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10.35 am
Mr. Jim Dowd (Lewisham, West): The Minister seems surprised that I have anything to say. I appreciate that his engagements in Northern Ireland may mean that he is not au fait with how the extended Adjournment debates on a Wednesday morning work. I guarantee to leave him the bulk of the remaining time in which to reply.
First, I congratulate the hon. Member for East Antrim (Mr. Beggs) on arranging the debate, which is timely and important given the severe difficulties that many hospitals throughout Northern Ireland have faced recently, and continue to face. It is worth recalling that the hon. Member for Upper Bann (Mr. Trimble) has reminded us that other engagements mean that other hon. Members who represent Northern Ireland are unable to attend the debate. Hospital provision concerns every hon. Member from Northern Ireland, from every part of the political spectrum, largely because it is of such deep concern to their constituents.
The problems were presaged by the cuts in the health budget last year. The Royal Victoria, Ulster and Mater hospitals, and those in the Causeway and Green Park trusts, have been the most seriously affected--6,000 operations and 55,000 out-patient appointments have been cancelled since the summer.
The problems became so serious that the Royal Group in particular made arrangements to cut a further 1,700 operations and to offer that capacity to fundholding general practitioners. Because of that, the Department of Health and Social Services managed by some mysterious process, which I suspect may involve the 1997-98 budget, to find an additional £3.3 million for the Royal Victoria and Ulster hospitals. As the hon. Member for East Antrim said, the final figure is likely to be £5.2 million. The final irony is that it may not be possible to spend that money in the remaining few weeks of the current financial year.
The difficulties have their origins in a combination of the NHS reforms that have been pursued by the Government and this year's cut of about 3 per cent. in the
health budget. Even if the House takes the most generous view of the Minister's assertion that that contains a1.5 per cent. efficiency saving, we are still left with the reality of a 1.5 per cent. service reduction in Northern Ireland. Northern Ireland has experienced cuts of at least that scale.
In fairness, the Minister has never attempted to hide the facts. As the June edition of the Nursing Standard quoted him:
The cuts are obvious to all involved in the delivery of health care in Northern Ireland. A recent report from the British Medical Association spelt out the difficulties, and noted that the Northern Ireland Consultants and Specialists Committee had stated:
The most corrosive of the Tory reforms has been the wholly artificial internal market, which has set hospital against hospital and doctor against doctor, replaced co-operation with competition and fragmented decision making, making strategic planning much more difficult. It has distorted the relationship with patients, as the primacy of contracting clashes with the best interests of the patient, and produced a system where price too often takes precedence over quality. It has generated an explosion of unnecessary bureaucracy, with individual contracts and the pricing of individual items of surgical procedure producing an avalanche of paper throughout the system. Most damaging of all, it has led to the substantial inequity that is undermining the cardinal NHS principle of equality of access.
Experience throughout the United Kingdom, and Northern Ireland specifically, has brought to light innumerable cases where the likelihood of receiving acute or secondary treatment has become dependent on the management arrangements of the patient's general practitioner rather than medical priority. The chief executive of the Royal Group of Hospitals and Dental
Hospitals health and social services trust, Mr. William McKee, when announcing the reductions in the Royal in the summer, said as much. He was quoted in the Belfast Telegraph as saying:
The development of the internal market has not only distorted priorities, but wasted a great deal of money that should go to front-line patient care. We are well aware that the last thing that is needed is the destructive, dogmatic process that has been the Government's hallmark. We are keen to engineer change--health service professionals want changes--but we are fully conscious that the only way to construct enduring and beneficial advance is step by step, taking people with us as partners in the process to achieve our objectives.
Nowhere will that be better demonstrated than in our plans for locality commissioning. We intend the strategic planning of the health boards and the provider responsibilities of acute units to remain, but the decisions about what treatment to organise on behalf of patients should be drawn together in local GP commissioning groups. In the light of such changes, the role of health boards will be changed and they will be able to reassert their traditional strategic role.
I was very interested in what the hon. Member for East Londonderry said because he alluded to some of the key strategic issues concerning the changing nature of the delivery of health care and the need to take some fairly hard decisions. When I first served on the health authority just the other side of the River Thames--in Lambeth, Southwark and Lewisham--in 1976, we had 14 hospitals; today we have four. It has not been easy to achieve, but it has involved--more than anything--taking people with us rather than simply telling them what is good for them. To some extent, that element has been missing from the management of the health service in Northern Ireland.
The hon. Member for Belfast, South (Rev. Martin Smyth) mentioned the problems relating to the Royal Group of Hospitals and Dental Hospitals health and social
services trust, the Belfast City Hospital health and social services trust and other trusts. At present, formation of trusts throughout the health service is entirely spontaneous, and without strategy. At no time have services been considered, not institutions; what patients receive, not bricks and mortar. Even the recent merger of the Ulster Hospital trust and the North Down and Ards Community health and social services trust was driven solidly by the financial position of the Ulster hospital, not by any view about what care packages patients need.
"'As a Minister I have to come clean and tell you that efficiency savings are just not possible . . . Therefore I acknowledge that there will be cuts in services and I don't like it any more than you do.' Mr. Moss, addressing the first conference of the RCN management association in Northern Ireland, added:'As a Minister I can't stand over cuts like that for too long.' However, he insisted he would not resign over the matter."
That is precisely what happened--cuts were made but no resignation was forthcoming.
"Efficiency savings are cuts by another name and this constant haemorrhaging of funds has seriously weakened health care in the Province. We were disturbed to learn that some hospitals are having to restrict operations for non-urgent cases and that in others there is little money available to buy new equipment in order to meet efficiency targets.
The story is there to be read in the waiting list figures, which the hon. Member for East Londonderry (Mr. Ross) highlighted. Waiting lists overall grew 2 per cent. in England in the 12 months up to September 1996; the comparable figure in Northern Ireland was 13. During the same period, the number of people waiting more than12 months fell by 40 per cent. in England but increased by 75 per cent. in Northern Ireland. Those are not figures, but people waiting for treatment and care, and they are still waiting today.
We intend to take our findings to the Minister and the Chief Medical Officer in the hope that the current round will not be so harsh that it impedes good clinical practice. Clearly, the hospitals in the Province cannot sustain another round of imposed efficiency cuts."
"We can only provide services where the Health Board or fundholding GP is providing finance. This means that where a person lives and whether or not the GP is a fundholder"
will
"determine who we . . . treat."
The chief executive of the Eastern health and social services board, Dr. Kilbane, had to write to all the acute trusts in the area last autumn, following a conference of GP Forum, which represents fundholders and non-fundholders. He wrote:
"A very strong view was expressed at the meeting that General Practitioners were increasingly concerned at the use of criteria other than clinical need for choosing the order in which patients in the Board's area are treated. The Forum asked that the Board should draw to Trust Chief Executives attention and that they in turn should convey this view to clinical staff, that clinical need"
alone
"should be the criterion which governs the order in which patients are treated and the treatments they receive.
There we have it; a patently two-tier system--evidence of which is now incontrovertible--and the latest revelations from the Royal Victoria hospital, mentioned by the hon. Member for East Antrim, merely provide further proof.
I would be obliged if you would draw this strongly held view to the attention of appropriate . . . staff".
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