In raising the issue of the Faversham cottage hospital, I am asking the Undersecretary and his right hon. and hon. Friends for their help and support. I do not expect, nor seek, conclusive answers tonight. However, I want to place on record my concern, and that of the people of Faversham, about the present position. I hope that the Government will help to bring matters to a happy conclusion in the coming months.
I do not think that I am exaggerating when I say that the Faversham cottage hospital is in many ways an ideal institution. It is a 20-bed general practitioner community hospital in the heart of Faversham. It is ideally situated adjacent to the new health centre, and is admirably served by the general practitioners who, in addition, provide a limited casualty service. Faversham is a town with a real community spirit in the full meaning of the word. The hospital reflects that community spirit. It is a well-used hospital. There may be some disagreement about occupancy rates, but the average for last year was nearly 70 per cent., which is quite high—for December it was 72 per cent., for November 92 per cent., for October 94 per cent. and for September 84 per cent. Those are high figures. It is exactly the sort of hospital that the Minister has publicly and enthusiastically supported. It is what I call a real community hospital.
Last year I was informed by the doctors that they had learnt of proposals by the Canterbury and Thanet district health authority to take half of the GP beds and use them for geriatric patients who would have been displaced by major changes occurring in other parts of the district—perhaps including the closure of Herne hospital.
Faversham also has Bensted House hospital with 42 geriatric beds. That is an old institution, and we have long recognised that at some time there will be a need for major new geriatric facilities in the area. I regret that that seems a remote prospect at present. If 10 beds in the cottage hospital were used for long-stay geriatric patients displaced from elsewhere, the patients may not be Faversham people. Most of us recognise that it is generally desirable for elderly people to remain in their own communities whenever possible.
I do not want to attribute blame nor to criticise, but there does not seem to have been proper discussion about these questions, either with the local doctors or with the public. When these rumours were abounding, we were in the process of trying to arrange for a meeting of some kind to take place in order to try to allay the fears. Suddenly we learnt that the Kent area health authority had rather precipitated matters by demanding contingency plans for cuts in spending, so what we thought was just a long-term option became a plan adopted by the area.
In a short speech I can do no more than summarise inadequately the lengthy and complex background to these developments so, if my hon. Friend will allow me, I will write to him on any further points I have. However, let me put the key points. First, I question the need for such contingency plans. The area will not know until the new financial year what its position will be. It seems unduly pessimistic to assume that there are going to be unreasonable wage settlements beyond the cash limits or an under-funding of inflation. I regret what I will call unnecessary alarmism in projecting cuts of this kind.
Second, it seems wrong that the plan to change the nature of Faversham cottage hospital, which I have described as a successful intitution, should be taken not on medical grounds but as a spin-off of other changes elsewhere which themselves have been based upon an arbitrary and hypothetical financial calculation.
Third, if it were to happen—I want to emphasise this—it would deprive Faversham of an important medical facility. Perhaps I might quote one or two extracts from a letter I received from one doctor. He says:
there are no replacements for the beds which the Area proposes to close at Faversham. Where are the sick people to go instead? At present the beds at Faversham Hospital are constantly full of people sick enough to need hospital treatment, yet the Area has no plans for anywhere else for them to go.
Nor is the rate at which people fall sick and need hospital care likely to decline in Faversham. The elderly population, which makes greatest use of acute short stay hospital beds everywhere, is on the increase in Faversham.
what is to happen to the sick people who would have filled them and needed them?
Fourth, I am obviously not qualified to judge what size a geriatric unit should be, but it seems to me a total misuse of resources to use a small hospital of this kind for an eight bed geriatric unit with all the attendant specialist requirements. I would have thought that all logic points to the need for geriatric hospitals, certainly on a larger scale than this.
Fifth, I would like the Minister to advise me tonight or at a later stage of the precise statutory position with regard to consultation and to a change of this kind. I would like him to give me, if he can, an absolute assurance that this change would represent a change of use of such an order that the Secretary of State would expect there to be full consultation, and that he would have the right to call in such a plan and would in these circumstances veto it. Perhaps I might quote a letter I received from the Minister of State dated 3 April 1980 in reply to questions of this very kind which I raised. Regarding closures and changes he then said:
The instructions have always covered all closures or changes of use which amount to 'a substantial variation in provision', and this could well be less than a complete hospital. In all such cases if an Area Health Authority wishes to proceed with a closure without the agreement of the Community Health Council, it must submit its proposals through the Regional Health Authority for approval by the Secretary of State.
