In the debate on London on Friday 2 November my hon. Friend the Member for Uxbridge (Mr. Shersby) and I expressed grave concern about the way that the Hillingdon area health authority appears to be run. We drew the attention of the House then, as we do now, to the proposed closure of the accident and emergency unit at Mount Vernon hospital between 8 pm and 8 am. As evidence of our argument I quote my hon. Friend's speech:
it does not appear … that the authority is taking seriously enough the job of reducing its administrative costs, and, for reasons that are difficult to recognise, it is concentrating upon hitting the interests of patients."—[Official Report, 2 November 1979; Vol. 972, c. 1694–95.]
I shall develop further some of the statistical and factual arguments in my remarks.
In my judgment and in the judgment of my hon. Friends the Members for Uxbridge, Watford (Mr. Garel-Jones) and Harrow., West (Mr. Page), whom I see here tonight, in the judgment of the overwhelming majority of my constituents who have written to me, and above all in the judgment of the medical staff who work at the hospital, the required budgetary savings could be achieved by rigorous administrative economies rather than cuts in vital clinical services, if the determination to put patients' interests first existed on the part of the area health authority.
There is an intensity of feeling over this issue that I have not encountered in over four years in this House. You will recall, Mr. Deputy Speaker, that previously I represented a Bradford constituency, and Bradfordians are not short on local pride or prone to mince words when their interests are jeopardised.
No fewer than 30,000 local residents, not just from my own constituency but from Uxbridge, Watford, Harrow and South-West Hertfordshire, signed a petition against the proposed closure of the accident and emergency unit at Mount Vernon at night. It was taken to No. 10 Downing Street on 2 November. The petition was motivated:
purely by the desire to save the night-time casualty facilities at Mount Vernon Hospital … and has no connection with any political party, union or other association.
Naturally, feeling is most intense within the hospital itself. The medical staff, with justification, feel that drastic cuts in clinical services of the kind proposed by the area health authority would prejudice the calibre, capability and standing of the hospital as a whole.
The medical staff committee, on 11 October 1979, wrote to the chairman and members of the Hillingdon area health authority, following the authority's decision on 2 October to close the Mount Vernon casualty department at night. The committee expressed the hope:
that you wish to re-explore alternative methods of saving money at Mount Vernon, with the assistance of consultant medical staff.
The medical staff had produced what I called in this House on 2 November "carefully researched proposals" for administrative economies which would have obviated the need to close the casualty department at night, but which would still have enabled the area health authority to achieve the budgetary savings required by the Government's cash limits.
These proposals received only superficial attention from the area health authority. I shall quote what the consultants thought about this. They said:
We can only suppose that members of the area health authority were not aware that the alternatives were practical propositions costed by the same heads of departments who provided the figures for the Administrators' costing exercise".
That judgment was typical of the generosity of spirit of professional medical men whose concern is the care of patients and who do not look for political motivation in decisions. I say this because when the area management team poured
cold water—as it did, in its report to the area health authority of 23 October—on the administrative savings proposed by the medical staff, the area medical team showed that it was exercising entirely selective judgment, because its own proposed economies, biased as they were towards cuts in clinical services at Mount Vernon, had been costed by the same medical experts in the hospital.
What has been noteworthy has been the widespread public acceptance of the need on the part of the Government to demand economies from the National Health Service. Those constituents who have been in touch with me, with literally one or two exceptions, have backed wholeheartedly the Minister for Health's call at the Conservative Party conference for cuts in waste, extravagance and bureaucratic administrative costs rather than in services to patients.
I was not exaggerating when I claimed in the House on 2 November:
The local residents are not criticising the Government's desire to effect economies. Their criticism is directed at what they regard as an over-large bureaucracy and extravagant administrative expenses"—[Official Report, 2 November 1979; Vol. 972, c. 1687].
My postbag confirms that I was not exaggerating. One nurse writes:
It is ludicrous that wards and casualty departments are the first to be closed down when administrative headquarters are flourishing and are situated in this area in the most expensively rated districts, Eastcote High Street and Ruislip High Street, and when the buildings occupying them cover the costs needed to cover the cuts requested. The rental of these premises alone is many thousands of pounds.
The figure is over £90,000 a year and has to be set against the £8,300 to be saved by the closure of the casualty department at night in this financial year and £23,500 in the next financial year.
