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10.15 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am pleased to have the opportunity to respond to my hon. Friend the Member for Uxbridge (Sir M. Shersby). I congratulate him on securing a debate on the important topic of care for the elderly in Hillingdon and on the part that he has played in explaining some of the issues more sensibly than would otherwise have been the case. I know that he speaks on behalf of several colleagues, including my hon. Friend the Member for Harrow, West (Mr. Hughes).

He is also to be congratulated on securing a debate on health care 50 years to the day after Royal Assent to the Act that established the national health service. We shall see in considering health care in Hillingdon that the founding principles of the NHS are very much alive and well there as they are throughout the country.

It is a pity that the letter written by the chief executive of Hillingdon hospital has been taken out of context and used to generate unnecessary concern about hospital care for local elderly residents. I will put the letter into its proper context later, but first I want to make it absolutely clear--this is the most important point for my hon. Friend's constituents--that there was no question at any time of any Hillingdon resident of whatever age not getting from the NHS the care and treatment demanded by that resident's clinical condition. The health authority and local hospital trusts acted promptly to reassure local people of that.

Hillingdon hospital made it clear that it would under no circumstances decline to treat any patient, elderly or otherwise, and that no patient requiring emergency treatment would be turned away from accident and emergency untreated. Those reassurances have been fulfilled. In the four weeks since the chief executive's letter, no patient has been disadvantaged, and everyone who has needed a bed at Hillingdon has got one.

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Before discussing the Hillingdon situation in more detail, I should like to reassure the House on the treatment of elderly people generally. It is not and never has been Government policy for NHS treatment to be withheld from anyone on the ground of age. We have always made it clear that, whatever the age of a patient, there are no exceptions to the fundamental principle that the NHS is there to provide services for everybody on the basis of clinical need.

Let me turn to the recent circumstances at Hillingdon. The letter from the chief executive was not a panic measure in the face of a crisis but one part of a complex issue that local health and social services agencies had been working on constructively for some time. As my hon. Friend knows, two excellent hospitals serve Hillingdon residents: Mount Vernon hospital to the north, and Hillingdon hospital to the south. They are run by Mount Vernon and Watford Hospitals NHS trust, and Hillingdon Hospital NHS trust respectively.

Both are extremely good hospitals with good reputations and devoted and caring staff. More particularly, both hospitals provide comprehensive and excellent services for elderly people. The record speaks for itself. Hillingdon hospital provided 34,800 ordinary and day case treatments in 1995-96, and Mount Vernon provided 61,295 treatments--in both cases, some 4 per cent. more than in the previous year. That is a considerable tribute to the doctors, nurses and other staff at both hospitals. Both trusts have been in discussion with Hillingdon health authority about how services can best be provided to meet the needs of residents.

Back in the spring, Hillingdon hospital became concerned about the pressure on beds at the hospital. It already had an acclaimed bed management system which enabled it to use the 630 beds that it has as efficiently as possible. The reasons for the pressure appeared to be twofold. First, the hospital was seeing an increasing number of patients, particularly elderly patients, requiring hospital admission. Secondly, elderly patients were staying in hospital for longer.

The hospital explained its concerns to the health authority and the social services department and in June a working party was set up to examine the issues. Immediate action was also taken, including the provision of additional social work posts in the hospital to ensure prompt assessments of patients' continuing care needs and to assist in the hospital discharge process. Since then, hospital discharge has been kept under close review, and early last month the social services department made additional facilities available to take elderly patients discharged from hospital by re-opening 10 places in a refurbished residential care home, and by the approval of seven extra nursing home places.

It is clearly in everyone's interest to ensure that GPs refer patients to the most appropriate local hospital. It appeared, however, as my hon. Friend says, that in a few situations GPs in the vicinity of Mount Vernon hospital were referring elderly patients to Hillingdon hospital although Mount Vernon was the closest local hospital and could provide the service required.

This was the background to the Hillingdon hospital chief executive's letter to GPs of 3 October. It did not seek to deny treatment to anyone; rather it sought to

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ensure that patients were treated in the most suitable NHS hospital, and the one most conveniently situated for the patients themselves. The intention behind the letter was to ensure that NHS resources were used to best effect, for the benefit of all patients, whether young or old and wherever they lived in the Hillingdon borough.

When it became clear that the letter had generated anxiety, albeit misplaced, among the elderly of Hillingdon, the hospital promptly explained that under no circumstances did this mean that patients would be turned away. Mount Vernon and Watford Hospital NHS trust also acted to reassure residents, pointing out that, since the merger of Mount Vernon and Watford General hospitals under single trust management, the trust now guarantees admission for the elderly patients of local GPs and has some 90 beds for the elderly across the two sites.

I have already mentioned the working party set up in June to examine the pressures on Hillingdon hospital and to develop an action plan to address these concerns. The working party consisted of representatives from the two hospital trusts, Hillingdon health authority, social services, and Age Concern. The group was tasked with producing an action plan for the health authority meeting of 31 October. I stress that local co-operation between local agencies--health agencies, social services and the voluntary organisations--is essential. I am pleased to say that the group's action plan was duly prepared and endorsed at the health authority meeting last Thursday.

The action plan provides immediately 30 additional places in the community, including six in the independently run Hayes cottage hospital. Those 30 places include the 17 that I mentioned earlier. It also provides six new medical beds at Mount Vernon hospital to provide enhanced services to GPs' patients in the north of the borough. These steps should relieve the pressure on Hillingdon hospital now and into the future.

The health authority has also agreed in principle to provide further investment next year to support hospital discharge procedures at Hillingdon hospital, and to look at innovative approaches to patient care as an alternative to hospital admissions. All parties will be looking to improve working practices to ensure the timely discharge of patients from both trusts.

I should of course also point out that this action is complementary to the plans that Hillingdon and all other health authorities have prepared with trusts during the summer to ensure that the service is best placed to respond to any surges in emergency demand in the coming winter.

My hon. Friend also made the point that the problems in Hillingdon were not due to a lack of funds. That is true. I can tell him that the total personal social services resources available to Hillingdon stand at almost £35 million a year, 8.5 per cent. more in cash terms than last year and more than double the resources available six years ago.

Hillingdon health authority has more resources than ever before. Its revenue allocation for this year is £106.4 million, £3.3 million more in cash terms and more than £500,000 more in real terms than it was the previous year. I therefore agree with my hon. Friend that it is not a problem of lack of resources locally.

My hon. Friend also spoke about Abbeyfield homes. That serious issue needs to be investigated, and I undertake to reflect upon it and correspond with him about it.

As my hon. Friend was pleased to note, Hillingdon hospital is now reporting that although it is busy, the pressure on beds has eased, and it is managing its work

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load satisfactorily. My hon. Friend will also be pleased to note, as I am, that the founding principle of the national health service to provide health care to all, on the basis of need, regardless of ability to pay, is alive and well in Hillingdon, as it is throughout the country on this day, the 50th anniversary of the Act that established the NHS.

Question put and agreed to.

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