouth and Camborne (Ms Atherton), too, has had the opportunity to discuss the issues with the Secretary of State and me, and to express her own strong feelings about the concerns in the local community.

It may be helpful if I deal with the issues raised in two parts—first the funding issues and then the health authority's proposals. I must say at the outset that the Government believe that health need should be the driving force in determining where national health service cash goes. As the hon. Gentleman knows, we are committed to the fundamental principle of fairness, and to tackling inequalities in health.

I think that the hon. Gentleman would share my view that over recent years that approach has been sadly lacking in our national health service. We are determined to deal with that problem. I hope that he will also share my belief that there are no instant cures, no magic wands and no pots of gold. None the less, the Government will make determined progress year on year to achieve a better health service in all parts of the country.

That is why we have made the changes to the formula for allocating money to health authorities for next year. From 1 April resources will be allocated on the basis of health, social and economic need. The needs weighting has been increased to cover 100 per cent. of spending. I hope that the hon. Gentleman welcomes those changes as a step in the right direction.

I also hope that the hon. Gentleman will welcome two other changes that we have made to the formula. He dealt with one of those; may I briefly talk about both? The issue that he did not raise is the market forces factor, although he has expressed concern about it in the past, and raised it with me when we met some months ago.

The hon. Gentleman is not alone in expressing doubts about the operation of that element in the current formula. We have listened carefully to what trusts, health authorities and community health councils throughout the country have said about the distortions that the MFF brings.

As an interim step we have reduced the number of pay zones for 1998–99, smoothing out the starker variations created by the MFF. As the hon. Gentleman is aware, that will make a considerable difference—£1.8 million—to the funding target for Cornwall. I can offer him some assurance about further changes, too, because we have asked the new advisory committee on resource allocation, which the Government have established, to undertake a thorough review of the operation of the market forces factor. Indeed, that will be its work priority for the next year or so.

Secondly, we have taken into account the rural concerns that the hon. Gentleman has raised, involving the extra cost of providing health care. As a result of research findings, the formula for next year will be adjusted to take into account the additional costs of providing emergency ambulance services. That will make a difference of £1 million to the funding target for Cornwall and Isles of Scilly.

That will not be the end of the story. We shall also ask the advisory committee to investigate over the next year the impact of rurality on resource allocation. I know that there is impatience, but I hope that the hon. Gentleman shares my view that we must get such things right. The formula has been fiddled with too much the past, with too many tweakings at the margins. We must bring greater stability to the health service not only in Cornwall but throughout the country, so that the people understand, and health authorities and trusts can plan on the basis of the resources that will be made available to them.

Because so many of those important changes will take a little time to introduce, will the Minister seriously consider Sir John Banham's suggestion of a moratorium on the existing cuts and closure plans?

As I understand it, when the hon. Gentleman and his colleagues met the Secretary of State they agreed with him that as the consultations had begun, it was sensible for them to continue. I shall return to the subject of consultation and how it will be handled at the end of my speech, if I get time—but I understood that that was the common agreement reached, so I hope that the hon. Gentleman does not seek to undo it at this stage.

We shall examine the formula in detail. I cannot promise the hon. Member for Truro and St. Austell that the review of the formula will produce benefits for Cornwall specifically, but I can say that the outcome will be fairer than the present state of affairs.

Over the next year we shall try to ensure that the formula takes proper account of real population levels and the extra cost of providing services for ethnic minority communities. As I said, we are determined that NHS resources should be allocated fairly. I know that the hon. Gentleman will support that approach.

The hon. Gentleman knows that the target set by the formula is only part of the story. The distribution of growth money is just as important in determining what health authorities get to spend on local health services. For 1998–99 we used 60 per cent. of the available growth money to bring below-target health authorities nearer to their needs-based target, which reflects our desire for greater equity.

That all means that in the next financial year Cornwall and Isles of Scilly health authority will receive £277.5 million—marginally more than its needs-based target. I know that Opposition Members are fixated by real-terms increases, so I can tell them that that is a real-terms increase of £4.1 million—the highest such increase for five years and the highest percentage increase in the whole south-west region. It is substantially higher than the average percentage increase for Cornwall over the preceding five years. I hope that the hon. Gentleman will really welcome that. We are making a difference and we shall continue to make a difference.

That is not all. Cornwall and Isles of Scilly health authority will get £1.85 million extra to cope with pressures this year, as part of the winter boost for the NHS. Much, or at least part, of that money will be used to break down the Berlin walls that have developed over recent years between health and social care institutions.

There will be more money for home care packages, and more for additional beds and for tackling delays in discharge from hospital.

Cornwall county council has been mentioned, and I hope that the hon. Gentleman and his hon. Friends will take back a firm message to members of the Liberal Democrat party who serve on that council: it takes two to tango. When relationships break down and the health service and social services do not co-operate as fully as they should—that is what has happened in Cornwall under the hon. Gentleman's party's tutelage—it is vulnerable patients, elderly patients, disabled patients and patients with mental illness who suffer and pay the price.

Will Liberal Democrat Members take that message back and make it clear to their local councillors that the onus is now on them to co-operate rather than to compete? I hope that the message will be taken seriously. We shall increase resources year on year for the health service.

As for the consultation, I have listened carefully to what the hon. Member for Truro and St. Austell, my hon. Friend the Member for Falmouth and Camborne and others have said, but they will understand that as the proposals may come to Ministers for decision, it is not appropriate for me to comment in detail now.

What I will say is that it is the health authority's duty to ensure that it has the best possible services to meet the challenges that lie ahead. That means living within the resources available.

The hon. Member for Truro and St. Austell mentioned the chief executive's comments on television. I have had the pleasure of reading the transcript. I have read it two or three times during these proceedings and what he said is clear. Three times, he said that even if he had the money those proposals would still come forward. So, let us be clear. There is a difference between the proposals and the funding situation, which is clearly difficult for the health authority. It would be wrong and politically negligent to try to conflate two issues as some have sought to do. When the results of the consultation come back to Ministers, we will bear in mind the strong feelings that have been expressed in this place and, perhaps more importantly, by the local community.

We must now move on to the debate on the future of county council smallholdings.