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7.54 pm
Rev. Martin Smyth (Belfast, South): It is a pleasure to follow the hon. Member for Carshalton and Wallington (Mr. Forman), who gave us some cautionary warnings. I was interested in his reference to the Tomlinson report, for it reminded us in this computer age of the expression, gigo--garbage in, garbage out. Tomlinson admitted later that not all the figures had been given to him correctly. When we deal with statistics, it is important that we get them right or we can come up with the wrong conclusion. I also share the hon. Gentleman's view about a positive approach to the health service.
I took part in the debate on the 40th anniversary of the health service. On that occasion, I sensed some depression and commented that the only encouraging thing was, as the old saying goes, life begins at 40. Nine years on, we are still going on and there have been tremendous changes for the good in the health service.
Some of us remember bed blocking--beds were not occupied because the surgeon in charge did not want anyone else to use them so that he could put his patients in them in due course. Other things went on. We pay tribute to the improvements.
One of the great problems is that of growing expectations, whether of those who want to terminate life, those who want children through infertility treatment, or those who, at 80-odd years of age, want a hip replacement. Other people aged 40, who are having their hip replacements delayed because they are assessed as being too young for the operation, are no longer economically viable.
Often, however, the key is finance. I am sorry for those who were beginning to practise in the health service at the time, as the Government and practitioners did not listen to the advice of Enoch Powell--then my colleague, the right hon. Member for South Down--when he reminded them that he who paid the piper called the tune. Sooner or later, people discovered that, if the money was not forthcoming, there were difficulties. In the light of the motion and the statement by the shadow Chancellor of the Exchequer that there is to be no more spending or direct taxation, where will the money to meet the demands of our people's growing expectations come from?
The health boards in Northern Ireland and the health authorities in England and Wales depend largely on allocations from the Department of Health and, ultimately, on the Treasury, for the moneys to be expended. I would have liked to have been able to say that the recent injection of cash to make up deficiencies in capital expenditure and running expenditure allocated to England and Wales included money for Northern Ireland, but it did not.
The pressure is on to reduce expenditure in the health service. Some years ago, expenditure in Northern Ireland was 25 per cent. per capita above that in England and Wales. Now, we are behind both Scotland and Wales. Recently, the gap between us and England has narrowed to 11 per cent. No consideration is given to the different health needs of a people with a different spread of population. We do not have the large conurbations that make it easier to provide certain specialist services.
The Government pledged a year on year increase in Great Britain, but in Northern Ireland we have a year on year decrease of 3 per cent. Thankfully, we managed to convince the Minister that, as we have been squeezed for a long time, 3 per cent. up-front cuts would not be workable this year, and the figure was reduced to 1.5 per cent. However, the cuts remain a factor.
The people of Northern Ireland are not entirely happy with certain strictures that Ministers have been making. There is a parallel with those who are quick to criticise doctors who refuse to treat patients because they smoke or engage in behaviour that causes or aggravates their illness. The doctors say that they will not waste their time and money if the behaviour continues. This year, Ministers have lectured us to the effect that, because of the resurgence of terrorism, there will be cuts in funding for the health service. The Government are apparently prepared to punish the people of Northern Ireland because of the failure of successive Governments to deal with terrorism and with republican activists who seek to destroy the Province.
We must be realistic. Particular problems arise. The division between boards and trusts, purchasers and providers, has been helpful in some ways, but in others it has added problems. The boards pay for emergencies and the GP fundholders purchase elective surgery. The bodies are served by humans and, as with humans everywhere, there are differences of attitude. Some seek to balance the
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Some boards and some GP fundholders have been watching carefully how they purchase and how they provide services through the trusts, but some fundholders might spend up front because they rely on the boards to deal with the emergency purchasing and because they have the clout to jump queues for those in their practices who require emergency provision.
Dr. Joe Hendron (Belfast, West):
Does the hon. Gentleman accept that in Belfast and many parts of Northern Ireland the boards ring-fence the costs for fundholders' patients but not for non-fundholders' patients? That is particularly true in Belfast, and many patients suffer as a direct result, but it is not the general practitioners' fault. One could argue that it was the boards' fault, but in reality it is the Government's fault.
Rev. Martin Smyth:
I take the hon. Gentleman's point. He will also be aware that some practices--including, I suspect, the one with which he has been associated--have sought to join multi-funds and have been held back by the argument that training would not be available. Some are excellent practices with a high reputation for patient care and service provision.
I suspect that this year, as last year, the boards, which have been holding back funds--I am thinking particularly of the Eastern health and social services board--will suddenly discover that they have a fair amount to spend before the end of March and operations will be performed on Saturdays and Sundays while they try to clear the backlog. In the meantime, unnecessary suffering and distress are caused by the lack of a proper flow through the season.
Last week, the Belfast Telegraph carried the headline, "Cancer Unit in Crisis". It has been said this evening that perhaps local newspapers carry such headlines more than national newspapers. However, the headline refers to the major cancer service in Northern Ireland. For some time it has wanted another simulator to locate tumours and plan treatments, as the existing machine has broken down.
The problem is not that the staff are not doing their work properly. I know that personally, and the newspaper article quoted a staff member as saying:
The pressure is on, and I wonder why there are delays. Is it because discussion is taking place about where the centre of excellence should be? In the meantime, cancer patients who should be treated as soon as possible--doctors keep telling us that more can be done if treatment is given earlier--are left waiting. Why do we have that problem throughout the country?
I agreed with the arguments made by the hon. Member for Birmingham, Edgbaston (Dame J. Knight) about the pricing of surgery. It is easier now to target and to price. I wonder how right hon. and hon. Members would react if, in a national health service hospital trust, a cardiac surgeon said, "You need an operation; we could do it; but the board has not enough money to purchase it."
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Mark, who as a layman is a little more stark in his approach, said that she had
It all depends on the position of the person who is doing the reporting.
"suffered many things of many physicians and had spent all that she had, and was nothing bettered, but rather grew worse".
"'We are working really hard--I was in yesterday from 7 am and wasn't leaving until after 11 pm.'"
I know of other parts of the health service where people working under pressure have not even taken their statutory holidays, never mind days off in lieu for working extra hours.
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