I would submit that this is such a major change of use that it should come within that category, and therefore would need ultimately to be decided by the Secretary of State. Could I emphasise again that certainly there have not yet been any consultations about these plans.
Sixth, what would be most unsatisfactory is the possibility, perhaps rather the probability, that these cuts that have been talked about will not be needed. Even if that happens and the area perhaps suggests that we need not worry, nevertheless the threat of losing those 10 beds at a later stage will remain like an axe poised over our heads ready to fall at any time in future, perhaps with the Secretary of State declining to intervene because the proposal remained very much of a hypothetical nature. I urge my hon. Friend to bear in mind that very real worry and to help us on that score if he can.
When my hon. Friend examines this issue with great sympathy, as I know he will, I ask him to take into account the apparent unreality of some of the bases of decisionmaking. We are told that the district is over-bedded in theory and has too many GP beds. However, these beds are fully used. Where will the patients go? Many of the patients using the beds are elderly. Presumably they would not be classed as geriatric patients, although they are elderly, because they come under general practitioners and are not under consultant geriatricians. Surely we can be more intelligently flexible about these vital human matters than the definitions seem to allow.
I recognise the immense difficulties faced by the district and the area and by all those who have to try to manage our hospital services with limited resources. There are immense strains on them, especially on those in an area such as Canterbury and Thanet, which in theory is overbedded and faces acute difficulties.
I have tried to avoid criticism, but I and others could make severe criticism of how the matter has developed. We need a constructive and public discussion of these matters with the maximum of public consultation, public contribution and understanding. We need also the help and understanding of the Government in backing success—namely, in helping us to keep the Faversham cottage hospital as a 20-bed general practitioner community hospital.
I congratulate my hon. Friend the Member for Faversham (Mr. Moate) on securing this debate about the future of Faversham cottage hospital. I know that he has taken a close interest in the provision of health services in Kent and has been most assiduous in seeking to protect and advance the interests of his constituents. I am grateful to him for putting his case so plausibly and for giving me the opportunity to comment on the proposal for a partial change of use of the hospital. I hope to be able to give him the reassurances that he seeks about proper consultation.
I am pleased to see in his place my hon. Friend the Member for Canterbury (Mr. Crouch), whose interest in the Health Service in Kent is well recognised.
The first point that I should like to make is that no decision has yet been taken, nor indeed is any final decision imminent. I shall refer later to the various stages that must be gone through before any substantial change in Health Service provision can be made. However, I should mention now that although the general responsibility for determining the closure or change of use of health buildings rests with the appropriate area health authority, if local agreement cannot be reached—in particular, if the community health council objects—the final stage in the process could involve a decision by Ministers.
I give my hon. Friend the Member for Faversham the assurance that he seeks—namely, that the proposals that he has outlined fall within the procedure which can end with a decision made by Ministers. It would not be right for me to pre-empt such a decision or, indeed, any decision of the health authorities. I hope that nothing that I say tonight will prejudge that.
I endorse the tribute that my hon. Friend paid to the staff at Faversham hospital. If it did end up on a Minister's desk, we would certainly examine the premise on which the case rests and on which my hon. Friend cast some doubt.
I should also stress that Ministers are well aware of the feelings of local people towards Faversham cottage hospital, which I understand was built as long ago as 1887. My hon. Friend referred to the hospital's 20 beds now allocated to general practitioner medicine. I understand that the hospital also has its own casualty department where some minor operative procedures are carried out, and its own physiotherapy department with consultant outpatient appointments.
The completion in July 1979 of a health centre, which forms an integral unit with the hospital, is a particularly interesting and encouraging development. The whole complex provides, in addition to in-patient beds, casualty facilities, and out-patient clinics, community dental services, family planning, speech therapy, and accommodation for district nurses, health visitors, and midwives. It is clear that the dedication of the staff is greatly appreciated.
