I seek to raise in this short debate the needs of the National Health Service in the North-West. I do so on the basis that it is necessary to make sure that the Government are aware of the needs of the Health Service in the North-West, and are deeply conscious of and ever mindful of them. I want to ensure that the Government are fully aware that hon. Members on both sides of the House who represent the North-West will be ever vigilant in ensuring that the region receives its proper share of the available cake.
I use the word "proper" quite deliberately, because I believe that it is necessary to have regard to need as well as to population, to history as well as to the future, and to actual conditions as well as to statistics. It would appear to be clear in terms of the 1977–78 revenue allocations that the Minister has understood our special needs. I want to place on record my appreciation of that fact. But I warn the Minister that North-West Members take this merely as a declaration of long-term interest and intent and not as an end in itself. Even though we have had the highest percentage increase over the present year of any region in the country, we are still at the bottom of the league table, and we need, certainly for the whole of the foreseeable future, to maintain that fairer distribution, based on the real need which the Government have at last recognised.
I know that the Minister has already seen something of the hospitals in the North-West and I hope, should be in office long enough, that he will come and see us again to see our deprivation, to realise how beneficial the implementation of the Resources Allocation Working Party Report, "Sharing Resources for Health in England", will be to the region, and to appreciate how essential it is that that report and its recommendations should be implemented. The report talks of deprived regions and clearly demonstrates that the North-West is one of them. But I believe—and this is one of my reasons for securing this debate—that the facts should be brought out in the open and put on parliamentary record.
My constituency is one of the towns in that part of the country which, whilst having undeniable attractions—for example, Rochdale, has me as its Member—owe much of their urban development to the Industrial Revolution. To date, Rochdale still bears the scars of that period, and the heritage affects many buildings, including hospitals. The people of my constituency, and certainly their predecessors, bear the scars and wounds of the Industrial Revolution and have thus contributed to the economic wealth of the country far out of proportion to their number. We now want some of that cake returned to us.
Our hospitals, whilst doing a wonderful job, need vast sums of money spent on them. Better still, we could do with new ones to replace many of them. In 1974 the Strategic Plan for the North-West, prepared by the North-West Region Economic Planning Council, concluded:
The general quality of life in the Region as a whole as measured by pollution, housing, health and education, appears to be distinctly poor and often inferior to that of any other English Region …it is clearly in need of considerably more effort if it is not to be left further behind other Regions.
If one lives in the North-West one's expected life span is two years shorter than the average for England and Wales. One is more at risk of certain diseases throughout the whole of one's life. The death rate from coronary heart disease per 1,000 men between the ages of 45 and 64 is 4·92 in England and Wales, but only one of the 18 districts in the North-West Region has as low as that figure and the rest have figures significantly higher.
The death rates for diseases of the circulatory system or the respiratory system, for cancer, accidents, poisonings and even violence are all significantly higher in the North-West than the average for England and Wales.
Against that background one might have thought and, indeed, expected that the region would have had a larger proportion of the resources available allocated to it, but until this year that has not been the case. For years we have been the poor relation. Forty per cent. of our hospitals were built before 1900.
Indeed, 8·5 per cent. of them were built before 1850. Only 18·2 per cent. have been built since 1948. To do all the replacing of inadequate buildings that is necessary we should need about £400 million, and, even acknowledging, as I do, that much needs to be done in the country as a whole, it is stated in the working party report that the shortfall in the North-West even equitably to distribute the total national stock of hospitals is £75 million.
Even statistics of that kind in no way paint the real picture of inadequate sanitary facilities, of cold and draughty building, of lack of space needed for new equipment, of appalling waiting conditions for out-patients, and of cluttered corridors. These are factors and features of many of our North-Western hospitals. As I say, those features are not painted by cold statistics, and yet the conditions are well known to staff and patients.
These conditions make it difficult to attract staff. My own area, Rochdale, has, I understand, advertised three times for anaethetists and radiologists without response. I am told that in Salford it is two and a half weeks since a patient could be admitted from the medical emergency list. We are worse off in the North-West than in the country as a whole for laboratory technicians, occupational therapists, pharmacists, and physiotherapists. At present there are 57 consultant posts in the North-West Region which have been approved by the DHSS but which it has proved impossible to fill. In answer to one of my recent parliamentary Questions the Minister agreed that the North-West had a smaller number of general practitioners per 100,000 population than any other region; 44·7 is the average for the country but we have only 42.
