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Motion made, and Question proposed,
That for the purposes of any Act resulting from the Courts and Legal Services Bill [Lords], it is expedient to authorise (
(a) the payment out of money provided by Parliament of-- (
(i) any sums required by the Lord Chancellor for the payment of grants under the Act to the Advisory Committee on Legal Education and Conduct and the Authorised Conveyancing Practitioners Board ; (
(ii) any other expenses incurred by the Lord Chancellor under the Act ; and
(iii) any increase attributable to the Act in the sums payable out of money provided by Parliament under any other enactment ; (
(b) the payment out of the Consolidated Fund of any increase attributable to the Act in the sums to be paid out of that Fund under any other enactment.-- [Mr. Lilley.]
Mr. Austin Mitchell (Great Grimsby) : It is, perhaps, entirely appropriate that a non-lawyer should speak on this Bill via the money resolution, because the Bill has been-- [Interruption.]
Mr. Mitchell : I have never seen so many lawyers working so hard for so little and at such length, which is why I am speaking on the money resolution. The Bill has provoked a protracted matrimonial dispute between the Law Society and the Bar Council. I am concerned with the consumers' point of view, which arises under the money resolution because its provisions do not cover the Lord Chancellor's increased expenditure and expenditure under related legislation, such as the extension of the ombudsman role.
The real problem of the inadequate provision of legal services is financial. The system seriously fails the people--not the wealthy who can always afford to pay for legal services, but the mass of the people who need the backing of the law in employment rights, housing matters, domestic and matrimonial disputes and so on.
All those issues are fairly inexpensive and of no great interest to the legal profession because there is little reward in them. However, they require the adequate provision of services so that people can have their rights protected. That is where both the money resolution and the Bill fall down. The provisions of the money resolution are inadequate to extend the services that we want to those in society who are currently badly served by the administration of justice. They require a department--a Ministry of Justice--answerable in the Chamber. They require a public defender service providing effective protection for the mass of the people. They require a legal services commission. They require proper training, in particular for judges, which is covered in the money resolution. I do not know why we have not yet established a YTS-type training scheme for judges. Under our system we have some of the worst-trained judges in the world.
Column 1520Certainly we have nothing like the provision for training of judges as exists in France. Finally, they require the type of injury compensation scheme that exists in New Zealand.
Instead, the Lord Chancellor has gone for the market solution to try to get more work out of the system for less money. He has gone for a money resolution that covers less ground. A market solution--increased competition--makes fewer demands on the public purse and gets more work out of the system. I have no objection to that as a principle, but it does not cover enough ground. The money resolution is not as extensive as I would have wanted it to be. I congratulate the Lord Chancellor on the Bill, first for having begun progress after the logjam which built up under his predecessors and secondly for the ingenious solutions that he has gone in for. However, there are other areas in which we could serve the consumer better without making substantial demands on the money resolution--for instance, by making barristers and lawyer advocates in the higher court liable in law for incompetence, negligence and inadequacy. Why should they be exempt from legal action of that nature? No one else has that protection. We need to bring them into the scope of negligence cases and they should be taken to court for inadequacy in their work.
The money resolution covers the extra work of judges, but the extra work that falls on them in respect of their control over access to representation in higher courts is not something that they should have to do in any case.
Why should judges, who made their views on solicitor representation in higher courts absolutely clear, and who are defending the vested interests of barristers in this matter, have power over that area? Why not allow solicitors to operate in the higher courts on the same basis as we now allow lay people to operate in the county courts? It could be as simple as that. It would not need the expenditure in the money resolution if we opted for that more straightforward solution and then let the consumer choose whose services he wanted to represent him.
We could also get a wider range of representation by providing that the solicitor who prepared the case could present it in the court. That could be done without extra expenditure, thus widening the range of choice. If we maintain the ban on those who prepare cases representing them in court we are imposing a rule that does not apply in the lower courts, and it is wholly unnecessary.
We could have direct access to barristers. I am alarmed to find that the Bar Council has taken preliminary steps to discipline barristers who work in solicitors' firms. Why can we not establish a principle of direct access to barristers?
