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Motion made, and Question put forthwith pursuant to Standing Order No. 102(5) (Standing Committees on European Community Documents.)

Discharge of Dangerous Substances to Water

That this House takes note of European Community Document No. 8337/88 and the Supplementary Memorandum submitted by the Department of the Environment on 10th July 1989 relating to the control of discharges of dangerous substances to water, and supports the Government's efforts to secure the future selection of substances for priority action according to clear, scientific criteria.-- [Mr. Sackville.]

Question agreed to.

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Health Care, Hackney

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

11.18 pm

Ms. Diane Abbott (Hackney, North and Stoke Newington) : I wish to address the problems of the Health Service, specifically those in Hackney. The crisis faced by the Health Service is multi-dimensional. I do not intend to deal with every aspect, but I cannot let time pass without referring to the imminent and horrifying possibility, for those interested in patient care, of the Army being used as strike-breakers in an ambulance workers' dispute in which the ambulance workers have at no time threatened emergency care or services.

I wish to deal with three aspects of health care in Hackney : first, the cuts in the level of provision ; secondly, the horror of free market principles being applied to the Health Service ; and, thirdly, the future of St. Bartholemew's hospital. We hear a lot from the Government about their notion of themselves as the custodians of our Health Service. We have heard the Prime Minister say that the Health Service is safe in the Government's hands. We in Hackney are not aware of this. All that we have seen in the past is a series of savage cuts in the level of provision.

In the past few years in my part of London we have seen not one, but six, hospitals close down. We have lost the Mothers' hospital, most of the provision on the site of the Hackney hospital, the German hospital, St. Leonard's hospital and the Metropolitan hospital. When the Mothers', Hackney and the German hospitals were closed, we were promised compensatory provisions at the new Homerton hospital. The promise of a new hospital dates back to 1976, and, although phase 1 was built, phase 2 has been delayed for almost a decade. The consequence is that a small group of some of the most pathetic patients--the elderly, the mentally ill and the psychogeriatric patients--remain in what is left of the site of the old Hackney hospital.

I challenge the Minister to visit that site, which is now almost wholly evacuated. It is like a ghost hospital. The buildings are more than 100 years old and they are a fire risk, yet it is there that some of the most pathetic and deprived clients of the Health Service are forced to live out their days. The conditions have been described by consultants as both unpleasant and inappropriate. Despite the superhuman efforts and dedication of the staff, many of my constituents--vulnerable, elderly and psychiatrically ill patients--are being forced to linger on in a derelict, virtually slum environment. It appears that phase 2 of the Homerton hospital, which would save those psychiatrically ill patients from such conditions, may be postponed indefinitely. That shows a shocking lack of good faith by the health authority. Therefore, I have raised this matter this evening for one main reason--to urge a swift commitment from the appropriate authorities to end the years of delay and forthwith to set in train the building of phase 2. Hundreds and hundreds of pathetically ill, elderly and psychiatric patients are waiting for an answer to the problem.

There have been cuts in provision and the closure of local hospitals without any compensatory new facilities. Further cuts in provision have occurred because the health authorities are very short of money, through no fault of

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their own, because of the consequences of inflation, under-funded wage settlements, increasingly complex cases and the increasing price of drugs.

As a consequence of that under-funding and the shortage of money, the City and Hackney are suffering a series of bed closures. St. Bartholomew's hospital has a capacity for 850 beds, but it is funded for only 600 and currently it is virtually half empty. It is a flagship hospital--the oldest hospital in London--that has marvellous, purpose-built wards for cancer, geriatric and psychiatric patients, but they are mothballed and empty. If that is the operation of the free market, it is the economics of the madhouse. Week in and week out I receive letters from my constituents who for years wait in pain for surgery while Bart's is half empty because of the Government's refusal to make the funds available to enable the hospital to utilise all its beds.