The Resources Allocation Working Party postulated target allocations for each region in relation to revenue allocations for 1976–77. That chart assumes a figure of 100 per cent. for target allocations. The North-West region is below that at 80 per cent., again the lowest of any region. Five regions, including four metropolitan regions, are already above 100 per cent.; indeed, two have reached almost 120 per cent. That proves that patients in this region have been forced to accept lower standards of care, and that is what hon. Members from the North-West have been saying for many years, long before I arrived here.
It for all those reasons, and time forbids my saying more, that I make this strong plea for continued priority allocation to the North-West. Although the North-West may be further from London than some of those whose bleatings about this matter have become known to us recently, I assure the Minister that we feel just as strongly about these matters.
I am not asking for favoured treatment for the North-West, but for fair treatment. For 30 years the Health Service has been unfair to the North-West in terms of allocation of resources. I am aware of the plea in some quarters for a recognition of the so-called centres of excellence. I do not object to such centres, but I cannot see why they should be so heavily weighted in London or to London. There should be a more equitable distribution throughout the country and the cost should be met from the overall financial allocation to each region based on the working party's formula. I hope that the Minister will resist any pressure to give extra money to London at the expense of the regions, on centres of excellence grounds or other grounds.
I realise and recognise that past wrongs cannot be put right overnight. What worries and concerns me is the possible development of the attitude that, because of a particular shortage of resources at this time, we must hasten slowly to redress past unfair balances. That I reject entirely. Now is the time to act. I am grateful that the Minister has done so this year, but let him or any of his successors, whoever they may be, whenever they come to power, clearly understand that this redressing must continue. Nothing less will satisfy us and nothing less will be fair.
Whether or not they are short, resources should be most carefully directed to the areas of greatest need. For the Health Service the areas of greatest need are in the North-West. I hope that that will not be forgotten or overlooked by this or any other Government.
I congratulate the hon. Member for Rochdale (Mr. Smith) on his initiative in rais- ing this matter in an Adjournment debate, because it is a source of concern to Members who represent North-West constituencies, as can be seen from the attendance in the Chamber. Although the Chamber is not overcrowded, there are more Members present than is normal for an Adjournment debate. I see present my hon. Friend the Member for Middleton and Prestwich (Mr. Callaghan), my hon. Friend the Member for Stockport, North (Mr. Bennett) and the hon. Member for Colne Valley (Mr. Wainwright), who I am sure considers himself to be in this region for National Health Service purposes.
I worked in the Health Service in another part of the country for 16 years before I came to this House. I was astonished and dismayed when I saw the facilities that were available for my constituents in Oldham, and I have since discovered that that is true of almost the whole of the region.
I suggest to my hon. Friend the Minister of State that he considers throwing his weight behind the plea that we have made that this whole matter be thoroughly aired in the Standing Committee on Regional Affairs. When we were invited by the Chief Whip to suggest subjects for discussion, that is one that the Labour Group put forward. There are many hon. Members who wish to put points additional to those made by the hon. Member for Rochdale, and I hope that my hon. Friend will bear this in mind when he is approached about the possibility of having such a debate.
As my hon. Friend the Member for Oldham, East (Mr. Lamond) said, this is a well-attended Adjournment debate. There was a similar well-attended Adjournment debate when we discussed the application of the Resource Allocation Working Party's Report to London. I think that I was able on that occasion to explain the situation to hon. Members, and I hope that tonight I shall be equally successful in respect of the North-West. I hope to reassure all my hon. Friends and those who have raised this subject that the National Health Service needs of the North-West Region have been and will continue to be carefully and even generously considered within the constraints of the prevailing economic situation.
I agree with the hon. Member for Rochdale (Mr Smith). My right hon. Friend and I fully recognise that the North Western Regional Health Authority is deprived and under-provided compared with other regions in England. In the basic matter of physical resources the North-West Region is at a disadvantage in having a large number of old hospitals in poor condition. A recent national survey in England and Wales of hospital property showed that 56 per cent. of hospitals in the old Manchester Region were built between 1850 and 1918, whereas the national average is just over 41 per cent. Matters were not improved when the one new hospital built during recent years, at Crewe, in the old Manchester Region was transferred to Mersey Region following reorganisation in April 1974.
In addition, figures produced in the 1975 annual report of the North-Western Regional Health Authority show that the region is clearly not one of the healthiest places in the country in which to live. Its population has a higher proportion of those age groups which place the greatest demands on the health services—the under 15s and over 65s. The general mortality rate is higher in the North-West than in England and Wales. The 1974 figures show 13·3 deaths per 1,000 population in the North-West as against an average of 11·9 in England and Wales.