I am interested to hear the comments that my hon. Friend has received from his constituents. Is he aware that the Mount Vernon hospital is held in high esteem in my constituency? I have received a number of written representations from people who not only work at that hospital but receive medical care there. Many people are concerned that if this casualty service is closed, urgent emergency casualties at night will be taken to the Watford Peace Memorial hospital which is already considerably overstretched. Once someone has received emergency treatment in a hospital, he tends to continue at that hospital as an out-patient. I hope that my hon. Friend will bear in mind that the Mount Vernon hospital enjoys a high reputation for plastic surgery. Urgent cases, brought to the Watford Peace Memorial hospital, are frequently referred to the Mount Vernon hospital because that is the place where the best treatment can be obtained. The services and facilities at the Watford Peace Memorial hospital are not available two weekends out of every four and an emergency case would probably have to travel a considerable distance to receive care.
I am grateful to my hon. Friend, particularly for the last point that he made. A private citizen bringing a casualty to that hospital by car would not necessarily know that. The ambulance service would be informed. Although there are vacant premises in Uxbridge cottage hospital and Harefield hospital the area management team has refused to follow up the medical staff committee's recommendation that at least Cromwell House be vacated and the administrative staff moved to these vacant premises in the hospitals.
Another constituent who works at Mount Vernon writes:
As an employee of the authority, I find their attitude to patients indefensible. I work in the Health Service because I care for people who are sick. If cuts are to be made, there are plenty of useless sacred cows that could be removed without any detrimental effects to the service. We all know how to reduce spending but there is not much leadership in the management. They seem to go for the easy life.
Something is clearly wrong. Twenty-two junior doctors do not write, without good cause, to the area administrator, as they did on 10 October:
to censure your management of this area.
They forcefully regretted that:
You have dismissed the alternative financial savings proposed by the hospital consultant staff and we cannot accept that the alternatives have been fully considered.
Nor can I. The area has not disputed that at least £26,850 must be saved from Mount Vernon's budget this year and £83,720 next year to meet the 2 per cent. overall cut in area expenditure demanded by Government cash limits. The medical staff suggests the closure of the staff
health department at Mount Vernon. There is already one such department in existence at Harefield hospital, down the road. This would save £1,500 this year and £15,000 next year. Although the people who use it—the medical staff—advocate its closure, the administrators two miles away know better:
The AMO is currently reviewing the staff health service in the area",
writes the area management team:
and it may be possible after further discussion and consultation with the staff organisations to make some modest savings in this service. The area management team could not, however, support the abolition of this service, which is regarded as essential for staff welfare.
The medical staff suggest that natural wastage and a reduction in the number of secretaries be used to effect economics—£12,750 this year and £28,750 next year. This was based on last year's turnover for secretaries and is not, as the AMT suggests in its response, some figment of its imagination. Savings in the dispensing of drugs have been considered, as proposed by the medical staff. Some have been implemented, but further suggestions, for example, the dispensing of not more than a week's supply of take-home drugs for out-patients, are being discussed currently.
Even the proposed savings on photocopying of the medical staff received a classically obtuse response which was revealing about the authority's whole attitude. It said:
The AMT had considered the alternative proposals put forward by the medical staff committee before completing the recommendations for economies approved by the AHA on 2 October. The proposals were, however, received as the final package was being put together to be sent out to members, and in the time available the only item considered feasible for inclusion was a saving of photocopying for which a sum of £1,000 was included
On further reflection it found that to be wrong and it now says that up to £6,000 could in extreme circumstances be saved on photocopying.
There are so many examples of this kind which make me believe that the area chairman was utterly wrong to ignore the anxiety of staff and local residents and, at the emergency meeting, to cast his vote twice—once to resolve the tied vote—in favour of closure.
In this kind of situation, his response should not have been one dictated by rule books and political attitudes. His duty was to make every effort imaginable to maintain clinical services, even if drastic administrative savings were required. It is reprehensible for area health authorities to seek to flout cash limits, but it is equally wrong for a chairman, by his own words and actions, to appear to act more in the political style expected of a former deputy leader of a local authority, which he is, than as the supposedly non-partisan custodian of the health and medical care of the community.
At the conclusion of my remarks on 2 November, I asked for a review. I am grateful that my hon. Friend the Minister of State intervened last week, and I am pleased that the moratorium on closure until tomorrow night has occurred. But in view of the fact that this hospital serves an area which includes the premier NATO headquarters in this country, the premier naval headquarters, RAF Northolt with its VIP movements, and Heathrow airport from which an emergency at night, perhaps involving a jumbo jet, cannot be ruled out, it is totally wrong to close this kind of facility, especially as the hospital also has a burns and plastic surgery unit.