The cab rank principle was put into the Bill by Lord Alexander to restrict competition among solicitors in the higher courts or, as the Legal Action Group put it, "to make mischief". Really it is there as a restraint on competition, because it is difficult for solicitors to comply with that ruling. I shall quote briefly from the Legal Action Group's current report :
"The Bar's own cab-rank rule does not bear too much investigation. Only from last month has this vaunted bulwark of the country's civil liberties actually required a barrister to act in a legally aided case. The exceptions to the general principle remain so wide that any barrister could devise a justification for refusing almost any particular case or general class of work."
The editorial concludes that the real issue is to ensure that "every client should have access to a solicitor, not that every solicitor must act in every case."
Column 1521The money resolution covers the Authorised Conveyancing Practitioners Board. I am concerned that the board will effectively cover only the work of banks and building societies. There is a different rule-making system through the Law Society for solicitors and a different system again through the Council for Licensed Conveyancers for licensed conveyancing. As a result of the separation of powers, there will be three rule-makers. It will be difficult to achieve a level playing field and a system that ensures that each operates under the same rules and competes on the same basis. The way that the Authorised Conveyancing Practitioners Board will operate will be inadequate.
The money resolution will cause extra expenditure for courts. The Government's views on the proposals of the civil justice review have not been clarified.
The Bill makes some welcome changes, particularly in respect of debts. I welcome them because the procedures have been too automatic and abrupt and the consumer has had too little power in them. However, I am not sure how it will work in practice. The civil justice review made 91 recommendations. We need to know what the Government's response will be before we can adequately judge how much expenditure will be involved and what regulations will follow to implement the provisions of the Bill. When will the Government give their considered response to those 91 recommendations, many of which affect expenditure under the money resolution? The problem of debt will increase the more the current deflation bites. To know how those procedures will operate, we must be aware of the Government's position.
The legal services ombudsman will have an expanded role, but we are not sure how he will function. He needs to have power to deal with shoddy and inadequate work and negligence. There is a provision in the Bill that all procedures must be exhausted before there is recourse to the ombudsman, whose expenditure is covered by the money resolution. The previous procedures under the Solicitors Complaints Bureau were not satisfactory because it had no power to award compensation. Will it be given power to do so and will the Government table an amendment to enable that, because it will have an effect on the number of cases that come before the legal services ombudsman? The money resolution is wide-ranging, which is why this has been a rather more wide-ranging speech than it would have been. It embraces the least adequate part of the Bill. The Bill is good because it enhances competition and therefore enhances the drive of legal services to serve the consumer. But that is not enough, and we still need wider provisions and the correction of various parts of the Bill, which I hope will be made in Committee. We want to establish the basic principle that the legal system is a service industry working to serve the people, particularly the consumer of legal services, rather than the self-interest of those who operate it.
Mr. Bob Cryer (Bradford, South) : I am grateful for this opportunity at the end of our main debate to speak to the money resolution. I suppose that the House should be grateful that we have not been pressed for time today in debating the Bill. Indeed, we could have examined the
Column 1522statement made earlier by the Secretary of State for Trade and Industry in much more detail and every hon. Member who wanted to speak on Second Reading of the Bill could still have done so. It is gratifying to know that those of us who were concerned that there should be proper examination of the statement were proved right. In view of the Government's track record of incompetence and shambolic action in the past week, it behoves the House on every available opportunity to examine what the Government are doing. That is what we are doing on this money resolution.
I do not cavil at the Attorney-General's claim that there is a need for speedier hearings of cases in civil courts. The Government say that that can be achieved by transferring cases from the High Court to the county courts, and I believe that that is probably right. However, the amount of money that the Government have allocated for that, including judicial salaries, ranges from £1.6 million to £2.1 million for the first three years. The Government also point out that there could be a bulge in activity in the courts which will be incorporated within a maximum figure of £3 million in the first year, £4.5 million in the second year and £5 million in the third. Ministers should explain to the House the basis for those figures, which are included in the explanatory memorandum at the beginning of the Bill. We are anxious that adequate resources should be available to ensure that the transfer is made speedily and effectively so that there can be adequate access to the county courts for people who, as several hon. Members who declared their interests as lawyers said, complain about cost and delays. Those are the two principal complaints about legal issues. I hope that the Solicitor-General can assure the House that the amount of money provided is adequate and that the calculations have been made very carefully.