During the past few weeks there has been an announcement that, because of chronic under-funding, 75 beds at Bart's are to be closed, 100 agency nurses are to go, cleaning and catering jobs are to be cut, and offices are to be cleaned only once a fortnight. General practitioners are complaining locally that it is far more difficult now to get acutely ill patients into hospital. Patients arrive and have to wait six hours for a bed. Bart's however, has been forced to stop using 75 beds.

How can the Government say that the Health Service is safe in their hands? Bart's is famed for its health care throughout the world. It is full of doctors, student doctors, nurses and ancillary workers who wish only to serve the public, and there is the poor community of Hackney with its pressing needs. I repeat the question : how can the Government say that the Health Service is safe in their hands? As a result of their failure to make the correct level of funding available, Bart's is having to close beds and mothball wards. The part of east London which I represent has had to face real cuts in provision.

A new and grotesque concept that the caring Clarke, the Secretary of State for Health, has presented to the Health Service is called acute sector productivity. What does that term mean? It is one of many euphemisms that have been presented to us over the years for cuts in provision. This so- called productivity means more patients using the same number of beds with the same number of staff, or fewer staff. Patient throughput might make sense in terms of a production line in industry, but when it is applied to health care it is grotesque and leads to real suffering.

One of my constituents, Mrs. Mann, lives on the Woodberry Down estate. She is 88 years of age and registered as blind. She has been treated for Parkinson's disease. She has high blood pressure and a heart condition. In June, she was admitted to the Whittington hospital. After a stay of about one month she was discharged because her bed was needed. Within 24 hours of discharge she was found collapsed on the floor of her flat. She was taken to the Homerton hospital the same evening but sent home again because no bed was available. In the end, because of the direct intervention of her GP, she was readmitted to the Whittington hospital, but only for three days. Once more, she was discharged. All that happened in the name of increased throughput. On Friday 8 September, when she was discharged, she found herself sitting in a chair day and night because she was unable to

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get herself in and out of bed. Eventually her home help became so concerned that she called the GP, who diagnosed a chest infection and hypothermia.

Ministers seem not to understand that increased patient throughput leads inevitably to an increased level of readmission. That is the result of patients being sent home far too early. In Hackney, there is poor housing and social services are overstretched. There is insufficient support for those who were hospital patients. A consultant at Bart's has said :

"Consultants are already cutting corners in order to get patients out of hospital, in many cases before they are ready to cope in their home circumstances."

What sort of political and managerial philosophy lies behind the treatment of my constituent, Mrs. Mann? I believe that it stems from a balance sheet. It is based on figures and ignores patient care and the social and economic realities that face many of those who are dependent on the Health Service. It seems to me that the philosophy of the so-called "caring Mr. Clarke" will downgrade the traditional, solicitous in-patient care to the status of a hokey-cokey hospital service--in, out, in, out, shake them all about.

The notion that money can be saved in the Health Service by increasing throughput--particularly when applied to hospitals serving the kind of deprived constituency that I represent--although it may lead to increased patient throughput in the short term, will lead to increased patient misery in the medium term, along with a decrease in service and care, and a decline in the high standards that we have come to expect from our Health Service.

I want to talk about the future of St. Bartholomew's hospital, because it is a subject of great concern to the people of Hackney. They look to Bart's as the major teaching hospital with Hackney in its catchment area. Bart's is the oldest hospital in London : it was founded in 1123, and founded with a mission--I quote from the original draft--to

"minister to the necessities of the poor gathered together in that place"

and to be a house for

"the care of the sick poor".

What will the proposal for Bart's, the Homerton and the other hospital in the district to opt out as a self-governing trust mean to the necessities of the poor, and the care of the sick poor? I believe--and the people of Hackney believe--that it will inevitably mean that the needs and demands of the working class people in the vicinity of Bart's will be neglected in the drive for profit and profitable specialties.

We hear of plans involving sponsorship from Marks and Spencer and, for the first time, private wards at Bart's. That is an extraordinary falling-off from the original idealism of more than 800 years ago, and I suspect that St. Bartholomew is turning in his grave as our thoroughly modern Ministers, with their free-market slide rules, slowly demean a still great hospital to the production-line numbers game of a battery-hen factory.