Anything that my hon. Friend the Under-Secretary of State can suggest to facilitate the kind of review which I have advocated would be greatly appreciated by local residents, medical staff and, I am sure, all the local Members of Parliament, including my hon. Friend the Member for Uxbridge.
I have, Mr. Deputy Speaker.
I wish to intervene briefly to support my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson). He has raised a matter which is of deep concern not only to the residents of Hillingdon but to those of other towns nearby such as Harrow, Watford, and so on.
This is a matter which deserves a very full reply from the Minister. I hope that my hon. Friend will say whether the decision to close down—even on a temporary basis—an important accident department at a major hospital should be taken to save the comparatively trivial sum of £8,300 this year and £23,500 in a full year.
I hope that he will deal fully with these matters and will give an explanation which can be considered both by the regional and the area health authorities. I hope that those authorities will note that at 2.40 am my hon. Friends the Members for Harrow, West (Mr. Page), Watford (Mr. Garel-Jones), Ruislip-Northwood and I are in the House raising this matter on behalf of our constituents, whose servants we are.
I do, Mr. Deputy Speaker.
On behalf of my constituents in Harrow, West, I wish to thank my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson) for raising this vitally important matter tonight. It is of real concern to my constituents. It was disgraceful that the area chairman on this occasion cast his vote twice to save money at the "sharp end" of patient care in the hospital concerned.
If the casualty department at Mount Vernon hospital is closed, an essential part of the training of surgeons and registrars will be lost, and when that is lost the prestige of that hospital which enables it to gain staff of repute and dedication is likely also to be lost.
I beg my hon. Friend the Under-secretary to give a reprieve to the people of this part of London so that the department remains open, although, of course, we totally support the economies which will have to be made in other ways.
My hon. Friend the Member for Ruislip—Northwood (Mr. Wilkinson) has made an eloquent and powerful case on behalf of his constituents—as one would expect from an experienced parliamentarian—and on behalf of those who would be affected by the proposed temporary closure. He was well supported by my hon. Friends.
I understand their concern and that of those they represent. That concern was needlessly aggravated by the error in the official notice in the two local papers which said that the closure of the accident and emergency department at Mount Vernon would be permanent. The chairman of Hillingdon area health authority has apologised to my hon. Friend the Member for Ruislip—Northwood and to my hon. Friend the Minister for Health for this mistake and has assured him that the authority has no intention of going back on its resolution to use its
best endeavours to find sufficient funds to reopen the Accident and Emergency Unit at Mount Vernon Hospital as soon as possible".
I am grateful to my hon. Friends for raising this subject, since it gives me the opportunity to explain the actions which many authorities, particularly in London, are having to take. I hope also that I shall be able to allay some of their anxieties.
My hon. Friends will know that it is our policy that all Government-financed bodies—and that includes health authorities—must stay within their budgets. In order to do that, each area health authority must take whatever action is necessary to keep its expenditure this year within the revenue allocated to it by the regional health authority, and to ensure that it is in a position to contain next year's expenditure within the allocation it might reasonably anticipate in that year.
While we expect that authorities will do everything they can to find ways of making the necessary economies without affecting patient services, we accept that that will not always be possible. My right hon. Friend the Secretary of State for Social Services made this clear in this House on 17 July when he said:
some health authorities—this applies especially to those in London—are faced with the need to make real cuts this year so as to remain within their cash limits".—[Official Report, 17 July 1979; Vol. 970, c. 1435.]
The resource allocation working party has been a factor here. It should be
realised, however, that even when patient services are affected, this does not mean that services to patients will be totally withdrawn. In some cases the opportunity can be taken to reorganise services in order to treat the same number of patients for a lower cost. This can bring benefits not only in reducing costs now but in preparing for expansion to meet different needs when more money becomes available. I am glad to see that the Hillingdon area health authority had these points very much in mind in planning its present savings. It intends, for example, to economise by introducing Monday to Friday working in one ward to treat those patients who are expected to be in for only a few days. The authority has also made it clear that, if the economies achieve the desired result next year—and it is not yet possible to predict exactly what its financial situation will be then—it hopes to be able to make modest improvements perhaps by opening a closed cardiac ward at Harefield hospital and new geriatric beds at Hillingdon hospital.
Nevertheless, we recognise that some of the changes which have to be made affect patient services adversely. Where this happens, there is a requirement that local interests should be consulted and a procedure is laid down for doing this. Statutory Instrument 1973, No. 2217 which sets out in paragraph 20(1) the requirement that community health councils should be consulted does, however, contain a proviso that the requirement shall not apply to any proposal on which the area authority is satisfied that, in the interests of the Health Service, a decision has to be taken without allowing time for consultation.
