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East London and the City Health Authority

1.29 pm

Mr. Nigel Spearing (Newham, South): This debate should not be necessary. Earlier this year, we debated the circumstances of East London and the City district health authority, partly because of the closure of Bart's and the 30 per cent. reduction in the number of beds planned for the three east London boroughs: Hackney, Tower Hamlets and Newham. They are three of the neediest boroughs in the country, but they do not lack in human spirit and initiative.

The base problem involves capitation. My hon. Friend the Member for Newham, North-East (Mr. Timms) wishes to catch your eye, Madam Deputy Speaker, and he may pursue that point further. The money allocated to the authority in order to purchase health facilities from the providers is tied to a national formula that is clearly inadequate. The situation has worsened in the past few years: we would have had £50 million more per year, but for an adjustment in the capitation formula that does not take account of the needs of people coming to the borough from other parts of the world, the age of the population and the health needs of the area. In the same period, I am told that Surrey received an increase of £30 million as a result of the same adjustment. That capitation formula must be altered again.

Recently, we have faced an even bigger, visible--if not financial--anomaly: the way in which psychiatric need is met. We all know about the scandalous difficulties in the mental health service. However, we forget that, when people go to court, are found incapable of pleading properly and are not sentenced, they pass from the responsibility of the Home Office to that of the health service. In my district, there are about 60 or 65 persons of that ilk or those who have been released from prison, upon whom the health service spends some £7 million. We believe that that funding should be provided centrally, as few health districts elsewhere carry that sort of load--I believe that it is only about half a dozen.

We aim at least to sustain health service delivery in the area. Despite claims in the Budget and the Prime Minister's comments in Prime Minister's questions yesterday, we cannot do so. On 2 December, I asked the Secretary of State for Health--who was boasting about increases in health service expenditure--about the situation in east London. He replied:

"The authority also has bids for other funds, which are currently being considered".--[Official Report, 2 December 1996; Vol. 286, c. 686.]

We need those funds because we must sustain existing services with an £18 million shortfall in delivery. The authority has announced cuts of £40 million. We need that additional £18 million--or as much as the Government can supply through the bids. I received a written reply yesterday about the bids for health authorities, which are described as undergoing structural or strategic change. My health authority is undergoing structural change in respect of possible closures, to which I shall refer in a moment.

When Bart's closed, we were told that we would have a new hospital at Homerton. A few weeks ago, the authority published the option of closing Homerton or Newham general hospital--two major hospitals in east London. It was forced to dismiss that option as unfeasible, but it must

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still find the equivalent savings. Newham is experiencing difficulties because it maintains a huge accident and emergency facility--although I understand that it costs less per head of population than many similar facilities elsewhere. A and E needs must be met by relocating facilities and resources from elsewhere in the hospital.

We are facing extensive cuts. The authority has told general practitioners that they must be more careful about hospital admissions--it employs bureaucratic terms such as "gatekeeping" or "readjustment of entry". GPs have been told that out-patients will not be seen until after April 1997 and that waiting times may increase to 18 months. There will be a reduction in provider contracts of 7,500 bed days, which means less provision to meet consistently growing needs.

There are 40 vacancies among the estimated 400 GP posts in the area. GPs are finding the load difficult to bear and thus are less enthusiastic about their perceived role. Why should they stay in east London, when the prevailing conditions do not allow them to do their jobs as professionals? As a result of the cuts, GPs are being asked to recommend fewer people for admission to hospital. They are then required to provide more at-home care when people are released from hospital, under a policy of "fewer in and quicker out". At the same time as they are providing increased care on the ground, they are told to expect redundancies among practice nursing staff and general domiciliary services. Local authority social services also have difficulty meeting existing need.

The need is so great that the local medical committee--a statutory body--took the unusual step of writing to the Secretary of State. It was not alone: it was joined by three voluntary borough forums of general practitioners, who work co-operatively together and play an essential part in the structure. Some 200 signed the letter that was sent to the Secretary of State on 5 November. As of yesterday, I understand that they have received no reply or acknowledgment of the letter. That is astonishing--it may be the result of delayering in the civil service; I do not know. It is all the more remarkable because, having received no reply, the group then sent a letter to The Times outlining the problems that they face, which was published on 10 December, but they still received no reply.

