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Lord Annan: My Lords, the noble Viscount has spoken so generously that I very much hope that the House will give me leave to withdraw my amendment.

Amendment, by leave, withdrawn.

On Question, Motion agreed to.

South Birmingham: Hospital Services

7.51 p.m.

Lord Howell rose to ask Her Majesty's Government what action they propose to take to ensure that South Birmingham Health Authority provides adequate hospital services for patients.

The noble Lord said: My Lords, first, my noble friend Lady Fisher has had to go home. She has not been well recently and has had to withdraw from this debate which I am sure your Lordships will understand. Secondly, I believe I am right in saying that according to

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information which has reached me rather late the Minister spent a considerable amount of time in Birmingham yesterday visiting the hospitals and no doubt acquainting herself with what she believed I might say and getting the answers. Perhaps I may say how much I welcome that. It is very good--especially in the context of these hospitals--that Ministers themselves are trying to investigate and come to grips with the story as I shall unfold it. Although I am critical I want the noble Baroness to know that her visit was appreciated.

I have initiated the debate because it is no longer possible to tolerate the disastrous state of affairs governing the management of the South Birmingham hospitals. There has been financial and administrative chaos in this hospital group for many years past. Vast sums of money have been abused. At least an extra £6 million was provided to bail them out of their financial predicament, following which specific assurances were made to the Public Accounts Committee which have not been met. Now redundancies and closures are taking place on a grand scale. The essential point of this debate; namely, the health service of the good people of Birmingham is being sacrificed on the altar of financial book-keeping to which this hospital group management now gives top priority over patient care.

These are strong words, but I intend to prove every one of them. There is a long history of this matter, but I do not need to detain the House over much about it. It became so notorious that the Public Accounts Select Committee of the other place held hearings about it and issued two of the most damning reports I have ever read in 40 years' membership of Parliament. They ought to produce resignations or sackings, but no such events occurred; nor did the appropriate Ministers of the day--they are not the present Ministers--think it right to accept any responsibility.

Perhaps I may comment that every penny of public money is a Treasury and ministerial responsibility. It matters not whether it is spent by a quango or a health authority. If there is abuse, or worse, it is the ultimate responsibility of the department and the Minister. No such responsibility has been accepted in the affairs of the South Birmingham Health Authority.

In its first report issued in October last year, the Public Accounts Committee says that serious shortcomings in the management control and accountability of the regionally managed services led to a waste of at least £10 million, this at the expense of health care for sick people in the West Midlands. The PAC says that it was astonished that the privatisation of the supplies branch proceeded without the knowledge of the regional health authority. There were serious failings at all levels of management and a serious failure by members of the RHA and its then chairman.

A second hearing of the PAC took place and it reported as recently as July of this year. In the interim the RHA had provided an additional £6 million of funds to meet redundancy costs and to balance the books. The questions and answers at this second hearing on 16th February this year are the starting point for my anxieties.

My colleague, Mr. Terry Davis, Member of Parliament, took the lead. Again and again he asked for assurances that after the £6 million payment and the

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previous report, the financial affairs of the South Birmingham Health Authority were now in order and that it now had enough money to balance the books and to provide treatment for all who need it. He asked: is it a question of overspending or underfunding? Sir Duncan Nichol told the committee that he thought so but that he relied on the judgment of the region. Yet he was the chief executive of the National Health Service.

The same question was then directed by Mr. Davis to the chairman of the West Midland Region, Mr. Brian Baker. That revealed that an extra £11.2 million was given to the South Birmingham authority in 1992 to clear up its accumulative debt. Sir Duncan Nichol believed that the authority had now been allocated enough money year by year to meet its obligations and to ensure that there was no underfunding; so did the regional chairman.

I must now ask the House to consider the present chaos, which I shall describe, in the affairs of this group of hospitals in the light of those specific assurances. There has been a most serious and continuing deterioration of services; a serious collapse of morale affecting consultants and nursing staff; and a continual worsening of services for patients who have the right under the law--the National Health Service Act--to receive full and immediate treatment for their illnesses.

