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one of those leaflets, because I believe that it is scaremongering in the extreme and full of half truths. One of the thorny issues to be discussed at the meeting is the consultative document from South Manchester health authority which was published at the end of September 1989. Since its publication, I have been bombarded with letters from anxious constituents.

The health authority's ultimate aim is for a single site hospital to cater for the south Manchester area, but it would take at least 10 years to achieve that. The great problem is what happens in the interim 10 years. The health authority believes that a programme of rationalisation between Wythenshawe and Withington hospitals will be necessary.

The health authority put forward two options. It recommended what it called option A. In option A, Withington hospital would be the major centre and would also be allocated general surgery. The effect would be that residents in my constituency would be more remote from district general hospital services. That would also lead to an over-concentration near the centre of Manchester.

Most people who have written to me have emphasised how strongly they felt that Wythenshawe hospital should remain a major accident centre. After all, we have a major airport in our area. Manchester international airport has grown enormously in importance over the past three years. It has been estimated that travelling time from the airport to Wythenshawe hospital is up to 10.5 minutes, whereas from the airport to Withington it is up to 19.75 minutes. That difference could be vital if we had another disaster at Manchester airport. No doubt that is why the police, the fire service and the airport have objected to Wythenshawe's limited accident and emergency role as envisaged in option A. I hope that my hon. Friend the Minister can visualise the anxiety that has been expressed by my constituents. The staff at Wythenshawe hospital have not been idle--in fact, they have been very active in putting forward their views. They have now published their own document, which they call option C. They believe that, if their option is adopted by the local authority, it will match the savings that have been put forward in option A, will provide increased patient choice and, perhaps most important, will provide an acceptable soluton for patients, general practitioners and consultants. I am told that option C is being given serious consideration and that no decision is likely to be made by the health authority before mid-March at the earliest.

Having read all the papers, I must say that, in its response to South Manchester health authority, Trafford health authority has suggested that the management of Wythenshawe hospital be transferred from south Manchster to Trafford because it believes that that would be beneficial to residents in south Trafford. I am anxious to ensure that my constituents have the best possible health care. I await my hon. Friend's speech with interest.

The infamous Labour party leaflet states that cuts are imminent. In fairness, nothing could be further from the truth. I hope that my hon. Friend the Minister will confirm that if South Manchester health authority's conclusion is unacceptable to the community health council, the matter will be referred to the North-West regional health authority and that, if matters are not resolved at that stage, the issue will be taken to the Department of Health--in other words, that nothing has been decided, nor is the final decision imminent. As usual, in its desire to cause mischief,

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the Labour party either does not know the facts or has ignored them. I hope that my hon. Friend the Minister can give some reassurance and nail some of the misrepresentations that have been put around by political opportunists.

10.13 pm

The Minister for Health (Mrs. Virginia Bottomley) : With his usual eloquence, my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) has outlined his constituents' concerns and their understandable wish to ensure that they receive a high standard of medical care. I am shocked to hear about the way in which the local Labour party has been exploiting people's fears--once again being involved in scaring rather than caring for people. As my hon. Friend rightly said, consultation is going on at the moment, but no firm decisions have been made. I shall outline the situation as we see it.

I compliment my hon. Friend on his thorough exposition of the current provision of hospital services both in his and in neighbouring constituences. It is true that he has certain advantages in so clearly presenting the facts, not the least being that he has been such an assiduous Member of Parliament for many years. It is almost 10 years since he raised the very same issue in the House with one of my predecessors, my hon. Friend the Member for Ealing, Acton (Sir G. Young), who was then the Under-Secretary of State. Many aspects of health care have changed dramatically since that debate--perhaps not in terms of the physical hospital buildings, but in the number and quality of health treatments enjoyed in Altrincham, Sale and other parts of the Trafford area.

It might be helpful to consider how hospital care in the district has been developed since that earlier debate in June 1980. Trafford general hospital at Davyhulme park now provides district general services for the district, having been built up from some 360 beds in 1980 to about 470 beds now. There has been a £4 million development providing modern acute geriatric and rehabilitation beds--something which my hon. Friend was particularly keen should be provided for Trafford residents.

The district health authority has decided to develop mental illness services within the district boundary. It has been decided to build a £2.8 million extension at the Trafford general hospital to provide acute in-patient and out-patient facilities. That project should be completed by 1991. Even more important than buildings and beds is the number of patients who are treated, and there has been a one third increase in the number treated in each available acute bed since 1982.