In taking its decision on the economies which it thought necessary the Hillingdon area health authority invoked this proviso resolving that:
In the interest of the health service a decision had to be taken without allowing time for consultation".
When savings have to be made, the decision on how this should be done is a matter for the health authority concerned and I have obtained a certain amount of factual information from Hillingdon AHA which may help to put the matter into perspective.
Had no action been taken to reduce expenditure, the authority would have been about £650,000 overspent at the end of this year. The swing which it has agreed to make, together with adjustments in the cash flow, should enable it to keep within its cash limits this year. Further savings will, however, be required next year to compensate for the adjustment in cash flow, if this is not to leave the authority in financial difficulties in 1980–81.
I well understand that local concern has arisen from the proposal to close the accident and emergency department between 8 pm and 8 am. Lest there should be any fear that patients who are already in the department at 8 pm might be sent away without treatment, I am assured that treatment will continue until everything necessary has been done for them.
I think it may be helpful if I indicate how many people are likely to be affected by this proposal. The figures available, which are from 7 pm to 8 am—an hour longer than the time during which the department will be closed—show that an average of about 19 cases enter the department each night. Of these, three are ambulance cases, the majority of them arranged admissions, who have in the past entered through casualty but will go direct to the wards when the department is closed.
The remaining 16 cases arrive independently and most of them by car since, as my hon. Friend will know, there are few houses within walking distance of the hospital. Of these cases, it is estimated that 30 per cent. are minor, which should properly have been dealt with by general practitioners. Although most of the remainder will be put to inconvenience because they may have to travel further to reach the neighbouring departments at Hillingdon, Northwick Park or Watford, the distances are not great and the additional time taken, at night when traffic is light, should not be long.
Reference has been made to the alternative proposals put forward by the Mount Vernon hospital medical committee and others and it has been suggested that these were possibilities. Some of the proposals had already been included in the economies agreed by the AHA. Some had been examined and, though attractive, could not be implemented quickly enough to have any impact this year, or much impact next year. Others are still being examined though some of them would not offer major savings. Others were felt to be impractical for various reasons.
It seems to me that the alternatives were carefully examined and that time was given to the consideration of the savings. Discussion began at the authority's meeting on 18 September and continued at extraordinary meetings on 2 and 23 October. I understand that the latter meeting, which was concerned almost entirely with the accident and emergency department at Mount Vernon, went on for about four hours.
My hon. Friend referred to a number of other suggestions and perhaps I could deal with one of them. That is the possible transfer of administrative offices from Cromwell House and Keele House to hospital wards. There are some major difficulties. The ward accommodation is not necessarily suitable and would require conversion. That would cost money, as would the transfer itself.
The real problem is time. There must be time to carry out the conversion, for staff consultation and to find someone else to take over the leases which have 19 years to run. It is doubtful that there could be a real saving until well into the next financial year.
Criticism has been made of the authority in that insufficient economies have been made in administrative and other services. Considerable savings have been made in the past few years, particularly in clerical and administrative staff. In addition, since the authority is a single district area and does not have the extra tier of management, it started with low administrative costs and thus has less scope than others to make reductions.
This was recognised by those members of the authority who had strong reservations about the night-time closure of the accident and emergency department at Mount Vernon. In an attempt to reverse the decision they proposed that the area management committee be instructed to submit alternative proposals as soon as possible to achieve the same amount of savings in clinical services at Mount Vernon hospital
The Government's overriding consideration is that the authority should keep within its cash limit. Members of that authority have the prime responsibility to decide that this is done in the best way.
The error in the announcement of the closure can be criticised—it is a careless mistake which should not be allowed to happen—but I am not convinced that the authority has acted improperly. I am arranging for a full report of this debate to be submitted at once to the chairman of the area health authority while the unit is still open. The Minister has been in touch with the chairman of the regional health authority, to whom I shall send a a copy of this debate, in view of that authority's interest. I understand that it may examine with the area authority the alternative proposals for staying within cash limits. The Minister is also seeing a deputation, led by my hon. Friends the Members for Harrow, West (Mr. Page) Uxbridge (Mr. Shersby) and Watford (Mr. Garel-Jones) on Wednesday. The chairman of the area health authority may wish to postpone closure until then.
I have gone as far as I can. I am bringing to the attention of the chairman of the health authority the remarks of my hon. Friends and me. I hope that he will take them into account.