House of Commons Hansard Debates for 18 Nov 1993

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Mid Cheshire hospitals trust has a recurrent shortfall--not one, but a recurrent shortfall--against target return of at least £3 million against a background of ever-increasing demand for services and its large maintenance bill.

We then come to the practical means which are being suggested for dealing with some of the problems. We discover that my constituents, who have already seen a number of ward closures at that hospital, will be told that more wards will be shut, that there will be consolidation--which is a Conservative word for ensuring that not as many people are cared for as were before--and that there will be such cuts in clinical services that in my view the orthopaedic services will be rendered virtually non-existent.

I could give the House a list ; it does not mean anything to hon. Members, but it will mean a great deal to my patients and constituents. In order to meet the strategic directional changes, we shall integrate in-patient facilities for ENT and ophthalmology, merge wards 18 and 19, close down wards 9 and 10 and form them into a single unit, close ward 19A altogether and develop day care services--of course, but at what cost? Can one always provide the same level of care through day care services that one can with in-patient care? Of course not. We are going to merge wards 13 and 15 into a unit with a vascular interest, which is a nice way of putting it. Ward 14 will be closed, and the proposal says :

"NB six beds are also used for Gynaecology."

We will notice, because that is a result of a previous alteration. I am sure that the Minister will give us his normal calm recitation of facts that have been supplied to him by those who are now adept at covering up the truth of what is really happening in the national health service. He will probably say that the hon. Lady is exaggerating ; she does not understand it ; she does not know anything about it. Let me, therefore, give him some more facts. The implications of the changes are a net reduction of 39 beds and very high occupancy levels in remaining wards. Availability of beds is currently not a constraint, the document says, but there is no doubt in my mind that there will be considerable constraints if we lose that number of beds. It is said that there will be serious consequences for handling emergency medical overflow. It is said that no additional developments in hospital services can be generated by cost savings, and although it is thought that the establishment will be held at average in-post levels, any future initiatives to increase patient activity could not be at marginal cost.

There is no suggestion that what is being imposed on the hospital is being done in order to improve its efficiency. Not even the regional health authority--which will itself be cut so that it will not be capable of understanding statistics that are given to it about the need for proper patient care and for services--argues that what is being imposed is in the interests of the patient. Something very different is being imposed. It is the kind of brutal attack on funding for the national health service that is the reality of Conservative health care--not all the simple, rather beautifully phrased, careful terms that somehow hide the reality. That is what will happen in my constituency.

Already the atmosphere in the hospital is worrying. I feel that it is important that I should come here and say these things tonight because one of the things which the Government have done, and for which the Minister has never taken credit, is to frighten health service workers so

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that they do not dare to speak openly about what is happening to their jobs and their hospital. They are worried. Many of them know that they have already been earmarked for redundancy. All right, they are told now that those will be non-medical jobs, but tomorrow they will be medical jobs. Today they are told of voluntary reductions ; tomorrow the reductions will be compulsory.

The Government also tell us that the unit is highly efficient. Not only do Ministers praise the administration of Leighton hospital, but they give it awards. They say how well run it is by everyone concerned and that it is part of the Government's quality initiative. The hospital even had a visit in the past three weeks--naturally, one of which I was not notified--by a Minister who told the hospital how brilliantly it was operating.

Some measures will have a direct impact. It is stated that the service in accident and emergency departments will be improved through nurse practitioners. Nurse practitioners, we are told, are "experienced nurses who have taken a course on the diagnosis and management of common injuries"

and who

"are able to practise in their own right".

Fine. Let me tell the Minister after a lifetime of living in hospitals that trained doctors, even at consultant level, know that the real problem with accident and emergency work is that a number of people present their injuries in such a way that those injuries can be missed even by people with considerable training. Any major hospital can provide the Minister with cases of people who left the accident and emergency department, sat on the steps and were afterwards readmitted, if they were lucky, or suffered because their condition was missed.

If the Minister is simply about to tell us that the hospital is run efficiently, is treating more people, has a faster input--that the peas are running faster through the pea factory--and that that is the only way that he will estimate how good health care is, he might as well save his breath to cool his porridge. We know that that is nonsense.

We know that many more people are going to that district general hospital than previously and that the staff are doing a good job in enormously difficult circumstances. However, we also know that the staff are demoralised and frightened for their future. We know that the administrators expect to close basic services in a number of wards. We know that it is inconceivable that £3 million can be found in the time available.

The effect will be to deprive my constituents of what was an efficient, if underfunded, desperately important hospital. There is no way that the Government will get away with this constant fairy tale about not worrying because the hospital is bound to be able to cope. We have reached the point where consultants and nurses are directly affected by the regrading of sisters, by shoving various specialties together in some wards to close others, by closing wards at weekends and by the refusal to refill vacancies, all of which is having and will continue to have a direct effect on patient care. The situation is dangerous.