The region still has an unacceptably high rate of infant and perinatal mortality—that is, still-births and deaths under one week—and further data derived from the Registrar General's Statistical Review show that the North-West has a greater proportion of sufferers from bronchitis and cardiovascular disease than in the country as a whole.
To add to these problems, the region is also poorly served in terms of numbers by professional, medical, paramedical and other staff in health-related professions—that is, dentists, chiropodists, physiotherapists, occupational therapists, audiologists and general practitioners. At October 1975 the average patient list size of general practitioners in the North-West was 2,459, against an average of 2,365 for England as a whole. Given this rather sombre picture, the obvious ques- tion is why, if this is the extent of the problem, something has not been done about it before. I cannot say why nothing has been done before, but what I can say is what is now being done to improve matters under this Government.
Successive Governments have faced the problem of eliminating inequalities in health care provision, in the North-West Region and elsewhere, against the background of rising demand and limited resources. In 1971 the Department introduced the Crossman formula, when the Department was headed by the late Richard Crossman. By this formula the relative need of regions for revenue funds for hospital services on the basis of population, beds and cases, was judged. This confirmed an already well-known fact, and the Manchester Region was assessed as being needy, although not by any means the most needy region.
In 1976 we developed a more sophisticated technique in that we received the report of the Resource Allocation Working Party, to which the hon. Gentleman has referred, dealing with the allocation of health resources among the various areas and regions of England. The working party was made up of representatives of health authorities and the Department, and had been set up to advise Ministers on the principles and methods for allocating capital and revenue resources to National Health Service authorities on as objective and fair a basis as possible and according to the health care needs of their populations. Here again the Committee recognised the principle of fairness. The hon. Gentleman was keen to argue that principle. He said that he would argue the case of fairness in deference to favoured terms for the North-West. I have a feeling that he could well have argued a case for discrimination in favour of the North-West without deserting sound ground.
The result of this report was that my right hon. Friend confirmed on 21st December last the Government's long-term commitment to a fairer allocation of money between different regions. He also said that, having considered the views of the National Health Service authorities and other interested bodies consulted in the report, he had accepted the recommendations of the working party as a basis for distributing resources for 1977–78.
What this means is that we have a much more sophisticated instrument for judging how resources should be distributed around the country. The principal innovation in the criteria proposed for judging the health care needs of populations compared with the previous formula is the introduction of standardised mortality ratios for diseases as a proxy indicator of relative health care needs.
My hon. Friend has referred to the fact that in terms of the long-term needs of the North-West he will be moving to a fairer allocation. For my constituents and those of my hon. Friends present tonight, some of whom are likely to die sooner in the North-West than people in any other region, long-term is not soon enough. We are anxious to see something in the immediate future to make sure that there is a fairer deal for the North-West.
I quite understand my hon. Friend's impatience. He will realise that we are living in a time when the economic climate is such that the new funds coming into the Health Service are not substantial. It is fair to say that other people in the rest of the country are also entitled to their health services. The record of this Government in this matter is better than any of their predecessors.
I was coming to a rough English translation of the formula I have given from the Resource Allocation Working Party which involves the use of death rates, roughly speaking, as an indicator of the health needs of an area, weighted for age and sex. The application of these mortality ratios to the population of the North-West health region shows it to be in greater need of health care than hitherto indicated.
The result of that is that the region will continue to receive one of the highest rates of real terms additions. There is no doubt, and there is no point in trying to dodge the issue, that the equalisation will take time. What is not realised is the need for careful planning to effect the necessary rationalisation of services in the deprived areas without putting important activities and institutions at risk elsewhere. We cannot achieve equalisation overnight, particularly in a situation of low growth nationally. Such a step would involve taking millions of pounds from the richer regions, and if it were done too quickly it would damage patient services, jeopardise the national medical student programme and destroy centres of medical excellence.
All this might be done without achieving a commensurate properly planned build-up of services in the relatively deprived regions such as the North-Western to receive and utilise the extra resources. The policy at this stage, therefore, is primarily concerned intra-regionally with the disbursement of new money coming into the Health Service.
The Secretary of State has recently notified allocations to regional health authorities and, as the hon. Member will know from my Answer on 8th March, the North-Western Region received an increase in its revenue allocation of approximately 3·2 per cent. in real terms, and that is more than twice the national average.
