When I applied for this debate in the middle of May, I intended to use it as a follow up to my work with the Department of Health and Social Security, correspondence between Ministers and myself and Ministers' visits to see conditions in the Mansfield district.
I intended to ask about the speeding up of the resource allocation working party's report on finance for the central Nottinghamshire area since the area would benefit from a steady increase in cash which would allow something to be done about the abnormal waiting times in the area. I have had other meetings with a number of bodies about the problems of the central Notts area.
At the King's Mill hospital, the waiting list for ear, nose and throat and children's surgery was 826 in March this year, and 521 of that number had been on the list for more than a year. The waiting list for general surgery was 848, of whom 271 had been on the list for more than a year. The waiting lists for gynaecology was 529.
Central Nottinghamshire covers a very heavily industrialised area, mostly coal mining, so that it gets more than its fair share of broken limbs, hernias and other things that go with heavy industry. I must stress at the outset that, if it were not for the work of the medical staff and administrators, many of the peole in that area would not be able to go back to work, fit and able, as soon as they do. I also stress that nothing I have to say about the medical services in the area is any reflection on the dedication and sense of duty and work of the staff, who work wonders in the buildings they have. The doctors, nurses, administrators, the League of Friends and all others concerned do their best to give the finest possible service. They have done wonders in keeping the service going with the resources at their disposal.
However, since I applied for the debate, things have happened at an alarming rate, and that has made by original intentions for the debate take a back seat. Since the announcement of the debate, I have had so much paper and advice sent to me that I probably have enough material for a three-hour speech. But other hon. Members wish to speak, so I shall confine myself to the bare bones of the case.
Central Nottinghamshire area health district is facing its most serious financial crisis since the inception of the National Health Service. For a considerable number of years, the health district has been severely under-funded. Although it provides health services for a number approaching 200,000, the level of funding is significantly lower than the national average. In the last financial year, only £65 per head per year was available for the hospital and community services in the district whilst the national average was about £100 per head, in the Trent region £90 per head, and in the Nottinghamshire area as a whole £80 per head.
There are two main problems. First, the district is short of facilities—for example, in bed provision for some specialties, outpatient facilities, and so on. In consequence it is not giving a full service to the community. Historically, it has not been funded to an extent anything like the national average. Secondly, the district is now seriously under-funded even for the support of the facilities and services that it does have. Indeed, we are talked of as a deprived area.
The buildings from which the health services are provided in the district are considerably below the standard we would all like to see. Nearly all the hospitals are coping with environmental problems. For example, wards for the mentally-handicapped at Victoria hospital were described as deplorable when last visited by the Minister of State. To all of us who know them—and I live quite close to the hospital—they are a fire trap and fit only for the bulldozer. I am sure that anyone who sees them would agree.
The geriatric patients are in totally unsatisfactory conditions. There is a ward which is little more than a tin hut which the hospital advisory service years ago recommended should be demolished. Outpatient facilities are overcrowded and cramped. Some are in buildings of which the NHS must be ashamed. All this is a complex which used to be, in the old terms in Mansfield, the workhouse. Indeed, to many of the elderly who have to go there it still carries that stigma. They do not talk about going into the Victoria hospital but about going into the workhouse. The staff and the administrators have worked wonders with the place, but they deserve better.
General hospital services are provided in an ex-American Army emergency hospital, built in the 1940s. It is of the old spider variety, well known to ex-Servicemen and not known for efficiency. The Americans, when they come back to Mansfield, must wonder at its still being in use. A great job has been done by the staff and the administrators.
We have also two small and somewhat old former voluntary general hospitals. The nature of much of the capital stock in the district, coupled with many years of financial restriction, has resulted in an enormous backlog of repair and maintenance work which can no longer be avoided if buildings are to be kept serviceable. This will cost the district many hundreds of thousands of pounds in the next few years.
The overall financial situation has reached the point at which the routine replacement of essential equipment cannot be maintained, let along the updating of general furniture and ward equipment. I am informed that essential equipment in the pathology department is now breaking down and, although it should be replaced, there are no funds available for these expensive items. I am told that difficulty is even experienced with the replacement of X-ray cassettes resulting in spoilt films and the necessity for repeat exposures which cannot be in the best interests of the patient.
In this financial year, the district's problems have become extremely acute. The district is about £1 million adrift in this financial year and about £½ million in the following year. If this money is not put into the district budget, everyone is agreed that the patients will suffer. There is no capital development to defer to assist in balancing the books. This serious financial shortfall comes after many years of determined efforts to achieve economies. In these circumstances, it will not be possible to maintain present services and, being required to balance the books, the district management team has reluctantly suggested the closure of wards and units to the further detriment of an already deficient service.
When one considers the deprived state within the health services in our district, it is impossible to believe that such a situation can be allowed to develop.