That has meant that the total number of patients treated has increased by 7 per cent. overall and by far more than that in some specialties. For example, the number of ear, nose and throat treatments has increased by two thirds. A similar pattern emerges from a study of day case patients at Trafford general hospital. In the six years since 1982, the annual number of patients has almost doubled--it has increased by 92 per cent.--from 2,600 to 5,000. In fact, all specialties--general surgery, urology, orthopaedics, ENT and gynaecology--are achieving more treatments for day patients. I want to illustrate just how much hospital care the residents of Trafford are now receiving. For district acute specialist services, Trafford residents do far better than others in the north-west region. Of 21 wards in the district, residents in all but four have more treatment in hospital

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than the average for the region as a whole. The same picture emerges for all specialties funded by districts and the regional health authority, excluding maternity and psychiatry.

I hope that my hon. Friend recognises that, although a district general hospital has not been built in Altrincham to serve the residents in that part of south Trafford, there has certainly been no reduction in hospital treatment. The reality is that far higher efficiency in providing modern medical treatment has more than enabled existing hospitals to provide adequate treatment. Another key indicator is that waiting times for treatment at Trafford general hospital are far better than those experienced in other districts in the north west region. One could be forgiven for concluding that, in many respects, Trafford district health authority has been and is providing better access to hospital treatment for its residents than many other districts.

The necessity for a second hospital at Altrincham was being sharply questioned as long ago as 1980. It is clear from the remarks of my hon. Friend the then Under-Secretary of State that he had not been convinced, at that stage, that the relocation of acute beds in south Trafford was vital in relation to the level of services that the residents were then receiving. He was not sure about the plans for 140 new acute beds as there was then overprovision of acute beds in Manchester generally which was well recognised. It is fair to say that my hon. Friend showed remarkable prescience in that judgment, as the events of the intervening years have shown.

The regional and district health authorities have since come to recognise that those additional new acute beds could not be justified against a background of shorter stays in hospital allowing acute beds, medical staff and medical equipment to be used more intensively. There is no debate about them now, because in 1988 the regional health authority agreed with a submission from Trafford district that the future hospital development in the south of the district would be for an out-patient department for investigation and diagnostic work, short-stay cases requiring minor treatments, day facilities for geriatric and elderly mentally infirm patients living in the community, with, possibly, some long-stay beds for elderly patients. In short, the option appraisal by the district had shown that there was a need for a community hospital which would be a referral centre for district specialty services--for example, orthopaedics, urology, general surgery, gynaecology and obstetrics, and paediatrics at Trafford general hospital, Wythenshawe and Withington.

My hon. Friend will recall that in 1980 it was said that the residents of south Trafford received a substantial part of their acute services, including maternity, accident and emergency and paediatric services, from Wythenshawe hospital. Now, I am told, in-patient acute treatment for Trafford residents is handled at Trafford general hospital--about 60 per cent. ; at Wythenshawe--about 30 per cent. ; and at Withington--about 10 per cent. A few cases go to Hope hospital in Salford and to the Manchester royal infirmary. Often this is to obtain a regional specialty treatment available at those hospitals for all the residents of the north-west region. Present-day preoccupations can be summarised in three questions. First, what has happened to the plan for a

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community hospital to serve primarily the residents in the south of the Trafford district? Secondly, where will these same patients go to be treated for conditions normally handled at district general hospital level if Wythenshawe hospital loses some of its district specialties? Thirdly. will Trafford district be able to continue to develop hospital treatment and care for all its residents now and in the future given present and future funding?

The community hospital plan was agreed by the North Western regional health authority in May 1988. The authority resolved then to develop plans for a community hospital in south Trafford. It decided that an application should be prepared for the Department of Health to give approval in principle to the development, and that there would be rationalisation of district specialty services in south Manchester.

I can assure my hon. Friend the Member for Altrincham and Sale that the regional health authority has not ruled out the development of the Trafford community hospital. Equally, it has not rejected the option appraisal and conclusions that led up to its decision in May 1988. I understand that the earlier provisional date for a start on the south Trafford community hospital was in 1995-96, and, of course, the present three-year regional capital programme does not go that far. There is therefore no firm decision about the programme in the longer term.

I believe that the regional health authority has since stopped further design work on the plans for the hospital only because there is more urgent work to do on developments in the early years of the capital programme. I can state categorically that this does not imply that the regional health authority has withdrawn its support for the scheme.

Let me turn to the recent public consultation undertaken by South Manchester health authority on the future provision of district and regional specialties in Withington and Wythenshawe hospitals. My hon. Friend mentioned these and the decisions to be undertaken. The South Manchester authority issued in September last year what it called "Strategy for the Future : Proposals for Consultation." As my hon. Friend said, no decisions have been made. I emphasise that the proposals were for public consultation, and a three-month period was allowed for the submission of comments and observations. This period has just ended, and, as my hon. Friend has said, Trafford district authority has forcefully made its views known to the South Manchester authority. I know, too, that there have been energetic representations at other levels.