The plan for Bart's--to open it up to private medicine so that it can minister to the yuppies of the City--can, I believe, be achieved only at the expense of health care for the immediate community. If that is not the case--if Ministers are convinced that for such a hospital to opt out will mean no dropping-off in service, and possibly even an improvement--I challenge them to allow the local community to have a say in whether their local teaching

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hospital should be allowed to opt out. I suspect that they will not be allowed it, for at no point in the documentation issued on the matter are local people or patients given any say in whether their hospitals opt out.

The future of Bart's, that great old teaching hospital--that great old centre of learning, teaching and care, in the words of its founders, "for the sick poor"--is, I feel, a paradigm for the future of the Health Service. The market is to be all ; the local community and patients are not to be allowed a say. It will all be reduced to the managerial philosophy of the accountant, of the balance sheet, of making the figures match.

We know from talking to consultants, doctors, nurses and ancillary workers at Bart's that, although the majority have been prepared to declare an interest in the proposal, that majority also feel that they have no option. If they had a free choice, they undoubtedly would not choose to opt out.

Inner London, particularly my district of Hackney in east London, will face a Health Service crisis at Christmas. If we have a severe winter and a rise in the number of people using the accident and emergency unit, the number of bed closures will mean that we shall be unable to cope. Due to the Government's arid balance sheet manipulation, due to their failure to fulfil promises about new build in the district, and, above all, due to their mindless espousal of market forces as opposed to the humanitarian and caring impulses of the founders of hospitals such as Bart's, the people of Hackney are facing a health care crisis as never before.

I challenge the Minister to dispute that fact. I challenge him to say that he will make money available so that Bart's can fill its beds instead of being obliged to have closed wards. I challenge him to say that he will make money available so that Bart's will be able to make good the 100 or so agency nurses that it has had to get rid of. Above all, I challenge the Minister to say that the Government will make a reality of their boast about the National Health Service and that they will face up to the real meaning of market place ethics when they are applied to health care.

I challenge the Government to commit themselves to making available money for the building of phase 2 of the Homerton hospital. Finally, I challenge them to admit here what the founders of Bart's knew 800 years ago : that when it comes to the care of the sick, when it comes to the needs of the sick poor, when it comes to

"waiting upon the sick with diligence"

the ethics and thinking of the market place have no real place. Even at this late hour and at this late stage, I challenge the Government to reconsider their far-reaching proposals for the Health Service, to think about the damage that they are wreaking, and to reflect upon the health care crisis that is facing the inner cities. 12.37 am

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : I share the great concern of the hon. Member for Hackney,North and Stoke Newington (Ms. Abbott) for the wellbeing of the citizens who live in the catchment area of the district health authority. I part company, however, with her analysis of the district health authority's problems and her prescriptions for the future. I do not share her view that it is an arid exercise to consider resource implications. Governments of whatever political persuasion have to consider the proper allocation of

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resources so as to ensure that the money allocated to district health authorities is used in the most efficient way possible. The hon. Lady knows that by professional background and training I am an accountant. I do not believe that the application of sound financial management and practice is inhumanitarian. The reverse is the case. The most humanitarian way to run the National Health Service is always to be concerned about using scarce resources in the most efficient way. She knows that in 1989-90 the City and Hackney district health authority has been allocated just over £100 million. She also knows that there have been no cuts in that district. Gross revenue expenditure by the City and Hackney district health authority rose from some £70 million in 1982-83 to just over £100 million in the current financial year. That represents a very significant increase in cash terms and in real terms. I find the hon. Lady's reference to cuts in the district difficult to comprehend.

Ms. Abbott : Is it not the case that Bart's has recently had to close 75 beds?