I spell out some of the factors: a daily fight to get very sick patients into an inadequate number of beds; routine cancellation of operations for seriously ill patients; no ophthalmology service now available for this large area of Birmingham; a pioneering gastro-intestinal unit has disappeared; the world-renowned burns unit is under threat. The consultants there wrote directly to the Secretary of State in September. I ask the Minister whether any action has followed their approaches to the Minister. Varicose veins patients are now shipped to Manchester for treatment which could be provided much more cheaply in Birmingham. One hundred waiting heart patients were contracted to receive treatment at the infamous Clydebank hotel, or Clydebank hospital, which has now collapsed. It is now hoped to send them to King's College Hospital in London. I shall return to that matter shortly.

There is at present a total ban on non-emergency admissions. The intensive care unit had to refuse 60 emergency patients during the year because there were no beds. The breast cancer unit was left without a consultant surgeon when he left saying:

    "it is not possible to provide a top quality service under the financial restrictions".

Fracture clinics are cancelled due to the shortage of junior doctors. The consultant urologist says,

    "he is ashamed of the service he can offer after having his bed complement reduced from 52 to 22".

In that department 1,000 patients have been waiting for up to two years for treatment. That is a most serious matter and one can imagine their discomfort.

In its policy document Looking Forward the RHA proposes to axe 1,100 beds and replace them with community care. That is in just one group of hospitals. Not only is there no money for such a programme, but

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the community care programme is now being asked to transfer money back to acute services to keep those acute services alive. The same policy document forecasts a reduction of between 332 and 482 beds --that is 43 per cent. of all beds--by 1997-98. In fact, the programme has been accelerated to such an extent that a 375-bed loss has already been achieved in 1994--not 1997. Staff cuts of the magnitude of 1,200 have been ordered by the region. In fact, 300 went last year, 775 this year and another 400 will go next year when the general hospital loses its acute unit.

It is my contention that the care and treatment of patients is the National Health Service's supreme duty. All financial management and book balancing are merely mechanical factors to enable patients to be treated. That is the purpose of the National Health Service, but that is not the position in that group of hospitals. The very opposite is the case.

On 11th April this year, Mr. Bryan Baker, the chairman of the West Midlands Executive, wrote to Mr. Brian Stoten, the chairman of the South Birmingham Authority and demanded a robust action plan to achieve real savings. He promised £6 million for redundancy costs and another £10 million for price support. He confirmed in his letter the 1,200 staff reductions in the acute unit and the additional 400 to be added from the general hospital. He concluded by expressing his concern that the:

    "Corporate information care plan and the quarterly monitoring information have been rendered largely meaningless".

That is a disgraceful letter. It contains not one word of concern about the effect of all that on patient care and the services provided for the sick, which is the prime responsibility of those gentlemen and that authority.

The authority is now taking refuge for its policy of mass destruction in the hearings held before the Public Accounts Committee, which is why I went into detail about them earlier. In a letter to the British Medical Association dated 12th May 1994, Mr. Michael Waterland, the chief executive of the acute services unit, says that the focus of the PAC hearings was on its fiscal duty. So it was, but equally compelling were the assurances that were sought and given that funds are adequate to meet patient needs, as I have already shown.

In his letter to the BMA, Mr. Waterland says that, irrespective of quality, his hospital group has three priorities. I shall quote what he stated in his letter. He said that priority No. 1 was "income and expenditure balance"; that priority No. 2 was "income and expenditure balance"; and that priority No. 3 was "income and expenditure balance". When he made the same point to the Community Health Care Council, I understand that he added:

    "patient care is a secondary consideration".

That is quite intolerable, quite contrary to the purpose of the health service and, I believe, quite contrary to the purpose of the Government. So it is, and that is the gravamen of my charge. Patient care and attention, the first duty of the health service, has been sacrificed in those hospitals on the altar of financial expediency.

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Finally, I turn to the effect of all that on waiting lists and staff morale. The waiting list deterioration is quite deplorable and totally in contrast to the Government's wishes and claims about improvements. In March 1993, 218 patients had been waiting over one year. By March this year, that number had increased to 1,037. In September 1993, 20 urology patients had been waiting for more than one year. By June this year, that figure had increased to 227. In general surgery, no patients had been waiting more than a year in September 1993, but by June this year 235 patients were waiting. In ENT, the number of patients waiting for treatment for more than a year rose from 36 in September 1993 to 135 in June 1994.

