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Mr. MacShane: Will the hon. Gentleman endorse Labour's policy for a windfall tax to put a quarter of a million people back into work?
Mr. Hayes: Like so many other things, that does not work. The hon. Gentleman is talking about raiding pension funds, about raiding the consumer and about raising energy prices, which will affect the elderly, the frail and the vulnerable. That is what the hon. Gentleman wants to do, but it does not add up--like everything else that we have had from the embattled party on the Opposition Benches, which genuinely believes that it will win the next general election.
Dr. Joe Hendron (Belfast, West): Health has been defined by the World Health Organisation as a state of complete physical and mental well-being, not merely the absence of disease. The national health service was established in Northern Ireland in 1948, two years after it was established in Britain. Its purpose was to provide cradle-to-grave care for the entire community. That was nearly 50 years ago. Today there is a crisis in that great service, and there is a crisis in Northern Ireland.
I have listened carefully to the debate. Of course there are many good things with the national health service. Why would there not be? But that does not mean that there is not a crisis. I speak as a non-fundholding general practitioner who does very little GP work at this time. The main threat to health care provision is the across-the-board efficiency saving of 3 per cent. per annum which has been imposed by Government. It is, of course, Government policy to encourage people to take out private insurance.
In a recent article in the British Medical Journal, a group of senior medical consultants said that patients' lives were being placed at risk because of the pressure on trusts to make year-on-year efficiency savings of 3 per cent. The consultants said that cash cuts meant that patients were being sent home by hospitals much too soon after surgery. Indeed, in Northern Ireland there are many examples of patients being discharged with undue haste and with limited provision for follow-up care at home.
Although Northern Ireland receives 11 per cent. more per capita on health expenditure than the average for the United Kingdom, other statistics must be taken into consideration. Northern Ireland suffers 20 per cent. more heart deaths among men than the average in the United Kingdom. That indicates that for that component of the health service we would need an increase in resources of about 20 per cent. Northern Ireland's unemployment rate
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In addition to the increased number of heart deaths and the increased numbers in unemployment and poverty, it must be remembered that a quarter of a century of terrorist violence has brought with it increased health needs among our peoples, and that applies very much to both communities.
In recent weeks, the Prime Minister endowed the Secretary of State for Health--I hesitate to say this, as I have heard other hon. Members mention the figure of£300 million--with additional money for the healthservice. The Northern Ireland media gave the figure as£500 million. Perhaps that is inaccurate, but it is somewhere around that figure. I understand that not a penny piece of that will be directed to Northern Ireland. Indeed, it appears that it will go to England and Wales. If the first figure is correct, in terms of population it would mean £17.5 million for the health service in Northern Ireland.
In his statement of 12 February, the Health Minister for Northern Ireland, who was here earlier, said that cuts would not be implemented without reductions in service. I believe that that point was made by the hon. Member for Mid-Ulster (Rev. William McCrea). I congratulated the Minister at the time on his forthrightness in making that statement. I hope that he will guarantee that additional funding, in real terms, will be made available to deal with the implications of the Children Order. Will additional resources be made available to ensure that health boards can fulfil the commitment in terms of community care, which is required by the Government's legislation?
Has the Department of Health in Northern Ireland an accurate device to calculate the health needs and resources for health for the people of Northern Ireland in comparison to a base population, for example, that of England and Wales? How can the Minister be sure that resources that have been provided are adequate to meet the health needs of the population in Northern Ireland, bearing in mind the increased disease, poverty and unemployment? In its report published on 14 November, the Northern Ireland Audit Office recommended that any review of the capitation formula for funding should aim to ensure that the distribution of funds to purchase treatment matches the identified and prioritised needs of the purchasing authorities.
Why do we need more resources in Northern Ireland? It is the poorest region in the United Kingdom. I do not think that anyone would argue with that. In Northern Ireland, unemployment stands at 11.1 per cent.--39.8 per cent. higher than the United Kingdom average--and 38 per cent. of households live in poverty. Basic essentials cost more in Northern Ireland. For example, electricity prices are 3 per cent. higher. Although we spend 11 per cent. per capita more on the health service than the rest of the UK, our coronary heart disease level is 20 per cent. higher and unemployment is 40 per cent. higher. Long-term unemployment is linked with an increase in
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What do the health cuts mean to the people of Northern Ireland? They mean that home help services are being cut, a reduction in meals on wheels, a reduction in key staff in the community such as social workers, community psychiatric nurses and day centre staff. I pay tribute to the people involved in primary health care, having been involved in it myself for 35 years in west Belfast. The cuts mean waiting lists for funding for domiciliary care packages and residential care. The hon. Member for Mid-Ulster referred to that earlier.