I understand the concern that is felt about the possibility of a change of the use of some of the beds at the hospital. People get used to small hospitals close to where they live, and when they hear of any proposals to rationalise services, involving a change of use of the local unit, they naturally object to what they see as the possible withdrawal of a service they value. They see the hospital as their hospital. They have visited patients there, of they have been patients themselves. It is convenient. They often know some of the staff. We have made it quite clear that we fully recognise the value of small hospitals. Last May we issued a consultation paper on the future pattern of hospital provision in England. In it, we argued for less emphasis on the centralisation of services in very large hospitals and for the retention of a wider range of local facilities.
However, we see a need for flexibility of approach to deal with differing local circumstances. Area health authorities need to ensure that their resources are deployed to the best possible advantage of the community as a whole. Demographic and treatment needs are changing and institutions should respond to these changes.
As my hon. Friend knows well, there are, unfortunately, for historical reasons, and because of marked movements in population in recent years, significant inbalances in health services provision both between the health regions and within individual regions and, in some cases, within health areas. These differences can be clearly seen in the Thames South-East region and in Kent. Indeed, the need to secure a fairer distribution of the financial resources available to the NHS within the Thames South-East region has been debated in the HOuse on several occasions. Both my hon. Friends have taken part.
We have continued the principle adopted by previous Governments of pursuing a policy of redistribution of resources to achieve a fairer distribution across the country. The South-East Thames regional health authority, in common with other regional health authorities, has adopted similar criteria in allocating resources to those that we have applied nationally. The Kent area health authority's policy has the specific aim of bringing all its six districts up to a common level of achievement in terms of their RAWP targets by 1988.
Because of the imbalances in health services provision within Kent, the effect of the area health authority's policy is that the Canterbury and Thanet health district in which the hospital finds itself can expect little if any revenue growth in 1981–82 and the financial years immediately beyond. This reflects, for example, the need to inject resources into the Medway health district—in which my hon. Friend also has an interest —whose case for improved health services provision my hon. Friend has, rightly, vigorously pressed in the past.
We come to the possible 2 per cent. revenue cut to which my hon. Friend referred. In common with other health districts in Kent, the Canterbury and Thanet health district was asked last September by the area health authority to prepare contingency plans for a possible 2 per cent. revenue cut in 1981–82. This was purely a precaution against cash limits not proving sufficent to cope with pay and price increases. Health authorities have a statutory duty not to exceed their cash limits and I cannot, therefore, do other than express admiration for the foresight and prudence this demonstrates. However, I cannot share the pessimism which led to the choice of 2 per cent. Cash limits for 1981–82 are not yet quite ready to be announced, but I refer the House to the statement made by my right hon. and learned Friend the Chancellor of the Exchequer on 24 November where he said:
Expenditure in other parts of the public services will be subject to broadly the same financial disciplines
as those announced by the rates support grant.
The rate support grant limit will allow for a 6 per cent. annual increase in earnings from due settlement dates in the current pay round. It will provide for an increase in prices other than pay of 11 per cent. between the average levels for 1980-81 and 1981–82."—[Official Report, 24 November 1980; Vol. 994, c. 315.]
This is a realistic approach which need not give rise to a squeeze at all, let alone one of 2 per cent. Much of course will depend on the outcome of pay negotiations and it would be wrong for me to speculate on the outcome of these since they are the responsibility of the appropriate Whitley councils.
In response to the area health authority's request, the district management teams have considered several options designed to release revenue moneys in ways that would not be inconsistent with the longer-term plans for health services in the district. Two of the options were discussed by the area health authority at its meeting on 20 January and one of these was supported in principle for planning purposes. Both options envisaged a series of adjustments affecting a number of hospitals, including the closure of Herne hospital, located in an old workhouse institution, the provision of replacement facilities for the elderly patients in other hospitals and a reduction in GP medicine beds at Faversham cottage hospital from 20 to 10 and the redesignation of eight of those beds for elderly patients.
I understand that it has been proposed in the district's plans for some time that Herne hospital should eventually close. It has also been recognised that the district has in some specialities more beds than recommended in the regional health authority's guidelines. This is the case so far as general practitioner beds are concerned. I note that my hon, Friend challenges that. Currently, 114 general practitioner medicine beds are being provided, all of which are in the western half of this bi-polar district. Until recently the regional health authority's guidelines suggested a reduction to about 55 beds. However, these guidelines have just been reviewed and the latest guidelines suggest a reduction, in stages, to 67 beds. The precise figures are, I understand, still being discussed between the regional and area health authorities, but the figures that I have mentioned indicate that a reduction of some 50 to 60 general practitioner medicine beds is thought to be appropriate.