The Trent region is seriously short of finance. Improvement of the region's resources by the speeding up of RAWP is an essential part of the solution of central Notts problems. I have today received a letter from the chairman of the area health authority which says:
We are doing all we can to help there"—
which is central Notts—
but I don't pretend that services in Central Nottinghamshire can ever be brought up to the standard in other Districts, let alone other parts of the country, until its District General Hospital at King's Mill is both built and funded.
The letter adds:
unless money is allocated more quickly to Nottinghamshire, and unless the NHS as a whole is effectively protected against pay and price increases, the service may change shape but it won't improve much. This is what RAWP was all about; and anything you can do to speed up the process of reallocation and sustain the growth in NHS as a whole will be welcome to us.
The subject of this debate has the backing not only of the mass of the population but also of the chairman of the area health authority and members of that authority and others. There are those in my area and the area north of Nottingham who subscribe to the view that not only does England finish at the River Trent but that Nottinghamshire also
finishes there or at the city boundaries. This claim about the area north of the city of Nottingham is aired at all levels. On many occasions, it is unfounded.
However, with the inequality of finance allocation within Nottinghamshire, the development of the Nottingham university teaching hospital is taking a major share of the blame for the situation in central Nottinghamshire. This is unfortunate. I am sure that the hard working and dedicated band of area health authority and administrators would not want to be seen in this situation. But one senior nurse said to me over the weekend "What are we supposed to do? If they have all the money, they will have to take all the patients. We will have to take them to the university hospital by the busload". I am sure that she did not mean that and that she will continue her dedicated work. I quote her to prove the frustrations of such people.
It is not a short-term problem. There is an area and district deficiency in resources now and will be for the next 10 years. The development of the new district general hospital on the Kings Mill site is programmed to start soon. However, if substantial revenues are not made available soon there is a danger that this major development will be delayed. It is difficult to overestimate the damaging effect of such a delay upon local health services.
The health district needs a substantial injection of funds in the next decade to bring it into line. Without it the health services in the centre of Nottinghamshire will deteriorate quickly.
One can imagine my surprise when I received a document marked "In Strict Confidence"—but that was pencilled out. It was the district management's report to the area health authority. I understand the report was accepted reluctantly at the meeting on 7 June.
I shall deal only with the broad issues, not the details. The report first dealt with the concentration of services. It said that ward 4 of the Harlow Wood hospital was to remain closed. It mentioned the closure of the general practitioners' part of the maternity unit at Kings Mill hospital. Some children have to wait up to two years to have their tonsils attended to, but the report mentions that ENT and children's surgeries are to be combined to make two wards into one to save on staffing. The report talks of the closure of the two pre-convalescent wards at Newstead hospital. Debdale Hall hospital and the Langwith Lodge Diabetic unit was to close. The report also mentioned the closure of a geriatric ward at Forest hospital.
These closures will not meet the shortfall. If the district is required to balance its books, the report states that additional closures will have to be considered. It lists, the Forest hospital, a further ward at Harlow Wood, a surgical ward at Kings Mill, a medical ward at Kings Mill, the open access service for GPs to pathology and radiology and parts of the casualty service.
The effect on staff morale would be devastating. Such closures will not be allowed without struggle. The local press and television are joining in the fight. There is no way in which such savage cuts will be accepted. The community health council has already turned down the report unanimously.
The Minister has a straightforward decision to make—either cash or closures. In the area there is a health finance action group comprising doctors, social workers, trade unionists and nurses. They state that the proposed cuts mean redundancies. They have produced three editions of "Health News" and have organised a petition. I shall be overwhelmed by the number of signatures and letters which I receive on this subject. The petition reads:
We, the undersigned, demand that Her Majesty's Ministers correct the serious underfunding in the Central Nottinghamshire Health District as a matter of urgency and in accordance with the expressed intention to provide adequate health care for all of Her Majesty's subjects.
I was a Minister for a considerable time and I answered many an Adjournment debate, so I do not expect that the Minister—or I would be very suprised if he had after the Budget and the vote we have had tonight—has got within his brief the will, or the finance, to give me an injection of £2 million tonight. But I trust that he will agree to meet me and discuss what I have said with the hon. Members for the area. The hon. Members who cover that area, my hon. Friend the Member for Ashfield (Mr. Haynes)
and the hon. Member for Newark (Mr. Alexander), and myself are all members of the area health authority at present, and my hon. Friend the Member for Ashfield is a past chairman of the community health council itself.
I would like the Minister to meet the three of us, plus the chairman of the community health council and the area health authority and anyone else the Minister would care to bring along.
Thank you, Mr. Deputy Speaker, for allowing us to have this debate. It is not the one I originally intended, but things have increased in pace in central Nottinghamshire and I hope everyone understands