The idea of an ombudsman for legal services is good. The difficulties of complaining about barristers are legion. There has always been a qualification that people might seek to reopen a case if they complain about a barrister's negligence and sue in tort for that negligence. That has always been a difficulty.
The Law Society has probably been the body most effective at protecting its members rather than the general public when complaints are made. As one might expect, the Law Society's rules for dealing with complaints about solicitors are highly complicated and normally require a solicitor to interpret them to the luckless person who believes that he has been badly dealt with. In my experience of constituents who have made complaints, a general system of supervision by an ombudsman is likely to yield better results more effectively and more quickly than the turbid and complicated rules laid down by the Law Society, which has a vested interest in maintaining those rules.
Column 1523Mr. John Fraser (Norwood) : Will my hon. Friend give us an example of the complicated rules about making a complaint?
Mr. Cryer : One of my constituents felt that his case had been mishandled by a solicitor, and wrote to the Law Society and obtained a copy of its rules. We went through the rules extremely carefully and found that he had very little basis for a complaint. That left him feeling dissatisfied. He had the bones of a case, but after an exhaustive search we were not able to proceed. That was my constituent's experience. As a result, I had to drag my eyes through the Law Society's list of rules, which I found to be extremely complicated. Rules to be used for facilitating complaints should be as straightforward as possible so as to encourage justified complaints.
Legal education will cost about £750,000 in the first year. The provision for legal education and conduct is welcome because legal education seems unnecessarily chaotic. It is only relatively recently, for example, that polytechnics have started to run courses to qualify solicitors. I refer to courses such as the common professional entrance exam in which, in effect, an ordinary degree can be converted to a law degree to allow entrance to the Law Society finals. I hope that the money will be well spent to clarify the legal position and also to encourage the sons and daughters of working men and women to become solicitors and barristers.
For many years, entry--certainly to the barristers' occupation--has been too expensive for many families to contemplate, despite the fact that in the past 10 or 15 years scholarships of one kind or another have been introduced.
Mr. Cryer : I inform the hon. and learned Gentleman that for many families entry into the barrister's occupation represents a potential financial burden that they cannot accept with equanimity. Of course, under the Government, the general position with fees has not helped at all.
According to the financial memorandum, the overall annual cost of the Bill will be about £5 million, rising to £6.5 million. That includes money payable for judicial salaries. I am sorry that the Bill does not tackle the difficult problem with our judiciary. The judiciary is appointed to be independent so that the arms of the Executive and of the judiciary are not merged and so that the Executive cannot warp the law. That is the theory, but it does not work out very well in practice.
One problem is that judges are often ignorant and arrogant and cannot easily be removed from office except by a joint address of both Houses of Parliament. That means that some judges--I cannot name them because Members, as elected representatives, cannot even comment on judges, such is the insulation of their position--make statements about cases on which they have made decisions. Months later, they refer back to previous cases in which they have made decisions of horrifying indifference to some of the circumstances. By going on the media in the full glare of publicity and referring to previous cases, they resurrect the case on which they commented previously, which brings back the full horror of the first occasion to the family concerned.
Column 1524Skinner) was absolutely right to mention Judge Pickles. Judges say, "I can't be sacked, I must carry out my duties and I believe that they include commenting on cases as I choose." The Lord Chancellor has expressed general criticism of Judge Pickles' comments and, in a letter to me, he has also expressed great concern. The Government must tackle the problem of maintaining some independence for the judiciary, while providing a better way of ensuring that judges conform to some reasonable rules, which includes preventing them from commenting freely on judicial decisions that they themselves have made and producing the harm that I have described.
Judges who feel that they are better in a television studio can abandon their jobs and go full-time as commentators or do some sort of comedy turn.
