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9.49 am
Mr. David Trimble (Upper Bann): I congratulate my hon. Friend the Member for East Antrim (Mr. Beggs) on securing this debate. It is unfortunate that the debate coincides with what will probably be the last plenary session of the inter-party talks in Northern Ireland before the pre-election recess; that explains why hon. Members from other Northern Ireland parties are not present. One of the advantages of having a somewhat larger party is that we have greater depth of resources and can afford to be in two places at one time.
We must bear in mind some general points about hospital provision. I hope that the Minister agrees that the Government have an obligation to deliver to the people of Northern Ireland the same quality of health care as is available elsewhere in the United Kingdom, and agrees that, because of our differing circumstances, to achieve that may require more expenditure in Northern Ireland than elsewhere.
I regret to say that Northern Ireland has, generally speaking, a much less healthy population than the average English region--that problem is not confined to Northern Ireland: there are regional differences elsewhere as well--and the difference will have to be reflected in the services provided.
Northern Ireland has a lower density of population, so one cannot say that it needs the same provision as a region in southern England with a population of 1.6 million. Our greater geographical area and sparser population impose additional burdens on services, and an apparently higher level of provision will be needed to obtain the same level of service. One will also have to take account of the nature
of the road network. Our roads vary in quality, and my hon. Friend the Member for East Antrim referred to some of the difficulties that his constituents encounter as a result.
Those general points will have to be borne in mind when we consider what appears to be the Department's fundamental strategy, which is to close comparatively small hospitals in order to concentrate on half a dozen acute hospitals to provide for the health needs of the whole of Northern Ireland. Does the Minister believe that that is the right strategy and that it takes account of the particular needs of the people of Northern Ireland--or is it driven by the needs and desires of administrators and consultants? That is a fundamental question.
We must also ask whether the policy of closingthe comparatively small hospitals is a good thing initself. When the right hon. Member for Wokingham(Mr. Redwood) was Secretary of State for Wales, he discovered that there were no significant financial savings in that policy and he reversed it in Wales. Those hospitals should be able to deliver a service. There is no reason why centres serving populations of 20,000 or so should not be able to sustain a certain level of provision.
The closures involve not only significant transitional costs but a significant loss in terms of recent investment. The Minister will know that my concern relates largely to the situation in Banbridge and the recent closure of its hospital. One of the disadvantages of that decision is that the investment in surgical wards a few years ago has largely been written off.
The way in which policy has been implemented in Northern Ireland recently seems to me to involve significant waste and to ignore the geographical realities, which do not always coincide with trust boundaries. Banbridge hospital was part of the Craigavon area hospital trust and a satellite to the main hospital.
The Minister has decided that Craigavon area hospital will have to provide for the need that would otherwise have been provided for at Banbridge, but that does not always take account of the geography. It is not all that easy or convenient to travel from Banbridge to Craigavon; the roads on that route are less convenient than the major dual carriageway that runs roughly north to south from Newry to Lisburn and Belfast.
Consequently, the closure at Banbridge does not assist the hospital trust and is likely to involve a transfer of resources out of the area. The nature of the road network also creates problems in the provision of an ambulance service. When the hospital is withdrawn from Banbridge there will obviously be a greater need for a better ambulance service. One need not labour the point that speed is crucial in terms of people's prospects, especially in the case of heart attacks, for example. The necessary speed of response is simply not provided in Banbridge, and especially the rural part.
We get assurances from the trust that ambulances are available and response times adequate, but we hear far too many stories from constituents who have had to wait a long time for ambulances. I am not satisfied that the reports from Ministers and administrators give us a correct and accurate picture of the situation. There is a general lack of confidence in the ambulance provision in the Banbridge area, and that needs to be addressed seriously.
The Minister will know of the alternatives proposed by Banbridge council, which has tried to be realistic. It would much prefer the hospital to be kept open, but it has been prepared seriously to consider other ways of delivering a good service, through developing what is referred to as a polyclinic or community hospital. That would build on the present out-patient services and try to provide as much of the service that people need as close to them as possible.
I am glad to see the Minister nodding in agreement, but unfortunately the only promise that I am aware of his having made so far is simply to continue the existing out-patient services. I hope that he will go much further than that.
Banbridge presented proposals for a polyclinic to the Department some time ago, but what response has been made and what action taken? No clear decision has emerged, and instead we shall have further delay as a result of the decision to explore the possibilities of the private finance initiative. I appreciate the fact that the Minister is working with financial problems, and that PFI is sometimes regarded as a way round those, but it means a further delay.