Unless the Government are prepared to be if not realistic, then at least to listen to those who know what they are talking about, my constituents will have a valid argument for saying to the Government, who are keen on treating health care as a business, "You would not ask any business in the world to find a £3 million cut in the time available. You are prepared to wreck the NHS and to exclaim how efficient you are by getting rid of top level

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administrators." What the Government have done is indefensible and what they are about to do is appalling. In no circumstances whatever will the Minister escape blame if this goes ahead.

10.19 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : After the statesmanlike intervention of the hon. Memberfor Crewe and Nantwich (Mrs. Dunwoody) in an earlier debate on the problems of eastern Europe, I am disappointed by what she has just said. She descended from a sensible beginning to an unforgivable piece of depressing rhetoric about the health service, which will do no good at all. What sort of impression does the hon. Lady think that phrases like "bankruptcy", "crisis" and " a dangerous situation" will have on the patients, staff and the people trying to manage the difficult situation in her local hospital?

The hon. Lady need not hold up headlines from the press. The health service is not about headlines but about--and I choose my words carefully--one of the great benevolent and beneficent organisations in the world. It does an extraordinary job and it does not need politics and rhetoric flying around.

I would not be so starry eyed as to say that I am relaxed about the situation at the hospital, as the hon. Lady accused me of being. I am not. There has clearly been a continued overspend. We are relying on managements at hospitals around the country to atisfactory situation, but we agree that we have to face it.

Mrs. Dunwoody : If there have been continual problems of overspend that need to be dealt with, why has the previous executive not moved outside the national health service but gone elsewhere within it ? If his financial management was so lacking, why has he been appointed to another NHS unit ?

Mr. Sackville : If another trust or unit wishes to hire that person, it is its affair ; he is no longer at the Leighton hospital. I think that the hon. Lady will agree that the management there is first-rate, realistic and will try to tackle this problem.

Let me put the matter in context. The hon. Lady knows that there have been a number of favourable developments at her local hospital, and I hope that she will give credit for that. She mentioned that my noble colleague Lady Cumberlege was at the hospital recently to open a new unit. The hon. Lady will know that a new day surgery case unit was opened in April of this year. She will know that on 5 November--on the visit to which I referred-- Lady Cumberlege opened a new endoscopy unit. The hon. Lady will also know that the funding required to renew the roof, about which we spoke in an earlier debate this year, has now been approved. She will know that work is in progress on a £2 million rehabilitation unit for elderly people which will provide accommodation of a high quality, improve discharge times and be of great service. She will know that £800,000 has just been spent on a CAT scanner and its associated equipment. She will also know that the necessary action has been taken to reduce junior doctors' hours six months ahead of the national target.

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Those are all things of which the people who work at the hospital can be proud. It is good news, which should be put on the record after the hon. Lady's litany of doom and gloom.

There is a deficit that has to be tackled. I agree that actions taken in the past were quite clearly not realistic about the future funding. When it was clear that actions needed to be taken further to improve efficiency at the Leighton hospital, such actions were not taken, and those things must be faced up to.

The hospital continues effectively and viably. Activity, as the hon. Lady knows, has continued upwards. The description of the hospital being in crisis does not begin to paint a proper picture of what is happening.

The hon. Lady will be aware that in-patient activity rose in the past year and that the number of out-patients treated went up by another 6 per cent. to reach 149,000. She will also be aware that the number of patients seen during the past year was above the level at which the trust had contracted to provide. Leighton continues to be an effective hospital.

How is the deficit to be faced? The hon. Lady gave one version which I do not recognise. My information is that a number of measures will be taken, including the transfer of surgical patients to a day-case basis. That is not only good for patients, but it represents the way in which to treat more patients more effectively. It also reduces the number of acute in- patient beds. I am sure that the hon. Lady will acknowledge that that process is going on in hospitals in Britain and around the world. It is a necessary procedure and it probably should have been adopted earlier at Leighton with the establishment of the new day-case unit.

The combination of various wards with out-patient facilities will go ahead without any detriment to patient

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care. I have already mentioned the rehabilitation service, which will improve discharge times and thus efficiency. There is no doubt about the fact that a number of management posts will need to be revised and that is one of the more painful actions that will have to be taken.

Consideration will also be given to the way in which support services and the so-called hotel services are provided. More market testing will take place to ensure that any costs that can be contained are contained. Investigations will also be instigated to consider how private-sector finance can be introduced in some areas. That is central to our policy. Those studies will identify the circumstances in which capital and outside expertise can be supplied by the private sector.

Income-generation schemes will continue to be sought to provide more revenue to the trust. A selective freezing of vacancies will be operated in an effort to ensure that there is a proper use of manpower. Such matters as the billing for ECRs--extra-contractual referrals--for patients coming from other districts will also be considered, as it represents a way in which the financial management of the hospital can be improved.

A sensible and sensitive programme of cost containment is under way. It is not sensible for the hon. Lady to tell her constituents and the rest of the public that her local hospital is in crisis. That will not help anyone. The hon. Lady must realise that she has an excellent local hospital. She should encourage the staff and management who are continuing to manage and run an excellent hospital in difficult circumstances.

The problems at Leighton hospital are surmountable, but that will not be possible if we adopt the style of approach that the hon. Lady displayed this evening.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes past Ten o'clock.

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