I realise that there are difficulties, but this matter should be tackled in Committee. There should be some warning to the as yet handful of the judiciary who behave with complete impunity to all pleadings from the rest of the judicial establishment. The Lord Chancellor says that he can do nothing. I understand that if a judge comments in the fashion that I have described the practice is for him to be sent off to some provincial circuit with uncomfortable lodgings where it is drafty and nasty.
Mr. Cryer : My hon. Friend the Member for Bolsover queries what I am saying. I am told that that is the way in which judges are brought into some sort of conformity, but it is not working. It is fair to comment on that fact in relation to the money resolution, which deals with salaries paid from the Consolidated Fund. Indeed, they are paid from the Consolidated Fund so that there can be no taint of Government money being paid direct to the judiciary in recognition of its so-called "independent" position.
In conclusion, I hope that the Solicitor-General has been suitably briefed on the money resolution because it is an important part of our scrutiny and, as I said earlier, with the Government's sorry record of incompetence, we have to seize every opportunity to ensure that that scrutiny is maintained.
The key provisions in the Bill in relation to the money resolution are in parts I and II, which take forward the recommendations of the civil justice review and the Government's proposals concerning the provision of legal services. As the hon. Member for Bradford, South (Mr. Cryer) has rightly said, part I is expected to give rise to additional annual expenditure increasing from £1.6 million to £2.1 million for the first three years. Such costs should be essentially transitional, representing the need to increase both judicial and administrative capacity in certain parts of the system--principally in the county courts--which will, in the main, be offset over time as a result of revised and streamlined procedures. As I said in
Column 1525the Second Reading debate, it is, however, estimated that there will be a continuing need for around 50 additional staff in the longer term to strengthen the listing arrangements in trial centres, which will be where the new work will in the main be dealt with. This is, of course, separate from the additional provision announced in the autumn statement last year, which will enable the Lord Chancellor to increase the numbers of staff in the courts by about 350 to take account of recent increases in the work load. Judicial salaries are paid from the Consolidated Fund, but those of registrars, who will be retitled "district judges" as a result of the Bill, are paid from the Lord Chancellor's Vote. The increase in numbers of the judiciary required in connection with part I will be predominantly at the "district judge" level. All the expenditure relating to this part--including the transitional bulge in legal aid expenditure referred to in the financial memorandum and caused by the faster throughput of business--is therefore expected to fall under the head at paragraph (a)(iii) in the money resolution.
Part II of the Bill sets out the new framework for the provision of legal services and establishes the Lord Chancellor's advisory committee for legal education and conduct, the legal services ombudsman and the Authorised Conveyancing Practitioners Board, together with its associated ombudsman scheme and appeal tribunals. The cost of all these bodies--which will pave the way to enable the provision of legal services to become less restrictive, while maintaining standards and public confidence in those providing them--may be taken into account at paragraph (a)(i) and (ii) in the money resolution. However, it is intended that the Authorised Conveyancing Practitioners Board and the conveyancing ombudsman should in time become self-financing through fees.
The hon. Member for Great Grimsby (Mr. Mitchell), who unfortunately must be elsewhere engaged--
The Solicitor-General : --welcomed the new scheme for the legal services onbudsman. He asked whether the legal services ombudsman had power to award compensation. The answer is that he has power to recommend compensation but not to enforce it. To enable him to enforce it would effectively make him another sort of court, whereas he is intended to be a different type of scrutineer. Publicity, which would no doubt appeal to the hon. Gentleman, is a considerable weapon in enforcing this type of ombudsman's decision.
In order not to keep hon. Members from some clearly entertaining material, I conclude my remarks on the money resolution and commend it to the House.
Question put and agreed to.
Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Chapman.]
Mr. Kenneth Hind (Lancashire, West) : I welcome the opportunity given to me by Mr. Speaker to raise the problems caused by the waiting lists at Wrightington hospital in my constituency and within the West Lancashire health authority which is almost coterminous with my constituency.
Before I enter into the arguments on the matter, I pay tribute to the dedicated staff and doctors at the two main hospitals which make up West Lancashire health authority--Wrightington hospital and Ormskirk district and general hospital. In the past 12 months we have been granted £25 million by the North Western regional health authority to build a new hospital. I am pleased to say that it is now under construction. My hon. Friend the Minister for Health recently visited West Lancashire to cut the sod to start building the new hospital.