Bringing in PFI could delay provision by a further two years and that is not satisfactory. Many people regard its introduction with distaste because they see it as a roundabout way of transferring the advantages of the site, its development potential, and the profit that will come from it, to the private sector.
As for the strategy that is supposed to underlie the Department's approach in the maintaining of six acute hospitals, I fear that what is happening to health provision in my area will undermine the service. As I said earlier, it is unlikely that, following the closure of Banbridge hospital, all the patients will travel to Craigavon. Given the geography of the area, there is a strong possibility that many will go to Daisy Hill, Lagan Valley or even Belfast--for the prospects of Daisy Hill and Lagan Valley are not completely unclouded. Some resources will be transferred from Banbridge to other hospital trusts. Craigavon needs the finance that comes from Banbridge; it cannot cope with the present situation. I am worried that the future of Craigavon area hospital may be undermined.
As was said earlier, the primary concern now seems to be the convenience of consultants and administrators rather than the needs of patients. Moreover, there is an overall lack of finance. The present Minister may not be able to remedy that, but it is a serious problem. Despite what was said by the Chancellor of the Exchequer, there has not been an overall increase in resources for the health service in Northern Ireland, although substantial additional resources have been made available in England and Wales. Indeed, the Government's current expenditure plans show significant real increases for England and Wales as a whole, while Northern Ireland's total block grant for the current financial year shows a decrease of 0.5 per cent. in real terms. That is not a large figure, but it is a decrease in real terms. There are also problems relating to allocation within the block, and other problems arising from that.
Rev. Martin Smyth (Belfast, South):
I appreciate the opportunity to contribute to the debate on health issues. My hon. Friends have dealt, to a large extent, with individual examples--specific constituency issues--but they have also touched on principles. My hon. Friend the Member for Upper Bann (Mr. Trimble) referred to the PFI. I believe that some large firms in Northern Ireland would find the task that they have been asked to undertake too small for their own capacity, in terms of the time taken up by consultation and planning and the lack of any attempt to press ahead with major issues. I am thinking of firms such as Mivan in south Antrim. I wonder whether we have sufficiently thought out the issues involved in some of the schemes that are considered in Northern Ireland.
I echo the tribute paid by my hon. Friend the Member for East Antrim (Mr. Beggs) to the dedicated skill of those who provide our health service. We must bear it in mind that some of the problems that we are experiencing arise from the tremendous success of that service. For instance, people who had cardiac surgery 10 or 14 years ago are now returning for more, and the same applies to those who have had orthopaedic operations in the past. After years of useful, healthy life, those people now find that they need further surgery. I do not want to minimise the work that has been done, and I feel that the entrepreneurial and inventive skills involved should be recognised.
Having said that, I must add that, as the Minister will know from his own figures, informed observers are criticising the lack of spending on Northern Ireland's health care. The quality of the service was at its peak in 1992. The Minister can heave a sigh of relief: he was not responsible for such matters then, and cannot be held responsible for the whole downturn which has followed. Let me ask him, however, about the split in the spend in the top slicing. How much do the Department and the health management executive keep to cover overall demand? How much, for example, has been spent on independent consultants? How much time has been taken up? Who, in that sense, manages? There seem to be many different fingers in the pot.
Are we looking for a real remedy for the problems of hospital provision, or just a repair job to tide us over? There is a tendency to employ more consultancy and management staff, rather than introduce better technology. I have been interested in the issue of medical records for some years, and I believe that one of the difficulties in the past has been the fact that consultants have been blamed for not bringing patients in when, in fact, the medical records were at fault. Given that £1 million may have to be spent to provide a hospital building, or part of a building, to house medical records, would not a good computer be cheaper, take up less space and provide the answers much faster? I raise that point because it has been brought to my attention.
I understand that schedule 3 to the Health and Personal Social Services (Northern Ireland) Order 1991 reserves powers for the Department, which may determine whether it might be impractical to negotiate or contract for certain services. How often has it done that? Is it true, for example, that the Eastern health and social services board pays 23 per cent., compared with the average of 50 per cent. paid by health authorities in Great Britain? Is there a proper spread of finances?
The other night, I was thinking about a cause celebre--a missionary strategy in an African country years ago. Excellent nurses were sent out to that country, but within a year each returned broken. Finally, the council of the sending body decided to look at what was happening on the ground, and realised that there was a senior nurse there who should have been dispatched long since.
Are we dispatching the right people? The Ulster hospital has lost two chairmen and one chief executive. Is it a fact that in 1995 its trust board asked for permission to do consultancy work so that it could get to the heart of what was happening in the hospital and that that permission was given only in 1996, a year later? Why did it take so long if there was obviously a problem?
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