Mr. Freeman : If the hon. Lady will permit me, I shall be happy to deal with that in the eight minutes left of this Adjournment debate. Before I do so, I should like to tell the hon. Lady that I visited Hackney earlier this year to look at the community psychiatric services. I know that the hon. Lady will join me in congratulating the district health authority on its organisation of those excellent services. I visited the community psychiatric research unit which is based at the hospital. The unit was funded originally through the generosity of David Sainsbury and is now funded by the district health authority. I met the directors, Dr. Turner and Mr. Adrian Lovet, and I visited two people who were living in their own flats with support from the district health authority, having left psychiatric care at the hospital. I also visited two group homes, one at Clapton common which is run by the local mental health association and one in E8 run by a local voluntary organisation called Vanguard Housing. I was very impressed by what I saw. I have reached the conclusion that community psychiatric care is working in Hackney and I congratulate all those involved.

The hon. Lady referred to patient throughput. I remind the House that the discharge of patients from hospital is a matter of clinical responsibility. Doctors, not hospital administrators, take decisions about when people are discharged. The national trend in Britain, together with many other western European countries, is that the average stay in hospital is getting shorter. That is to be welcomed. Patients generally prefer to leave hospital as quickly as possible after they have been medically treated. I am advised that in the City and Hackney district health authority, day surgery increased by 22 per cent. between 1982 and 1986. That is excellent.

The Labour party's common belief that the quantity, though not necessarily the quality, of health care in the National Health Service can be measured by the number of beds available is misleading. What counts is not the number of beds but the number of patients treated. Patient throughput in the City and Hackney area has gone up, and that is the best measure of health care.

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The hon. Lady might be interested in the 1987-88 Ko"rner Health Service indicators for the City and Hackney. I hope that she has studied them, but if she has not had the chance to do so I should be happy to send her the statistics. The document states :

"Throughput values ranged from the high values for Ophthalmology and Gynaecology to the low values for Trauma and Orthopaedics and General Surgery/Urology. Lengths of stay for patients over 65 years were high or very high for all specialties except Ophthalmology. For patients age 16-64 years they were mostly mid range except for very high value for General Surgery/Urology. They were also very high for Paediatrics. Day case rates were mainly mid range except for the high values for Ophthalmology and Gynaecology."

Therefore, patient throughput needs to be examined by specialty. The hon. Lady asked me to comment on the situation at Bart's and I am happy to do so. Three wards have been closed temporarily. The hon. Lady knows that two have been closed for operational reasons of maintenance and fire safety and one has been closed for financial reasons. The hon. Lady mentioned the financial difficulties not only for Bart's, but for the entire health district. North East Thames regional health authority recognises the position of the City and Hackney and is in discussion with the district about what can be done to ameliorate the present situation.

One of the main causes of the potential overspend in City and Hackney health authority is due to the increased numbers of cases being referred to St. Bartholomew's hospital from outside the district requiring complex and intensive nursing care. As a result, the authority has had to use additional agency nurses and ask nurses to work increased overtime.

The hon. Lady will know, if she has studied the White Paper "Working for Patients", that that document carries an excellent message of hope for Bart's, a major teaching hospital, and I trust that she will join me in hoping that legislation, if presented, will receive a swift passage, since it will bring hope to her constituents and represents an excellent message for the medical staff at St. Bartholomew's.

That will be the position because money will follow the patient. The hon. Lady will know that only about 30 per cent. of patients treated at Bart's live in the district. About 70 per cent. come from outwith the district. Thus, our proposal that money should follow the patient will mean that, through the mechanism of contracts, resources will flow from surrounding districts to Bart's in those specialties in which, as the hon. Lady rightly said, Bart's has an outstanding reputation.

We shall end the efficiency trap by which consultants and doctors who work hard eat up the fixed resources in their budgets more quickly and then, halfway or two thirds of the way through the year, find themselves having exhausted their budgets and having to curtail their activities. We do not want that to happen in future. We want greater flexibility in the funding of the NHS, and the Government's White Paper, presented earlier this year, foreshadowing legislation, will be of great assistance, not only to the hon. Lady's constituents but to the NHS in general.

Question put and agreed to.

Adjourned accordingly at fourteen minutes to One o'clock.

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