The Royal Victoria hospital Belfast has announced that it will not carry out non-emergency surgery on patients from non-fundholding GPs. The Ulster hospital carries out cancer procedures on patients of non-fundholding GPs free of charge, and I give it full marks for that. The Western health board in Northern Ireland has cut coronary artery bypass operations by 10 per cent. and there has been a 20 per cent. reduction in joint replacements and in ear nose and throat operations. If that is not a crisis, I do not understand the meaning of the word. There have been massive cuts at the Mater Infirmorum Hospital Health and Social Services trust. And so it goes on. I am aware that other hon. Members wish to speak, so I shall move on quickly.
On 30 October 1996, the Royal Victoria hospital, which is known world wide for its excellence--it was the first hospital in the world to have a cardiac ambulance--announced that because of funding difficulties faced by the Eastern health board it would have to stop non-urgent work across a wide range of specialties. The patients of GP fundholders would be all right--it was the patients of non-fundholding GPs who would suffer. I find it difficult to understand when Conservative Members seem to scoff at the fact that the patients of non-fundholding doctors have to wait. I could go on for hours about that subject alone. It is a crisis, but Conservative Members do not understand that. We are talking about thousands of patients and about primary health care.
Some people may try to blame non-fundholders and say that they should become fundholders, but I do not accept that argument. However, at present non-fundholding doctors have no choice but to apply to become fundholders. They must then wait nine months to a year to prove their accountancy abilities--although they were trained as doctors--before they are accepted.
The Government appear to have ring-fenced resources for the patients of fundholding GPs but have not done so for patients of non-fundholding doctors through the Eastern board. The Royal group of hospitals is the largest trust in Northern Ireland and has proportionately the lowest management costs in the Province. I opposed the introduction of trusts from the beginning, but I admit that in management terms the Royal group of hospitals seems to have performed its work fairly well in comparison with other establishments.
I appreciate that the Minister is currently considering an option appraisal for the Royal Maternity hospital, but I remind him that the hospital's neonatal unit serves thewhole of Northern Ireland. It is a place of excellence
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Hip joint replacement surgery will be cut dramatically from the record-breaking total of more than 2,000 joint replacements last year. Activity will probably be reduced by 50 per cent., which will mean an increase in waiting lists--waiting time is currently less than nine months--month after month. By the end of the financial year, patients may be waiting more than two years for joint replacement surgery. Further cuts will mean the dismantling of what has become the world's leading centre for joint replacement surgery.
The Minister is conducting a cost appraisal of the cancer services at Belvoir Park hospital, and it is important that the Green Park trust is represented on the team that carries out that appraisal. Industrial action has been taken at the Downe hospital in Downpatrick and at other hospitals throughout the north of Ireland. I should point out that the private organisation Compass is able to change the contracts of support workers involved in strike action: non-negotiated contract changes are totally unacceptable.
The Ulster, North Down and Ards hospital trust has also been severely affected by the cuts. Daisy Hill hospital in Newry--in the territory of my hon. Friend the Member for Newry and Armagh (Mr. Mallon)--serves all of South Down and Armagh, which is a remote rural area. The local population is implacably opposed to plans to centralise services at Craigavon area hospital. No direct public transport serves the hospital, so access is a major problem.
On what basis are decisions made to reduce the number of hospitals or to cut trust and hospital services? Are the reasons clinical, financial or professional? I should like to understand the basis of the decision making. Community trusts are also badly affected. The Eastern board has informed the North and West Belfast trust in my territory that "a phased programme of realignment"--what a lovely expression--is to be implemented. What does that mean? The board has simply used fancy words to say that services for the elderly will be greatly curtailed. The Down Lisburn trust has similar problems.
Community district nurses, community psychiatric nurses, social workers, health visitors and midwives are overworked and underpaid. They provide a magnificent service, but they are not appreciated by Government. Some such people are my patients and I have worked with others for years. They have told me their problems and I take no pleasure in recounting them today.
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