I could give many examples of the suffering that that is causing very sick people. I shall content myself with just one case. Mr. Anthony Damms lives at 111 Eastfield Road, Bordesley Green. In June 1993 he suffered a heart attack and was treated at the Heartlands Hospital, from where he was referred to the Queen Elizabeth Hospital in December last year. He was told he needed bypass surgery and that that would take place in six to eight weeks' time. In April this year he was told he must wait until July or August. In August he was told it may be another 12 months. However, on 21st November--a month ago--he received a call to report for tests on 25th November with a view to being operated on on 2nd December--last week. Told to check the position on the day before--1st December--he did so only to be told not to come in as there were no beds available.

Out of the blue last Saturday morning, two days after he should have been admitted, Mr. Damms received a letter, not from the Queen Elizabeth Hospital but from the consultant he had seen 18 months ago at the Heartlands Hospital, telling him that he may still have a considerable wait and asking him whether he would consider treatment in London. His wife tells me that he also suffers very badly from arthritis and cannot walk across the road, much less travel to London

No citizen should receive such treatment. At this point I was going to ask the noble Baroness to look into the case, but such is the expedition that occurs when Members of Parliament raise matters in the House that I am glad to report that the television companies interviewing me today have informed me that Mr. Damms has now been told that he will have his operation on 29th December. Perhaps I may say how very pleased I am for Mr. Damms that we have achieved such a remarkable success, but I am bound to ask: What about the other 99 patients who have been waiting a long time and need an operation? Is somebody going to do something about them? However, we must be thankful for small mercies and on behalf of Mr. Damms and his family, I must express my appreciation.

I turn now to staff morale. It could hardly be worse. The number of consultants who have resigned is frightening. They include four consultants in haematology; one vascular surgeon; one general surgeon; and one microbiologist. Seven other consultants have taken early retirement.

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In September and November last year one of the ward sisters felt it to be her duty to draw the serious situation to the attention of the directorate. Among other matters in her letter which I have seen she referred to the fact that her ward had been left with only two nurses on duty, no provision for meals or help for the manual handling of patients. Agency nurses were of poor quality. There were often no domestic services and no team cleaning. In September she wrote:

    "In short, the ward is filthy. Nurses already stretched to the limit are having to clean toilets and baths. I have written to the hotel services manager to no avail. My ward has an excellent reputation. I have never known morale so low, my keen conscientious staff are looking elsewhere for other jobs where they will be valued".

Then in November the sister wrote again. She said that she had no alternative but to close the ward as patients' lives were at risk and the few remaining staff could not be expected to manage under those pressures. That shows an alarming situation which merits the most intensive investigation. Like all the facts that I have quoted, they speak for themselves. No embellishments are necessary.

Mr. Brian Edwards, the chief executive of the West Midlands NHS Executive, has kindly sent me during the past few days a copy of a letter he has written to the South Birmingham Acute Unit. I have no doubt that he has also sent a copy to the Minister in anticipation of the debate. It was obviously an attempt to anticipate what I was going to say. It expresses confidence that waiting list targets can be met and that performances will be improved. One can only hope so, but those generalised comments ignore totally the vast cuts in staff and beds that have taken place, and the vast increase in demands for admissions.

My belief is that the only way to restore confidence is to have an independent outside inquiry into the affairs of the hospital. That is not into the financial mismanagement--the PAC has done that--but into the level of patient care which is the sole purpose of the NHS.

Sir Duncan Nichol gave firm assurances that the action plan put in place to rectify the financial mismanagement in that area health authority would not damage the service. The truth is that it has not solved the financial problems, and it has damaged seriously the services provided for the public. That is why an independent inquiry is now essential to restore public confidence. If the Minister cannot grant me that request today, perhaps I may hope that she will continue to apply her mind to the hospital to ensure that the finances are put right and, what is most important, that the good people of Birmingham receive the services to which they are entitled.

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