It is not possible to say what, if any, elements of the present plans for adjusting provision in the Canterbury and Thanet health district the area health authority will eventually seek to implement, or when. The authority will certainly wish to take into account the financial allocation that it receives for the coming financial year, and this has still to be determined by the regional health authority. We hope to be able to announce regional health authorities' volume allocations for 1981–82 in the very near future.
As I said earlier, the final cash limits, which include provision to cover inflation during the year, are not quite ready for announcement. I do not, therefore, believe that I should discuss them in detail before I am in a position to make this announcement. However, I have no reason to believe that their operation will require the Kent area health authority to invoke the contingency plans which it has prudently prepared and which have given rise to this Adjournment debate.
This year there has not been as much scope for the redistribution of resources between the health regions as we should have liked. We decided that the better off regional health authorities should, notwithstanding that they were already relatively well funded, receive an increase of 0·3 per cent. to assist them in the process of redistribution of resources within their regions. With the limited amount of funds available, that decision meant that we could not give more than 0·6 per cent. to the most deprived regions which have many areas and districts very considerably below their RAWP target allocations. The South-East Thames regional allocation was increased by 0·31 per cent, and, in line with the regional health authority's policy of allocating its growth money to the Kent and East Sussex areas, the former received an increase on 0.67 per cent., some £1·02 million.
In 1978–79 Kent area health authority received growth moneys totalling £3·65 million, an uplift of 3·34 per cent., and in 1979–80 growth moneys, totalling £3.12 million, an uplift of 2·8 per cent. In these two years, the regional health authority received 0·72 and 1·12 per cent. growth. Kent area health authority has, therefore, in each of the last three financial years recived development additions not less than twice those for the region as a whole.
None the less, I know that many people have hoped for greater progress in securing a more equitable distribution of resources within the region. However, as my hon. Friend the Member for Canterbury knows, there are very real practical difficulties for the regional health authority in redressing the imbalances in provision. It is not only a question of financial constraints, and it its bound to take time to achieve a reasonable measure of equalisation of provision.
Perhaps I could turn now to the process to be gone through if no agreement can be reached on the proposals. I have drawn hon. Members' attention to these during previous Adjournment debates, but I feel that their importance cannot be overstressed. The appropriate area health authority is required to prepare a consultative document covering such matters as the reasons for its proposals, the financial background, the implications for staff, the relationship between the closure or change of use and other developments and plans and, of course, the effect on patients who might be affected by the proposal, particularly in relation to transport facilities. That would have to answer the question posed by my hon. Friend the Member for Faversham about what would happen to the GP patients currently being treated in Faversham hospital.
Comments on the proposals in the consultative document are invited within three months from such bodies as the local community health council, the associated local authorities, joint staff consultative committees and other staff organisations, family practitioner committees and local advisory committees. Hon. Members whose constituents would be affected would also be informed of the proposals.
If the community health council which is given the opportunity to study the comments of the other bodies consulted and the area health authority's views on those comments objects to the proposals, it is entitled to submit to the authority a constructive and detailed counter proposal, paying full regard to the factors, including restraints on resources, which led the authority to make its original proposal. If the authority is unable to accept the counter proposal the matter is referred to the regional health authority. If it, too, is unable to agree with the community health council and wishes the closure or change of use to proceed, the case is then referred to Ministers for decision.
I have made it clear that, if proposals are referred to us, Ministers will not agree to any change of use unless it can be clearly demonstrated to be in the best interests of local health services and the communities they serve. But we are, as I have explained, a long way from that point as far as Faversham hospital is concerned. It is by no means certain yet that the area health authority will seek to implement the changes embodied in the health district's plans. Representatives of the district management team have, I understand, offered to discuss the situation with my hon. Friend and representatives of the town council, and I very much hope that they will do so.
I hope that I have been able to allay some of my hon. Friend's fears. All concerned will, I know, give full consideration to the points that have been raised here tonight.