The purpose of the debate is to draw attention to the problems of orthopaedic surgeons at Wrightington hospital. Waiting lists in West Lancashire health authority are low compared with national averages. That is a tribute to the staff. However, the position of the orthopaedic side, particularly upper limb, is extremely bad. It is acute and needs to be brought to the attention of the House. Action must be taken to deal with this problem.
The major problem arises from the waiting list of Mr. John Stanley, the upper limb surgeon. He is in need of additional support. The problem arises because Wrightington hospital is a regional centre of excellence. It draws patients from all over the country. During the past 12 months, 94 district health authorities have referred patients there. It is one of those hospitals that has been in the forefront of orthopaedic surgical technique developments and has played a major part in the development of hip replacement surgery for people afflicted with arthritis. That has become an operation that is widely carried out throughout the Health Service, and much of the work on it was pioneered at Wrightington.
Wrightington is also a centre of excellence for rheumatology and contains one of the small units in the north-west which deal with rheumatology in children. In recent years, the rheumatology ward at Wrightington has been the subject of debate in this House. I am pleased that, due to the attitude of my hon. Friend the Member for Derbyshire, South (Mrs. Currie) when she was a Minister, that institution continues to supply a good service to the people of the north-west.
At present, there are 1,660 patients awaiting admission to Wrightington hospital. Of those, 1,065 have been waiting six months or more. Of those, 791 patients are on Mr. John Stanley's list for upper limb surgery. His difficulty is that he is one of six specialist upper limb surgeons practising, particularly on hands and arms, in the United Kingdom. Of his patients, 568 have been waiting for six months, and 427 for more than 12 months.
Therefore, the problem has existed for some time. When the Department of Health recently analysed the worst 100 waiting lists in the country, Wrightington's list came 58th. It was hoped, at that time, both by the district health authority and me, that the announcement by the Department of Health in the White Paper "Working for
Column 1527Patients" that 100 new consultants would be created would result in Wrightington receiving a consultant to alleviate its problems. The North Western regional health authority absorbs about 9 per cent. of the total national expenditure on health care. But an examination of the number of consultants who had been appointed by the Department, following the undertaking in "Working for Patients", found that only six had been appointed to the north-west--less, on a global examination of the position, than would be expected according to the number of patients and the volume of NHS resources absorbed by the North Western region.
Today, the NHS treats more patients, with more staff, than ever before. It is a demand-led system. Resources have to be placed at the points where the pressure arises and demand is greatest. Wrightington falls into that category. Since 1985-86, the number of patients treated at Wrightington has slowly increased, from 2,305 in 1985-86 to 2,715 in 1989-90--an increase of more than 400 in discharges. But in 1985-86, the number of patients who had been on the waiting list for 12 months or more was 218 ; in 1989-90, it was 628. Therefore, despite the fact that more patients are being treated, the number on the waiting lists is increasing.
That is a tribute to the success of Wrightington and to the ability of the doctors there to provide excellent service--but it is making matters more difficult. Ministers in the Department of Health have tried to lessen the problem by means of the waiting list initiative. We are grateful that in 1987-88 another 250 patients were allowed operations because of the increased resources from that initiative. The comparable figures for 1988- 89 were 120, and for 1989-90, 140. However, despite consideration by the Department and its clear understanding that the problem needs tackling, the waiting lists continue to grow. It appears that Wrightington is a victim of its own success. If the problem continues, the waiting lists will only grow. An application has been made to the Department under the so-called Yates initiative, whereby the Government determine whether waiting lists can be reduced by providing funds to hospitals centrally. I hope that my hon. Friend the Minister will look with some sympathy at our application for £235,000 to carry out more operations so as to reduce the waiting list.
It is impossible to discuss the waiting lists in one hospital without also considering the district health authority as a whole. West Lancashire district health authority has two major hospitals--the district hospital at Ormskirk, where a new hospital is being built, and Wrightington itself.
Over the past 12 months the formula by which the regions are funded by the Department has been changed. As a result, West Lancashire health authority has received a budget increase of 6.5 per cent. in the past year. That is made up of amounts of 5.8 per cent. and 0.7 per cent., the latter being a non-recurring sum.