I do not know whether officers of the Department of Health read The Times or whether the Minister has been briefed about the matter--perhaps he will tell us today when he replies to the debate. In addition, BBC South-East broadcast a 30-minute television programme on 28 November highlighting the plight of the people of east London and the ineffective funding of their health services. I presume that the Department of Health knows about that.

Not only are the professionals in difficulty, but there is pressure on the voluntary organisations. In east London--like everywhere else--there is great concern for those who are ill, who need constant care and who may turn to hostels or to similar organisations to meet their needs. The Newham Care and Repair service, which allows people to be discharged from hospital and returned to their home sooner than might occur otherwise, is to be cut. The elderly derive particular benefit from the service, as their conditions often necessitate structural adjustments in the

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home and they may require daily care and visits. It is proposed to cut that service--although decisions are still up in the air in view of the £18 million shortfall.

The organisation Turning Point is located in the constituency of my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore)--he may mention it if he catches your eye, Madam Deputy Speaker. An imaginative scheme, Breaking Ground, deals with 15 mentally retarded people with severe health needs. They literally break ground and are recuperated through horticultural activities.

I have mentioned the problem of those who are found incapable of pleading in court. I highlight the terrible instance of a person who was discharged prematurely from Neasden hospital in Hertfordshire--which has its own problems--visited a club run by the borough and murdered one of my constituents. The Laudat Bennett case is well known, but has not been solved properly. I believe that the circumstances that led to the incident are still cause for concern, although increased funding has been provided for psychiatry in the borough.

We face all those difficulties in an area that demonstrably needs more than other areas. I do not think that the Secretary of State understands the effects of the capitation system and the way in which the market works. Each so-called profit centre naturally seeks to make its own economies without knowing the human knock-on effects. Its work is always predicated on contracts, which are sometimes not fulfilled for the future. The Royal London hospital has problems: it usually makes capital gains, but it cannot be sure of the plans.

The biggest problem of all is closures. It is clear from the documents that have been produced by East London and the City health authority that it is considering closing not Newham or Homerton hospital, but St. Andrew's hospital in Bromley-by-Bow. It is an old building--it is an old workhouse--which has 150 beds and serves mainly Newham. The staff are renowned in the area for their teamwork. They do a great job. The hospital provides ancillary services. By accountants' calculations, it could save so many million pounds if it were run down.

There are long-term plans for the replacement of the facilities at St. Andrew's by facilities at Newham general hospital, which has 40 fewer beds. Those plans depend on the private finance initiative, which is not coming along at all fast. The premature rundown of St. Andrew's in Bromley-by-Bow would be disastrous, and would put pressure on the other hospitals in the area. Beds would be removed and the services provided by the laboratories reduced. The corporate nature of the staff is important: they tend to be long-serving because of the type of surgery that they undertake. They work in difficult conditions, but they are greatly appreciated by the people of Newham.

I want to put several questions to the Minister. Did he receive the letter from GPs? Why did he not reply? Are the facts that it contains not correct? As far as I know, they are. Did he not see their letter in The Times? Did he not hear about the half-hour television broadcast that dealt with the problems in east London? How much of the Government's money, which is out for bidding--the complicated document has been placed in the Library--will be available for application by East London and the City health authority? I am told that some of the money that it hopes to obtain has already been included in its calculations: it has been taken into account, even allowing

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for the £18 million that the authority has to find. We must know the answer to that question before the coming financial year, in order to make proper plans.

It would be a scandal if people were given long-term notice--which they are now, particularly in the voluntary sector. There are fears throughout the health service staff. The Minister knows that one of the greatest assets of our great health service--or what was once a great health service--is the dedication of the staff. They are being asked to do more and more with less and less. Is that right? The Prime Minister says that the health service is getting more and more, but I do not believe it.

Dissembling has become a d-word in the House, although I would not go as far as to accuse the Government of dissembling in this instance. We need to know--through the loophole of finance--that we shall receive a good part of that £18 million to sustain our services. We are told that the health service is expanding, but how can it be when we have also been told to expect vicious cuts? That is debilitating, and is beginning to destroy a health service of which this country has been proud.

It is because of the initiative of general practitioners and others that we have managed to obtain a response from the people in the service. We await the Government's reply. They are responsible to the electors, who pay for the service that we are all proud of and wish to sustain.

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