In deciding allocations for 1977–78 my right honourable Friend has taken a middle course between the desire to move as quickly as possible to a fairer distribution of resources among health regions and the need for some room for manoeuvre in the relatively well endowed regions. These latter regions, like other regions, are having to meet the needs of an ageing population—the national number of people over 65 increases by about 1 per cent. a year—but, above all, they have to continue the major redeployment of hospital services needed to release resources for other uses, particularly the build-up of the community health services in the inner city areas.
These regions need more time for manoeuvre, but it should be recognised that growth of a fraction of 1 per cent.—which is what the Thames regions have received this year—really represents an absolute cut in a region's ability to meet the growing demand that arises from demographic change. We are dealing with matters as quickly as we can.
The middle course I have adopted in no way conflicts with the recommendations of the working party: RAWP has not been "put on ice", neither have its recommendations been diluted, and I have fully adopted the working party's recommendations for revenue allocations for this coming financial year. I hope that this statement will give the honourable Member the reassurance he and others in the North-West may have been seeking. It is not generally understood that the working party did not recommend the actual level of allocations for 1977–78 or future years. Its recommendations are largely directed at establishing a target allocation towards which at all levels of the Health Service authorities' actual allocations should gradually be moved.
The extent to which movement is possible in any one year depends on a variety of factors. It is essentially a judgmental process and takes into account the additional resources available, local circumstances, and factors which at the moment cannot be objectively quantified in the formulae for resource distribution as recommended by the Resource Allocation Working Party.
Another new feature in the revised arrangements for the allocation of revenue funds is the institution of a separate identified allowance styled as the "service increment for teaching"—or SIFT. This is designed to meet the additional cost to the NHS of the provision of clinical teaching facilities for the training of medical and dental undergraduate students. There is an increasing number of these institutions in areas outside London. Therefore, this concept is of use to them.
This allowance will be a significant protection in the allocation of the North-Western Region which has a rapidly increasing number of medical students. I understand, in fact, that the University of Manchester has now one of the largest medical schools in Europe. I recently accepted the invitation of the vice-chancellor of the university to visit the medical school in the near future.
The North-Western RHA has a plan for the development of health services in its region over the next 10 to 15 years. Its plan indicates where the present shortages in provision lie and sets out certain basic aims and ways to improve the situation. Already some steps have been taken. Two new major hospitals, one a teaching hospital, are now being built—one at Preston and one at Salford. Similar advances have been made in providing health centres in the region. At 31st December 1975 there were 67 such centres in the region, an average of 1·67 per 100,000 total population against an average of 1·36 per 100,000 total popula- tion in the country as a whole. Training facilities for staff are also being improved with the hope that staff who train in the region will settle and practise there. That is a general experience that we have discovered.
In addition to the undergraduate medical schools, the region also has a dental school in Manchester, and dental training is an important function of that teaching area. Training for the rehabilitation professions is provided in Salford teaching area and a new degree course for speech therapists is now in existence at Manchester University.
In the North-West divided into health areas services are managed at area level and within areas and districts. We cannot discuss the services in the North-West just in terms of the levels of allocations to the regional health authority. The services within the region are patchy, just as in other regions. Redressing these inequalities among areas and districts are decisions for the regional health authorities themselves. It is now up to them to go ahead and do so.
Guidance on how best this might be done has been issued by my right hon. Friend, but I do not expect to see great amounts of revenue moneys next year switched between areas and districts, although I hope that some limited movement will be possible. There is clearly a maximum rate at which resources can sensibly be increased or diminished without damage to important services and without insupportable organisational strain. This does not mean that economies and rationalisation will not take place. They may, but they will not in the main relate to the redistribution of resources between areas under the Resource Allocation Working Party's formula.
The object of this whole exercise is to see the national resources of this national service evenly distributed so that we have a truly national service and that the population in the North-West has the same opportunity for access to health care as those in the so-called rich regions in the South-East.
My hon. Friend the Member for Oldham, East suggested that this might be a suitable topic for discussion in the Regional Affairs Committee. That is obviously not a matter on which I can take a decision, but I am sure that the attention of the Leader of the House will be drawn to my hon. Friend's suggestion and it is to be hoped that we shall be able to have such a debate. I would certainly co-operate in any arrangement.
I have spent a great deal of my relatively short time at the Department of Health and Social Security looking at events in the North-West. I have been there about half-a-dozen times and I have a couple more visits lined up to look at the problem. I can assure hon. Gentlemen that I am pursuing this problem against a background of trying to inform myself as fast as possible of the actual technical problems in the region.