I am sure that my hon. Friend will make the point that the retail prices index and health pay and prices costs are not necessarily one and the same, because the RPI contains some elements that are not relevant to pay and prices in the Health Service, such as mortgage interest rates, and so on. But some aspects of health costs, especially those relating to drugs, have risen in price well above the rate of inflation. So the district health authority,
Column 1528those who take an interest in health in the area and I all believe that 6.5 per cent. is not enough. If it is implemented, it will unfortunately entail a reduction in the health authority's resources over the coming years.
The change in the formula, as it has affected the North Western region, worries me. Unless it is reconsidered, we shall face the same problem next year, and the year after. This year the problem has been concealed, to some extent, by the large increase in the NHS budget generally, but the same formula for determining increases will apply next year. The North Western region's morbidity rate is extremely high, and the formula has been changed to the detriment of the region. If the Department were to look into that, it would benefit the health authorities in the region, which is the second biggest in the country.
When my hon. Friend does his calculations for Wrightington and examines the health authority's problems, I ask him to consider the performance of West Lancashire district health authority over the past few years. It is a model of financial rectitude and has followed Government guidelines time and time again. Over the past five years it has increased the number of patients it treats by 20 per cent. and has never overspent its budget. Unlike other district health authorities which have closed wards when they have overspent to reduce costs, West Lancashire has never called on that requirement, although major structural changes have been made as small cottage hospitals have been closed, such as Greenlane--Brandreth is planned for the future--to centralise treatment in Ormskirk, which is the geographical centre of the district, in modern facilities that are being built.
The cost improvements asked for by the regional health authority and the Department have always been delivered, but a small authority which covers 120,000 patients who are served by the hospitals within its environs has its limits. There is a deep feeling, particularly among the members of the district health authority, that overspenders benefit, while they have done everything that they have been called on to do.
I ask my hon. Friend the Minister to look at all those factors when he considers West Lancashire health authority, particularly at the morbidity ratio and the changes in the formula that will affect the North Western region as a whole and West Lancashire in particular. I again impress on him that the service at Wrightington will be a demand-led service of excellence. It is recognised throughout the country as second to none. It is demanded and will continue to be demanded by the public. The consultants who are doing such a good job deserve the support not only of their colleagues on the district health authority, but of Members of the House and the Government as a whole. I hope that my hon. Friend will look with sympathy on the difficult task that they face, perhaps with a view to helping to alleviate those problems while improving the service to patients. 10.57 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : I congratulate my hon. Friend the Member for Lancashire, West (Mr. Hind) on presenting a case on behalf of his constituents with his customary clarity and courtesy.
It is nice to see you back in the Chair, Mr. Deputy Speaker, after your visit to New Zealand. I understand
Column 1529that you and your wife were able to combine it with a few days holiday. I hope that you enjoyed your holiday and that your official visit was a great success.
Mr. Freeman : My hon. Friend concentrated his remarks principally on Wrightington hospital, which is just without his constituency boundaries. He would want me to say that our hon. Friend the Member for Chorley (Mr. Dover) represents the constituency that includes Wrightington. I understand that a good proportion of the staff and patients must come from my hon. Friend's constituency. It is part of the West Lancashire health authority, to which I pay tribute for achieving significant improvements in health care over the past six years. Indeed, my hon. Friend will be interested to know that the most recent accurate statistics for 1982 to 1987-88 show in- patient admissions up 22 per cent., out-patient treatments up 33 per cent. and day cases, principally day case surgery, up 60 per cent. It is interesting that treatment of patients in the trauma and orthopaedics specialty increased by 29 per cent. between 1982 and 1988-89. Those are truly remarkable figures which are a tribute to the skill, dedication and hard work of the staff.