The regional general manager has clearly stated the managers' position. First, the regional health authority has not abandoned previous agreements. Secondly, the Trafford managers always recognised that South Manchester would at some point need to rationalise district specialty services between Wythenshawe and Withington. Thirdly, future hospital development in south Trafford was, and continues to be, focused upon improved provision for the elderly and mentally infirm. Those groups, in whom I know my hon. Friend has a special interest, are often the ones that do not hit the headlines, but they are enormously important in the context of the provision of health care.

At the heart of the Trafford authority's concern is the proposed rationalisation of the acute medical wards and the fact that the major part of the accident and emergency department might be transferred from Wythenshawe to

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Withington, which, as my hon. Friend said, might be less convenient for patients in the south-west part of Trafford district, who might then prefer to be treated at Trafford general hospital.

I sympathise with Trafford health authority in its concern to protect the high hospital treatment levels currently enjoyed by their residents. That is a major responsibility for the authority, and it is right to make its views known to South Manchester. I hope and am confident that those views will be fully noted and taken into account. Trafford authority is right to consider how the potential rationalisation at Wythenshawe will affect its own district specialty services provided at the Trafford general hospital. It is also clearly right to seek to ensure that better provision for the mentally ill and elderly in Trafford finds a place in future regional plans for the Greater Manchester area.

My hon. Friend will understand that Ministers would not intervene in the planning process at this stage. The Government intend to establish a broad set of policies to give health authorities the greatest possible discretion, within those policies, to allocate priorities and make their own financial arrangements. That is endorsed in our recent White Paper, "Working for Patients". The responsibility of access to district specialty services for the residents of south Trafford lies fairly and squarely on the regional health authority and the district authorities for South Manchester and Trafford. Clearly, it would be helpful if they could get together to discuss the next action before final decisions are taken after the public consultation on South Manchester's recent consultation document.

It is not the right moment for Ministers to consider the options. However, as my hon. Friend knows, no final decision on the rationalisation of hospital services will be taken without the agreement between the South Manchester authority, the community health council and the regional health authority. If, sadly, agreements cannot be reached, the matter will come to Ministers for a decision on such a significant change of use of hospital facilities. My words should not be construed as supporting a policy of inaction by the South Manchester authority which needs to ensure that its services are provided in an effective manner providing high standards for local residents.

Finally, I shall refer to future financial resources for the north west region as a whole and Trafford in particular. My hon. Friend will know that the public expenditure plans which have been published result in the north- west receiving an additional £77.8 million funding this year.

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That represents a real increase in resources of 2.21 per cent. Those are impressive figures, especially against the background of broadly unchanging total population in the region as a whole. My hon. Friend will know the precise allocation of resources to his district in the near future, but the final details are a matter for the regional health authority.

The Trafford district health authority clearly has to maintain existing services within its budget and is committed to doing so. When it receives its cash allocation for 1990-91 in the next few weeks, it will be better able to judge what savings it can make on existing patterns of patient care in order to finance the many improvements that it has made or intends to make.

I should like my hon. Friend to know our overall record of spending in the north-west. There has been more than a 33 per cent. increase in real resources since 1978-79, even greater than the average for England as a whole, which has increased by 30 per cent., and that is for a region which is not growing in population size, as many are. In terms of treatment, in- patient cases have risen by 43 per cent., day cases have almost doubled and out-patient numbers increased by 11 per cent. There have been 23 per cent. more doctors, 16 per cent. more nurses and 37 per cent. more occupational and physiotherapists over the past 10 years. That is a remarkable and dramatic record. Trafford health authority's spending has risen from £12.2 million in 1979-80 to £32.3 million in 1989-90. South Manchester's spending has risen from £37.4 million to £102.6 million. That is a dramatic real increase--20 per cent. for Trafford and 24 per cent. for South Manchester. Those are significant advances.

My hon. Friend deserves our credit for raising this enormously important issue. His constituents rightly look to him for guidance and advice. We in the House respect and admire the way in which, with clarity and conviction, my hon. Friend ably and articulately represents the needs of his constituents. I shall certainly draw his remarks to the attention of the chairman of the regional health authority so that when looking at the development of services and the allocation of resources throughout his region he will be well aware of the concerns that my hon. Friend has so ably expressed on behalf of his constituents.

The motion having been made at Ten o'clock and the debate having continued for half an hour, Mr. Speaker-- adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.

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