Trauma and orthopaedic work, in which my hon. Friend is particularly interested tonight, includes broken limbs, hip and knee replacements and investigations into chronic arthritic conditions. I understand that, last year, some 3,730 patients in west Lancashire were treated for trauma and orthopaedic conditions requiring hospital treatment compared with 2,880 in 1982--a significant increase. One understands that the population is aging and that the pressure for orthopaedic care is consequently increasing, and that technological advances, particularly the modern marvel of the hip replacement, which my hon. Friend and I, if we ever reach a great age, may well be candidates for, make possible surgery that was not dreamed of by our parents, let alone our grandparents. My hon. Friend referred to the visit to Ormskirk of my hon. Friend the Minister for Health to kick-start a piece of construction equipment preparing the site for the new hospital--a £25 million development, with 139 beds for medical and general surgery, 23 for children and 8 for intensive therapy patients, and a modern accident and emergency department. I am sure that my hon. Friend is looking forward to the completion of that project, which will be of great value to the people of Lancashire.
My hon. Friend referred to the revenue allocation for west Lancashire, and I was busily trying to calculate the figures as he spoke. For the record, it is important to note that, for the year 1989-90, the year that has just ended, I calculate that the authority received some £25,310,000, made up of £24,568,000, to which was added AIDS money of £165,000, growth or development money of £379,000 and a number of other miscellaneous items totalling £198,000. The record should also show that, in the year to come, the allocation is £27,051,000, to which should be added an allocation for AIDS, certain White Paper work and capital charge preparation of some £200,000, giving a total of £27,251,000. I make that an increase of about£2 million, or 8 per cent.
Column 1530I would not argue with my hon. Friend about the precise mathematics, but when we start moving in 1991-92 to full and proper weighted capitation, I believe that, from advice that I have received, albeit provisional, my hon. Friend's district will be a gainer, presumably reflecting the fact that either the population is forecast to increase and/or demographic factors will move in favour of his constituents --that is, if their average age is particularly high in comparison with the rest of the region, or if their relative health is such that the district merits a greater allocation of funds. The provisional signs are that my hon. Friend's district will benefit. I understand that Wrightington hospital has located within it a regional specialty service for joint replacements, including upper limb, hip and knee replacements. One associates the hospital with the late Professor Sir John Charnley, who, even to a relative layman such as myself, is well known for his pioneering work on hip replacements.
It is relevant to note that, of the 942 hip replacements carried out in 1988-89, 34 per cent. were for patients living outside the north-western region. My hon. Friend quoted a slightly different figure, but it made the same point, that on orthopaedic work the hospital is serving a broad area.
The service deals with the lion's share of complex rheumatoid cases for the whole of the north-west and Mersey regions, and provides the only service for those two regions for wrist replacement and 90 per cent. of elbow replacements. It provides the only wrist surgery service in Great Britain, so it is not surprising that the hospital is facing a growing demand for surgery that is reflected in the activity figures for that specialty and in the waiting lists. Over the past four years, patient activity has increased from 2,232 cases in 1986-87 to 2,715 in 1989-90--an increase of 22 per cent. At the same time, the number of patients coming forward for treatment has increased at an even faster rate. One understands the reasons--the hospital's reputation and the increase in the aging population. The increase has been so fast that the number of patients waiting for more than 12 months increased from 339 in 1986-87 to 628 in 1989-90. At 1 March, 628 patients had been waiting for more than one year. My hon. Friend drew my attention to the fact that 427 patients are on Mr. Stanley's list for upper limb surgery.
Wrightington hospital has met all the efficiency targets set for it by the region. Last year, a target baseline figure of 2,304 treatments was set, and 2,715 were achieved. The irony is that, the better and more successful a hospital is at treating patients, the more likely it is to run up against cash constraints imposed by the current funding system.
My hon. Friend knows that, from April 1991 onwards, the new regime will benefit the hospital in two ways. First, there will be a contracting system whereby, if patients are referred from outside to a hospital of such distinction, money will follow those patients. The hospital's budget will become more flexible to the extent that, the more that it can attract patients from outside its district, the more money will flow into it. Secondly, our new system of allocating funds on the basis of weighted capitation should work in favour of districts where demographic and relative health factors indicate the necessity of allocating further funds.
Column 1531becoming a self-governing trust because, as my hon. Friend pointed out, it is in their interests to do so? That change could be of some help to them in the future.